- 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.
- Network meta-analysis of 7 RCTs (n=2278): PALOMA 2, MONALEESA 2, MONALEESA 7, MONARCH 3, FALCON, SWOG, and FACT.
- Funding: None.
- 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.
- Results not based on individual patient data.
- The number of trials was small.