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Published on: May 17, 2024
Peri-operative CDK4/6 inhibitors in DIEP flap breast reconstruction: Early safety data and proposed management
O Sharp1, Y Yousif1, N M L Battisti1
1The Royal Marsden Hospital, 203 Fulham Rd, London SW3 6JJ, United Kingdom.
Abstract:
The introduction of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors has significantly altered the treatment paradigm for hormone receptor-positive, HER2-negative breast cancer. Increasingly, surgeons encounter patients receiving these agents at the time of breast reconstruction, yet there is no published evidence on the safety of free tissue transfer in this context. We present the first series examining post-operative outcomes in patients exposed to CDK4/6 inhibitors undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction and outline a pragmatic management approach. We report a retrospective, consecutive cohort series of all unilateral DIEP breast reconstructions undertaken between January 2024 and January 2026 at our institution. We include 232 patients, 9 of whom (4%) underwent peri-operative CDK4/6 inhibition. The median age was 51 years. Overall, 18% of patients were obese (BMI ≥ 30), 7% had a smoking history, and 2% had diabetes. CDK4/6 inhibitors administered were Abemaciclib (n=6), Ribociclib (n=2) and Palbociclib (n=1), and patients were recommended a median of 2 weeks off treatment pre-operatively. Pre-operative haemoglobin, white cell, neutrophil and lymphocyte counts were all significantly lower in the CDK4/6 inhibitor group (p<0.05). No minor complications occurred in CDK4/6 patients compared with 11% in non-exposed patients (p=0.6). Major complications were rare, occurring in 0% of CDK4/6 inhibitor patients and 2.2% of non-exposed patients (p=1.0). In this early series, CDK4/6 inhibition did not adversely affect surgical outcomes. We advocate for close coordination with oncology regarding temporary treatment interruption. Larger, multi-centre studies are needed to fully assess the risk profile of peri-operative CDK4/6 inhibitors in autologous reconstruction.
Insights
Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors did not increase complications in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Surgeons can safely perform autologous reconstruction with careful oncology coordination.
Area of Science:
- Oncology
- Plastic Surgery
- Breast Cancer Treatment
Background:
- Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors are standard for hormone receptor-positive, HER2-negative breast cancer.
- Surgeons increasingly encounter patients on CDK4/6 inhibitors requiring breast reconstruction.
- Evidence on free tissue transfer safety with CDK4/6 inhibitors is lacking.
Purpose of the Study:
- To evaluate post-operative outcomes of deep inferior epigastric perforator (DIEP) flap breast reconstruction in patients exposed to CDK4/6 inhibitors.
- To establish a management approach for these patients.
Main Methods:
- Retrospective, consecutive cohort series of unilateral DIEP flap breast reconstructions.
- Analysis of 232 patients, including 9 exposed to peri-operative CDK4/6 inhibitors.
- Comparison of complication rates between exposed and non-exposed groups.
Main Results:
- No minor complications in the CDK4/6 inhibitor group versus 11% in the non-exposed group (p=0.6).
- 0% major complications in the CDK4/6 inhibitor group versus 2.2% in the non-exposed group (p=1.0).
- Lower pre-operative haemoglobin and white cell counts observed in the CDK4/6 inhibitor group.
Conclusions:
- Peri-operative CDK4/6 inhibition did not adversely affect surgical outcomes in this early series.
- Close coordination with oncology for temporary treatment interruption is recommended.
- Further multi-center studies are needed to fully assess risks.
