ArticleFrontiers in medicine2026
Sequential CDK4/6 inhibition in bone-only metastatic HR+/HER2- breast cancer: a case of prolonged disease control with abemaciclib after clinical progression on palbociclib-based therapy.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The efficacy of sequential cyclin-dependent kinase (CDK4/6) inhibition after clinical progression on a prior CDK4/6 inhibitor remains controversial, particularly in patients with bone-only hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (MBC), for whom evidence remains limited. Herein, we describe prolonged clinical benefit with abemaciclib after clinical progression during palbociclib-based therapy in this setting. Case report: A 59-year-old woman with stage IIIA HR+/HER2- breast cancer underwent modified radical mastectomy in 2016, followed by adjuvant AC-P (doxorubicin hydrochloride 70 mg, cyclophosphamide 800 mg, and paclitaxel liposomes 180 mg) chemotherapy, radiotherapy, and letrozole maintenance. Two years later, she developed an isolated scapular metastasis with secondary endocrine resistance. Since palbociclib was not yet covered by insurance, she received an initial chidamide + exemestane therapy, which proved ineffective. Using second-line palbociclib combined with fulvestrant and zoledronic acid therapy, disease stabilization was achieved for up to 12 months. Subsequently, CA15-3 marker levels increased, accompanied by progressive osteolytic bone destruction and bone pain. When abemaciclib was included in China's national reimbursement list in January 2022, the regimen was switched to abemaciclib + fulvestrant + zoledronic acid. CA15-3 levels normalized within 3 months; moreover, serial imaging revealed no new lesions. As of September 2023, the patient has remained progression-free for >20 months and experienced only manageable grade 2 diarrhea. Conclusion: This case suggests that sequential CDK4/6 inhibition could help achieve >20 months of progression-free disease control in a patient with bone-only HR+/HER2- MBC after clinical progression during prior palbociclib-based therapy and underscored the need for biomarker-guided strategies in this distinct population.
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