(palbociclib)
The following clinically significant adverse reactions are described elsewhere in the labeling:
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
PALOMA-2: IBRANCE plus Letrozole
Patients with estrogen receptor (ER)-positive, HER2-negative advanced or metastatic breast cancer for initial endocrine-based therapy
The safety of IBRANCE (125 mg/day) plus letrozole (2.5 mg/day) versus placebo plus letrozole was evaluated in PALOMA-2. The data described below reflect exposure to IBRANCE in 444 out of 666 patients with ER-positive, HER2-negative advanced breast cancer who received at least 1 dose of IBRANCE plus letrozole in PALOMA-2. The median duration of treatment for IBRANCE plus letrozole was 19.8 months while the median duration of treatment for placebo plus letrozole arm was 13.8 months.
Dose reductions due to an adverse reaction of any grade occurred in 36% of patients receiving IBRANCE plus letrozole. No dose reduction was allowed for letrozole in PALOMA-2.
Permanent discontinuation associated with an adverse reaction occurred in 43 of 444 (10%) patients receiving IBRANCE plus letrozole and in 13 of 222 (6%) patients receiving placebo plus letrozole. Adverse reactions leading to permanent discontinuation for patients receiving IBRANCE plus letrozole included neutropenia (1.1%) and alanine aminotransferase increase (0.7%).
The most common adverse reactions (≥10%) of any grade reported in patients in the IBRANCE plus letrozole arm by descending frequency were neutropenia, infections, leukopenia, fatigue, nausea, alopecia, stomatitis, diarrhea, anemia, rash, asthenia, thrombocytopenia, vomiting, decreased appetite, dry skin, pyrexia, and dysgeusia.
The most frequently reported Grade ≥3 adverse reactions (≥5%) in patients receiving IBRANCE plus letrozole by descending frequency were neutropenia, leukopenia, infections, and anemia.
Adverse reactions (≥10%) reported in patients who received IBRANCE plus letrozole or placebo plus letrozole in PALOMA-2 are listed in Table 4.
| IBRANCE plus Letrozole (N=444) | Placebo plus Letrozole (N=222) | |||||
|---|---|---|---|---|---|---|
| Adverse Reaction | All Grades % | Grade 3 % | Grade 4 % | All Grades % | Grade 3 % | Grade 4 % |
| Grading according to CTCAE 4.0. CTCAE=Common Terminology Criteria for Adverse Events; N=number of patients; N/A=not applicable; | ||||||
| ||||||
Infections and infestations | ||||||
Infections* | 60† | 6 | 1 | 42 | 3 | 0 |
Blood and lymphatic system disorders | ||||||
Neutropenia | 80 | 56 | 10 | 6 | 1 | 1 |
Leukopenia | 39 | 24 | 1 | 2 | 0 | 0 |
Anemia | 24 | 5 | <1 | 9 | 2 | 0 |
Thrombocytopenia | 16 | 1 | <1 | 1 | 0 | 0 |
Metabolism and nutrition disorders | ||||||
Decreased appetite | 15 | 1 | 0 | 9 | 0 | 0 |
Nervous system disorders | ||||||
Dysgeusia | 10 | 0 | 0 | 5 | 0 | 0 |
Gastrointestinal disorders | ||||||
Stomatitis‡ | 30 | 1 | 0 | 14 | 0 | 0 |
Nausea | 35 | <1 | 0 | 26 | 2 | 0 |
Diarrhea | 26 | 1 | 0 | 19 | 1 | 0 |
Vomiting | 16 | 1 | 0 | 17 | 1 | 0 |
Skin and subcutaneous tissue disorders | ||||||
Alopecia | 33§ | N/A | N/A | 16¶ | N/A | N/A |
Rash# | 18 | 1 | 0 | 12 | 1 | 0 |
Dry skin | 12 | 0 | 0 | 6 | 0 | 0 |
General disorders and administration site conditions | ||||||
Fatigue | 37 | 2 | 0 | 28 | 1 | 0 |
Asthenia | 17 | 2 | 0 | 12 | 0 | 0 |
Pyrexia | 12 | 0 | 0 | 9 | 0 | 0 |
Clinically relevant adverse reactions in <10% of patients who received IBRANCE plus letrozole in PALOMA-2 included epistaxis (9%), lacrimation increased (6%), dry eye (4.1%), vision blurred (3.6%), and febrile neutropenia (2.5%).
