Comparative real-world progression free survival of CDK4/6 inhibitors in HR+/HER2− breast cancer patients with bone metastases
BACKGROUND: The introduction of CDK4/6 inhibitors (CDK4/6i) has improved outcomes in hormone receptor-positive (HR+)/HER2-negative metastatic breast cancer (mBC), including in patients with bone metastases. Assessing their comparative effectiveness in real-world settings is crucial. METHODS: This retrospective, multicenter cohort study (January 2019-December 2023; median follow-up 39 months) evaluated the real-world progression-free survival (rwPFS) of abemaciclib, ribociclib, and palbociclib combined with endocrine therapy (ET) in HR+/HER2- mBC patients with bone metastases. Overall survival (OS) was a secondary exploratory endpoint. A total of 1399 patients with ECOG PS 0-1 and at least 12 months of follow-up were included. Analyses used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to adjust for confounding. RESULTS: Palbociclib showed shorter rwPFS (22 months) compared to abemaciclib (32 months; HR = 1.47, p = 0.001) and ribociclib (35 months; HR = 1.49, p < 0.001). No significant difference was observed between abemaciclib and ribociclib. OS was also lower with palbociclib (47 months) versus abemaciclib (60 months; HR = 1.77, p < 0.001) and ribociclib (64 months; HR = 1.69, p = 0.001). Results were consistent after PSM and IPTW adjustment. CONCLUSION: Ribociclib and abemaciclib may provide superior rwPFS and OS compared to palbociclib in HR+/HER2- mBC patients with bone metastases.
Authors
- Elisa Tiberi
- Alessandra Chirco (ORCID: https://orcid.org/0000-0001-5008-3201)
- Teresa Arcuri
- Ornella Garrone (ORCID: https://orcid.org/0000-0001-7359-5410)
- Lorena Filomeno (ORCID: https://orcid.org/0009-0002-6484-6833)
- Alessandra Guarino
- Elisabetta Cretella (ORCID: https://orcid.org/0000-0001-8491-3058)
- Michele Iuliani (ORCID: https://orcid.org/0000-0003-3536-7630)
- Michelino De Laurentiis (ORCID: https://orcid.org/0000-0001-9009-1572)
- Silvia Cavaliere
- Simona Pisegna (ORCID: https://orcid.org/0000-0002-6910-9528)
- Cristina Fiore
- M. Mazzotta
- Federica Villa (ORCID: https://orcid.org/0009-0005-5052-1079)
- Sara Ramella (ORCID: https://orcid.org/0000-0002-5782-7717)
- Azzurra Irelli (ORCID: https://orcid.org/0000-0003-4724-6297)
- Luca Visani (ORCID: https://orcid.org/0000-0002-7079-231X)
- Maria Grazia Rossino
- Niccolò Bertini (ORCID: https://orcid.org/0009-0006-1053-6265)
- Michela Palleschi (ORCID: https://orcid.org/0000-0003-2623-4705)
- Annarita Verrazzo (ORCID: https://orcid.org/0009-0007-0974-3635)
- Caterina Sposetti (ORCID: https://orcid.org/0000-0003-3211-8516)
- Sonia Simonetti (ORCID: https://orcid.org/0000-0002-0673-1272)
- Francesca Sofia Di Lisa
- Claudia Piombino (ORCID: https://orcid.org/0000-0002-7224-4536)
- Annalisa La Cesa
- Paolo Orsaria (ORCID: https://orcid.org/0000-0002-6224-7784)
- Edy Ippolito
- Marianna Sirico (ORCID: https://orcid.org/0000-0002-2536-3858)
- Barbara Tagliaferri (ORCID: https://orcid.org/0000-0002-4889-5574)
- Roberta Scafetta
- Luigia Stefania Stucci (ORCID: https://orcid.org/0000-0003-2063-1435)
- Ilaria Bonaparte
- Ilaria Portarena
- Federica Domati
- Matteo Vergati
- Simone Foderaro (ORCID: https://orcid.org/0000-0001-5864-0180)
- Maria Vittoria Bonomo
- V. Ricozzi
- L. Sisca
- Federica Riva (ORCID: https://orcid.org/0000-0002-7245-2386)
- Mauro Minelli
- Delia De Lisi
- Marta Piras
- Agnese Fabbri
- C. Porta
- Sara D'Alessandro
- Federica Puce
- Antonella Grasso
- Francesco Antonio Vilardi
- Fabio Venuti
- Elena Speziale
- Claudio Vernieri
- Andrea Botticelli
- Vittorio Altomare
- Bruno Vincenzi
- Giuseppe Tonini
- Icro Meattini
- Patrizia Vici
- Francesco Pantano
- Orazio Caffo
- Ugo De Giorgi
- Roberta Caputo
- Giuliana D'Auria
- Angela Toss
- Simone Scagnoli
- Daniele Santini
- Carmen Criscitiello
- Rossana Berardi
- Carla Gullotta
- Luigi Rossi
- Marco Donato
- Stefania Gori
- Giuseppe Curigliano
- Raffaella Troiano
- Alessio Cortellini
- Giampaolo Bianchini
- Rebecca Pedersini
Institutions
- University of Modena and Reggio Emilia (IT)
- Marche Polytechnic University (IT)
- University of Salento (IT)
- Vita-Salute San Raffaele University (IT)
- Università Campus Bio-Medico (IT)
- University of Milan (IT)
- University of Trento (IT)
- Leo Pharma (Australia) (AU)
- Azienda Ospedaliera San Giovanni Addolorata (IT)
- Policlinico Umberto I (IT)
- Martin University (US)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Ospedale Santa Chiara (IT)
- Ospedale di Bolzano (IT)
- Istituti Clinici Scientifici Maugeri (IT)
- Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT)
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IT)
- Ospedale Sacro Cuore Don Calabria (IT)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Ospedale Papa Giovanni XXIII (IT)
- Azienda Ospedaliero-Universitaria di Modena (IT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Dana-Farber Cancer Institute (US)
- Azienda Ospedaliera Sant'Andrea (IT)
- Ospedale di Belcolle (IT)
- Ospedale Sandro Pertini (IT)
- Dana-Farber/Harvard Cancer Center (US)
- Nini Hospital (LB)
- Policlinico Tor Vergata (IT)
- Campus Bio Medico University Hospital (IT)
- Tumori Foundation (US)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Maastro Clinic (NL)
- University of Florence (IT)
- University of Bari Aldo Moro (IT)
- European Institute of Oncology (IT)
- Sapienza University of Rome (IT)
Publication Details
- Journal
- The Oncologist
- Published
- 2026-04-10
- DOI
- https://doi.org/10.1093/oncolo/oyag146
- Primary Topic
- Advanced Breast Cancer Therapies
- Type
- article
- Field-Weighted Citation Impact
- 0.00