1
|
Gnant M, Dueck AC, Frantal S, Martin M, Burstein HJ, Greil R, Fox P, Wolff AC, Chan A, Winer EP, Pfeiler G, Miller KD, Colleoni M, Suga JM, Rubovsky G, Bliss JM, Mayer IA, Singer CF, Nowecki Z, Hahn O, Thomson J, Wolmark N, Amillano K, Rugo HS, Steger GG, Hernando Fernández de Aránguiz B, Haddad TC, Perelló A, Bellet M, Fohler H, Metzger Filho O, Jallitsch-Halper A, Solomon K, Schurmans C, Theall KP, Lu DR, Tenner K, Fesl C, DeMichele A, Mayer EL. Adjuvant Palbociclib for Early Breast Cancer: The PALLAS Trial Results (ABCSG-42/AFT-05/BIG-14-03). J Clin Oncol 2022; 40:282-293. [PMID: 34874182 PMCID: PMC10476784 DOI: 10.1200/jco.21.02554] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Palbociclib is a cyclin-dependent kinase 4 and 6 inhibitor approved for advanced breast cancer. In the adjuvant setting, the potential value of adding palbociclib to endocrine therapy for hormone receptor-positive breast cancer has not been confirmed. PATIENTS AND METHODS In the prospective, randomized, phase III PALLAS trial, patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer were randomly assigned to receive 2 years of palbociclib (125 mg orally once daily, days 1-21 of a 28-day cycle) with adjuvant endocrine therapy or adjuvant endocrine therapy alone (for at least 5 years). The primary end point of the study was invasive disease-free survival (iDFS); secondary end points were invasive breast cancer-free survival, distant recurrence-free survival, locoregional cancer-free survival, and overall survival. RESULTS Among 5,796 patients enrolled at 406 centers in 21 countries worldwide over 3 years, 5,761 were included in the intention-to-treat population. At the final protocol-defined analysis, at a median follow-up of 31 months, iDFS events occurred in 253 of 2,884 (8.8%) patients who received palbociclib plus endocrine therapy and in 263 of 2,877 (9.1%) patients who received endocrine therapy alone, with similar results between the two treatment groups (iDFS at 4 years: 84.2% v 84.5%; hazard ratio, 0.96; CI, 0.81 to 1.14; P = .65). No significant differences were observed for secondary time-to-event end points, and subgroup analyses did not show any differences by subgroup. There were no new safety signals for palbociclib in this trial. CONCLUSION At this final analysis of the PALLAS trial, the addition of adjuvant palbociclib to standard endocrine therapy did not improve outcomes over endocrine therapy alone in patients with early hormone receptor-positive breast cancer.
Collapse
Affiliation(s)
- Michael Gnant
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Amylou C. Dueck
- Alliance Statistics and Data Center and Mayo Clinic, Phoenix, AZ
| | - Sophie Frantal
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Miguel Martin
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute—Center of Clinical Cancer and Immunology Trials; Cancer Cluster Salzburg, Salzburg, Austria
| | - Peter Fox
- Central West Cancer Care Centre, Orange Health Service, Orange, NSW, Australia
| | | | - Arlene Chan
- Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
| | | | - Georg Pfeiler
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Marco Colleoni
- IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | | | | | - Christian F. Singer
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | - Zbigniew Nowecki
- The Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | - Norman Wolmark
- NSABP Foundation, Inc, and The UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA
| | - Kepa Amillano
- Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Guenther G. Steger
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | | | | | | | | | - Hannes Fohler
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Otto Metzger Filho
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
- Alliance Foundation Trials, Boston, MA
| | | | | | | | | | | | | | - Christian Fesl
- ABCSG, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | | | | |
Collapse
|