Here's What Patients With Breast Cancer Need to Know About CDK 4/6 Inhibitors

CDK 4/6 inhibitors have changed the way treatment is thought about and given for patients with breast cancer, but the cost and side effects associated with the therapies need to be understood as much as the benefits.

At the 2020 CURE® Educated Patient Breast Cancer Summit, held March 7, 2020, in Miami, Florida, CURE had the chance to discuss with Patricia Jakel, a clinical nurse specialist in the Solid Tumor Program at UCLA Medical Center, Santa Monica, had the chance to discuss what this therapy means for patients. In particular, she highlighted how patients with breast cancer can get advice about the inhibitors and the essential information they need to know about them.

CURE®: Could you provide a brief overview of CDK 4/6 inhibitors for patients?

Jakel: The drugs actually are targeted, and they work on part of the cells. Chemotherapy is like an atom bomb going off in your body. It goes after the cancer cells, but unfortunately, it goes after a lot of other cells that are not cancerous like your GI tract, your bone marrow and your hair follicles. Targeted therapies, which tend to be oral therapies, go after parts of the cell that are mutating and sometimes not turning off or turning on too much and not undergoing cell death or apoptosis.

So, this is a way to actually target instead of seeking and destroying, we're actually targeting those cancer cells. Unfortunately, these cells get smart and they end up with a resistance against certain types of drugs. So, it's really fascinating. And I think in the next five years, it's going to be amazing actually what comes out not just for breast cancer, but a lot of other tumors also.

What would you say is the most important information for patients to consider when taking these drugs?

Ask questions, educate yourself. No questions are too dumb. No questions are too small. And the other thing is, [when] people that attend a conference like this, [they] tend to be people that are in the know. I really worry about our underserved population.

I'm in Southern California [and] we have a huge homeless population, who's doing screening mammograms on those women? Who are taking care of those women when they're diagnosed, if they ever get diagnosed with breast cancer? So, I really worry about the underserved population. Someone that's embarrassed to say, ‘Hey, I don't have the money for my copayment.’

Now, someone talked about these drugs are $10,000 a month and I know that from a personal experience, so you think about 10% of that, that's $1,000. Now it's $12,000 in a year, and people are embarrassed to admit that. Other patients are the frontline and they want it, but I think as nurses, oftentimes we have to sit down and have that conversation. You know, this is a lot of money. Can you afford it? It always makes people uncomfortable to talk about money, but I think it's a big reality and it's becoming more and more of a reality depending on health care choices.

What advice would you give patients on CDK 4/6 inhibitors that may want to seek alternative treatment due to side effects?

I think support, support, support, [and] meeting other people with breast cancer. And then talking to your physician, when you get diagnosed with breast cancer you have a whole team to work with. We have a multidisciplinary breast clinic so other patients see the surgeon, the radiation oncologist, the pathologist and the oncologist. And actually, we have the nurse practitioner who does breast cancer survivorship all in our multidisciplinary.

So, you have that opportunity to ask a lot of questions. It's really hard in the beginning because you don't know what to ask. And so, it's a difficult thing. But then questions start to formulate, and you start to be able to reach out and talk to people.