点击蓝字,关注我们激素受体阳性HER2阴性乳腺癌大约占全部病例的70%,内分泌治疗是这些患者的标准治疗方案,但是大多数患者最终对内分泌治疗耐药,细胞周期蛋白依赖性激酶CDK4和CDK6过度活跃是内分泌治疗耐药的主要原因之一。对于激素受体阳性HER2阴性晚期乳腺癌内分泌治疗耐药患者,PALOMA-3、MONALEESA-3、MONARCH 2、DAWNA-1研究已经证实:CDK4/6抑制剂哌柏西利、瑞波西利、阿贝西利、达尔西利联合氟维司群与单用氟维司群相比,进展或死亡风险分别降低58%、43%、45%、58%。2025年6月,复旦大学附属肿瘤医院胡夕春和张剑等学者发表一期临床研究结果证实,中国原研CDK4/6抑制剂泰瑞西利联合氟维司群治疗激素受体阳性HER2阴性晚期乳腺癌内分泌治疗耐药患者客观缓解率达53.8%、中位无进展生存达17.0个月。一期临床研究之后,该药物直接进入三期临床研究的探索,由胡夕春教授和王树森教授牵头开展。BTP-66711 (NCT03791112): A Phase I Study of BPI-16350 in Patients with Advanced Solid Tumor2025年7月31日,《美国医学会杂志》肿瘤学分册在线发表复旦大学附属肿瘤医院陶中华①、张剑①、胡夕春✉️、中山大学肿瘤防治中心郑秋帆①、王树森✉️、山东第一医科大学附属肿瘤医院王永胜、哈尔滨医科大学附属肿瘤医院蔡莉、威海市立医院徐红燕、宜昌市中心人民医院许新华、邢台市人民医院孔祥顺、永州市中心医院丁思娟、天津市肿瘤医院郝春芳、四川省肿瘤医院王浩、郑州大学第一附属医院宗红、蚌埠医科大学第一附属医院金鑫、河南科技大学第一附属医院王新帅、广西医科大学第一附属医院李扬、南阳医学高等专科学校第一附属医院杨秀丽、贝达药业丁列明等学者的TIFFANY研究报告,首次对泰瑞西利联合氟维司群或者单用氟维司群治疗激素受体阳性HER2阴性晚期乳腺癌内分泌治疗耐药患者的有效性和安全性进行随机对照。TIFFANY/BTP-66732 (NCT05433480): A Study of BPI-16350 in Combination With Fulvestrant in Patients With HR+ and HER2- Locally Advanced, Recurrent or Metastatic Breast CancerOfficial Title: A Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study to Compare Fulvestrant Plus BPI-16350 or Plus Placebo in Patients With HR+, HER2- Locally Advanced, Recurrent or Metastatic Breast Cancer With Disease Progression Following Endocrine Therapy该多中心安慰剂双盲随机对照三期临床研究于2022年5月25日至2023年4月25日在中国69家医院入组激素受体阳性HER2阴性晚期乳腺癌既往内分泌治疗期间疾病进展且接受过不超过一线化疗女性患者274例(年龄中位53.0岁、四分位46.0至60.0岁)按2比1随机分为两组:泰瑞西利(每天一次口服400毫克)联合氟维司群184例(67.2%)或安慰剂联合氟维司群90例(32.8%)直至疾病进展、死亡或由于各种原因停止治疗。主要终点为研究者评定的无进展生存,次要终点包括客观缓解率、总生存和安全性。结果,截至2024年3月31日,中位随访12.9个月,泰瑞西利组与安慰剂组相比:进展或死亡发生率:43.5%比71.1%中位无进展生存期:16.5个月比5.6个月(95%置信区间:12.8~16.6、4.5~9.2)进展或死亡风险比:0.37(95%置信区间:0.27~0.52,P<0.001)可测量病灶客观缓解率:45.6%比12.9%(95%置信区间:37.6%~53.7%、6.1%~23.0%,P<0.001)泰瑞西利组与安慰剂组相比,最常见的≥3级治疗期间不良事件发生率:中性粒细胞减少:15.2%比5.6%贫血:12.0%比4.4%低钾血症:12.0%比0%泰瑞西利组未发生药物相关死亡病例,安慰剂组发生1例药物相关死亡病例。因此,该研究结果表明,对于激素受体阳性HER2阴性晚期乳腺癌既往内分泌治疗期间疾病进展患者,泰瑞西利联合氟维司群与安慰剂联合氟维司群相比,进展或死亡风险降低63%,有统计学意义和临床意义,安全性可控。JAMA Oncol. 2025 Jul 31. IF: 20.1Tibremciclib or Placebo Plus Fulvestrant in Hormone Receptor-Positive and ERBB2-Negative Advanced Breast Cancer After Endocrine Therapy: A Randomized Clinical Trial.Tao Z, Zhang J, Zheng Q, Wang Y, Cai L, Xu H, Xu X, Kong X, Ding S, Hao C, Wang H, Zong H, Jin X, Wang X, Li Y, Yang X, Li W, Du X, Chen H, Wu P, Li P, Mao L, Ding L, Hu X, Wang S.Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Sun Yat-sen University Cancer Center, Guangzhou, China; Shandong Cancer Hospital, Jinan, China; Harbin Medical University Cancer Hospital, Harbin, China; Weihai Municipal Hospital, Weihai, China; Yichang Central People's Hospital, Yichang, China; Xingtai People's Hospital, Xingtai, China; The Central Hospital of Yongzhou, Yongzhou, China; Tianjin Medical University Cancer Center Institute and Hospital, Tianjing, China; Sichuan Cancer Hospital, Chengdu, China; The First Affiliated Hospital of Zhengzhou Hospital, Zhengzhou, China; The First Affiliated Hospital of Bengbu Medical College, Bengbu, China; The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China; The First Affiliated Hospital of Guangxi Medical University, Nanning, China; The First Affiliated Hospital of Nanyang Medical College, Nanyang, China; Betta Pharmaceuticals Co, Ltd, Hangzhou, China.QUESTION: Does the addition of tibremciclib to fulvestrant prolong progression-free survival (PFS) for patients with hormone receptor-positive (HR+) and ERBB2 (formerly HER2)-negative (ERBB2-) advanced breast cancer (ABC) who experienced progression while receiving prior endocrine therapy (ET)?FINDINGS: This phase 3 randomized clinical trial involved 274 patients with HR+/ERBB2- ABC who experienced progression while receiving prior ET. The combination of