HER2/Neu Over-expressing Locally Advanced Breast Cancer, Metastatic Breast Cancer
Conditions
Keywords
Metastatic breast cancer, locally advanced breast cancer, HER2/neu positive breast cancer, HER2/neu over-expressing, progressive-free survival (PFS), over survival (OS), bolero, bolero 3, Breast cancer, everolimus, HER+, vinorelbine, herceptin, trastuzumab, RAD001
Brief summary
This phase III, double-blind, placebo-controlled multinational study will assess the combination everolimus, vinorelbine, and trastuzumab compared to the combination vinorelbine and trastuzumab with respect to progressive-free survival and over survival in HER2/neu positive women with locally advanced or metastatic breast cancer who are resistant to trastuzumab and have been pre-treated with a taxane.
Interventions
Oral everolimus was taken once 5 mg/day (2 × 2.5 mg tablets) and were packaged into blister packs.
Oral everolimus placebo was taken once 5 mg/day (2 × 2.5 mg tablets) and were packaged into blister packs.
intravenous vinorelbine (25 mg/m2 weekly)
intravenous trastuzumab (2 mg/kg weekly following a 4 mg/kg loading dose on Day 1 of Cycle 1 only)
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically or cytologically confirmed invasive breast carcinoma with locally recurrent or radiological evidence of metastatic disease. Locally recurrent disease must not be amenable to resection with curative intent. * HER2+ status defined as IHC 3+ staining or in situ hybridization positive * Patients with resistance to trastuzumab * Prior taxane therapy * Patients with an ECOG performance status of 0 - 2 * Patients with measurable disease as per RECIST criteria * Documentation of negative pregnancy test for patients of child bearing potential prior to enrollment within 7 days prior to randomization. Sexually active pre-menopausal women must use adequate contraceptive measures, excluding estrogen containing contraceptives, while on study; * Patients must meet laboratory criteria defined in the study within 21 days prior to randomization
Exclusion criteria
* Prior mTOR inhibitors or vinca alkaloid agents for the treatment of cancer * More than three prior chemotherapy lines for advanced disease. * Symptomatic CNS metastases or evidence of leptomeningeal disease. Previously treated asymptomatic CNS metastases are allowed provided that the last treatment for CNS metastases was completed \>8 weeks prior to randomization * Impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral everolimus * Peripheral neuropathy ≥ grade 2 at randomization * Active cardiac disease * History of cardiac dysfunction * Any malignancy within 5 years prior to randomization, with the exception of adequately treated in-situ carcinoma of the cervix uteri, basal or squamous cell carcinoma or non-melanomatous skin cancer * Known hypersensitivity to any study medication * Breastfeeding or pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progressive-free Survival (PFS) Per Investigator Assessment | Every 6 weeks until disease progression or death which ever occurred first up to about 41 months | PFS was defined as the time from the date of randomization to the date of first radiologically documented tumor progression or death from any cause, whichever occurs first. PFS primary analysis performed when 415 events were reached. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate (ORR) | Every 6 weeks until disease progression or death which ever occurred first up to about 41 months | ORR was defined as the percentage of participants whose best overall response was either complete response (CR) or partial response (PR) according to RECIST version 1.0. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. |
| Clinical Benefit Rate (CBR) | Every 6 weeks until disease progression or death which ever occurred first up to about 41 months | CBR was defined as the percentage of participants whose best overall response, according to RECIST, was either complete response (CR), a partial response (PR) or stable disease (SD) lasting for at least 24 weeks. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; SD = Neither sufficient shrinkage to qualify for PR or CR nor an increase in lesions which would qualify for PD; PD = At least a 20% increase in the sum of the longest diameter of all measured target lesions, taking as reference the smallest sum of longest diameter of all target lesions recorded at or after baseline. |
| Median Time to Deterioration of the ECOG Performance Status Score | baseline, until disease progression or death up to about 41 months | Time to deterioration of ECOG performance status score was summarized at time of assessment. ECOG (Eastern Cooperative Oncology Group)performance scale is a standard criteria for measuring how treatment of cancer impacts their level of functioning in terms of their ability to care for themselves, daily activity, & physical ability (walking, working, etc.). Scale score ranges from 0 to 5, 5 being the worst. ECOG scale index: 0 - Fully active, able to carry on all pre-disease performance without restriction. 1 - Restricted in physically strenuous activity but ambulatory & able to carry out work of a light or sedentary nature, e.g., light housework, office work. 2 - Ambulatory & capable of all self-care but unable to carry out any work activities. Up & about more than 50% of waking hours. 3 - Capable of only limited self-care, confined to bed or chair more than 50% of waking hours. 4 - Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair. 5 - Dead |
