Theme
Breakthrough in First-Line Care
Source
Source: Hortobagyi GN, Stemmer SM, Burris HA, et al. Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer. N Engl J Med. 2022;386:942-50. MONALEESA-2 ClinicalTrials.gov number, NCT01958021.
Ribociclib + Letrozole extends Median Overall Survival to >5 Years in Advanced HR+/HER2- Breast Cancer.
Median Overall Survival
63.9
Months
+12.5 Months vs Placebo
Risk Reduction
24%
Relative Reduction
HR: 0.76 (95% CI: 0.63–0.93)
P=0.008
P=0.008
MONALEESA-2 Protocol
- N=668 Postmenopausal, HR+/HER2-, no prior systemic tx.
- Intervention: Ribociclib (600mg) + Letrozole.
- Control: Placebo + Letrozole.
- Follow-up: Median 80 months.
Efficacy Milestones (Median Months)
Comparison of Overall Survival (OS) and Time to First Chemotherapy.
Long-Term Survival (6 Years)
Percentage of patients alive at the 72-month benchmark.
Recommendation: Standard of Care
Ribociclib plus Letrozole should be adopted as the preferred first-line standard of care. The data demonstrates a clinically meaningful extension of life exceeding five years—a milestone previously unreached in this setting—with a significant delay in the need for chemotherapy (median 50.6 months).
AbbreviationsQuick
CDK4/6, cyclin-dependent kinases 4 and 6; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; ER, estrogen receptor; HER2, human epidermal growth factor receptor 2; HR, hormone receptor; NE, could not be estimated; PgR, progesterone receptor.
Bibliography8
- Hortobagyi GN, Stemmer SM, Burris HA, et al. Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer. N Engl J Med 2022;386:942-50. (DOI: 10.1056/NEJMoa2114663)
- Hortobagyi GN, Stemmer SM, Burris HA, et al. Ribociclib as first-line therapy for HR-positive, advanced breast cancer. N Engl J Med 2016;375:1738-48.
- Im S-A, Lu Y-S, Bardia A, et al. Overall survival with ribociclib plus endocrine therapy in breast cancer. N Engl J Med 2019; 381: 307-16.
- Slamon DJ, Neven P, Chia S, et al. Overall survival with ribociclib plus fulvestrant in advanced breast cancer. N Engl J Med 2020; 382: 514-24.
- Goetz MP, Toi M, Campone M, et al. MONARCH 3: abemaciclib as initial therapy for advanced breast cancer. J Clin Oncol 2017;35:3638-46.
- Sledge GW Jr, Toi M, Neven P, et al. The effect of abemaciclib plus fulvestrant on overall survival in hormone receptor-positive, ERBB2-negative breast cancer that progressed on endocrine therapy — MONARCH 2: a randomized clinical trial. JAMA Oncol 2020; 6:116-24.
- Turner NC, Slamon DJ, Ro J, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med 2018; 379:1926-36.
- Cristofanilli M, Turner NC, Bondarenko I, et al. Fulvestrant plus palbociclib versus fulvestrant plus placebo for treatment of hormone-receptor-positive, HER2-negative metastatic breast cancer that progressed on previous endocrine therapy (PALOMA-3). Lancet Oncol 2016; 17:425-39.
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