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Daily Everolimus in Combination With Trastuzumab and Vinorelbine in HER2/Neu Positive Women With Locally Advanced or Metastatic Breast Cancer

A Randomized Phase III, Double-blind, Placebo-controlled Multicenter Trial of Daily Everolimus in Combination With Trastuzumab and Vinorelbine, in Pretreated Women With HER2/Neu Over-expressing Locally Advanced or Metastatic Breast Cancer.

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01007942
Acronym
BOLERO-3
Enrollment
569
Registered
2009-11-04
Start date
2009-10-31
Completion date
2015-06-30
Last updated
2017-04-05

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

HER2/Neu Over-expressing Locally Advanced Breast Cancer, Metastatic Breast Cancer

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

DRUGeverolimus

Oral everolimus was taken once 5 mg/day (2 × 2.5 mg tablets) and were packaged into blister packs.

DRUGPlacebo

Oral everolimus placebo was taken once 5 mg/day (2 × 2.5 mg tablets) and were packaged into blister packs.

DRUGvinorelbine

intravenous vinorelbine (25 mg/m2 weekly)

DRUGtrastuzumab

intravenous trastuzumab (2 mg/kg weekly following a 4 mg/kg loading dose on Day 1 of Cycle 1 only)

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Progressive-free Survival (PFS) Per Investigator AssessmentEvery 6 weeks until disease progression or death which ever occurred first up to about 41 monthsPFS 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

MeasureTime frameDescription
Overall Response Rate (ORR)Every 6 weeks until disease progression or death which ever occurred first up to about 41 monthsORR 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 monthsCBR 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 Scorebaseline, until disease progression or death up to about 41 monthsTime 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 monthsOS 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 PointCycle 2, Day 1Pre-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 PointCycle 2, Day 1Pre-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 PointCycle 3, Day 1Pre-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 monthsPRO = 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

ArmCount
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
Total569

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAbnormal test procedure01
Overall StudyAdministrative problems20
Overall StudyAdverse Event2914
Overall StudyDeath32
Overall StudyDisease progression217242
Overall StudyLost to Follow-up10
Overall StudyNew cancer therapy51
Overall StudyPatients untreated43
Overall StudyProtocol Violation11
Overall StudyWithdrawal by Subject1914

Baseline characteristics

CharacteristicEverolimus + Vinorelbine + TrastuzumabPlacebo + Vinorelbine + TrastuzumabTotal
Age, Continuous54.3 years
STANDARD_DEVIATION 10.98
53.4 years
STANDARD_DEVIATION 11
53.8 years
STANDARD_DEVIATION 10.99
Sex: Female, Male
Female
284 Participants285 Participants569 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
280 / 280280 / 282
serious
Total, serious adverse events
122 / 28058 / 282

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
Everolimus + Vinorelbine + TrastuzumabProgressive-free Survival (PFS) Per Investigator Assessment7.00 months
Placebo + Vinorelbine + TrastuzumabProgressive-free Survival (PFS) Per Investigator Assessment5.78 months
p-value: 0.006795% CI: [0.65, 0.95]Log Rank
Secondary

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.

ArmMeasureValue (NUMBER)
Everolimus + Vinorelbine + TrastuzumabClinical Benefit Rate (CBR)59.2 Percentage of participants
Placebo + Vinorelbine + TrastuzumabClinical Benefit Rate (CBR)53.3 Percentage of participants
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
Everolimus + Vinorelbine + TrastuzumabEverolimus Blood Concentrations by Leading Dose and Time PointPre-dose (Cmin) (n: 7, 32)2.928 ng/mlStandard Deviation 2.6197
Everolimus + Vinorelbine + TrastuzumabEverolimus Blood Concentrations by Leading Dose and Time Point2 hours post administration (C2h) (n:10, 43)13.035 ng/mlStandard Deviation 6.6842
Placebo + Vinorelbine + TrastuzumabEverolimus Blood Concentrations by Leading Dose and Time PointPre-dose (Cmin) (n: 7, 32)5.652 ng/mlStandard Deviation 4.1006
Placebo + Vinorelbine + TrastuzumabEverolimus Blood Concentrations by Leading Dose and Time Point2 hours post administration (C2h) (n:10, 43)22.005 ng/mlStandard Deviation 13.38
Secondary

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.

ArmMeasureValue (MEDIAN)
Everolimus + Vinorelbine + TrastuzumabMedian Time to Deterioration of the ECOG Performance Status Score32.66 months
Placebo + Vinorelbine + TrastuzumabMedian Time to Deterioration of the ECOG Performance Status Score21.55 months
Secondary

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.

ArmMeasureValue (NUMBER)
Everolimus + Vinorelbine + TrastuzumabOverall Response Rate (ORR)40.8 Percentage of participants
Placebo + Vinorelbine + TrastuzumabOverall Response Rate (ORR)37.2 Percentage of participants
Secondary

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.

ArmMeasureValue (MEDIAN)
Everolimus + Vinorelbine + TrastuzumabOverall Survival (OS)23.46 months
Placebo + Vinorelbine + TrastuzumabOverall Survival (OS)24.08 months
Secondary

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.

ArmMeasureGroupValue (MEDIAN)
Everolimus + Vinorelbine + TrastuzumabPRO: 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 + TrastuzumabPRO: 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 + TrastuzumabPRO: 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 + TrastuzumabPRO: 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 + TrastuzumabPRO: 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 + TrastuzumabPRO: 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 + TrastuzumabPRO: 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 + TrastuzumabPRO: 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
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
Everolimus + Vinorelbine + TrastuzumabTrastuzumab Blood Concentrations by Leading Dose and Time PointPre-infusion - dose (Cmin) (n: 73, 57)23.351 ng/mlStandard Deviation 6.3344
Everolimus + Vinorelbine + TrastuzumabTrastuzumab Blood Concentrations by Leading Dose and Time PointEnd of infusion (Cmax) (n: 75, 59)64.279 ng/mlStandard Deviation 27.8549
Placebo + Vinorelbine + TrastuzumabTrastuzumab Blood Concentrations by Leading Dose and Time PointEnd of infusion (Cmax) (n: 75, 59)60.576 ng/mlStandard Deviation 15.5198
Placebo + Vinorelbine + TrastuzumabTrastuzumab Blood Concentrations by Leading Dose and Time PointPre-infusion - dose (Cmin) (n: 73, 57)24.526 ng/mlStandard Deviation 7.996
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
Everolimus + Vinorelbine + TrastuzumabVinorelbine Blood Concentrations by Leading Dose and Time PointPre-infusion - dose (Cmin) (n: 76, 64)11.085 ng/mlStandard Deviation 66.8551
Everolimus + Vinorelbine + TrastuzumabVinorelbine Blood Concentrations by Leading Dose and Time PointEnd of infusion (Cmax) (n: 58, 49)867.147 ng/mlStandard Deviation 971.3057
Placebo + Vinorelbine + TrastuzumabVinorelbine Blood Concentrations by Leading Dose and Time PointPre-infusion - dose (Cmin) (n: 76, 64)0.061 ng/mlStandard Deviation 0.4888
Placebo + Vinorelbine + TrastuzumabVinorelbine Blood Concentrations by Leading Dose and Time PointEnd of infusion (Cmax) (n: 58, 49)1068.51 ng/mlStandard Deviation 1145.86

Source: ClinicalTrials.gov · Data processed: Mar 20, 2026