| IBRANCE plus Letrozole (N=444) | Placebo plus Letrozole (N=222) | |||||
|---|---|---|---|---|---|---|
| Laboratory Abnormality | All Grades % | Grade 3 % | Grade 4 % | All Grades % | Grade 3 % | Grade 4 % |
| N=number of patients; WBC=white blood cells. | ||||||
WBC decreased | 97 | 35 | 1 | 25 | 1 | 0 |
Blood creatinine increased | 96 | 2 | <1 | 91 | 0 | 0 |
Neutrophils decreased | 95 | 56 | 12 | 20 | 1 | 1 |
Hemoglobin decreased | 78 | 6 | 0 | 42 | 2 | 0 |
Platelets decreased | 63 | 1 | 1 | 14 | 0 | 0 |
Aspartate aminotransferase increased | 52 | 3 | 0 | 34 | 1 | 0 |
Alanine aminotransferase increased | 43 | 2 | <1 | 30 | 0 | 0 |
PALOMA-3: IBRANCE plus Fulvestrant
Patients with HR-positive, HER2-negative advanced or metastatic breast cancer who have had disease progression on or after prior adjuvant or metastatic endocrine therapy
The safety of IBRANCE (125 mg/day) plus fulvestrant (500 mg) versus placebo plus fulvestrant was evaluated in PALOMA-3. The data described below reflect exposure to IBRANCE in 345 out of 517 patients with HR-positive, HER2-negative advanced or metastatic breast cancer who received at least 1 dose of IBRANCE plus fulvestrant in PALOMA-3. The median duration of treatment for IBRANCE plus fulvestrant was 10.8 months while the median duration of treatment for placebo plus fulvestrant arm was 4.8 months.
Dose reductions due to an adverse reaction of any grade occurred in 36% of patients receiving IBRANCE plus fulvestrant. No dose reduction was allowed for fulvestrant in PALOMA-3.
Permanent discontinuation associated with an adverse reaction occurred in 19 of 345 (6%) patients receiving IBRANCE plus fulvestrant, and in 6 of 172 (3%) patients receiving placebo plus fulvestrant. Adverse reactions leading to discontinuation for those patients receiving IBRANCE plus fulvestrant included fatigue (0.6%), infections (0.6%), and thrombocytopenia (0.6%).
The most common adverse reactions (≥10%) of any grade reported in patients in the IBRANCE plus fulvestrant arm by descending frequency were neutropenia, leukopenia, infections, fatigue, nausea, anemia, stomatitis, diarrhea, thrombocytopenia, vomiting, alopecia, rash, decreased appetite, and pyrexia.
The most frequently reported Grade ≥3 adverse reactions (≥5%) in patients receiving IBRANCE plus fulvestrant in descending frequency were neutropenia and leukopenia.
Adverse reactions (≥10%) reported in patients who received IBRANCE plus fulvestrant or placebo plus fulvestrant in PALOMA-3 are listed in Table 6.
