Table 1 Results from pivotal prospective randomized controlled trials investigating palbociclib, ribociclib and abemaciclib combined with an endocrine partner in the treatment of first-line patients with HR + MBC.

From: The dilemma of selecting a first line CDK4/6 inhibitor for hormone receptor-positive/HER2-negative metastatic breast cancer

Trial Details

PALOMA-213,26

MONALEESA-212,15

MONALEESA-320,22,24

MONALEESA-718,25

MONARCH-314,29

CDK4/6 inhibitor

Palbociclib

Ribociclib

Ribociclib

Ribociclib

Abemaciclib

Endocrine therapy

Letrozole

Letrozole

Fulvestrant

Goserelin plus tamoxifen or NSAI

NSAI

Menopausal status

Post-menopausal

Post-menopausal

Post-menopausal

Pre/peri-menopausal

Post-menopausal

Sample size

666

668

365 (1L therapy)

672

493

Median follow up (months)

90

80

70.8

53.5

70.2

mPFS combination arm (months)

24.8

25.3

33.6

23.8

28.2

mPFS control arm (months)

14.5

16

19.2

13

14.8

mPFS HR (95% CI)

0.58 (0.46–0.72)

0.57 (0.46–0.7)

0.55 (0.42–0.72)

0.55 (0.44–0.69)

0.54 (0.42–0.69)

mPFS p value

<0.001

<0.001

n/a

<0.001

<0.001

mOS combination arm (months)

53.9

63.9

67.6

58.7

67.1

mOS control arm (months)

51.2

51.4

51.8

48

54.5

mOS HR (95% CI)

0.956 (0.777–1.177)

0.76 (0.63–0.93)

0.67 (0.5–0.9)

0.76 (0.61–0.96)

0.754 (0.584–0.974)

mOS p value

0.3378

<0.001

n/a

<0.001

0.0301a

% ≥1 dose reduction due to AE (combination arm)

36%

50.6%

n/a

31%

46.5%

% treatment discontinuation (combination arm)

9.7%

7.5%

n/a

4%

16.5%

  1. 1L first-line, NSAI non-steroidal aromatase inhibitor, mPFS median progression-free survival, mOS median overall survival, AE adverse events.
  2. aResults from preplanned interim analysis, the statistical significance threshold for abemaciclib superiority was not met.