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trastuzumab plus epirubicin and cyclophosphamide followed by docetaxel (n=309) vs. lapatinib plus epirubicin and cyclophosphamide followed by docetaxel (n=311)
randomized controlled trial
trastuzumab plus epirubicin and cyclophosphamide followed by docetaxel
trastuzumab: IV 6 mg/kg body weight, every 3 weeks (loading dose of 8 mg/kg on day 1 of the first EC cycle) / epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2 day 1, every 3 weeks / docetaxel: 100 mg/m2 day 1, every 3 weeks
lapatinib plus epirubicin and cyclophosphamide followed by docetaxel
lapatinib: 1,250 mg per day, starting on day 1 of the first cycle of EC until day 21 of the fourth cycle of docetaxel. Lapatinib was reduced to 1000mg per day to improve tolerability / epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2 day 1, every 3 weeks / docetaxel: 100 mg/m2 day 1, every 3 weeks
All patients received four cycles of epidubicin and cyclophosphamide followed by four cycles of docetaxel.
es-BC - HER2 positive - (neo)adjuvant (NA)
open label
at 126 centres in Germany and one centre in Switzerland
P3 / pCR at 2-sided with alpha at 0.05 in the ITT population
pertuzumab plus trastuzumab (n=129) vs. trastuzumab (n=129)
randomized controlled trial
pertuzumab plus trastuzumab plus an AI (letrozole or anastrozole)
pertuzumab: IV 840 mg and 8 mg/kg loading doses followed by 420 mg / trastuzumab: IV 6 mg/kg maintenance doses / anastrozole: PO 1mg/day or letrozole: PO 2.5mg/day
trastuzumab plus an AI (letrozole or anastrozole)
trastuzumab: IV 6 mg/kg maintenance doses / anastrozole: PO 1mg/day or letrozole: PO 2.5mg/day
investigator could decide to administered chemotherapy: docetaxel and paclitaxel IV
la/mBC - HER2 positive - 1st Line (L1)
open label
80 sites in 8 countries
P2 / PFS at 2-sided at 0.05 / no SAP
pertuzumab plus trastuzumab plus docetaxel (n=402) vs. trastuzumab plus docetaxel (n=406)
randomized controlled trial
pertuzumab plus trastuzumab plus docetaxel
pertuzumab: fixed loading dose of 840 mg IV, followed by 420 mg IV every 3 weeks until disease progression / trastuzumab: loading dose of 8 mg/kg of body weight IV, followed by a maintenance dose of 6 mg per kg IV every 3 weeks until disease progression / docetaxel: every 3 weeks at a starting dose of 75 mg per square meter IV (increase possible to100mg if the side-effect profile was acceptable)
placebo plus trastuzumab plus docetaxel
placebo IV / trastuzumab: loading dose of 8 mg/kg of body weight IV, followed by a maintenance dose of 6 mg per kg IV every 3 weeks until disease progression / docetaxel: every 3 weeks at a starting dose of 75 mg per square meter IV (increase possible to100mg if the side-effect profile was acceptable)
la/mBC - HER2 positive - 1st Line (L1)
Exclusion criteria: therapy for metastatic breast cancer, central nervous system metastases.
double blind
204 centers in 25 countries
P3 / The overall type I error rate for the analysis of primary endpoint of PFS, OS and ORR will be controlled at 5% at 2-sided, using the fixed sequence testing procedure, in this order. / 2 IA for OS.
The addition of pertuzumab to trastuzumab and docetaxel increase significantly the PFS and the OS
pertuzumab plus trastuzumab plus docetaxel (n=-9) vs. trastuzumab plus docetaxel (n=-9)
randomized controlled trial
pertuzumab plus trastuzumab plus docetaxel
pertuzumab: IV 840 mg loading dose,followed by 420 mg every 3 weeks / trastuzumab: IV 8 mg/kgloading dose, then 6 mg/kg every 3 weeks / docetaxel: IV 75 mg/m2 every 3 weeks
placebo plus trastuzumab plus docetaxel
placebo matching pertuzumab / trastuzumab: IV 8 mg/kgloading dose, then 6 mg/kg every 3 weeks / docetaxel: IV 75 mg/m2 every 3 weeks
la/mBC - HER2 positive - 1st Line (L1)
double blind
15 centres in China
P3 / statistical testing is considered exploratory
trastuzumab plus endocrine therapy (n=196) vs. trastuzumab plus chemotherapy (n=196)
randomized controlled trial
trastuzumab plus endocrine therapy
trastuzumab: on day 1 of study treatment as an initial loading dose of 8 mg/kg. Subsequent dosing and scheduling of trastuzumab was 6 mg/kg every 3 weeks / endocrine therapy
trastuzumab plus chemotherapy
trastuzumab: on day 1 of study treatment as an initial loading dose of 8 mg/kg. Subsequent dosing and scheduling of trastuzumab was 6 mg/kg every 3 weeks / chemotherapy
la/mBC - HER2 positive - 1st Line (L1)
open label
in 9 hospitals in China
P3 / nononferiority, PFS at 0.025 and HR <1.35 / All efficacy analysis will be performed based on the ITT population
afatinib plus vinorelbine (n=339) vs. trastuzumab plus vinorelbine (n=169)
randomized controlled trial
afatinib plus vinorelbine
afatinib: PO 40 mg/day / vinorelbine: IV 25 mg/m² per week
trastuzumab plus vinorelbine
trastuzumab: IV 2 mg/kg per week after an initial loading dose of 4 mg/kg / vinorelbine: IV 25 mg/m² per week
la/mBC - HER2 positive - 2nd Line (L2)
Exclusion criteria: previous treatment with vinorelbine or an EGFR-targeted or HER2-targeted drug other than trastuzumab
