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Armando Orlandi: Time to Challenge the Paradigm – CDK4/6 Inhibitors in Visceral Crisis

Armando Orlandi/photos.asco.org

Jun 3, 2025, 11:34

Armando Orlandi: Time to Challenge the Paradigm – CDK4/6 Inhibitors in Visceral Crisis

Armando Orlandi, Medical Director at the Agostino Gemelli University Hospital Foundation IRCCS, posted on LinkedIn:

“Time to Challenge the Paradigm: CDK4/6 Inhibitors in Visceral Crisis

The evidence is mounting, and it’s time for our treatment guidelines to evolve.

What the Data Shows:

3 major trials (RIGHT Choice, PADMA, ABIGAIL) demonstrate superior progression-free survival with CDK4/6i+ET vs chemotherapy
Similar time to response (3.9 vs 3.6 weeks) – debunking the “chemotherapy acts faster” myth
5-month overall survival advantage in real-world visceral crisis patients
Significantly better tolerability (6.3% vs 27.0% discontinuation rates)

The Bottom Line:
Current guidelines still recommend chemotherapy as the ONLY standard approach for HR+/HER2- metastatic breast cancer with visceral crisis. This needs to change.

We’re not advocating to replace chemotherapy entirely it remains valuable in specific scenarios. But we MUST integrate CDK4/6 inhibitors as a valid therapeutic option.

Why This Matters:
Every visceral crisis is unique. Some patients need immediate cytoreduction with chemotherapy. Others – particularly those with de novo disease, moderate organ dysfunction, or good performance status – may benefit more from the superior long-term outcomes and quality of life that CDK4/6 inhibitors offer.

Call to Action:
It’s time for guideline committees to acknowledge this convergent evidence and update recommendations to include CDK4/6i+ET as a valid first-line option alongside chemotherapy.

Patient-centered care means having options. Let’s give our patients the choice they deserve.

What are your thoughts on updating guidelines for visceral crisis management?”

Read OncoDaily’s Special Articles about ASCO 2025:

Highlights from ASCO 2025 Day 1

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