Efficacy and safety of CDK4/6 inhibitors combined with endocrine therapy for HR<sup>+</sup>/HER2<sup>- </sup>advanced/metastatic breast cancer: A network meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PU Yanjiao ¹ , LI Hui ¹ , CHEN Wei ¹ , DUAN Xueyu ¹ , CHEN Chunmei ² , WU Rui ¹ ,  WANG Xuechang ²

1. College of Pharmacy, Dali University, Dali, 671000, Yunnan, P. R. China;
2. Department of Pharmacy, The First People's Hospital of Anning, Kunming, 650302, P. R. China;

Corresponding author：

WANG Xuechang, Email: ynwangxc@163.com

Keywords：

HR⁺/HER2^- advanced/metastatic breast cancer; CDK4/6 inhibitor; endocrine therapy; effectiveness; security; meta-analysis

DOI：

10.7507/1007-4848.202311017

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the efficacy and safety of different cyclin-dependent kinase4/6 inhibitor (CDK4/6i) combined with endocrine therapy (ET) for HR⁺/HER2^- advanced or metastatic breast cancer based on mesh meta-analysis. Methods Randomized controlled trials (RCTs) of CDK4/6i in the treatment of HR⁺/HER2^- metastatic/advanced breast cancer were searched in PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases from inception to August 2023. Bayesian network meta-analysis was performed by R 4.2.0 software. Results Finally, 18 RCTs in 25 articles, covering 8 031 patients, involving 11 treatment regimens were included. There were no statistical differences in progression-free survival (PFS) or overall survival (OS) between CDK4/6i+ET combinations. DAL+FUL ranked first in PFS rate, and RIB+FUL ranked first in OS rate. In terms of effectiveness, ABE+AI and ABE+FUL ranked first in objective response rate (ORR) and clinical benefit rate (CBR), respectively. In terms of safety, there were significant differences in grade 3-4 AEs and SAE among some CDK4/6i types (P<0.05). Conclusion Current evidence shows that CDK4/6i+ET is superior to ET alone in the treatment of HR⁺/HER2^- advanced/metastatic breast cancer, and different combinations of CDK4/6i+ET have the same or similar effects, but the combination has a higher incidence of adverse reactions, and a reasonable treatment plan should be selected according to the individual situation of patients.

