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Fig 1.

Flow diagram for inclusion and exclusion of studies.

ESMO: European Society for Medical Oncology; ASCO: American Society of Clinical Oncology; AACR: American Association for Cancer Research.

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Table 1.

Characteristic of nine included trials.

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Table 2.

Medium follow-up, objective response rate, medium progression-free survival and overall survival of included trials.

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Fig 2.

Risk of bias for selected studies.

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Fig 3.

Forest plot of pooled hazard ratio for progression-free survival (PFS) in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

SE: standard error; CDK 4/6i: CDK 4/6 inhibitors; ET: endocrine therapy.

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Fig 4.

Forest plot of hazard ratio for progression-free survival (PFS) by subgroup analysis in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

ET: endocrine therapy; AI: aromatase inhibitors; CT: chemotherapy; PR: progesterone receptor; DFI: disease-free interval.

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Fig 5.

Forest plot of hazard ratio for progression-free survival (PFS) for Asian and non-Asian subgroups in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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Fig 6.

Forest plot of pooled hazard ratio for overall survival (OS) in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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Fig 6 Expand

Fig 7.

Forest plot of hazard ratio for overall survival (OS) by subgroup analysis in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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Fig 7 Expand

Fig 8.

Forest plot of hazard ratio for overall survival (OS) for Asian and non-Asian subgroups in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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Fig 8 Expand

Fig 9.

Forest plot of pooled relative risk for objective response rate (ORR) in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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Fig 10.

Forest plot of pooled relative risk for clinical benefit rate (CBR) in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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Fig 11.

Forest plot of pooled relative risk for grade 3/4 adverse events (AEs) in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy (A). Relative risk for grade 3/4 adverse events (AEs) by subgroup in type of CDK inhibitors between two treatment groups (B).

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Fig 12.

Forest plot of pooled relative risk for hematology toxicities (neutropenia, leukopenia, anemia) in CDK 4/6 inhibitors plus endocrine combination therapy and endocrine monotherapy.

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