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A Study of a Combination of Trastuzumab and Capecitabine With or Without Pertuzumab in Patients With HER2-positive Metastatic Breast Cancer (PHEREXA)

A Multicenter Randomized Phase III Study to Compare the Combination Trastuzumab and Capecitabine, With or Without Pertuzumab, in Patients With HER2-Positive Metastatic Breast Cancer That Have Progressed After One Line of Trastuzumab-Based Therapy in the Metastatic Setting (PHEREXA)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01026142
Enrollment
452
Registered
2009-12-04
Start date
2010-01-26
Completion date
2017-08-07
Last updated
2018-08-14

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

Conditions

Breast Cancer

Brief summary

This randomized, two-arm study evaluated the efficacy and safety of a combination of trastuzumab and capecitabine with or without pertuzumab in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. The study population consisted of female patients, whose disease had progressed during or following previous trastuzumab therapy for metastatic disease. All patients in Arm A and Arm B received trastuzumab (8 mg/kg iv as loading dose and then 6 mg/kg iv every 3 weeks thereafter) and capecitabine oral twice daily for 14 days every 3 weeks (1250 mg/m2 twice daily in Arm A and 1000 mg/m2 twice daily in Arm B). In addition, patients in Arm B received pertuzumab (840 mg iv as loading dose and then 420 mg iv thereafter) every 3 weeks. Study treatment continued until disease progression or unacceptable toxicity.

Interventions

DRUGCapecitabine

1000 mg/m2 po twice daily for 14 days every 3 weeks

DRUGPertuzumab

840 mg iv loading, then 420 mg iv every 3 weeks

DRUGTrastuzumab

8 mg/kg iv loading, then 6 mg/kg iv every 3 weeks

Sponsors

Hoffmann-La Roche
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* Adult female patients \>/=18 years of age * Metastatic HER2 positive breast cancer * Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 * Disease progression during or following trastuzumab-based therapy for 1st line metastatic breast cancer (trastuzumab must have been part of the last prior treatment regimen) * Prior treatment with taxane-containing regimen * Left ventricular ejection fraction (LVEF) \>/=50 percent * For women of childbearing potential agreement to use highly effective non-hormonal form of contraception or two effective forms of non-hormonal contraception by patient and/or partner. Contraception must continue for duration of study treatment and for at least 6 months after last dose of study drug treatment

Exclusion criteria

* Prior treatment with pertuzumab or capecitabine * Concurrent treatment with other experimental drug * Concurrent immunotherapy or anticancer hormonal therapy * Serious concurrent disease (e.g. active infection, uncontrolled hypertension, cardiovascular disease) * Central nervous system (CNS) metastases, which are not well controlled * History of exposure to anthracycline cumulative dose equivalent to 360mg/m2 * History of congestive heart failure of any New York Heart Association criteria, or serious cardiac arrhythmia requiring treatment * History of myocardial infarction within 6 months prior to randomization * History of LVEF decline to below 50% during or after prior trastuzumab therapy or other cardiac toxicity during previous trastuzumab treatment that necessitated discontinuation of trastuzumab * History of another cancer which could affect compliance or result interpretation * Inadequate organ function * Pregnant or breastfeeding women * life expectancy \< 12 weeks

Design outcomes

Primary

MeasureTime frameDescription
Progression Free Survival (Independent Assessment)Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).Progression Free Survival (PFS) was defined as the time from randomization to first documented disease progression (PD), as determined by an Independent Review Facility (IRF) using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0, or death from any cause, whichever occurred first. PD was defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. IRF review of tumor assessment ceased after the primary PFS analysis. The primary endpoint was analyzed after approximately 337 IRF-assessed PFS events were observed.