| Adverse Reaction | IBRANCE plus Fulvestrant (N=345) | Placebo plus Fulvestrant (N=172) | ||||
|---|---|---|---|---|---|---|
| All Grades | Grade 3 | Grade 4 | All Grades | Grade 3 | Grade 4 | |
| % | % | % | % | % | % | |
| Grading according to CTCAE 4.0. CTCAE=Common Terminology Criteria for Adverse Events; N=number of patients; N/A=not applicable. | ||||||
| ||||||
Infections and infestations | ||||||
Infections* | 47† | 3 | 1 | 31 | 3 | 0 |
Blood and lymphatic system disorders | ||||||
Neutropenia | 83 | 55 | 11 | 4 | 1 | 0 |
Leukopenia | 53 | 30 | 1 | 5 | 1 | 1 |
Anemia | 30 | 4 | 0 | 13 | 2 | 0 |
Thrombocytopenia | 23 | 2 | 1 | 0 | 0 | 0 |
Metabolism and nutrition disorders | ||||||
Decreased appetite | 16 | 1 | 0 | 8 | 1 | 0 |
Gastrointestinal disorders | ||||||
Nausea | 34 | 0 | 0 | 28 | 1 | 0 |
Stomatitis‡ | 28 | 1 | 0 | 13 | 0 | 0 |
Diarrhea | 24 | 0 | 0 | 19 | 1 | 0 |
Vomiting | 19 | 1 | 0 | 15 | 1 | 0 |
Skin and subcutaneous tissue disorders | ||||||
Alopecia | 18§ | N/A | N/A | 6¶ | N/A | N/A |
Rash# | 17 | 1 | 0 | 6 | 0 | 0 |
General disorders and administration site conditions | ||||||
Fatigue | 41 | 2 | 0 | 29 | 1 | 0 |
Pyrexia | 13 | <1 | 0 | 5 | 0 | 0 |
Clinically relevant adverse reactions in <10% of patients who received IBRANCE plus fulvestrant in PALOMA-3 included asthenia (8%), dysgeusia (7%), epistaxis (7%), lacrimation increased (6%), dry skin (6%), vision blurred (6%), dry eye (3.8%), and febrile neutropenia (0.9%).
| Laboratory Abnormality | IBRANCE plus Fulvestrant (N=345) | Placebo plus Fulvestrant (N=172) | ||||
|---|---|---|---|---|---|---|
| All Grades % | Grade 3 % | Grade 4 % | All Grades % | Grade 3 % | Grade 4 % | |
| N=number of patients; WBC=white blood cells. | ||||||
WBC decreased | 99 | 45 | 1 | 26 | 0 | 1 |
Neutrophils decreased | 96 | 56 | 11 | 14 | 0 | 1 |
Blood creatinine increased | 95 | 1 | 0 | 82 | 0 | 0 |
Hemoglobin decreased | 78 | 3 | 0 | 40 | 2 | 0 |
Platelets decreased | 62 | 2 | 1 | 10 | 0 | 0 |
Aspartate aminotransferase increased | 43 | 4 | 0 | 48 | 4 | 0 |
Alanine aminotransferase increased | 36 | 2 | 0 | 34 | 0 | 0 |
INAVO120: IBRANCE plus Inavolisib and Fulvestrant
Adults with PIK3CA-mutated, HR-positive, HER2-negative, locally advanced or metastatic breast cancer whose disease progressed during or within 12 months of completing adjuvant endocrine therapy and who have not received prior systemic therapy for locally advanced or metastatic disease
The safety of the combination of IBRANCE plus inavolisib and fulvestrant was evaluated in a randomized, double-blind, placebo-controlled study (INAVO120) in 324 patients with PIK3CA-mutated, HR-positive, HER2-negative, locally advanced or metastatic breast cancer [see Clinical Studies (14)].
Patients received either IBRANCE 125 mg orally once daily for 21 consecutive days followed by 7 days off treatment to comprise a cycle of 28 days plus fulvestrant in combination with inavolisib (n=162) or placebo (n=162). The median duration of treatment for IBRANCE plus inavolisib and fulvestrant was 9 months (range: 0 to 39 months).
Serious adverse reactions occurred in 24% of patients who received IBRANCE plus inavolisib and fulvestrant. Serious adverse reactions occurring in ≥1% of patients receiving IBRANCE plus inavolisib and fulvestrant included anemia (1.9%), diarrhea (1.2%), and urinary tract infection (1.2%).
Fatal adverse reactions occurred in 3.7% of patients who received IBRANCE plus inavolisib and fulvestrant, including (0.6% each) acute coronary syndrome, cerebral hemorrhage, cerebrovascular accident, COVID-19 infection, and gastrointestinal hemorrhage.
Permanent discontinuation of IBRANCE associated with an adverse reaction occurred in 8 of 162 (4.9%) patients receiving IBRANCE plus inavolisib and fulvestrant and in 0 of 162 patients receiving IBRANCE plus placebo and fulvestrant. Adverse reactions leading to discontinuation of IBRANCE in patients receiving IBRANCE plus inavolisib and fulvestrant were neutropenia, infections, alanine aminotransferase increased, gastric ulcer, intestinal perforation, hyperglycemia, type 2 diabetes mellitus, bone pain, musculoskeletal pain, transitional cell carcinoma, and acute kidney injury (0.6% each).