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3.	王金燕, 杨瑒, 朱凌曦, 等. 基于患者报告结局的乳腺癌患者社会功能的特征分析研究. 解放军护理杂志, 2022, 39(7): 21-24.
4.	Huppert LA, Gumusay O, Idossa D, et al. Systemic therapy for hormone receptor-positive/human epidermal growth factor receptor 2-negative early stage and metastatic breast cancer. CA Cancer J Clin, 2023, 73(5): 480-515.
5.	Kay C, Martínez-Pérez C, Meehan J, et al. Current trends in the treatment of HR⁺/HER2⁺ breast cancer. Future Oncol, 2021, 17(13): 1665-1681.
6.	Watt AC, Goel S. Cellular mechanisms underlying response and resistance to CDK4/6 inhibitors in the treatment of hormone receptor-positive breast cancer. Breast Cancer Res, 2022, 24(1): 17.
7.	Wang L, Gao S, Li D, et al. CDK4/6 inhibitors plus endocrine therapy improve overall survival in advanced HR+/HER2- breast cancer: A meta-analysis of randomized controlled trials. Breast J, 2020, 26(7): 1439-1443.
8.	Rugo HS, Rumble RB, Macrae E, et al. Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology guideline. J Clin Oncol, 2016, 34(25): 3069-3103.
9.	Petrelli F, Dottorini L, Di Menna G, et al. The role of CDK4/6 inhibitors in older and younger patients with breast cancer: A systematic review and meta-analysis. Breast, 2023, 71: 138-142.
10.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(10): ED000142.
11.	van Valkenhoef G, Dias S, Ades AE, et al. Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis. Res Synth Methods, 2016, 7(1): 80-93.
12.	Shim S, Yoon BH, Shin IS, et al. Network meta-analysis: Application and practice using Stata. Epidemiol Health, 2017, 39: e2017047.
13.	Zhang P, Zhang Q, Tong Z, et al. Dalpiciclib plus letrozole or anastrozole versus placebo plus letrozole or anastrozole as first-line treatment in patients with hormone receptor-positive, HER2-negative advanced breast cancer (DAWNA-2): A multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol, 2023, 24(6): 646-657.
14.	Xu B, Zhang Q, Zhang P, et al. Dalpiciclib or placebo plus fulvestrant in hormone receptor-positive and HER2-negative advanced breast cancer: A randomized, phase 3 trial. Nat Med, 2021, 27(11): 1904-1909.
15.	Finn RS, Crown JP, Lang I, et al. The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): A randomised phase 2 study. Lancet Oncol, 2015, 16(1): 25-35.
16.	Finn RS, Martin M, Rugo HS, et al. Palbociclib and letrozole in advanced breast cancer. N Engl J Med, 2016, 375(20): 1925-1936.
17.	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): Final analysis of the multicentre, double-blind, phase 3 randomised controlled trial. Lancet Oncol, 2016, 17(4): 425-439.
18.	Turner NC, Slamon DJ, Ro J, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med, 2018, 379(20): 1926-1936.
19.	Xu B, Hu X, Li W, et al. Palbociclib plus letrozole versus placebo plus letrozole in Asian postmenopausal women with oestrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer: Primary results from PALOMA-4. Eur J Cancer, 2022, 175: 236-245.
20.	Hortobagyi GN, Stemmer SM, Burris HA, et al. Updated results from MONALEESA-2, a phaseⅢ trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol, 2018, 29(7): 1541-1547.
21.	Hortobagyi GN, Stemmer SM, Burris HA, et al. Overall survival with ribociclib plus letrozole in advanced breast cancer. N Engl J Med, 2022, 386(10): 942-950.
22.	Slamon DJ, Neven P, Chia S, et al. PhaseⅢ randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J Clin Oncol, 2018, 36(24): 2465-2472.
23.	Slamon DJ, Neven P, Chia S, et al. Ribociclib plus fulvestrant for postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer in the phase Ⅲ randomized MONALEESA-3 trial: Updated overall survival. Ann Oncol, 2021, 32(8): 1015-1024.
24.	Tripathy D, Im SA, Colleoni M, et al. Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer (MONALEESA-7): A randomised phase 3 trial. Lancet Oncol, 2018, 19(7): 904-915.
25.	Lu YS, Im SA, Colleoni M, et al. Updated overall survival of ribociclib plus endocrine therapy versus endocrine therapy alone in pre- and perimenopausal patients with HR⁺/HER2^- advanced breast cancer in MONALEESA-7: A phase Ⅲ randomized clinical trial. Clin Cancer Res, 2022, 28(5): 851-859.
26.	Sledge GW, Toi M, Neven P, et al. MONARCH 2: Abemaciclib in combination with fulvestrant in women with HR⁺/HER2^- advanced breast cancer who had progressed while receiving endocrine therapy. J Clin Oncol, 2017, 35(25): 2875-2884.
