Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy
Abstract Background There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progre...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-02-01
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| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-023-10609-8 |
| _version_ | 1827983837694525440 |
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| author | Cengiz Karacin Berna Oksuzoglu Ayşe Demirci Merve Keskinkılıç Naziyet Köse Baytemür Funda Yılmaz Oğuzhan Selvi Dilek Erdem Esin Avşar Nail Paksoy Necla Demir Sema Sezgin Göksu Sema Türker Ertuğrul Bayram Abdüssamet Çelebi Hatice Yılmaz Ömer Faruk Kuzu Seda Kahraman İvo Gökmen Abdullah Sakin Ali Alkan Erdinç Nayır Muzaffer Uğraklı Ömer Acar İsmail Ertürk Hacer Demir Ferit Aslan Özlem Sönmez Taner Korkmaz Özde Melisa Celayir İbrahim Karadağ Erkan Kayıkçıoğlu Teoman Şakalar İlker Nihat Öktem Tülay Eren Enes Erul Eda Eylemer Mocan Ziya Kalkan Nilgün Yıldırım Yakup Ergün Baran Akagündüz Serdar Karakaya Engin Kut Fatih Teker Burçin Çakan Demirel Kubilay Karaboyun Elvina Almuradova Olçun Ümit Ünal Abdilkerim Oyman Deniz Işık Kerem Okutur Buğra Öztosun Burcu Belen Gülbağcı Mehmet Emin Kalender Elif Şahin Mustafa Seyyar Özlem Özdemir Fatih Selçukbiricik Metin Kanıtez İsa Dede Mahmut Gümüş Erhan Gökmen Arzu Yaren Serkan Menekşe Senar Ebinç Sercan Aksoy Gökşen İnanç İmamoğlu Mustafa Altınbaş Bülent Çetin Başak Oyan Uluç Özlem Er Nuri Karadurmuş Atike Pınar Erdoğan Mehmet Artaç Özgür Tanrıverdi İrfan Çiçin Mehmet Ali Nahit Şendur Esin Oktay İbrahim Vedat Bayoğlu Semra Paydaş Adnan Aydıner Derya Kıvrak Salim Çağlayan Geredeli Tuğba Yavuzşen Mutlu Doğan İlhan Hacıbekiroğlu |
| author_facet | Cengiz Karacin Berna Oksuzoglu Ayşe Demirci Merve Keskinkılıç Naziyet Köse Baytemür Funda Yılmaz Oğuzhan Selvi Dilek Erdem Esin Avşar Nail Paksoy Necla Demir Sema Sezgin Göksu Sema Türker Ertuğrul Bayram Abdüssamet Çelebi Hatice Yılmaz Ömer Faruk Kuzu Seda Kahraman İvo Gökmen Abdullah Sakin Ali Alkan Erdinç Nayır Muzaffer Uğraklı Ömer Acar İsmail Ertürk Hacer Demir Ferit Aslan Özlem Sönmez Taner Korkmaz Özde Melisa Celayir İbrahim Karadağ Erkan Kayıkçıoğlu Teoman Şakalar İlker Nihat Öktem Tülay Eren Enes Erul Eda Eylemer Mocan Ziya Kalkan Nilgün Yıldırım Yakup Ergün Baran Akagündüz Serdar Karakaya Engin Kut Fatih Teker Burçin Çakan Demirel Kubilay Karaboyun Elvina Almuradova Olçun Ümit Ünal Abdilkerim Oyman Deniz Işık Kerem Okutur Buğra Öztosun Burcu Belen Gülbağcı Mehmet Emin Kalender Elif Şahin Mustafa Seyyar Özlem Özdemir Fatih Selçukbiricik Metin Kanıtez İsa Dede Mahmut Gümüş Erhan Gökmen Arzu Yaren Serkan Menekşe Senar Ebinç Sercan Aksoy Gökşen İnanç İmamoğlu Mustafa Altınbaş Bülent Çetin Başak Oyan Uluç Özlem Er Nuri Karadurmuş Atike Pınar Erdoğan Mehmet Artaç Özgür Tanrıverdi İrfan Çiçin Mehmet Ali Nahit Şendur Esin Oktay İbrahim Vedat Bayoğlu Semra Paydaş Adnan Aydıner Derya Kıvrak Salim Çağlayan Geredeli Tuğba Yavuzşen Mutlu Doğan İlhan Hacıbekiroğlu |
| author_sort | Cengiz Karacin |
| collection | DOAJ |
| description | Abstract Background There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0–14.0) months in the ET arm of group A, and 5.3 (3.9–6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8–7.7) months in the ET arm of group B, and 5.7 (4.6–6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5–8.0) months in the ET arm of group C and 4.0 (3.5–4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET. |
| first_indexed | 2024-04-09T22:51:04Z |
| format | Article |
