Palbociclib combined with fulvestrant in premenopausalwomen with advanced breast cancer and prior progression on endocrine therapy: PALOMA-3 results

Sibylle Loibl*, Nicholas C. Turner, Jungsil Ro, Massimo Cristofanilli, Hiroji Iwata, Seock Ah Im, Norikazu Masuda, Sherene Loi, Fabrice André, Nadia Harbeck, Sunil Verma, Elizabeth Folkerd, Kathy Puyana Theall, Justin Hoffman, Ke Zhang, Cynthia Huang Bartlett, Mitchell Dowsett

*Corresponding author for this work

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

Background. The efficacy and safety of palbociclib, a cyclindependent kinase 4/6 inhibitor, combined with fulvestrant and goserelin was assessed in premenopausal women with advanced breast cancer (ABC) who had progressed on prior endocrine therapy (ET). Patients and Methods. One hundred eight premenopausal endocrine-refractory women ≥18 years with hormone receptor-positive (HR1)/human epidermal growth factor receptor 2-negative (HER22) ABC were among 521 women randomized 2:1 (347:174) to fulvestrant (500 mg)± goserelin with either palbociclib (125 mg/day orally, 3 weeks on, 1 week off) or placebo. This analysis assessed whether the overall tolerable safety profile and significant progression-free survival (PFS) improvement extended to premenopausal women. Potential drug-drug interactions (DDIs) and ovarian suppression with goserelin were assessed via plasma pharmacokinetics and biochemical analyses, respectively. (ClinicalTrials.gov identifier: NCT01942135) Results. Median PFS for premenopausal women in the palbociclib (n572) versus placebo arm (n536) was 9.5 versus 5.6 months, respectively (hazard ratio, 0.50, 95% confidence interval: 0.29-0.87), and consistent with the significant PFS improvement in the same arms for postmenopausal women. Any-grade and grade ≤ 3 neutropenia, leukopenia, and infections were among themost frequent adverse events reported in the palbociclib arm with concurrent goserelin administration. Hormone concentrations were similar between treatment arms and confirmed sustained ovarian suppression. Clinically relevant DDIs were not observed. Conclusion. Palbociclib combined with fulvestrant and goserelin was an effective andwell-tolerated treatment for premenopausal women with prior endocrine-resistant HR1/HER22 ABC. Inclusion of both premenopausal and postmenopausal women in pivotal combination ET trials facilitates access to novel drugs for young women and should be considered as a new standard for clinical trial design.

Original languageEnglish (US)
Pages (from-to)1028-1038
Number of pages11
JournalOncologist
Volume22
Issue number9
DOIs
StatePublished - Sep 2017

Keywords

  • Breast cancer
  • Fulvestrant
  • Goserelin
  • Neoplasm metastasis
  • Palbociclib
  • Premenopausal

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Palbociclib combined with fulvestrant in premenopausalwomen with advanced breast cancer and prior progression on endocrine therapy: PALOMA-3 results'. Together they form a unique fingerprint.

  • Cite this

    Loibl, S., Turner, N. C., Ro, J., Cristofanilli, M., Iwata, H., Im, S. A., Masuda, N., Loi, S., André, F., Harbeck, N., Verma, S., Folkerd, E., Theall, K. P., Hoffman, J., Zhang, K., Bartlett, C. H., & Dowsett, M. (2017). Palbociclib combined with fulvestrant in premenopausalwomen with advanced breast cancer and prior progression on endocrine therapy: PALOMA-3 results. Oncologist, 22(9), 1028-1038. https://doi.org/10.1634/theoncologist.2017-0072