Palbociclib or Ribociclib in First-Line Treatment in Patients With Hormone Receptor-Positive/Human Epidermal Receptor 2-Negative Advanced or Metastatic Breast Cancer? A Perspective Based on Pharmacologic Costs.

Abstract

PURPOSE\nTo assess the pharmacologic costs of CDK4/6 inhibitors (palbociclib and ribociclib) in hormone receptor-positive (HR+)/human epidermal receptor 2-negative (HER2-) advanced or metastatic breast cancer (BC). Pivotal phase 3 randomized controlled trials (RCTs) were considered.\n\n\nDISCUSSION\nTwo phase 3 RCTs including 1334 patients were considered. European Society for Medical Oncology Magnitude of Clinical Benefit Scale reached grade 3 for the PALOMA-2 and MONALEESA-2 trials. Pharmacologic costs of palbociclib and ribociclib at full dose were similar, at €3864 and €4002 per month of progression-free survival (PFS) gained, respectively. The reduction of dose of ribociclib (36.1% in the pivotal RCT vs. 36.0% of palbociclib in pivotal RCT) resulted in €2718 and €1348 per month of PFS gained at 400 and 200 mg daily, respectively.\n\n\nCONCLUSION\nWhen pharmacologic costs of drugs are combined with the measure of efficacy represented by PFS, both palbociclib and ribociclib are cost-effective first-line treatments in postmenopausal women with HR+/HER2- advanced or metastatic BC, with a lower cost in favor of ribociclib in patients with dose reduction.