| id | doaj.art-042edc2981bf4d52a01526b7a7c03f4f |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-09T22:51:04Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-042edc2981bf4d52a01526b7a7c03f4f2023-03-22T11:35:05ZengBMCBMC Cancer1471-24072023-02-0123111010.1186/s12885-023-10609-8Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapyCengiz Karacin0Berna Oksuzoglu1Ayşe Demirci2Merve Keskinkılıç3Naziyet Köse Baytemür4Funda Yılmaz5Oğuzhan Selvi6Dilek Erdem7Esin Avşar8Nail Paksoy9Necla Demir10Sema Sezgin Göksu11Sema Türker12Ertuğrul Bayram13Abdüssamet Çelebi14Hatice Yılmaz15Ömer Faruk Kuzu16Seda Kahraman17İvo Gökmen18Abdullah Sakin19Ali Alkan20Erdinç Nayır21Muzaffer Uğraklı22Ömer Acar23İsmail Ertürk24Hacer Demir25Ferit Aslan26Özlem Sönmez27Taner Korkmaz28Özde Melisa Celayir29İbrahim Karadağ30Erkan Kayıkçıoğlu31Teoman Şakalar32İlker Nihat Öktem33Tülay Eren34Enes Erul35Eda Eylemer Mocan36Ziya Kalkan37Nilgün Yıldırım38Yakup Ergün39Baran Akagündüz40Serdar Karakaya41Engin Kut42Fatih Teker43Burçin Çakan Demirel44Kubilay Karaboyun45Elvina Almuradova46Olçun Ümit Ünal47Abdilkerim Oyman48Deniz Işık49Kerem Okutur50Buğra Öztosun51Burcu Belen Gülbağcı52Mehmet Emin Kalender53Elif Şahin54Mustafa Seyyar55Özlem Özdemir56Fatih Selçukbiricik57Metin Kanıtez58İsa Dede59Mahmut Gümüş60Erhan Gökmen61Arzu Yaren62Serkan Menekşe63Senar Ebinç64Sercan Aksoy65Gökşen İnanç İmamoğlu66Mustafa Altınbaş67Bülent Çetin68Başak Oyan Uluç69Özlem Er70Nuri Karadurmuş71Atike Pınar Erdoğan72Mehmet Artaç73Özgür Tanrıverdi74İrfan Çiçin75Mehmet Ali Nahit Şendur76Esin Oktay77İbrahim Vedat Bayoğlu78Semra Paydaş79Adnan Aydıner80Derya Kıvrak Salim81Çağlayan Geredeli82Tuğba Yavuzşen83Mutlu Doğan84İlhan Hacıbekiroğlu85Department of Medical Oncology, UHS Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research HospitalDepartment of Medical Oncology, UHS Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research HospitalDepartment of Medical Oncology, Sakarya UniversityDepartment of Medical Oncology, Dokuz Eylül UniversityDepartment of Medical Oncology, Memorial HospitalDepartment of Medical Oncology, UHS Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research HospitalDepartment of Medical Oncology, Okmeydanı Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, VM Medical Park HospitalDepartment of Medical Oncology, Antalya Training and Research HospitalDepartment of Medical Oncology, Istanbul University Instıtue of OncologyDepartment of Medical Oncology, Acıbadem HospitalDepartment of Medical Oncology, Akdeniz UniversityDepartment of Medical Oncology, Zonguldak HospitalDepartment of Medical Oncology, Çukurova UniversityDepartment of Medical Oncology, Marmara University Pendik Training and Research HospitalDepartment of Medical Oncology, Adnan Menderes UniversityDepartment of Medical Oncology, Ankara City HospitalDepartment of Medical Oncology, Ankara City HospitalDepartment of Medical Oncology, Trakya UniversityDepartment of Medical Oncology, Istanbul Medipol University Bahçelievler HospitalDepartment of Medical Oncology, Muğla Sıtkı Koçman UniversityMersin Medical Park Hospital, Department of Medical OncologyDepartment of Medical Oncology, Necmettin Erbakan UniversityDepartment of Medical Oncology, Celal Bayar UniversityDepartment of Medical Oncology, Gülhane Training and Research HospitalDepartment of Medical Oncology, Afyonkarahisar Health Sciences University HospitalDepartment of Medical Oncology, Ankara Medical Park HospitalDepartment of Medical Oncology, Acıbadem University Maslak HospitalDepartment of Medical Oncology, Acıbadem University Maslak HospitalDepartment of Medical Oncology, Acıbadem University Maslak HospitalDepartment of Medical Oncology, Hitit University HospitalDepartment of Medical Oncology, Süleyman Demirel University HospitalDepartment of Medical Oncology, Kahramanmaraş Necip Fazıl City HospitalDepartment of Medical Oncology, Ersin Arslan Training and Research HospitalDepartment of Medical Oncology, UHS Dışkapı Yıldırım Beyazıt Training and Research HospitalDepartment of Medical Oncology, Hacettepe University Instıtue of OncologyDepartment of Medical Oncology, Ankara UniversityDepartment of Medical Oncology, Dicle UniversityDepartment of Medical Oncology, Fırat UniversityBatman Training and Research HospitalDepartment of Medical Oncology, Erzincan Binali Yıldırım UniversityDepartment of Medical Oncology, Atatürk Pulmonary Diseases HospitalDepartment of