Breast Cancer Update, Issue 2, 2016 (Video Program) - Video 17Clinical utility of everolimus/exemestane in HR-positive mBC
2:15 minutes.
TRANSCRIPTION:
DR LOVE: What about everolimus/exemestane? Do you utilize it? DR SLEDGE: I still use it. And I still use everolimus and exemestane fairly commonly, not without some qualms. I mean, the Phase III trial data on which the drug was approved by the FDA again was a trial that showed a significant improvement in terms of progression-free survival, unaccompanied by a significant improvement with further follow-up in overall survival with a drug that I think, arguably, has more toxicity than what we see with CDK4/6 inhibitors. My patients don’t like everolimus all that much as a group. I still offer it to them, because I think, again, there’s a benefit there. But is this a drug that we’re going to be using 5 or 10 years from now? I’m less certain. DR LOVE: I guess you could send them across the city to Hope Rugo and tell them, there they don’t have any problems, because they use the mouthwash. DR SLEDGE: We use the mouthwash as well, on a routine basis. And I actually think it does a good job in terms of preventing stomatitis. But we still have to deal with some issues, some GI upset issues. There’s a reasonable number of patients who develop pneumonitis. This is not a drug that’s free of toxicity, and it’s a drug that you have to monitor and be careful about. DR LOVE: Yes. Speaking of pneumonitis with everolimus, we had a case recently that was presented, and the patient was responding to exemestane/everolimus, developed, actually, symptomatic pneumonitis. Not badly symptomatic, but a little cough and shortness of breath. They stopped the everolimus, gave the steroids and then restarted the everolimus at a lower dose. And I was, like, kind of surprised, but then I found that a lot of people do that. DR SLEDGE: I think if the patient is responding well to therapy, then of course you’re talking about the usual tradeoffs of risk and benefit. And that’s something that you discuss with the patient. So I don’t think that that’s an unreasonable approach to take, but again, it’s not a data-based approach. It’s the usual working out of what works, what doesn’t work that goes on in doctors’ offices all the time. |