Association between treatment duration and overall survival in early-stage HER2+ breast cancer patients receiving extended adjuvant therapy with neratinib in the ExteNET trial.

Authors

Beverly Moy

Beverly Moy

Massachusetts General Hospital Cancer Center, Boston, MA

Beverly Moy , Masato Takahashi , Shoichiro Ohtani , Ewa Chmielowska , Naohito Yamamoto , Bruno P. Coudert , Feng Xu , Alvin F. Wong , Arlene Chan

Organizations

Massachusetts General Hospital Cancer Center, Boston, MA, NHO Hokkaido Cancer Center, Sapporo City, Japan, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan, Centrum Onkologii im. Prof. Franciszka Łukaszczyka, Bydgoszcz, Poland, Chiba Cancer Center, Chiba, Japan, Centre Georges Francois Leclerc, Dijon, France, Puma Biotechnology Inc., Los Angeles, CA, Puma Biotechnology Inc., San Francisco, CA, Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia

Research Funding

Pharmaceutical/Biotech Company
Puma Biotechnology Inc.

Background: Completion of planned treatment has been shown to improve clinical outcomes. In the ExteNET trial (NCT00878709), where diarrhea prophylaxis was not mandated, 17% of patients (pts) discontinued neratinib early due to diarrhea. This compares with 3.3% of pts from the CONTROL trial (NCT02400476) who used a neratinib dose-escalation strategy. Prior analyses have shown improved invasive disease-free survival (iDFS) in pts who completed planned duration of neratinib therapy in ExteNET (Table). Here we assess outcomes, including overall survival (OS), for pts who completed planned therapy in 3 groups from ExteNET: intent-to-treat (ITT) population; pts with hormone receptor-positive (HR+) disease who initiated neratinib within 1y after prior trastuzumab (HR+/≤1y, the population neratinib is approved for in the EU); and HR+/≤1y with residual disease post-neoadjuvant therapy (no pathologic complete response [pCR]). Methods: Pts with early-stage HER2+ breast cancer received oral neratinib 240 mg/d or placebo after trastuzumab-based (neo)adjuvant therapy. Pts who completed neratinib therapy (defined as ≥11m or cessation of neratinib if recurrence occurred prior to 11m) were compared with placebo (all randomized pts). iDFS and OS were analyzed using Kaplan-Meier methods; hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional-hazards models. Data cutoff: July 2019. Results: There were 2840 pts in the ITT population. The table shows iDFS and OS in the overall population and in pts who completed planned duration of neratinib therapy. Completion of planned neratinib was associated with improvements in iDFS and OS in all groups evaluated. Conclusions: These descriptive findings suggest that pts who receive the recommended duration of treatment of 1y with neratinib may have improved outcomes. Clinical trial information: NCT00878709


N
5-y iDFS rate, %
8-y OS rate, %
Neratinib
Placebo
Neratinib
Placebo
Δa
HR
(95% CI)
Neratinib
Placebo
Δa
HR
(95% CI)
ITT population
1420
1420
90.2
87.7
+2.5
0.73 (0.57–0.92)b
90.1
90.2
–0.1
0.95 (0.75–1.21)b
Completed therapyc
872
1420
91.0
87.7
+3.3
0.68 (0.52–0.90)
92.2
90.2
+2.0
0.78 (0.58–1.04)
HR+/≤1yd
670
664
90.8
85.7
+5.1
0.58 (0.41–0.82)
91.5
89.4
+2.1
0.79 (0.55–1.13)
Completed therapyc
402
664
93.1
85.7
+7.4
0.44 (0.28–0.68)
95.2
89.4
+5.8
0.49 (0.29–0.78)
HR+/≤1yd
no pCRe
131
164
85.0
77.6
+7.4
0.60 (0.33–1.07)
91.3
82.2
+9.1
0.47 (0.23–0.92)
Completed therapyc
92
164
89.5
77.6
+11.9
0.42 (0.20–0.87)
95.4
82.2
+13.2
0.29 (0.01–0.68)

aDifference (neratinib vs placebo); bStratified by stratification factors; cDefined as ≥11m of therapy or ended treatment due to disease recurrence in neratinib arm, and all randomized subjects in placebo arm; dHR+ and ≤1y after prior trastuzumab; eResidual disease post-neoadjuvant therapy.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Breast Cancer—Local/Regional/Adjuvant

Track

Breast Cancer

Sub Track

Adjuvant Therapy

Clinical Trial Registration Number

NCT00878709

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 540)

DOI

10.1200/JCO.2021.39.15_suppl.540

Abstract #

540

Poster Bd #

Online Only

Abstract Disclosures