Medical Oncology, Manisa City HospitalDepartment of Medical Oncology, Gaziantep UniversityDepartment of Medical Oncology, Pamukkale UniversityDepartment of Medical Oncology, Namık Kemal UniversityDepartment of Medical Oncology, Ege UniversityUHS İzmir Tepecik Training and Research HospitalDepartment of Medical Oncology, Ümraniye Training and Research HospitalKocaeli Medical Park, Department of Medical OncologyDepartment of Medical Oncology, Bahçelievler Memorial HospitalDepartment of Medical Oncology, Istanbul Medeniyet UniversityDepartment of Medical Oncology, Sakarya UniversityDepartment of Medical Oncology, Meddem HospitalDepartment of Medical Oncology, Kocaeli UniversityDepartment of Medical Oncology, Kocaeli Universityİzmir Bozyaka Training and Research HospitalDepartment of Medical Oncology, Koç UniversityDepartment of Medical Oncology, American HospitalDepartment of Medical Oncology, Mustafa Kemal UniversityDepartment of Medical Oncology, Istanbul Medeniyet UniversityDepartment of Medical Oncology, Ege UniversityDepartment of Medical Oncology, Pamukkale UniversityDepartment of Medical Oncology, Manisa City HospitalDepartment of Medical Oncology, Dicle UniversityDepartment of Medical Oncology, Hacettepe University Instıtue of OncologyDepartment of Medical Oncology, UHS Dışkapı Yıldırım Beyazıt Training and Research HospitalDepartment of Medical Oncology, UHS Dışkapı Yıldırım Beyazıt Training and Research HospitalDepartment of Medical Oncology, Süleyman Demirel University HospitalDepartment of Medical Oncology, Acıbadem University Maslak HospitalDepartment of Medical Oncology, Acıbadem University Maslak HospitalDepartment of Medical Oncology, Gülhane Training and Research HospitalDepartment of Medical Oncology, Celal Bayar UniversityDepartment of Medical Oncology, Necmettin Erbakan UniversityDepartment of Medical Oncology, Muğla Sıtkı Koçman UniversityDepartment of Medical Oncology, Trakya UniversityDepartment of Medical Oncology, Ankara City HospitalDepartment of Medical Oncology, Adnan Menderes UniversityDepartment of Medical Oncology, Marmara University Pendik Training and Research HospitalDepartment of Medical Oncology, Çukurova UniversityDepartment of Medical Oncology, Istanbul University Instıtue of OncologyDepartment of Medical Oncology, Antalya Training and Research HospitalDepartment of Medical Oncology, Okmeydanı Prof. Dr. Cemil Taşcıoğlu City HospitalDepartment of Medical Oncology, Dokuz Eylül UniversityDepartment of Medical Oncology, UHS Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research HospitalDepartment of Medical Oncology, Sakarya UniversityAbstract Background There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0–14.0) months in the ET arm of group A, and 5.3 (3.9–6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8–7.7) months in the ET arm of group B, and 5.7 (4.6–6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5–8.0) months in the ET arm of group C and 4.0 (3.5–4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.https://doi.org/10.1186/s12885-023-10609-8Advanced breast cancerCyclin-dependent kinaseRibociclibPalbociclibEverolimusFulvestrant |
| spellingShingle | Cengiz Karacin Berna Oksuzoglu Ayşe Demirci Merve Keskinkılıç Naziyet Köse Baytemür Funda Yılmaz Oğuzhan Selvi Dilek Erdem Esin Avşar Nail Paksoy Necla Demir Sema Sezgin Göksu Sema Türker Ertuğrul Bayram Abdüssamet Çelebi Hatice Yılmaz Ömer Faruk Kuzu Seda Kahraman İvo Gökmen Abdullah Sakin Ali Alkan Erdinç Nayır Muzaffer Uğraklı Ömer Acar İsmail Ertürk Hacer Demir Ferit Aslan Özlem Sönmez Taner Korkmaz Özde Melisa Celayir İbrahim Karadağ Erkan Kayıkçıoğlu Teoman Şakalar İlker Nihat Öktem Tülay Eren Enes Erul Eda Eylemer Mocan Ziya Kalkan Nilgün Yıldırım Yakup Ergün Baran Akagündüz Serdar Karakaya Engin Kut Fatih Teker Burçin Çakan Demirel Kubilay Karaboyun Elvina Almuradova Olçun Ümit Ünal Abdilkerim Oyman Deniz Işık Kerem Okutur Buğra Öztosun Burcu Belen Gülbağcı Mehmet Emin Kalender Elif Şahin Mustafa