27.	Sledge GW, 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(1): 116-124.
28.	Johnston S, Martin M, Di Leo A, et al. MONARCH 3 final PFS: A randomized study of abemaciclib as initial therapy for advanced breast cancer. NPJ Breast Cancer, 2019, 5: 5.
29.	Zhang QY, Sun T, Yin YM, et al. MONARCH plus: Abemaciclib plus endocrine therapy in women with HR⁺/HER2^- advanced breast cancer: The multinational randomized phase Ⅲ study. Ther Adv Med Oncol, 2020, 12: 1758835920963925.
30.	Park YH, Kim TY, Kim GM, et al. Palbociclib plus exemestane with gonadotropin-releasing hormone agonist versus capecitabine in premenopausal women with hormone receptor-positive, HER2-negative metastatic breast cancer (KCSG-BR15-10): A multicentre, open-label, randomised, phase 2 trial. Lancet Oncol, 2019, 20(12): 1750-1759.
31.	Martin M, Zielinski C, Ruiz-Borrego M, et al. Palbociclib in combination with endocrine therapy versus capecitabine in hormonal receptor-positive, human epidermal growth factor 2-negative, aromatase inhibitor-resistant metastatic breast cancer: A phaseⅢ randomised controlled trial-PEARL. Ann Oncol, 2021, 32(4): 488-499.
32.	Martín M, Zielinski C, Ruiz-Borrego M, et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer, 2022, 168: 12-24.
33.	Albanell J, Martínez MT, Ramos M, et al. Randomized phase Ⅱ study of fulvestrant plus palbociclib or placebo in endocrine-sensitive, hormone receptor-positive/HER2-advanced breast cancer: GEICAM/2014-12 (FLIPPER). Eur J Cancer, 2022, 161: 26-37.
34.	Robertson JFR, Bondarenko IM, Trishkina E, et al. Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): An international, randomised, double-blind, phase 3 trial. Lancet, 2016, 388(10063): 2997-3005.
35.	Robertson JF, Llombart-Cussac A, Rolski J, et al. Activity of fulvestrant 500 mg versus anastrozole 1 mg as first-line treatment for advanced breast cancer: Results from the FIRST study. J Clin Oncol, 2009, 27(27): 4530-4535.
36.	Ellis MJ, Llombart-Cussac A, Feltl D, et al. Fulvestrant 500 mg versus anastrozole 1 mg for the first-line treatment of advanced breast cancer: Overall survival analysis from the phase Ⅱ FIRST study. J Clin Oncol, 2015, 33(32): 3781-3787.
37.	Llombart-Cussac A, Pérez-García JM, Bellet M, et al. Fulvestrant-palbociclib vs letrozole-palbociclib as initial therapy for endocrine-sensitive, hormone receptor-positive, ERBB2-negative advanced breast cancer: A randomized clinical trial. JAMA Oncol, 2021, 7(12): 1791-1799.
38.	莫淼, 黄亮, 管晓翔. 瑞博西林联合氟维司群用于激素受体阳性、人表皮生长因子受体2阴性晚期乳腺癌的Ⅲ期研究—MONALEESA3研究解读. 中国癌症杂志, 2019, 29(6): 468-475.
39.	张军, 赵崇如, 刘万立, 等. 细胞周期蛋白依赖性激酶4/6抑制剂在乳腺癌治疗中的新策略. 中华乳腺病杂志(电子版), 2022, 16(2): 110-115.
40.	Huang T, He Y, Yu C, et al. The effect and safety of CDK4/6 inhibitors combined endocrine therapy on HR⁺, HER2^-breast cancer: A meta-analysis of randomized controlled trials. Endokrynol Pol, 2023, 74(1): 89-105.
41.	Zheng J, Wu J, Wang C, et al. Combination cyclin-dependent kinase 4/6 inhibitors and endocrine therapy versus endocrine monotherapy for hormonal receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: A systematic review and meta-analysis. PLoS One, 2020, 15(6): e0233571.
42.	Hu W, Sung T, Jessen BA, et al. Mechanistic investigation of bone marrow suppression associated with palbociclib and its differentiation from cytotoxic chemotherapies. Clin Cancer Res, 2016, 22(8): 2000-2008.
43.	Zhang P, Xu B, Gui L, et al. A phase 1 study of dalpiciclib, a cyclin-dependent kinase 4/6 inhibitor in Chinese patients with advanced breast cancer. Biomark Res, 2021, 9(1): 24.
44.	Hafner M, Mills CE, Subramanian K, et al. Multiomics profiling establishes the polypharmacology of FDA-approved CDK4/6 inhibitors and the potential for differential clinical activity. Cell Chem Biol, 2019, 26(8): 1067-1080.
45.	Braal CL, Jongbloed EM, Wilting SM, et al. Inhibiting CDK4/6 in breast cancer with palbociclib, ribociclib, and abemaciclib: Similarities and differences. Drugs, 2021, 81(3): 317-331.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3. 王金燕, 杨瑒, 朱凌曦, 等. 基于患者报告结局的乳腺癌患者社会功能的特征分析研究. 解放军护理杂志, 2022, 39(7): 21-24.
4. Huppert LA, Gumusay O, Idossa D, et al. Systemic therapy for hormone receptor-positive/human epidermal growth factor receptor 2-negative early stage and metastatic breast cancer. CA Cancer J Clin, 2023, 73(5): 480-515.