Dose reduction of IBRANCE due to an adverse reaction occurred in 38% of patients receiving IBRANCE plus inavolisib and fulvestrant and in 30% of patients receiving IBRANCE plus placebo and fulvestrant. Adverse reactions leading to dose reductions of IBRANCE in ≥2% patients receiving IBRANCE plus inavolisib and fulvestrant were neutropenia (30%), leukopenia (6%), and thrombocytopenia (3.7%).
Dose interruption of IBRANCE due to an adverse reaction occurred in 71% of patients receiving IBRANCE plus inavolisib and fulvestrant and in 61% of patients receiving IBRANCE plus placebo and fulvestrant. Adverse reactions leading to dose interruption of IBRANCE in ≥2% patients receiving IBRANCE plus inavolisib and fulvestrant were neutropenia (56%), infections (29%), leukopenia (12%), stomatitis (4.9%), anemia (6%), thrombocytopenia (4.3%), diarrhea (3.7%), pyrexia (3.1%), alanine aminotransferase increased (2.5%), hyperglycemia (2.5%), and nausea (2.5%).
The most common (≥20%) adverse reactions, including laboratory abnormalities, were decreased neutrophils, decreased hemoglobin, increased fasting glucose, decreased platelets, decreased lymphocytes, stomatitis, diarrhea, decreased calcium, fatigue, decreased potassium, increased creatinine, increased alanine aminotransferase (ALT), nausea, decreased sodium, decreased magnesium, rash, decreased appetite, COVID-19 infection, and headache.
Adverse reactions and laboratory abnormalities in INAVO120 are summarized in Table 8 and Table 9, respectively.
| Adverse Reaction | IBRANCE plus Inavolisib and Fulvestrant (N=162) | IBRANCE plus Placebo and Fulvestrant (N=162) | ||
|---|---|---|---|---|
| All Grades (%) | Grade 3-4 (%) | All Grades (%) | Grade 3-4 (%) | |
Gastrointestinal Disorders | ||||
Stomatitis* | 51 | 6† | 27 | 0 |
Diarrhea | 48 | 3.7† | 16 | 0 |
Nausea | 28 | 0.6† | 17 | 0 |
Vomiting | 15 | 0.6† | 4.9 | 1.2† |
General Disorders and Administration Site Conditions | ||||
Fatigue | 38 | 1.9† | 25 | 1.2† |
Skin and Subcutaneous Tissue Disorders | ||||
Rash‡ | 26 | 0 | 19 | 0 |
Alopecia | 19 | 0 | 6 | 0 |
Dry skin§ | 13 | 0 | 4.3 | 0 |
Metabolism and Nutrition Disorders | ||||
Decreased appetite | 24 | 0 | 9 | 0 |
Infections and Infestations | ||||
COVID-19 infection | 23 | 1.9 | 10 | 0.6 |
Urinary tract infection‡ | 15 | 1.2† | 9 | 0 |
Nervous System Disorders | ||||
Headache‡ | 22 | 0 | 14 | 0 |
Investigations | ||||
Decreased weight | 17 | 3.7† | 0.6 | 0 |
Clinically relevant adverse reactions occurring in <10% of patients who received the triplet combination of IBRANCE plus inavolisib and fulvestrant included abdominal pain, dry eye, dysgeusia, and dyspepsia.
| ALT=alanine aminotransferase. | ||||
| ||||
Laboratory Abnormality | IBRANCE plus Inavolisib and Fulvestrant* | IBRANCE plus Placebo and Fulvestrant† | ||
All Grades (%) | Grade 3-4 (%) | All Grades (%) | Grade 3-4 (%) | |
Hematology | ||||
Neutrophils (total, absolute) decreased | 95 | 82 | 97 | 79 |
Hemoglobin decreased | 88 | 8‡ | 85 | 2.5‡ |
Platelets decreased | 8 | 16 | 71 | 3.7 |
Lymphocytes (absolute) decreased | 72 | 9 | 68 | 14 |
Chemistry | ||||
Glucose (fasting) increased§ | 85 | 12 | 43 | 0 |
Calcium decreased | 42 | 3.1 | 32 | 3.7 |
Potassium decreased | 38 | 6 | 21 | 0.6‡ |
Creatinine increased | 38 | 1.9‡ | 30 | 1.2‡ |
ALT increased | 34 | 3.1‡ | 29 | 1.2‡ |
Sodium decreased | 28 | 2.5‡ | 19 | 2.5 |
Magnesium decreased | 27 | 0.6 | 21 | 0 |
Lipase (fasting) increased | 16 | 1.4‡ | 7 | 0 |
Other Clinical Trials Experience
The following adverse reaction has been reported following administration of IBRANCE: venous thromboembolism.
