Onkologikoa Foundation, San Sebastian, Spain
Ander Urruticoechea , Seock-Ah Im , Montserrat Munoz , Jose Baselga , Denise A. Yardley , Sarah Heeson , Sarah Jones , Adam Knott , Hannah Douthwaite , Tanja Badovinac Crnjevic , Sandra M. Swain
Background: T-DM1 was approved for pts with HER2+ MBC previously treated with trastuzumab (H) and a taxane based on the phase III EMILIA study. P in combination with H + docetaxel (T) later became the first-line standard of care for HER2+ MBC, but there are limited data on T-DM1 efficacy in pts who previously received P. We present exploratory efficacy results from pts treated with T-DM1 any time after P from 2 phase III studies: CLEOPATRA and PHEREXA. Methods: CLEOPATRA (NCT00567190) and PHEREXA (NCT01026142) are randomized, 2-arm trials evaluating P-based regimens for HER2+ MBC. CLEOPATRA studies H + T + P vs HT + placebo in pts with no prior anti-HER2 treatment (tx) or chemotherapy for MBC, while PHEREXA studies H + capecitabine (C) +/− P in pts who progressed during/after previous H tx for MBC. We assessed overall survival (OS) in an exploratory analysis of pts who either received or did not receive T-DM1 at any time after discontinuing study-assigned tx in CLEOPATRA or PHEREXA. Results: Of 408 pts who received HTP in CLEOPATRA and 228 pts who received HCP in PHEREXA, 32 and 43 pts received subsequent T-DM1, respectively (Table). Median duration of T-DM1 tx was 7.1 mo (range 0−44) and 4.2 mo (range 0−22), respectively, and median time from discontinuation of P to start of T-DM1 was 3.5 mo (range 1−47) and 10.6 mo (range 1−28). Conclusions: Although data are limited in these exploratory analyses, our results provide additional evidence of T-DM1 clinical activity in pts with HER2+ MBC who progressed on prior P + H, a finding with real-world implications. Clinical trial information: NCT00567190, NCT01026142
No T-DM1 | T-DM1 | |
---|---|---|
CLEOPATRA | ||
HT + placebo, n | 362 | 34 |
Pts with event, n (%) | 198 (54.7) | 20 (58.8) |
Median OS, mo (95% CI) | 39.6 (35–47) | 46.2 (34–57) |
HRa(95% CI) | 0.93 (0.58–1.49) P=0.7538b | |
HTP, n | 376 | 32 |
Pts with event, n (%) | 158 (42.0) | 11 (34.4) |
Median OS, mo (95% CI) | 61.4 (49–NR) | NR (49–NR) |
HRa(95% CI) | 0.62 (0.33–1.14) P=0.1196b | |
PHEREXA | ||
HC, n | 179 | 39 |
Pts with event, n (%) | 98 (54.7) | 16 (41.0) |
Median OS, mo (95% CI) | 23.7 (20–29) | 40.1 (31–57) |
HRa(95% CI) | 0.45 (0.26–0.81) P=0.0061b | |
HCP, n | 185 | 43 |
Pts with event, n (%) | 82 (44.3) | 16 (37.2) |
Median OS, mo (95% CI) | 32.8 (28–39) | 38.3 (34–NR) |
HRa(95% CI) | 0.53 (0.30–0.94) P=0.0283b |
avs no T-DM1. bLog-rank P-value. HR, hazard ratio; NR, not reached.
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