Palbociclib has no clinically relevant effect on the QTc interval in patients with advanced breast cancer

Anticancer Drugs. 2018 Mar;29(3):271-280. doi: 10.1097/CAD.0000000000000589.

Abstract

The aim of this study was to assess the potential effects of palbociclib in combination with letrozole on QTc. PALOMA-2, a phase 3, randomized, double-blind, placebo-controlled trial, compared palbociclib plus letrozole with placebo plus letrozole in postmenopausal women with estrogen receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer. The study included a QTc evaluation substudy carried out as a definitive QT interval prolongation assessment for palbociclib. Time-matched triplicate ECGs were performed at 0, 2, 4, 6, and 8 h at baseline (Day 0) and on Cycle 1 Day 14. Additional ECGs were collected from all patients for safety monitoring. The QT interval was corrected for heart rate using Fridericia's correction (QTcF), Bazett's correction (QTcB), and a study-specific correction factor (QTcS). In total, 666 patients were randomized 2 : 1 to palbociclib plus letrozole or placebo plus letrozole. Of these, 125 patients were enrolled in the QTc evaluation substudy. No patients in the palbociclib plus letrozole arm of the substudy (N=77) had a maximum postbaseline QTcS or QTcF value of ≥ 480 ms, or a maximum increase from clock time-matched baseline for QTcS or QTcF values of ≥ 60 ms. The upper bounds of the one-sided 95% confidence interval for the mean change from time-matched baseline for QTcS, QTcF, and QTcB at all time points and at steady-state Cmax following repeated administration of 125 mg palbociclib were less than 10 ms. Palbociclib, when administered with letrozole at the recommended therapeutic dosing regimen, did not prolong the QT interval to a clinically relevant extent.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents
  • Antineoplastic Combined Chemotherapy Protocols / blood
  • Antineoplastic Combined Chemotherapy Protocols / pharmacokinetics
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Breast Neoplasms / blood
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / physiopathology
  • Double-Blind Method
  • Electrocardiography / drug effects*
  • Female
  • Heart Rate / drug effects
  • Humans
  • Letrozole
  • Middle Aged
  • Nitriles / administration & dosage
  • Nitriles / blood
  • Nitriles / pharmacokinetics
  • Piperazines / administration & dosage
  • Piperazines / blood
  • Piperazines / pharmacokinetics
  • Pyridines / administration & dosage
  • Pyridines / blood
  • Pyridines / pharmacokinetics
  • Triazoles / administration & dosage
  • Triazoles / blood
  • Triazoles / pharmacokinetics

Substances

  • Antineoplastic Agents
  • Nitriles
  • Piperazines
  • Pyridines
  • Triazoles
  • Letrozole
  • palbociclib