| Overall Survival (OS) | Every 3 months until death up to 41 months | OS was defined as the time from date of randomization to the date of death from any cause. Final OS was conducted when 388 deaths occurred. |
| Everolimus Blood Concentrations by Leading Dose and Time Point | Cycle 2, Day 1 | Pre-dose (Cmin) and 2 hours post-dose (C2h) everolimus PK blood samples were collected at Cycle 2 Day 1. Only valid everolimus PK blood samples collected at steady state were used in the analyses. |
| Vinorelbine Blood Concentrations by Leading Dose and Time Point | Cycle 2, Day 1 | Pre-infusion (Cmin) and end of infusion (C2h) vinorelbine PK blood samples were collected at Cycle 2 Day 1. Only valid vinorelbine PK blood samples collected at steady state were used in the analyses. |
| Trastuzumab Blood Concentrations by Leading Dose and Time Point | Cycle 3, Day 1 | Pre-infusion (Cmin) and end of infusion (C2h) trastuzumab PK blood samples were collected at Cycle 3 Day 1. Only valid trastuzumab PK blood samples collected at steady state were used in the analyses. |
| PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Baseline, until disease progression or death up to about 41 months | PRO = patient reported outcomes; Time to deterioration (≥ 10% worsening from baseline), in the global health status of EORTC QLQ-C30 scale was done in the 3 functional scales (emotional, physical, & social functioning \[EF, PF, & SF\]). It contains 30 items & is composed of multi-item scales & single-item measures. These include 5 functional scales (physical, role, emotional, social & cognitive functioning), 3 symptom scales (fatigue, pain, nausea, & vomiting), a global health status/QoL scale, and 6 single items (dyspnea, diarrhea, constipation, anorexia, insomnia & financial impact). Each of the multi-item scale includes a different set of items - no item occurs in more than 1 scale. Each item in the EORTC QLQ-C30 has 4 response categories (1=Not at all, 2= A little, 3= Quite a bit, 4= Very much) with the higher number representing a worse outcome. The global health domain score of the QLQ-C30 questionnaire was pre-specified as the primary QoL domain of interest & disclosed here. |
Countries
Argentina, Australia, Belgium, China, Czechia, France, Germany, Greece, Hungary, Israel, Italy, Japan, Mexico, Poland, Singapore, Slovakia, Spain, Thailand, Turkey (Türkiye), United Kingdom, United States
Participant flow
Recruitment details
DCO ( Data cut-off) for patient disposition is 1-Apr-2015. Each Cycle = 21 days
Pre-assignment details
284 patients randomized to the Everolimus + trastuzumab + vinorelbine arm, 280 took drug. 285 patients randomized to the placebo + trastuzumab + vinorelbine arm, 282 too drug. A total of 569 were comprised to randomized total and 562 to safety.
Participants by arm
| Arm | Count |
|---|---|
| Everolimus + Vinorelbine + Trastuzumab Oral everolimus (5 mg/day) + intravenous vinorelbine (25 mg/m2 weekly) + intravenous trastuzumab (2 mg/kg weekly following a 4 mg/kg loading dose on Day 1 of Cycle 1 only) | 284 |
| Placebo + Vinorelbine + Trastuzumab Oral daily matching placebo + intravenous vinorelbine (25 mg/m2 weekly) + intravenous trastuzumab (2 mg/kg weekly following a 4 mg/kg loading dose on Day 1 of Cycle 1 only) | 285 |
| Total | 569 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Abnormal test procedure | 0 | 1 |
| Overall Study | Administrative problems | 2 | 0 |
| Overall Study | Adverse Event | 29 | 14 |
| Overall Study | Death | 3 | 2 |
| Overall Study | Disease progression | 217 | 242 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | New cancer therapy | 5 | 1 |
| Overall Study | Patients untreated | 4 | 3 |
| Overall Study | Protocol Violation | 1 | 1 |
| Overall Study | Withdrawal by Subject | 19 | 14 |
Baseline characteristics
| Characteristic | Everolimus + Vinorelbine + Trastuzumab | Placebo + Vinorelbine + Trastuzumab | Total |
|---|---|---|---|
| Age, Continuous | 54.3 years STANDARD_DEVIATION 10.98 | 53.4 years STANDARD_DEVIATION 11 | 53.8 years STANDARD_DEVIATION 10.99 |
| Sex: Female, Male Female | 284 Participants | 285 Participants | 569 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 280 / 280 | 280 / 282 |
| serious Total, serious adverse events | 122 / 280 | 58 / 282 |
Outcome results
Progressive-free Survival (PFS) Per Investigator Assessment
PFS was defined as the time from the date of randomization to the date of first radiologically documented tumor progression or death from any cause, whichever occurs first. PFS primary analysis performed when 415 events were reached. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.