5. Kay C, Martínez-Pérez C, Meehan J, et al. Current trends in the treatment of HR⁺/HER2⁺ breast cancer. Future Oncol, 2021, 17(13): 1665-1681.
6. Watt AC, Goel S. Cellular mechanisms underlying response and resistance to CDK4/6 inhibitors in the treatment of hormone receptor-positive breast cancer. Breast Cancer Res, 2022, 24(1): 17.
7. Wang L, Gao S, Li D, et al. CDK4/6 inhibitors plus endocrine therapy improve overall survival in advanced HR+/HER2- breast cancer: A meta-analysis of randomized controlled trials. Breast J, 2020, 26(7): 1439-1443.
8. Rugo HS, Rumble RB, Macrae E, et al. Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology guideline. J Clin Oncol, 2016, 34(25): 3069-3103.
9. Petrelli F, Dottorini L, Di Menna G, et al. The role of CDK4/6 inhibitors in older and younger patients with breast cancer: A systematic review and meta-analysis. Breast, 2023, 71: 138-142.
10. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10(10): ED000142.
11. van Valkenhoef G, Dias S, Ades AE, et al. Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis. Res Synth Methods, 2016, 7(1): 80-93.
12. Shim S, Yoon BH, Shin IS, et al. Network meta-analysis: Application and practice using Stata. Epidemiol Health, 2017, 39: e2017047.
13. Zhang P, Zhang Q, Tong Z, et al. Dalpiciclib plus letrozole or anastrozole versus placebo plus letrozole or anastrozole as first-line treatment in patients with hormone receptor-positive, HER2-negative advanced breast cancer (DAWNA-2): A multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol, 2023, 24(6): 646-657.
14. Xu B, Zhang Q, Zhang P, et al. Dalpiciclib or placebo plus fulvestrant in hormone receptor-positive and HER2-negative advanced breast cancer: A randomized, phase 3 trial. Nat Med, 2021, 27(11): 1904-1909.
15. Finn RS, Crown JP, Lang I, et al. The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): A randomised phase 2 study. Lancet Oncol, 2015, 16(1): 25-35.
16. Finn RS, Martin M, Rugo HS, et al. Palbociclib and letrozole in advanced breast cancer. N Engl J Med, 2016, 375(20): 1925-1936.
17. 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): Final analysis of the multicentre, double-blind, phase 3 randomised controlled trial. Lancet Oncol, 2016, 17(4): 425-439.
18. Turner NC, Slamon DJ, Ro J, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med, 2018, 379(20): 1926-1936.
19. Xu B, Hu X, Li W, et al. Palbociclib plus letrozole versus placebo plus letrozole in Asian postmenopausal women with oestrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer: Primary results from PALOMA-4. Eur J Cancer, 2022, 175: 236-245.
20. Hortobagyi GN, Stemmer SM, Burris HA, et al. Updated results from MONALEESA-2, a phaseⅢ trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol, 2018, 29(7): 1541-1547.
21. Hortobagyi GN, Stemmer SM, Burris HA, et al. Overall survival with ribociclib plus letrozole in advanced breast cancer. N Engl J Med, 2022, 386(10): 942-950.
22. Slamon DJ, Neven P, Chia S, et al. PhaseⅢ randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J Clin Oncol, 2018, 36(24): 2465-2472.
23. Slamon DJ, Neven P, Chia S, et al. Ribociclib plus fulvestrant for postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer in the phase Ⅲ randomized MONALEESA-3 trial: Updated overall survival. Ann Oncol, 2021, 32(8): 1015-1024.
24. Tripathy D, Im SA, Colleoni M, et al. Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer (MONALEESA-7): A randomised phase 3 trial. Lancet Oncol, 2018, 19(7): 904-915.
25. Lu YS, Im SA, Colleoni M, et al. Updated overall survival of ribociclib plus endocrine therapy versus endocrine therapy alone in pre- and perimenopausal patients with HR⁺/HER2^- advanced breast cancer in MONALEESA-7: A phase Ⅲ randomized clinical trial. Clin Cancer Res, 2022, 28(5): 851-859.
26. Sledge GW, Toi M, Neven P, et al. MONARCH 2: Abemaciclib in combination with fulvestrant in women with HR⁺/HER2^- advanced breast cancer who had progressed while receiving endocrine therapy. J Clin Oncol, 2017, 35(25): 2875-2884.
27. Sledge GW, 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(1): 116-124.
28. Johnston S, Martin M, Di Leo A, et al. MONARCH 3 final PFS: A randomized study of abemaciclib as initial therapy for advanced breast cancer. NPJ Breast Cancer, 2019, 5: 5.
