Palbociclib

(Ibrance®)

Palbociclib

Drug updated on 12/11/2024

Dosage FormCapsule (oral; 75 mg, 100 mg, 125 mg); Tablet (oral; 75 mg, 100 mg, 125 mg)
Drug ClassKinase inhibitors
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated for the treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer in combination with: an aromatase inhibitor as initial endocrine-based therapy in postmenopausal women or in men
  • Indicated for the treatment of adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer in combination with: Fulvestrant in patients with disease progression following endocrine therapy.

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Summary
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  • This summary is based on the review of 20 systematic review(s)/meta-analysis(es). [1-20]
  • Palbociclib (Ibrance) combined with endocrine therapy (ET) significantly improved both progression-free survival (PFS) and overall survival (OS) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor type 2 negative (HER2-) breast cancer, with findings consistent across randomized controlled trials (RCTs) and real-world evidence (RWE) studies. Comparative analyses noted ribociclib + ET improved OS more significantly than palbociclib + ET.
  • Health-related quality of life (HRQoL) measures, including aspects like physical functioning, fatigue, and pain, were either maintained or improved in patients treated with palbociclib across multiple studies, including older adults and Asian patients, with outcomes favorable compared to ET alone.
  • Palbociclib combined with ET achieved superior objective response rates (ORR) and disease control rates (DCR) relative to ET alone, indicating its robust therapeutic effect in managing HR+/HER2- advanced or metastatic breast cancer.
  • Palbociclib's safety profile included a relatively high incidence of neutropenia, consistent with other cyclin-dependent kinases (CDK) 4/6 inhibitors, and a lower risk of QTc prolongation (relative risk (RR) 1.51) compared to ribociclib (RR 3.12), indicating fewer cardiovascular events compared to ribociclib and abemaciclib.
  • Specific adverse events associated with palbociclib involved a lower incidence of diarrhea and fatigue than observed with abemaciclib, which had a higher rate of gastrointestinal toxicities; however, palbociclib presented an increased risk of stomatitis.
  • In real-world settings, older patients receiving palbociclib experienced higher rates of dose modifications and treatment discontinuations, yet these adjustments did not adversely affect the drug's efficacy.
  • Meta-analyses suggested that palbociclib, ribociclib, and abemaciclib each improved OS among AI-sensitive and AI-resistant patients, though palbociclib's OS improvement in AI-sensitive groups did not reach statistical significance (hazard ratio (HR) 0.83, 95% confidence interval (CI) [0.68-1.02]).
  • Palbociclib demonstrated similar effectiveness and safety outcomes in older patients (≥ 65 years) compared to younger populations, maintaining HRQoL even with higher rates of dose modifications in the older cohort. Additionally, Asian patients receiving palbociclib experienced consistent improvements in HRQoL. Cardiovascular safety was a relevant factor, with palbociclib showing a lower risk of major adverse cardiovascular events (MACE) relative to other CDK4/6 inhibitors.

Product Monograph / Prescribing Information

Document TitleYearSource
Ibrance (palbociclib) Prescribing Information.2023Pfizer Inc., New York, NY

Systematic Reviews / Meta-Analyses

Document TitleYearSource
A systematic review of health-related quality of life outcomes in patients with advanced breast cancer treated with palbociclib2024Journal of Comparative Effectiveness Research
QTc prolongation across CDK4/6 inhibitors: a systematic review and meta-analysis of randomized controlled trials2024JNCI Cancer Spectrum
Comparative efficacy and safety of CDK4/6 inhibitors combined with endocrine therapies for HR+/HER2-breast cancer: Systematic review and network meta-analysis2024Heliyon
Palbociclib in Older Patients with Advanced/Metastatic Breast Cancer: A Systematic Review2024Targeted Oncology
Aminobenzotriazole inhibits and induces several key drug metabolizing enzymes complicating its utility as a pan CYP inhibitor for reaction phenotyping2024Clinical and Translational Science
Risk of Cardiovascular Events with Cyclin-Dependent Kinases 4 and 6 (CDK 4/6) Inhibitors among Patients with Advanced Breast Cancer: A Systematic Review and Network Meta-Analysis2023Reviews in Cardiovascular Medicine
An Overview of the Safety Profile and Clinical Impact of CDK4/6 Inhibitors in Breast Cancer-A Systematic Review of Randomized Phase II and III Clinical Trials2023Biomolecules
The likelihood of being helped or harmed as a patient-centred tool to assess cyclin dependent kinase 4/6 inhibitors clinical impact and safety in metastatic breast cancer: a systematic review and sensitivity-analysis2023EClinicalMedicine
Health-related quality of life in breast cancer patients treated with CDK4/6 inhibitors: a systematic review2022ESMO Open
Role of Intrinsic Subtype Analysis with PAM50 in Hormone Receptors Positive HER2 Negative Metastatic Breast Cancer: A Systematic Review2022International Journal of Molecular Sciences
Evaluation of Information Theoretic Network Meta-analysis to Rank First-Line Anticancer Regimens for Hormone Receptor-Positive, ERBB2-Negative Metastatic Breast Cancer2022JAMA Network Open
Pharmacoeconomic evaluations of CDK4/6 inhibitors plus endocrine therapy for advanced hormone receptor-positive (HR+) and human epidermal growth factor receptor-2 negative (HER2-) breast cancer: a systematic review2022Annals of Translational Medicine
Systematic Review of Molecular Biomarkers Predictive of Resistance to CDK4/6 Inhibition in Metastatic Breast Cancer2022JCO Precision Oncology
Neoadjuvant Therapy of Cyclin-Dependent Kinase 4/6 Inhibitors Combined with Endocrine Therapy in HR+/HER2- Breast Cancer: A Systematic Review and Meta-Analysis2021Oncology Research and Treatment
Oral adverse effects of CDK4/6 inhibitors among breast cancer patients: a systematic review and meta-analysis2021Annals of Palliative Medicine
CDK4/6 inhibitors in breast cancer: differences in toxicity profiles and impact on agent choice. A systematic review and meta-analysis2021Expert Review of Anticancer Therapy
Progression-Free Survival and Overall Survival of CDK 4/6 Inhibitors Plus Endocrine Therapy in Metastatic Breast Cancer: A Systematic Review and Meta-Analysis2020International Journal of Molecular Sciences
Cyclin‑dependent kinase 4/6 inhibitors in combination with fulvestrant for previously treated metastatic hormone receptor‑positive breast cancer patients: A systematic review and meta‑analysis of randomized clinical trials2020Cancer Treatment and Research Communications
Endocrine therapies in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative, pretreated, advanced breast cancer: A network meta-analysis2020Medicine
First-Line Treatment for Endocrine-Sensitive Bone-Only Metastatic Breast Cancer: Systematic Review and Meta-analysis2019Clinical Breast Cancer

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