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Overall survival (OS) with first-line palbociclib plus letrozole (PAL+LET) versus placebo plus letrozole (PBO+LET) in women with estrogen receptor–positive/human epidermal growth factor receptor 2–negative advanced breast cancer (ER+/HER2− ABC): Analyses from PALOMA-2.
Abstract
LBA1003 Background: PAL was the first cyclin-dependent kinase 4/6 (CDK4/6) inhibitor approved for ER+/HER2– ABC based on the randomized, phase 2 PALOMA-1 study. PALOMA-2 is a randomized, double-blind, phase 3 trial in first-line ER+/HER2– ABC that confirmed a clinically and statistically significant improvement in progression-free survival (PFS) with PAL+LET versus PBO+LET (median PFS, 27.6 vs 14.5 months; hazard ratio, 0.56 [95% CI, 0.46–0.69]; P<0.0001). At the time of the final PFS analysis, OS data were not mature. Herein, we report OS results. Methods: 666 postmenopausal women with ER+/HER2– ABC who had not received prior systemic therapy for advanced disease were randomized 2:1 to receive PAL (125 mg/d orally, 3/1 week schedule) plus LET (2.5 mg/d orally, continuously) or PBO+LET. The primary endpoint was investigator-assessed PFS and a key secondary endpoint was OS. Per study design, 390 OS events are required to have 80% power to detect a hazard ratio <0.74 at a significance level of 0.025 (1-sided) using a stratified log-rank test. The planned final OS analysis was conducted when the number of events required for the analysis was observed. Results: At data cut-off (November 15, 2021), with a median follow-up of 90 months, 43 patients (pts; 10%) remained on PAL+LET and 5 pts (2%) on PBO+LET. With 405 deaths, median OS (95% CI) was 53.9 months (49.8–60.8) in the PAL+LET arm and 51.2 months (43.7 –58.9) in the PBO+LET arm (hazard ratio, 0.956 [95% CI, 0.777–1.177]; stratified 1-sided P=0.3378). In this OS analysis, a proportion of pts were not available for follow-up (withdrew consent or lost to follow-up) and were censored: 21% in the PBO+LET arm versus 13% in the PAL+LET arm. A posthoc sensitivity analysis excluding these pts resulted in a median OS (95% CI) of 51.6 months (46.9–57.1) with PAL+LET and 44.6 months (37.0–52.3) with PBO+LET (hazard ratio, 0.869 [95% CI, 0.706–1.069]). Of the pts who discontinued study treatment, 81% in the PAL+LET arm and 88% in the PBO+LET arm received post-study systemic therapy; 12% and 27% of pts who discontinued received CDK4/6 inhibitor, respectively. In pts with disease-free interval (DFI) >12 months, median OS (95% CI) was 66.3 months (52.1–79.7) in the PAL+LET arm (n=179) and 47.4 months (37.7–57.0) in the PBO+LET arm (n=93); hazard ratio, 0.728 (95% CI, 0.528-1.005). No new safety findings were observed. Conclusions: PALOMA-2 met its primary endpoint of improving PFS but not the secondary endpoint of OS. Pts receiving PAL+LET had numerically longer OS compared to PBO+LET, but the results were not statistically significant. Funding: Pfizer Inc (NCT01740427) Clinical trial information: NCT01740427.
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Palbociclib, in contrast to abemaciclib and ribociclib, has not shown a clinically meaningful or statistically significant difference in OS in the first- or second-line ABC setting or an invasive disease-free survival (IDFS) benefit in the EBC setting.
“which in contrast to abemaciclib and ribociclib, has not shown a clinically meaningful or statistically significant difference in OS in the firstor second-line ABC setting or an invasive disease-free survival (IDFS) benefit in the EBC setting.17,18,21,22”
From Abemaciclib plus a nonsteroidal aromatase inhibitor as initial therapy for HR+, HER2- advanced breast cancer: final overall survival results of MONARCH 3. (2024) · cites this paper as [17]
Consistent differences in outcomes (OS and IDFS) have emerged across phase III studies of CDK4/6 inhibitors.
“consistent differences in outcomes (OS and IDFS) have emerged across phase III studies of these therapies”
From Abemaciclib plus a nonsteroidal aromatase inhibitor as initial therapy for HR+, HER2- advanced breast cancer: final overall survival results of MONARCH 3. (2024) · cites this paper as [17]
The clinical relevance of the observed median OS improvement for palbociclib is less clear.
“while the clinical relevance of the observed median OS improvement for palbociclib is less clear.”
From Abemaciclib plus a nonsteroidal aromatase inhibitor as initial therapy for HR+, HER2- advanced breast cancer: final overall survival results of MONARCH 3. (2024) · cites this paper as [17]
First-line palbociclib + letrozole failed to demonstrate a statistically significant improvement in overall survival over letrozole alone in postmenopausal patients in the PALOMA-2 trial.
“First-line palbociclib in combination with the nonsteroidal aromatase inhibitor (NSAI) letrozole failed to demonstrate a statistically significant improvement in OS over letrozole alone in postmenopausal patients in the PALOMA-2 trial (median OS [mOS], 53.9 vs. 51.2 months [hazard ratio (HR) 0.96; 95% CI 0.78–1.18; P = 0.34]) [9].”
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Metadata
- Authors
- Finn, R. S., Rugo, H. S., Dieras, V. C., Harbeck, N., Im, S.-A., Gelmon, K. A., Walshe, J. M., Martin, M., Chavez Mac Gregor, M., Bananis, E., Gauthier, E. R., Lu, D. R., Kim, S., & Slamon, D. J.
- Affiliations
- University of California, Los Angeles (US)
- University of California, San Francisco (US)
- Centre Eugène Marquis (FR)
- LMU Klinikum (DE)
- Seoul National University (KR)
- BC Cancer Agency (CA)
- Cancer Trials Ireland (IE)
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Universidad Complutense de Madrid, GEICAM Breast Cancer Group, Madrid, Spain;
- The University of Texas MD Anderson Cancer Center, Houston, TX;
- Pfizer (United States) (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2022-06-10
- Volume
- 40
- Issue
- 17_suppl
- Pages
- LBA1003-LBA1003
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W4293083647
- Cited by
- 169
- References
- 0
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 52 · 2023: 79 · 2022: 10
- Type
- conference abstract
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Funders
- Pfizer Inc.
- Topics
- Health Sciences › Medicine › Oncology › Advanced Breast Cancer Therapies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Oncology › PARP inhibition in cancer therapy
- Keywords
- palbociclib, letrozole, CDK4/6 inhibitors, estrogen receptor-positive breast cancer, HER2-negative breast cancer, advanced breast cancer, first-line therapy, overall survival, PALOMA-2, progression-free survival, aromatase inhibitors, postmenopausal women, endocrine therapy, hazard ratio, statistical power
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