tibremciclib and fulvestrant significantly improved PFS compared with the combination of placebo plus fulvestrant; the median PFS was 16.5 (95% CI, 12.8-16.6) months in the tibremciclib arm, and the toxic effects were tolerable.MEANING: The results of this trial suggest that tibremciclib plus fulvestrant provides improvement in PFS for patients with HR+/ERBB2-ABC who experienced progression after ET, with a manageable safety profile.IMPORTANCE: Cyclin-dependent kinase (CDK) 4/6 inhibitors combined with endocrine therapy (ET) are now considered the standard treatment regimen for hormone receptor-positive (HR+) and ERBB2 (formerly HER2)-negative (ERBB2-) advanced breast cancer (ABC). Tibremciclib (BPI-16350), a novel CDK4/6 inhibitor, has demonstrated favorable tolerability and promising antitumor activity as a monotherapy or combined with fulvestrant among patients with HR+/ERBB2- ABC in a phase 1 trial. Further investigations are necessary to assess the efficacy and safety of tibremciclib.OBJECTIVE: To compare tibremciclib plus fulvestrant and placebo plus fulvestrant in terms of efficacy and safety among patients with HR+/ERBB2- ABC who exhibited disease progression after ET.DESIGN, SETTING, AND PARTICIPANTS: The TIFFANY trial was a double-blind, placebo-controlled, phase 3 randomized clinical trial of patients with HR+/ERBB2- ABC who had experienced progression while receiving prior ET and had received no more than 1 line of chemotherapy. This trial was conducted at 69 Chinese centers between May 25, 2022, and April 25, 2023. The data cutoff date for this analysis was March 31, 2024.INTERVENTIONS: Patients were randomly assigned to receive tibremciclib (400 mg, orally, once daily) plus fulvestrant or placebo plus fulvestrant at a 2:1 ratio until disease progression, death, or treatment discontinuation for various reasons.MAIN OUTCOMES AND MEASURES: The primary end point was investigator-assessed progression-free survival (PFS), and the secondary end points included the objective response rate, overall survival, and safety.RESULTS: A total of 274 female patients (median [IQR] age, 53.0 [46.0-60.0] years) were randomly assigned to receive tibremciclib plus fulvestrant (184 [67.2%]) or placebo plus fulvestrant (90 [32.8%]). Among these patients, 144 PFS events occurred (80 in the tibremciclib arm and 64 in the placebo arm), with a median follow-up of 12.9 months for both arms. Tibremciclib plus fulvestrant significantly improved PFS compared with placebo plus fulvestrant (median, 16.5 months [95% CI, 12.8-16.6] vs 5.6 months [95% CI, 4.5-9.2]; hazard ratio, 0.37; 95% CI, 0.27-0.52; P < .001). In patients with measurable disease, tibremciclib plus fulvestrant achieved an objective response rate of 45.6% (95% CI, 37.6%-53.7%) compared with 12.9% (95% CI, 6.1%-23.0%) in the placebo arm (P < .001). The most common grade 3 or higher treatment-emergent adverse events in the tibremciclib vs placebo arm were neutropenia (15.2% vs 5.6%, respectively), anemia (12.0% vs 4.4%, respectively), and hypokalemia (12.0% vs 0%, respectively). No drug-related deaths occurred in the tibremciclib arm, and 1 death occurred in the placebo arm.CONCLUSIONS AND RELEVANCE: The results of this randomized clinical trial suggest that tibremciclib plus fulvestrant was associated with statistically significant and clinically meaningful improvements in PFS compared with placebo plus fulvestrant. Furthermore, tibremciclib plus fulvestrant demonstrated a manageable safety profile in patients with HR+/ERBB2- ABC who experienced progression while receiving prior ET.