Time frame: Every 6 weeks until disease progression or death which ever occurred first up to about 41 months
Population: The Full Analysis Set (FAS) consisted of all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Progressive-free Survival (PFS) Per Investigator Assessment | 7.00 months |
| Placebo + Vinorelbine + Trastuzumab | Progressive-free Survival (PFS) Per Investigator Assessment | 5.78 months |
Clinical Benefit Rate (CBR)
CBR was defined as the percentage of participants whose best overall response, according to RECIST, was either complete response (CR), a partial response (PR) or stable disease (SD) lasting for at least 24 weeks. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; SD = Neither sufficient shrinkage to qualify for PR or CR nor an increase in lesions which would qualify for PD; PD = At least a 20% increase in the sum of the longest diameter of all measured target lesions, taking as reference the smallest sum of longest diameter of all target lesions recorded at or after baseline.
Time frame: Every 6 weeks until disease progression or death which ever occurred first up to about 41 months
Population: The Full Analysis Set (FAS) consisted of all randomized patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Clinical Benefit Rate (CBR) | 59.2 Percentage of participants |
| Placebo + Vinorelbine + Trastuzumab | Clinical Benefit Rate (CBR) | 53.3 Percentage of participants |
Everolimus Blood Concentrations by Leading Dose and Time Point
Pre-dose (Cmin) and 2 hours post-dose (C2h) everolimus PK blood samples were collected at Cycle 2 Day 1. Only valid everolimus PK blood samples collected at steady state were used in the analyses.
Time frame: Cycle 2, Day 1
Population: The Safety Set consisted of all patients who received at least one dose of the study treatment and who had at least one valid post-baseline safety assessment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Everolimus Blood Concentrations by Leading Dose and Time Point | Pre-dose (Cmin) (n: 7, 32) | 2.928 ng/ml | Standard Deviation 2.6197 |
| Everolimus + Vinorelbine + Trastuzumab | Everolimus Blood Concentrations by Leading Dose and Time Point | 2 hours post administration (C2h) (n:10, 43) | 13.035 ng/ml | Standard Deviation 6.6842 |
| Placebo + Vinorelbine + Trastuzumab | Everolimus Blood Concentrations by Leading Dose and Time Point | Pre-dose (Cmin) (n: 7, 32) | 5.652 ng/ml | Standard Deviation 4.1006 |
| Placebo + Vinorelbine + Trastuzumab | Everolimus Blood Concentrations by Leading Dose and Time Point | 2 hours post administration (C2h) (n:10, 43) | 22.005 ng/ml | Standard Deviation 13.38 |
Median Time to Deterioration of the ECOG Performance Status Score
Time to deterioration of ECOG performance status score was summarized at time of assessment. ECOG (Eastern Cooperative Oncology Group)performance scale is a standard criteria for measuring how treatment of cancer impacts their level of functioning in terms of their ability to care for themselves, daily activity, & physical ability (walking, working, etc.). Scale score ranges from 0 to 5, 5 being the worst. ECOG scale index: 0 - Fully active, able to carry on all pre-disease performance without restriction. 1 - Restricted in physically strenuous activity but ambulatory & able to carry out work of a light or sedentary nature, e.g., light housework, office work. 2 - Ambulatory & capable of all self-care but unable to carry out any work activities. Up & about more than 50% of waking hours. 3 - Capable of only limited self-care, confined to bed or chair more than 50% of waking hours. 4 - Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair. 5 - Dead
Time frame: baseline, until disease progression or death up to about 41 months
Population: The Full Analysis Set (FAS) consisted of all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Median Time to Deterioration of the ECOG Performance Status Score | 32.66 months |
| Placebo + Vinorelbine + Trastuzumab | Median Time to Deterioration of the ECOG Performance Status Score | 21.55 months |
Overall Response Rate (ORR)
ORR was defined as the percentage of participants whose best overall response was either complete response (CR) or partial response (PR) according to RECIST version 1.0. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Time frame: Every 6 weeks until disease progression or death which ever occurred first up to about 41 months
Population: The Full Analysis Set (FAS) consisted of all randomized patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Overall Response Rate (ORR) | 40.8 Percentage of participants |
| Placebo + Vinorelbine + Trastuzumab | Overall Response Rate (ORR) | 37.2 Percentage of participants |
Overall Survival (OS)
OS was defined as the time from date of randomization to the date of death from any cause. Final OS was conducted when 388 deaths occurred.
