# Real-Life Efficacy of Palbociclib and Ribociclib in Advanced Breast Cancer

## TL;DR

This study compares the real-life effectiveness of two CDK 4/6 inhibitors in treating advanced breast cancer, finding similar outcomes but a higher 3-year survival rate with ribociclib.

## Contribution

The study provides real-world evidence supporting the clinical trial findings of CDK 4/6 inhibitors in metastatic breast cancer.

## Key findings

- Median progression-free survival was 24 months overall, with no significant difference between ribociclib and palbociclib.
- Three-year overall survival was significantly higher in the ribociclib group compared to the palbociclib group.
- Ribociclib showed better progression-free survival when combined with letrozole or fulvestrant, though only significant with letrozole.

## Abstract

Background: Clinical trials in metastatic hormone receptor-positive (HR+) human epidermal growth factor receptor-2 (HER2)-negative patients have shown that cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors both increase response rates and provide survival benefits. The efficacy of these therapies needs to be supported by real-life data. In this study, we aimed to evaluate treatment response, survival and affecting factors in patients with HR+/HER2− metastatic breast cancer (MBC) who were followed up with CDK 4/6 inhibitors in our center. Materials and methods: A retrospective analysis of 120 patients with HR+/HER2− MBC treated with ribociclib or palbociclib in combination with letrozole or fulvestrant was performed. Results: Median progression-free survival (mPFS) was 24 months in the general population, 27 months in the ribociclib arm and 20 months in the palbociclib arm, with no significant difference in progression-free survival (PFS) in both arms (p = 0.25). The mPFS was longer in the ribociclib + letrozole arm compared to palbociclib + letrozole (27 vs. 20 months, respectively). PFS was also longer in patients receiving ribociclib + fulvestrant compared to palbociclib + fulvestrant but not statistically significant (33 vs. 21 months, respectively). Median overall survival (mOS) was not reached, but 3-year overall survival (OS) was statistically significantly longer in the ribociclib arm (87% vs. 55.5%, respectively, p = 0.03). Conclusion: Palbociclib and ribociclib are first-line treatment options for metastatic HR+/HER2− disease and have similar efficacy. In our study, while the mPFS was not statistically significant in both arms, the 3-year OS rate was higher in the ribociclib arm and statistically significant. Our findings were confirmed in randomized studies comparing both agents head-to-head.