Abemaciclib is a cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitor currently under investigation for use in breast cancer. A related editorial describes the recent approval of 2 other CDK4/6 inhibitors (palbociclib and ribociclib) by the FDA (only palbociclib is approved for use in the EU so far) and that in the absence of robust clinical data differentiating the effectiveness of these three CDK4/6 inhibitors one would hope that—in a free market—the availability of three drugs in the same class would also result in some competition on the basis of costs, aside from the usual efforts to identify marketing distinctions without a meaningful clinical difference. Ideally, the CDK4/6 inhibitor(s) that will be used the most should be those whose cost is the lowest, while providing similar or greater effectiveness and tolerance, thereby making these drugs accessible to all patients who need them.
A related grand round begins with a case vignette highlighting current challenges in diagnosis and management of advanced breast cancer, summary of the current literature and suggested approaches to management.