Secondary

MeasureTime frameDescription
Overall Survival (OS) Rate Based on a 2-year Truncated AnalysisFrom randomization until death from any cause (up to 2 years)The Overall Survival (OS) 2-year truncated analysis is the Kaplan-Meier estimate of the percentage of participants who were surviving at 2 years. OS is defined as the time from the date of randomization to the date of death from any cause, with censoring of all events and follow-up beyond the end of the second year.
Investigator Assessment Progression-Free Survival (PFS)Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 7.5 years).Investigator Assessment Progression-Free Survival (PFS) was defined as the time from randomization to the first documented progressive disease, as determined by the investigator using Response Evaluation Criteria in Solid Tumors (RECIST) v1.0, or death from any cause, whichever occurred first. PD is defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
Time to Progression (TTP) Based Upon Independent Review Facility (IRF) AssessmentTumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).Time to Progression (TTP) was defined as time between randomization and the first occurrence of progressive disease (PD), based on IRF assessment.
Overall Survival (OS)From randomization until death from any cause (up to 7.5 years).Overall Survival (OS) was defined as the time from the date of randomization to the date of death from any cause. The results of the final OS analysis are presented here. Participants who were alive or lost to follow-up at the time of the analysis were censored at the last known alive date. Participants with no postbaseline information were censored at the time of randomization plus 1 day. Prior to the final data analysis cut-off, it was ensured that all participants who were in survival follow-up had been contacted as recently as possible within the last 3 months to confirm current survival status.
Overall Objective Response Rate (ORR)Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).Overall Objective Response Rate is based upon investigator and IRF assessments. Objective Response Rate (ORR) was defined as the percentage of participants with a confirmed complete response (CR) or partial response (PR) among those who had measurable disease at baseline. CR was defined as the disappearance of all target lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD.
Clinical Benefit Rate (CBR)Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).Clinical Benefit Rate is based upon Independent Review Facility (IRF) assessments; defined as the percentage of participants a complete response (CR), partial response (PR), or stable disease for at least 8 cycles or 6 months.
Duration of Objective ResponseTumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).Duration of Objective Response was defined for the subpopulation of responders as time from first Independent Review Facility (IRF)-assessed complete response (CR) or partial response (PR) to subsequent first documented, IRF-confirmed evidence of disease progression. Only participants with an objective response were included in the analysis of duration of objective response.
Time to Treatment Failure (TTF) Based Upon Independent Review Facility (IRF) AssessmentTumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).Time to Treatment Failure (TTF) was defined as time between randomization and date of disease progression based on independent review, death, or withdrawal of treatment due to adverse events, withdrawn informed consent, refusal of treatment/failure to cooperate, or failure to return, whichever occurred first.

Countries

Argentina, Austria, Belgium, Brazil, Canada, Croatia, Czechia, Estonia, France, Germany, Hong Kong, Hungary, Italy, Mexico, Netherlands, Peru, Poland, Romania, Russia, South Korea, Spain, Thailand, United Kingdom

Participant flow

Recruitment details

452 participants were randomized to one of two treatment arms: trastuzumab and capecitabine (Arm A, 224 participants) or pertuzumab with trastuzumab and capecitabine (Arm B, 228 participants). Of participants randomized to Arm A: trastuzumab and capecitabine, 6 participants did not receive study treatment.

Participants by arm

ArmCount
A: Capecitabine + Trastuzumab
Capecitabine \[Xeloda\]: 1250 mg/m2 po twice daily for 14 days every 3 weeks. Trastuzumab \[Herceptin\]: 8 mg/kg iv loading, then 6 mg/kg iv every 3 weeks.
218
B: Capecitabine + Trastuzumab + Pertuzumab
Capecitabine \[Xeloda\]: 1000 mg/m2 po twice daily for 14 days every 3 weeks. Pertuzumab \[Perjeta\]: 840 mg iv loading, then 420 mg iv every 3 weeks. Trastuzumab \[Herceptin\]: 8 mg/kg iv loading, then 6 mg/kg iv every 3 weeks.
228
Total446

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath136134
Overall StudyWithdrew consent or lost to follow-up3629

Baseline characteristics

CharacteristicA: Capecitabine + TrastuzumabB: Capecitabine + Trastuzumab + PertuzumabTotal
Age, Continuous55.1 years
STANDARD_DEVIATION 10.1
53.0 years
STANDARD_DEVIATION 11.21
54.0 years
STANDARD_DEVIATION 10.72
Region of Enrollment
Argentina
3 participants4 participants7 participants
Region of Enrollment
Austria
2 participants3 participants5 participants
Region of Enrollment
Belgium
12 participants11 participants23 participants
Region of Enrollment
Brazil
7 participants6 participants13 participants
Region of Enrollment
Canada
3 participants6 participants9 participants
Region of Enrollment
Croatia
4 participants3 participants7 participants
Region of Enrollment
Czech Republic
12 participants10 participants22 participants
Region of Enrollment
France
19 participants12 participants31 participants
Region of Enrollment
Germany
23 participants11 participants34 participants
Region of Enrollment
Hong Kong
5 participants11 participants16 participants
Region of Enrollment
Hungary
13 participants29 participants42 participants
Region of Enrollment
Italy
16 participants18 participants34 participants
Region of Enrollment
Korea, Republic of
14 participants24 participants38 participants
Region of Enrollment
Mexico
1 participants0 participants1 participants
Region of Enrollment
Netherlands
0 participants2 participants2 participants
Region of Enrollment
Peru
7 participants8 participants15 participants
Region of Enrollment
Poland
6 participants6 participants12 participants
Region of Enrollment
Romania
6 participants8 participants14 participants
Region of Enrollment
Russian Federation
8 participants3 participants11 participants
Region of Enrollment
Spain
39 participants31 participants70 participants
Region of Enrollment
Thailand
0 participants5 participants5 participants
Region of Enrollment
United Kingdom
18 participants17 participants35 participants
Sex: Female, Male
Female
218 Participants228 Participants446 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
136 / 218134 / 228
other
Total, other adverse events
209 / 218216 / 228
serious
Total, serious adverse events
53 / 21858 / 228

Outcome results

Primary

Progression Free Survival (Independent Assessment)

Progression Free Survival (PFS) was defined as the time from randomization to first documented disease progression (PD), as determined by an Independent Review Facility (IRF) using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0, or death from any cause, whichever occurred first. PD was defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. IRF review of tumor assessment ceased after the primary PFS analysis. The primary endpoint was analyzed after approximately 337 IRF-assessed PFS events were observed.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).