The following adverse reactions have been identified during post-approval use of IBRANCE. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Respiratory Disorders: Interstitial lung disease (ILD)/non-infectious pneumonitis
Skin and Subcutaneous Tissue Disorders: Palmar-plantar erythrodysesthesia syndrome (PPES)
| This Patient Information has been approved by the U.S. Food and Drug Administration. Revised September 2025 | ||
PATIENT INFORMATION | ||
What is the most important information I should know about IBRANCE? IBRANCE may cause serious side effects, including: Low white blood cell counts (neutropenia). Low white blood cell counts are very common when taking IBRANCE and may cause serious infections that can lead to death. Your healthcare provider should check your white blood cell counts before and during treatment. If you develop low white blood cell counts during treatment with IBRANCE, your healthcare provider may stop your treatment, decrease your dose, or may tell you to wait to begin your treatment cycle. Tell your healthcare provider right away if you have signs and symptoms of low white blood cell counts or infections such as fever and chills. Lung problems (pneumonitis). IBRANCE may cause severe or life-threatening inflammation of the lungs during treatment that can lead to death. Tell your healthcare provider right away if you have any new or worsening symptoms, including:
Your healthcare provider may interrupt or stop treatment with IBRANCE completely if your symptoms are severe. See "What are the possible side effects of IBRANCE?" for more information about side effects. | ||
What is IBRANCE? IBRANCE is a prescription medicine used: In adults to treat hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer that has spread to other parts of the body (metastatic) in combination with:
In adults with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative and with an abnormal phosphatidylinositol-3-kinase catalytic subunit alpha (PIK3CA) gene breast cancer that has spread to nearby tissue or lymph nodes (locally advanced), or to other parts of the body (metastatic) in combination with:
It is not known if IBRANCE is safe and effective in children. | ||
What should I tell my healthcare provider before taking IBRANCE? Before taking IBRANCE, tell your healthcare provider about all of your medical conditions, including if you:
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. IBRANCE and other medicines may affect each other causing side effects. Know the medicines you take. Keep a list of them to show your healthcare provider or pharmacist when you get a new medicine. | ||
How should I take IBRANCE?
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What are the possible side effects of IBRANCE? IBRANCE may cause serious side effects. See "What is the most important information I should know about IBRANCE?" The most common side effects of IBRANCE when used with either letrozole or fulvestrant include:
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The most common side effects of IBRANCE when used in combination with inavolisib plus fulvestrant include:
IBRANCE may cause fertility problems in males. This may affect your ability to father a child. Talk to your healthcare provider about family planning options before starting IBRANCE if this is a concern for you. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all of the possible side effects of IBRANCE. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. | ||
How should I store IBRANCE?
Keep IBRANCE and all medicines out of the reach of children. | ||
General information about the safe and effective use of IBRANCE Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use IBRANCE for a condition for which it was not prescribed. Do not give IBRANCE to other people, even if they have the same symptoms you have. It may harm them. You can ask your pharmacist or healthcare provider for more information about IBRANCE that is written for health professionals. | ||
What are the ingredients in IBRANCE? Active ingredient: palbociclib Inactive ingredients: microcrystalline cellulose, lactose monohydrate, sodium starch glycolate, colloidal silicon dioxide, magnesium stearate, and hard gelatin capsule shells. The light orange, light orange/caramel and caramel opaque capsule shells contain: gelatin, red iron oxide, yellow iron oxide, and titanium dioxide. The printing ink contains: shellac, titanium dioxide, ammonium hydroxide, propylene glycol, and simethicone. ![]()
For more information, go to www.pfizer.com or call 1-800-438-1985. | ||
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