Time frame: Every 3 months until death up to 41 months
Population: The Full Analysis Set (FAS) consisted of all randomized patients.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Overall Survival (OS) | 23.46 months |
| Placebo + Vinorelbine + Trastuzumab | Overall Survival (OS) | 24.08 months |
PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%)
PRO = patient reported outcomes; Time to deterioration (≥ 10% worsening from baseline), in the global health status of EORTC QLQ-C30 scale was done in the 3 functional scales (emotional, physical, & social functioning \[EF, PF, & SF\]). It contains 30 items & is composed of multi-item scales & single-item measures. These include 5 functional scales (physical, role, emotional, social & cognitive functioning), 3 symptom scales (fatigue, pain, nausea, & vomiting), a global health status/QoL scale, and 6 single items (dyspnea, diarrhea, constipation, anorexia, insomnia & financial impact). Each of the multi-item scale includes a different set of items - no item occurs in more than 1 scale. Each item in the EORTC QLQ-C30 has 4 response categories (1=Not at all, 2= A little, 3= Quite a bit, 4= Very much) with the higher number representing a worse outcome. The global health domain score of the QLQ-C30 questionnaire was pre-specified as the primary QoL domain of interest & disclosed here.
Time frame: Baseline, until disease progression or death up to about 41 months
Population: The Full Analysis Set (FAS) consisted of all randomized patients.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration - global QoL domain by at least 10% | 8.31 months |
| Everolimus + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration in the EF domain by at least 10% | 15.18 months |
| Everolimus + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration in the SF domain by at least 10% | 11.33 months |
| Everolimus + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration in the PF domain by at least 10% | 11.96 months |
| Placebo + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration in the SF domain by at least 10% | 13.11 months |
| Placebo + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration - global QoL domain by at least 10% | 7.29 months |
| Placebo + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration in the PF domain by at least 10% | 12.48 months |
| Placebo + Vinorelbine + Trastuzumab | PRO: Time to Deterioration in Global Health Status/QoL Domain Score of the European Organization for the Research and Treatment of Cancer (EORTC)-Core Quality of Life Questionnaire (QLQ-C30) (by at Least 10%) | Deterioration in the EF domain by at least 10% | 12.45 months |
Trastuzumab Blood Concentrations by Leading Dose and Time Point
Pre-infusion (Cmin) and end of infusion (C2h) trastuzumab PK blood samples were collected at Cycle 3 Day 1. Only valid trastuzumab PK blood samples collected at steady state were used in the analyses.
Time frame: Cycle 3, Day 1
Population: The Safety Set consisted of all patients who received at least one dose of the study treatment and who had at least one valid post-baseline safety assessment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Trastuzumab Blood Concentrations by Leading Dose and Time Point | Pre-infusion - dose (Cmin) (n: 73, 57) | 23.351 ng/ml | Standard Deviation 6.3344 |
| Everolimus + Vinorelbine + Trastuzumab | Trastuzumab Blood Concentrations by Leading Dose and Time Point | End of infusion (Cmax) (n: 75, 59) | 64.279 ng/ml | Standard Deviation 27.8549 |
| Placebo + Vinorelbine + Trastuzumab | Trastuzumab Blood Concentrations by Leading Dose and Time Point | End of infusion (Cmax) (n: 75, 59) | 60.576 ng/ml | Standard Deviation 15.5198 |
| Placebo + Vinorelbine + Trastuzumab | Trastuzumab Blood Concentrations by Leading Dose and Time Point | Pre-infusion - dose (Cmin) (n: 73, 57) | 24.526 ng/ml | Standard Deviation 7.996 |
Vinorelbine Blood Concentrations by Leading Dose and Time Point
Pre-infusion (Cmin) and end of infusion (C2h) vinorelbine PK blood samples were collected at Cycle 2 Day 1. Only valid vinorelbine PK blood samples collected at steady state were used in the analyses.
Time frame: Cycle 2, Day 1
Population: The Safety Set consisted of all patients who received at least one dose of the study treatment and who had at least one valid post-baseline safety assessment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Everolimus + Vinorelbine + Trastuzumab | Vinorelbine Blood Concentrations by Leading Dose and Time Point | Pre-infusion - dose (Cmin) (n: 76, 64) | 11.085 ng/ml | Standard Deviation 66.8551 |
| Everolimus + Vinorelbine + Trastuzumab | Vinorelbine Blood Concentrations by Leading Dose and Time Point | End of infusion (Cmax) (n: 58, 49) | 867.147 ng/ml | Standard Deviation 971.3057 |
| Placebo + Vinorelbine + Trastuzumab | Vinorelbine Blood Concentrations by Leading Dose and Time Point | Pre-infusion - dose (Cmin) (n: 76, 64) | 0.061 ng/ml | Standard Deviation 0.4888 |
| Placebo + Vinorelbine + Trastuzumab | Vinorelbine Blood Concentrations by Leading Dose and Time Point | End of infusion (Cmax) (n: 58, 49) | 1068.51 ng/ml | Standard Deviation 1145.86 |