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05433480PMID: 40742733DOI: 10.1001/jamaoncol.2025.2092ESMO Open. 2025 Jun;10(6):105121. IF: 8.3A phase I dose-escalation and dose-expansion study of tibremciclib, a novel CDK4/6 inhibitor, monotherapy and in combination with fulvestrant in HR-positive/HER2-negative advanced breast cancer.Zhang J, Liu R, Gao S, Chen W, Han X, Wang Z, Zhou H, Wang Y, Chen J, Ma Y, Liu K, Shen Z, Ding L, Li P, Hu X.Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Nanchang Third Hospital, Nanchang, China; Anhui Provincial Hospital, Hefei, China; The First Affiliate Hospital of Bengbu Medical University, Bengbu, China; Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China; Yantai Yuhuangding Hospital, Yantai, China; Betta Pharmaceuticals Co., Ltd., Hangzhou, China.HIGHLIGHTSTibremciclib, a novel CDK4/6 inhibitor, shows a favorable safety profile in HR-positive/HER2-negative ABC in phase I study.Tibremciclib plus fulvestrant shows robust efficacy (ORR 53.8%, median PFS 17.0 months) in HR-positive/HER2-negative ABC.Tibremciclib exhibits dose-proportional exposure, long half-life (35.9-51.1 h), and no interaction with fulvestrant.BACKGROUND: Tibremciclib (BPI-16350) is a novel potent selective inhibitor of cyclin-dependent kinase 4 and 6 (CDK4/6). This phase I, first-in-human study assessed the tibremciclib monotherapy and combined with fulvestrant in advanced breast cancer (ABC).PATIENTS AND METHODS: This open-label, phase I study (NCT03791112) comprised dose escalation (phase Ia) and expansion (phase Ib). In phase Ia, Chinese patients with advanced solid tumors received tibremciclib monotherapy (50-500 mg orally once daily). Based on the tolerability and preliminary antitumor activity from phase Ia, two dose cohorts (300 or 400 mg orally once daily) were selected in phase Ib to combine with fulvestrant in patients with hormone receptor (HR)-positive/human epidermal growth receptor 2 (HER2)-negative ABC who failed endocrine therapy. The primary endpoints were safety and tolerability, and secondary endpoints included pharmacokinetics (PK) and antitumor activity.RESULTS: In phase Ia, 24 patients with advanced tumors (23 ABC and 1 abdominal liposarcoma) received tibremciclib monotherapy, while in phase Ib, 78 patients with HR-positive/HER2-negative stage IV ABC received tibremciclib plus fulvestrant, with a median age of 56.0 (range 26-66) years and 53.5 (range 33-71) years, respectively. In phase Ia, one dose-limiting toxicity (grade 3 blood creatinine increased) occurred at 500 mg and the maximum tolerated dose was not reached. In phase Ib, the recommended phase II dose (RP2D) was tibremciclib 400 mg plus fulvestrant 500 mg. Frequently reported treatment-emergent adverse events of any grade were grade 1-2 blood creatinine increased, hypertriglyceridemia, and anemia. PK demonstrates dose proportionality, a half-life of ~35.9-51.1 h, and no drug-drug interaction with fulvestrant. In phase Ia, one patient achieved partial response (PR), with a confirmed objective response rate (ORR) of 4.2% and a disease control rate (DCR) of 70.8%. In phase Ib, 42 patients achieved PR, with an ORR of 53.8% and a DCR of 87.2%.CONCLUSIONS: Tibremciclib monotherapy or combined with fulvestrant was well tolerated with the RP2D set at 400 mg plus fulvestrant 500 mg. PK was consistent with dose proportionality. Both regimens showed preliminary antitumor activity in patients with HR-positive/HER2-negative ABC, supporting further evaluation in a phase III study (NCT05433480).KEYWORDS: breast cancer; cyclin-dependent kinase 4 and 6; fulvestrant; safety; tibremciclibPMID: 40403388DOI: 10.1016/j.esmoop.2025.105121(来源:SIBCS)声 明凡署名原创的文章版权属《肿瘤瞭望》所有,欢迎分享、转载。本文仅供医疗卫生专业人士了解最新医药资讯参考使用,不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导,也不应被视为诊疗建议,如果该信息被用于资讯以外的目的,本站及作者不承担相关责任。