The dilemma of selecting a first line CDK4/6 inhibitor for hormone receptor-positive/HER2-negative metastatic breast cancer.

Palbociclib combined with fulvestrant did not reach statistical significance in the intention-to-treat (ITT) population, achieving an OS benefit only in the subset of patients with endocrine sensitive disease; however, this trial included patients who had received significantly more prior therapies in the metastatic setting compared to patients on the MONARCH-2 and MONALEESA-3 trials, investigating abemaciclib and ribociclib, respectively, in the pre-treated setting 23 .

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