HR+ HER2- metastatic breast cancer: which CDK 4/6 inhibitor works best?

  • Rossi V & al.
  • Cancers (Basel)
  • 26 Oct 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • The 3 CDK 4/6 inhibitors (ab−emaciclib, palbociclib, and ribociclib) work equally well in comparison to fulvestrant (F) or aromatase inhibitor (AI) monotherapy, according to a network meta-analysis of 7 randomized controlled trials (RCTs) of metastatic breast cancer (mBCa) patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative tumors.

Why this matters

  • CDK 4/6 inhibitors plus AI or F have recently become first-line therapies for mBCa, but this is the first network meta-analysis to compare their effects on PFS.
  • Given their similar efficacy, the choice of CDK 4/6 inhibitor should rest with the adverse event profile.

Study design

  • Network meta-analysis of 7 RCTs (n=2278): PALOMA 2, MONALEESA 2, MONALEESA 7, MONARCH 3, FALCON, SWOG, and FACT.
  • Funding: None.

Key results

  • CDK 4/6 recipients had similarly longer PFS, the main outcome in comparison to fulvestrant or AI monotherapy:
    • Palbociclib+AI: HR, 0.68; 95% Credible Interval (CrI), 0.53-0.87.
    • Ribociclib+AI: HR, 0.65; 95% CrI, 0.53-0.79.
    • Abemaciclib+AI: HR, 0.63; 95% Crl, 0.47-0.86.
  • Results were independent of type of CDK 4/6 inhibitor, age, race, performance status, disease site, prior chemotherapy, prior endocrine therapy, disease-free interval, menopausal status, or expression of the progesterone receptor.

Limitations

  • Results not based on individual patient data.
  • The number of trials was small.