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Kisqali patient portrayal.

Reduced risk of distant recurrence

In the NATALEE trial, KISQALI + AI reduced the threat of recurrence with incurable metastatic disease in the broadest population of patients with stage II/III HR+/HER2- eBC at high risk of recurrence.

In patients with stage II/III HR+/HER2- eBC,

Over 5 years, KISQALI showed a 29% reduction in the risk of distant recurrence

The DDFS benefit was consistent with iDFS and increased over time with KISQALI + AI, beyond the treatment period

NATALEE: KISQALI + AI vs AI alone

At a median follow-up of 55.5 months

KM curve of distant disease-free survival at 5 years: 86.8% with Kisqali + AI vs 82.5% with AI alone. 29% reduction in risk of distant recurrence; HR=0.709 (95% CI: 0.608-0.827).

Hazard ratio is based on stratified Cox model.2

DDFS was defined as the time from randomization to the date of the first event of distant recurrence, second primary non-breast invasive cancer (excluding basal and squamous cell carcinomas of the skin), or death (any cause).2

In a 5-year post hoc analysis1:

  • At 3 years: 2.6% absolute difference

  • At 5 years: 4.3% absolute difference

  • At the time of data cutoff, only 11.3% of patients receiving KISQALI + AI had experienced a DDFS event vs 14.7% of patients treated with AI alone

  • The 5-year analysis was prespecified and observational in nature; as such, there was no prespecified statistical procedure controlling for type 1 error

Kisqali can help reduce the risk of distant recurrence with incurable metastatic disease.

NATALEE was a randomized, multicenter, open-label, phase III study of KISQALI + letrozole or anastrozole (n=2549) vs letrozole or anastrozole (n=2552) for the adjuvant treatment of men and women with stage II/III HR+/HER2- eBC, including all those with node-positive or high-risk node-negative disease (eligible stages and nodal status include: anatomic stage group IIB-III, or anatomic stage group IIA that is either node positive, or node negative with histologic grade 3, or histologic grade 2 with Ki-67 ≥20% and/or high risk by gene signature testing). iDFS was the primary end point; DDFS was a secondary end point. At a median follow-up of 33.3 months, with 509 iDFS events in the study (226 [8.9%] in the KISQALI arm and 283 [11.1%] in the NSAI-alone arm), iDFS at the 3-year landmark was 90.7% for KISQALI + NSAI vs 87.6% for NSAI alone (absolute difference 3.1%); there was a 25.1% relative reduction in the risk of an iDFS event; HR=0.749 (95% CI: 0.628-0.892).3-5

AI, aromatase inhibitor; DDFS, distant disease-free survival; eBC, early breast cancer; HER2-, human epidermal growth factor receptor 2-negative; HR, hazard ratio; HR+, hormone receptor-positive; iDFS, invasive disease-free survival; NSAI, nonsteroidal aromatase inhibitor.
References: 1. Crown J, Stroyakovskii D, Yardley DA, et al. Adjuvant ribociclib plus nonsteroidal aromatase inhibitor therapy in patients with HR-positive/HER2-negative early breast cancer: 5-year follow-up of NATALEE efficacy outcomes and updated overall survival. ESMO Open. Published online October 17, 2025. doi:10.1016/j.esmoop.2025.105858 2. Slamon D, Lipatov O, Nowecki Z, et al. Ribociclib plus endocrine therapy in early breast cancer. N Engl J Med. 2024;390(12):1080-1091;(protocol). doi:10.1056/NEJMoa2305488 3. Kisqali. Prescribing information. Novartis Pharmaceuticals Corp. 4. Slamon D, Lipatov O, Nowecki Z, et al. Ribociclib plus endocrine therapy in early breast cancer. N Engl J Med. 2024;390(12):1080-1091. doi:10.1056/NEJMoa2305488 5. Hortobagyi GN, Lacko A, Sohn J, et al. A phase III trial of adjuvant ribociclib plus endocrine therapy versus endocrine therapy alone in patients with HR-positive/HER2-negative early breast cancer: final invasive disease-free survival results from the NATALEE trial. Ann Oncol. 2025;36(2):149-157. doi:10.1016/j.annonc.2024.10.015