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Kisqali patient portrayal.

KISQALI + AI consistently improved iDFS across subgroups, regardless of stage, nodal status, or menopausal status

At 5 years, in patients with stage II/III HR+/HER2- eBC at high risk of recurrence,

iDFS results favored KISQALI across prespecified subgroups, including no nodal involvement

NATALEE: KISQALI + AI vs AI alone1

Table showing hazard ratios and confidence intervals for subgroups including anatomic stage (stage II, stage III), nodal status (node-negative, node-positive), and menopausal status (premenopausal/men, postmenopausal).

Hazard ratios reported as KISQALI + AI vs AI alone. 
*Nodal status classification according to AJCC staging. Nodal status is from the worst stage derived per surgical specimen or at diagnosis.1

Results from the subgroup analysis included no prespecified statistical procedure controlling for type 1 error.

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

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). At a median follow-up of 33.3 months, with 509 iDFS (primary end point) 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).2-4

In the Natalee trial, Kisqali consistently reduced the threat of recurrence in the broadest range of patients, including those with no nodal involvement.
AI, aromatase inhibitor; AJCC, American Joint Committee on Cancer; eBC, early breast cancer; HER2-, human epidermal growth factor receptor 2-negative; HR, hazard ratio; HR+, hormone receptor-positive; iDFS, invasive disease-free survival; N, nodal status; NSAI, nonsteroidal aromatase inhibitor.
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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. Kisqali. Prescribing information. Novartis Pharmaceuticals Corp. 3. 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 4. Slamon DJ, Fasching PA, Hurvitz S, et al. Rationale and trial design of NATALEE: a phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2− early breast cancer. Ther Adv Med Oncol. 2023;15:1-16. doi:10.1177/17588359231178125