open label
350 hospitals in 41 countries worlwilde
P3 / at 2-sided alpha of 0.05 in the ITT population. / evaluation of OS in the same manner as PFS, although the trial was not powered to evaluate OS and post-progression treatments were expected to confound results
Recruitement stopped on April 26, 2013 following recommandation of the independent data monitoring committee on the basis of a benefit–risk assessment, and conclude that there was a low likelihood of the study meeting the predefined criteria for increased progression-free survival with afatinib versus trastuzumab and that tolerability was lower in the afatinib group
lapatinib plus capecitabine (n=43) vs. trastuzumab plus capecitabine (n=43)
randomized controlled trial
lapatinib plus capecitabine
lapatinib: 1250 mg/day / capecitabine: 2000 mg/m2/day on days 1-14 every 3 weeks
trastuzumab plus capecitabine
trastuzumab: 4 mg/kg loading then 2 mg/kg weekly or 8 mg/kg loading then 6 mg/kg every 3 weeks / and capecitabine: 2500 mg/m2/day on days 1-14 every 3 weeks
la/mBC - HER2 positive - 2nd Line (L2)
Exclusion criteria: patients with symptomatic brain metastases
open label
28 institutions in Japan
P2 / PFS at 1-sided at 0.10
the study did not met its primary endpoint, lapatinib plus capecitanine did not improve PFS compare to trastuzumab plus capecitabine
lapatinib plus trastuzumab (n=148) vs. lapatinib (n=148)
randomized controlled trial
lapatinib plus trastuzumab
lapatinib: PO 1000mg/day / trastuzumab: IV 2 mg/kg weekly (after the initial 4 mg/kg loading dose)
lapatinib monotherapy
lapatinib: PO 1500mg/day
cross-over population was comprised of 73 patients (49%) who, after documented disease progression after a minimum of 4 weeks of lapatinib monotherapy, opted to receive the combinationtreatment.
la/mBC - HER2 positive - 2nd Line (L2)
open label
88 centers in North America and Europe
P3 / PFS (in ITT population) at 2-sided alpha = 0.05 / no IA planned / The study was not powered for inference testing of the secondary end points.
the study met its primary endpoints, PFS was significantly increased in the combination group compare to lapatinib alone.
neratinib (n=1420) vs. placebo (n=1420)
randomized controlled trial
neratinib
neratinib: 240mg PO daily for 12 months
placebo
placebo: PO daily for 12 months
la/mBC - HER2 positive - 2nd Line (L2)
double blind
495 centers in Europe, Asia, Australia, New Zealand, and North and South America
P3 / IDFS in ITT population at 2-sided 5%. no IA planned. There were 3 different sponsors during the study, resulting to 3 global amendments with notable changes to study design. Final amendment: IDFS in the ITT population at 2yr.
neratinib plus capecitabine (n=51) vs. lapatinib plus capecitabine (n=50)
randomized controlled trial
neratinib plus capecitabine
neratinib: 240 mg PO once daily continuously in 21-day cycles with no break between cycles / capecitabine: 1,500 mg/m2 PO daily in 2 evenly spaced doses [750 mg/m2 twice a day] on days 1-14 of 21-day cycles ///// Prophylactic antidiarrheal medication was mandated for the duration of cycle 1 in this group
lapatinib plus capecitabine
lapatinib: 1,250 mg PO once daily continuously / capecitabine: 2,000 mg/m2 PO daily in 2 evenly spaced doses [1,000 mg/m2 twice a day] on days 1-14 of 21-day cycles
la/mBC - HER2 positive - 2nd Line (L2)
open-label
203 sites in 28 countries in Europe, North and South America, Asia, and Australia
P3 / Coprimary end points were analyzed using an overall type I error rate of 0.01 for PFS and 0.04 for OS. No interim analysis. (trial was considered positive if either PFS or OS were statistically significant at the split alpha level).Descriptive analysis for this study population (patients with brain metastasis)
Descriptive analysis for this population (patients with brain metastasis)
neratinib plus capecitabine (n=307) vs. lapatinib plus capecitabine (n=314)
randomized controlled trial
neratinib plus capecitabine
neratinib: 240 mg PO once daily continuously in 21-day cycles with no break between cycles / capecitabine: 1,500 mg/m2 PO daily in 2 evenly spaced doses [750 mg/m2 twice a day] on days 1-14 of 21-day cycles ///// Prophylactic antidiarrheal medication was mandated for the duration of cycle 1 in this group
lapatinib plus capecitabine
lapatinib: 1,250 mg PO once daily continuously / capecitabine: 2,000 mg/m2 PO daily in 2 evenly spaced doses [1,000 mg/m2 twice a day] on days 1-14 of 21-day cycles
la/mBC - HER2 positive - 2nd Line (L2)
open-label
203 sites in 28 countries in Europe, North and South America, Asia, and Australia
P3 / Coprimary end points were analyzed using an overall type I error rate of 0.01 for PFS and 0.04 for OS. No interim analysis. (trial was considered positive if either PFS or OS were statistically significant at the split alpha level)
Neratinib plus capecitabine significantly improved PFS but not significantly for OS, compared to lapatinib plus capecitabine.
