Highlights
- tibremciclib plus fulvestrant extends median progression-free survival (PFS) to 16.5 months compared to 5.6 months for placebo plus fulvestrant in advanced HR+/HER2- breast cancer refractory to endocrine therapy.
- The combination reduces the risk of disease progression or death by 63% (HR 0.37, P<0.001).
- Objective response rate (ORR) and disease control rate (DCR) are substantially higher with tibremciclib.
- Safety profile is consistent with existing CDK4/6 inhibitors and manageable.
Study Background and Disease Burden
Breast cancer is the most common malignancy among women globally, with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) subtypes accounting for approximately 70% of cases. Despite advances in endocrine therapy, disease progression and resistance remain significant clinical challenges, particularly in advanced or metastatic disease. The introduction of cyclin-dependent kinase (CDK) 4/6 inhibitors in combination with endocrine agents has redefined the standard of care for HR+/HER2- advanced breast cancer, yet new agents with enhanced efficacy and tolerability are urgently needed for patients progressing on or after endocrine therapy.
Study Design
The TIFFANY phase 3 study, led by Professor Xichun Hu (Fudan University Shanghai Cancer Center) and Professor Shusen Wang (Sun Yat-sen University Cancer Center), was a randomized, double-blind, placebo-controlled trial conducted across 69 medical centers in China. The study enrolled 274 adult women with locally advanced or metastatic HR+/ERBB2- breast cancer who had experienced disease progression after prior endocrine therapy. Participants were randomized in a 2:1 ratio to receive either tibremciclib (400 mg orally once daily) plus fulvestrant (n=184) or placebo plus fulvestrant (n=90).
The primary endpoint was investigator-assessed progression-free survival (PFS), with secondary endpoints including objective response rate (ORR), disease control rate (DCR), duration of response (DoR), clinical benefit rate (CBR), and safety. Data cut-off was March 31, 2024, with a median follow-up of 12.9 months in both groups.
Key Findings
Progression-Free Survival: The median PFS was 16.5 months in the tibremciclib group versus 5.6 months in the placebo group, constituting a near threefold improvement (hazard ratio [HR] 0.37, 95% CI not specified, P<0.001). Independent review committee (IRC) assessment confirmed these findings with an identical hazard ratio.
Subgroup Analyses: The PFS benefit was consistent across key subgroups, including menopausal status, presence or absence of visceral metastases, and extent of metastatic disease. This suggests broad applicability of the regimen in the second-line setting.
Secondary Endpoints:
– ORR in patients with measurable disease was 45.6% for tibremciclib plus fulvestrant, significantly higher than 12.9% with placebo (P<0.001).
– DCR was 89.1% versus 76.7%, respectively.
– Median DoR was 14.9 months (tibremciclib) versus 11.0 months (placebo).
– CBR was 74.5% for tibremciclib compared to 42.2% for placebo.
These outcomes were corroborated by IRC assessments, reinforcing the robustness of the data.
Overall Survival: At data cut-off, overall survival data were immature and not reported.
Safety: The adverse event profile of tibremciclib was consistent with established CDK4/6 inhibitors. The most common grade 3 or higher treatment-emergent adverse events in the tibremciclib arm were neutropenia (15.2% vs 5.6%), anemia (12.0% vs 4.4%), and hypokalemia (12.0% vs 0%). No drug-related deaths occurred in the tibremciclib group. One death occurred in the placebo group.
Expert Commentary
The TIFFANY study positions tibremciclib as a potentially best-in-class CDK4/6 inhibitor for second-line management of HR+/HER2- advanced breast cancer after endocrine therapy failure. While cross-trial comparisons must be approached cautiously, the observed hazard ratio for PFS improvement is notably lower than those reported for other agents in this class, suggesting a potentially greater magnitude of benefit. Importantly, the regimen demonstrated consistent benefit across clinically relevant subgroups, and the safety profile was in line with expectations for CDK4/6 inhibition.
Nevertheless, limitations include the lack of mature overall survival data and the study’s exclusive Chinese patient population, which may affect generalizability to broader, multiethnic cohorts. The ongoing investigation of tibremciclib in the first-line setting is highly anticipated.
Conclusion
Tibremciclib in combination with fulvestrant marks a significant advance in the treatment landscape for patients with HR+/HER2- advanced breast cancer after endocrine therapy progression, offering a near tripling of PFS with manageable toxicity. Its approval in China provides an important new therapeutic option, with further studies underway to define its role in earlier lines of therapy. Continued follow-up for overall survival and real-world effectiveness will be critical to confirm these promising results.
References
1. Tao Z, Zhang J, Zheng Q, et al. Tibremciclib or Placebo Plus Fulvestrant in Hormone Receptor–Positive and ERBB2-Negative Advanced Breast Cancer After Endocrine Therapy: A Randomized clinical trial. JAMA Oncol. Published online July 31, 2025. doi:10.1001/jamaoncol.2025.2092