29. Zhang QY, Sun T, Yin YM, et al. MONARCH plus: Abemaciclib plus endocrine therapy in women with HR⁺/HER2^- advanced breast cancer: The multinational randomized phase Ⅲ study. Ther Adv Med Oncol, 2020, 12: 1758835920963925.
30. Park YH, Kim TY, Kim GM, et al. Palbociclib plus exemestane with gonadotropin-releasing hormone agonist versus capecitabine in premenopausal women with hormone receptor-positive, HER2-negative metastatic breast cancer (KCSG-BR15-10): A multicentre, open-label, randomised, phase 2 trial. Lancet Oncol, 2019, 20(12): 1750-1759.
31. Martin M, Zielinski C, Ruiz-Borrego M, et al. Palbociclib in combination with endocrine therapy versus capecitabine in hormonal receptor-positive, human epidermal growth factor 2-negative, aromatase inhibitor-resistant metastatic breast cancer: A phaseⅢ randomised controlled trial-PEARL. Ann Oncol, 2021, 32(4): 488-499.
32. Martín M, Zielinski C, Ruiz-Borrego M, et al. Overall survival with palbociclib plus endocrine therapy versus capecitabine in postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer in the PEARL study. Eur J Cancer, 2022, 168: 12-24.
33. Albanell J, Martínez MT, Ramos M, et al. Randomized phase Ⅱ study of fulvestrant plus palbociclib or placebo in endocrine-sensitive, hormone receptor-positive/HER2-advanced breast cancer: GEICAM/2014-12 (FLIPPER). Eur J Cancer, 2022, 161: 26-37.
34. Robertson JFR, Bondarenko IM, Trishkina E, et al. Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): An international, randomised, double-blind, phase 3 trial. Lancet, 2016, 388(10063): 2997-3005.
35. Robertson JF, Llombart-Cussac A, Rolski J, et al. Activity of fulvestrant 500 mg versus anastrozole 1 mg as first-line treatment for advanced breast cancer: Results from the FIRST study. J Clin Oncol, 2009, 27(27): 4530-4535.
36. Ellis MJ, Llombart-Cussac A, Feltl D, et al. Fulvestrant 500 mg versus anastrozole 1 mg for the first-line treatment of advanced breast cancer: Overall survival analysis from the phase Ⅱ FIRST study. J Clin Oncol, 2015, 33(32): 3781-3787.
37. Llombart-Cussac A, Pérez-García JM, Bellet M, et al. Fulvestrant-palbociclib vs letrozole-palbociclib as initial therapy for endocrine-sensitive, hormone receptor-positive, ERBB2-negative advanced breast cancer: A randomized clinical trial. JAMA Oncol, 2021, 7(12): 1791-1799.
38. 莫淼, 黄亮, 管晓翔. 瑞博西林联合氟维司群用于激素受体阳性、人表皮生长因子受体2阴性晚期乳腺癌的Ⅲ期研究—MONALEESA3研究解读. 中国癌症杂志, 2019, 29(6): 468-475.
39. 张军, 赵崇如, 刘万立, 等. 细胞周期蛋白依赖性激酶4/6抑制剂在乳腺癌治疗中的新策略. 中华乳腺病杂志(电子版), 2022, 16(2): 110-115.
40. Huang T, He Y, Yu C, et al. The effect and safety of CDK4/6 inhibitors combined endocrine therapy on HR⁺, HER2^-breast cancer: A meta-analysis of randomized controlled trials. Endokrynol Pol, 2023, 74(1): 89-105.
41. Zheng J, Wu J, Wang C, et al. Combination cyclin-dependent kinase 4/6 inhibitors and endocrine therapy versus endocrine monotherapy for hormonal receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: A systematic review and meta-analysis. PLoS One, 2020, 15(6): e0233571.
42. Hu W, Sung T, Jessen BA, et al. Mechanistic investigation of bone marrow suppression associated with palbociclib and its differentiation from cytotoxic chemotherapies. Clin Cancer Res, 2016, 22(8): 2000-2008.
43. Zhang P, Xu B, Gui L, et al. A phase 1 study of dalpiciclib, a cyclin-dependent kinase 4/6 inhibitor in Chinese patients with advanced breast cancer. Biomark Res, 2021, 9(1): 24.
44. Hafner M, Mills CE, Subramanian K, et al. Multiomics profiling establishes the polypharmacology of FDA-approved CDK4/6 inhibitors and the potential for differential clinical activity. Cell Chem Biol, 2019, 26(8): 1067-1080.
45. Braal CL, Jongbloed EM, Wilting SM, et al. Inhibiting CDK4/6 in breast cancer with palbociclib, ribociclib, and abemaciclib: Similarities and differences. Drugs, 2021, 81(3): 317-331.

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Latest ArticlesEfficacy and safety of CDK4/6 inhibitors combined with endocrine therapy for HR⁺/HER2^-advanced/metastatic breast cancer: A network meta-analysis

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesEfficacy and safety of CDK4/6 inhibitors combined with endocrine therapy for HR+/HER2- advanced/metastatic breast cancer: A network meta-analysis

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Latest ArticlesEfficacy and safety of CDK4/6 inhibitors combined with endocrine therapy for HR⁺/HER2^-advanced/metastatic breast cancer: A network meta-analysis