From:  Post-CDK4/6 inhibitor therapy in HR+/HER2– advanced breast cancer: expanding options and persisting uncertainties

 Selected novel endocrine agents with proven single-agent efficacy post-CDK4/6i: approval status and AE profiles.

SubstanceIndication EMA1Indication FDA1Incidence of AEs (% of patients)Incidence of treatment-related AEs (% of patients)
Most common, any grade2Most common, ≥ G32Most common, any grade2Most common, ≥ G32Overall, any gradeOverall, ≥ G3Overall, G5Leading to treatment discontinuation
ElacestrantESR1-mutated, after ≥ 1 line of ET including a CDK4/6i [142]ESR1-mutated, after ≥ 1 line of ET [143]Nausea (35)
Fatigue (19)
Vomiting (19)
Decreased
appetite (14.8)
Arthralgia (14.3) [41]
Nausea (2.5)
Back pain (2.5)
ALT increased (2.1)
AST increased (1.7)
Headache (1.7) [41]
Nausea (25.3)
Fatigue (11)
Vomiting (11)
Hot flush (9.7)
Decreased appetite (7.6)
Diarrhea (7.6) [41]
Nausea (1.7)
Fatigue (0.8)
Vomiting (0.4)
Decreased appetite (0.4)
Abdominal pain (0.4) [41]
63.3 [41]7.2 [41]0 [41]3.4 [41]
ImlunestrantESR1-mutated, after endocrine-based regimen [144]ESR1-mutated, after ≥ 1 line of ET [145]Fatigue/Asthenia (22.6)
Diarrhea (21.4)
Nausea (17.1)
Arthralgia (14.1)
AST increased (12.5) [46]
Anemia (2.1)
Neutropenia (2.1)
AST increased (0.9)
Thrombopenia (0.9)
Arthralgia (0.6)
Back pain (0.6)
Vomiting (0.6)
Leukopenia (0.6) [46]
Not reported [46]Not reported [46] 48.9 [46]4.6 [46]0.33 [46]2 [47]
Camizestrant (75 mg)Not approved [88]Not approved [87]TEAEs:4
Photopsia (12)
Anemia (10.8)
Cough (9.5)
Asthenia (8.1)
Nausea (8.1) [44]
No TEAE ≥ G3 occurred in > 1 patient4, 5 [44]Not reported [44]Not reported [44]53 [44]1 [44]0 [44]3 [44]
VepdegestrantNot approved [88]ESR1-mutated, after ≥ 1 line of ET [146]Fatigue/Asthenia (26.6)
ALT increased (14.4)
AST increased (14.4)
Nausea (13.5)
Anemia (12.2) [52]
Neutropenia (1.9)
Hypokalemia (1.9)
Anemia (1.6)
QT prolonged (1.6)
Hypertension (1.6) [52]
Fatigue/Asthenia (18.6) ALT increased (9.6)
AST increased (9)
Neutropenia (8.7)
QT prolonged (8) [52]
Neutropenia (1.9) Fatigue/Asthenia (1)
ALT increased (0.6)
QT prolonged (0.6)
Arthralgia (0.6) [52]
56.7 [52]7.7 [52]0 [52]1.6 [52]

1 All indications refer to advanced, HR+/HER2– breast cancer; 2 the five most common AEs are listed; ties at 5th rank are all included; 3 death due to right ventricular failure; 4 for Camizestrant (SERENA-2 trial), incidence of specific AEs and treatment-related AEs were not reported. Therefore, treatment-emergent AEs (TEAEs) are listed instead. Definition of treatment-emergent AE (from SERENA-2 protocol): events will be defined as treatment-emergent if they onset or worsen during the treatment period or safety follow-up period; 5 numerous ≥ G3 TEAEs each occurred in only a single patient; these individual events are not listed for clarity. AE: adverse event; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CDK4/6i: CDK4/6 inhibitor; EMA: European Medicines Agency; ET: endocrine therapy; FDA: Food and Drug Administration; G: grade; HER2–: HER2-negative; HR+: hormone receptor-positive.