tucatinib plus trastuzumab plus capecitabine (n=198) vs. trastuzumab plus capecitabine (n=93)
randomized controlled trial
tucatinib plus trastuzumab plus capecitabine
tucatinib: 300mg PO twice daily / trastuzumab: 6 mg IV per kg of body weight once every 21 days, with an initial loading dose of 8 mg per kg; subcutaneous administration was allowed / capecitabine: 1000 mg PO per square meter of body-surface area orally twice daily on days 1 to 14 of each 21-day cycle
placebo plus trastuzumab plus capecitabine
placebo: PO twice daily / trastuzumab: 6 mg IV per kg of body weight once every 21 days, with an initial loading dose of 8 mg per kg; subcutaneous administration was allowed / capecitabine: 1000 mg PO per square meter of body-surface area orally twice daily on days 1 to 14 of each 21-day cycle
la/mBC - HER2 positive - 2nd Line (L2)
Excludion criteria: had previously received treatment for metastatic disease with capecitabine or a HER2-targeted tyrosine kinase inhibitor (although patients who had received lapatinib more than 12 months before initiating a trial regimen), patients with leptomeningeal disease
double-blind
155 sites in 15 countries
P2 / To maintain strong control of the family-wise type I error rate at 0.05, the PFS in the ITT population will be tested at 0.05, if it is significant, te alpha will be split between OS (0.02) and the PFS (in patients with brain metastases) (0.03) (If only one of OS and PFS(with brain metastases) is statistical significant, the unused alpha can be passed to the other one following the GSHv procedure.) / 1 IA for PFS (with brain metastases) with alpha at 0.008, and 2 IA for OS (1st IA alpha at 0.007) / (ITT population was not the same for PFS and OS, because authors continued to include patients to increase the power for the analyses)
Adding tucatinib to trastuzumab and capecitabine increase significantly PFS for patients with brain metastases.
tucatinib plus trastuzumab plus capecitabine (n=410) vs. trastuzumab plus capecitabine (n=202)
randomized controlled trial
tucatinib plus trastuzumab plus capecitabine
tucatinib: 300mg PO twice daily / trastuzumab: 6 mg IV per kg of body weight once every 21 days, with an initial loading dose of 8 mg per kg; subcutaneous administration was allowed / capecitabine: 1000 mg PO per square meter of body-surface area orally twice daily on days 1 to 14 of each 21-day cycle
placebo plus trastuzumab plus capecitabine
placebo: PO twice daily / trastuzumab: 6 mg IV per kg of body weight once every 21 days, with an initial loading dose of 8 mg per kg; subcutaneous administration was allowed / capecitabine: 1000 mg PO per square meter of body-surface area orally twice daily on days 1 to 14 of each 21-day cycle
la/mBC - HER2 positive - 2nd Line (L2)
Excludion criteria: had previously received treatment for metastatic disease with capecitabine or a HER2-targeted tyrosine kinase inhibitor (although patients who had received lapatinib more than 12 months before initiating a trial regimen), patients with leptomeningeal disease
double-blind
155 sites in 15 countries
P2 / To maintain strong control of the family-wise type I error rate at 0.05, the PFS in the ITT population will be tested at 0.05, if it is significant, te alpha will be split between OS (0.02) and the PFS (in patients with brain metastases) (0.03) (If only one of OS and PFS(with brain metastases) is statistical significant, the unused alpha can be passed to the other one following the GSHv procedure.) / 1 IA for PFS (with brain metastases) with alpha at 0.008, and 2 IA for OS (1st IA alpha at 0.007) / (ITT population was not the same for PFS and OS, because authors continued to include patients to increase the power for the analyses)
The study met its primary endpoints. Adding tucatinib to trastzumab and capecitabine incrase significantly the PFS and OS.
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