Seyyar Özlem Özdemir Fatih Selçukbiricik Metin Kanıtez İsa Dede Mahmut Gümüş Erhan Gökmen Arzu Yaren Serkan Menekşe Senar Ebinç Sercan Aksoy Gökşen İnanç İmamoğlu Mustafa Altınbaş Bülent Çetin Başak Oyan Uluç Özlem Er Nuri Karadurmuş Atike Pınar Erdoğan Mehmet Artaç Özgür Tanrıverdi İrfan Çiçin Mehmet Ali Nahit Şendur Esin Oktay İbrahim Vedat Bayoğlu Semra Paydaş Adnan Aydıner Derya Kıvrak Salim Çağlayan Geredeli Tuğba Yavuzşen Mutlu Doğan İlhan Hacıbekiroğlu Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy BMC Cancer Advanced breast cancer Cyclin-dependent kinase Ribociclib Palbociclib Everolimus Fulvestrant |
| title | Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy |
| title_full | Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy |
| title_fullStr | Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy |
| title_full_unstemmed | Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy |
| title_short | Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy |
| title_sort | efficacy of subsequent treatments in patients with hormone positive advanced breast cancer who had disease progression under cdk 4 6 inhibitor therapy |
| topic | Advanced breast cancer Cyclin-dependent kinase Ribociclib Palbociclib Everolimus Fulvestrant |
| url | https://doi.org/10.1186/s12885-023-10609-8 |
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efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT bugraoztosun efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT burcubelengulbagcı efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mehmeteminkalender efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT elifsahin efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mustafaseyyar efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT ozlemozdemir efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT fatihselcukbiricik efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT metinkanıtez efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT isadede efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mahmutgumus efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT erhangokmen efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT arzuyaren efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT serkanmenekse efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT senarebinc efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT sercanaksoy efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT gokseninancimamoglu efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mustafaaltınbas efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT bulentcetin efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT basakoyanuluc efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT ozlemer efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT nurikaradurmus efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT atikepınarerdogan efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mehmetartac efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT ozgurtanrıverdi efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT irfancicin efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mehmetalinahitsendur efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT esinoktay efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT ibrahimvedatbayoglu efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT semrapaydas efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT adnanaydıner efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT deryakıvraksalim efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT caglayangeredeli efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT tugbayavuzsen efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT mutludogan efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy AT ilhanhacıbekiroglu efficacyofsubsequenttreatmentsinpatientswithhormonepositiveadvancedbreastcancerwhohaddiseaseprogressionundercdk46inhibitortherapy |