Population: All randomized participants.

ArmMeasureValue (MEDIAN)
A: Capecitabine + TrastuzumabProgression Free Survival (Independent Assessment)9.0 months
B: Capecitabine + Trastuzumab + PertuzumabProgression Free Survival (Independent Assessment)11.1 months
Comparison: The null hypothesis for the primary endpoint is that the survival distributions of IRF-assessed PFS in the two treatment groups are the same. The alternative hypothesis is that the survival distributions of IRF-assessed PFS in the treatment and the control arms are different:~H0: IRF PFS\<pertuzumab\> = IRF PFS\<control\> vs. H1: IRF PFS\<pertuzumab\> ≠ IRF PFS\<control\>p-value: 0.073195% CI: [0.65, 1.02]Log Rank
Secondary

Clinical Benefit Rate (CBR)

Clinical Benefit Rate is based upon Independent Review Facility (IRF) assessments; defined as the percentage of participants a complete response (CR), partial response (PR), or stable disease for at least 8 cycles or 6 months.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).

Population: Participants without a post-baseline tumor assessment were considered to be non-responders and were not included in this outcome measure.

ArmMeasureValue (NUMBER)
A: Capecitabine + TrastuzumabClinical Benefit Rate (CBR)54.0 Percentage of participants
B: Capecitabine + Trastuzumab + PertuzumabClinical Benefit Rate (CBR)63.6 Percentage of participants
Secondary

Duration of Objective Response

Duration of Objective Response was defined for the subpopulation of responders as time from first Independent Review Facility (IRF)-assessed complete response (CR) or partial response (PR) to subsequent first documented, IRF-confirmed evidence of disease progression. Only participants with an objective response were included in the analysis of duration of objective response.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).

ArmMeasureValue (MEDIAN)
A: Capecitabine + TrastuzumabDuration of Objective Response30.0 Weeks
B: Capecitabine + Trastuzumab + PertuzumabDuration of Objective Response51.6 Weeks
Secondary

Investigator Assessment Progression-Free Survival (PFS)

Investigator Assessment Progression-Free Survival (PFS) was defined as the time from randomization to the first documented progressive disease, as determined by the investigator using Response Evaluation Criteria in Solid Tumors (RECIST) v1.0, or death from any cause, whichever occurred first. PD is defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions; or the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 7.5 years).

Population: All randomized participants.

ArmMeasureValue (MEDIAN)
A: Capecitabine + TrastuzumabInvestigator Assessment Progression-Free Survival (PFS)9.0 Months
B: Capecitabine + Trastuzumab + PertuzumabInvestigator Assessment Progression-Free Survival (PFS)11.8 Months
Secondary

Overall Objective Response Rate (ORR)

Overall Objective Response Rate is based upon investigator and IRF assessments. Objective Response Rate (ORR) was defined as the percentage of participants with a confirmed complete response (CR) or partial response (PR) among those who had measurable disease at baseline. CR was defined as the disappearance of all target lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).

Population: Participants without a post-baseline tumor assessment were considered to be non-responders and were not included in this outcome measure.

ArmMeasureGroupValue (NUMBER)
A: Capecitabine + TrastuzumabOverall Objective Response Rate (ORR)Complete Response (CR) - IRF Assessment0 Percentage of participants
A: Capecitabine + TrastuzumabOverall Objective Response Rate (ORR)Partial Response (PR) - IRF assessment32.9 Percentage of participants
A: Capecitabine + TrastuzumabOverall Objective Response Rate (ORR)Complete Response (CR) - Investigator Assessed1.2 Percentage of participants
A: Capecitabine + TrastuzumabOverall Objective Response Rate (ORR)Partial Response (PR) - Investigator Assessed36.0 Percentage of participants
B: Capecitabine + Trastuzumab + PertuzumabOverall Objective Response Rate (ORR)Partial Response (PR) - Investigator Assessed38.0 Percentage of participants
B: Capecitabine + Trastuzumab + PertuzumabOverall Objective Response Rate (ORR)Complete Response (CR) - IRF Assessment1.8 Percentage of participants
B: Capecitabine + Trastuzumab + PertuzumabOverall Objective Response Rate (ORR)Complete Response (CR) - Investigator Assessed6.7 Percentage of participants
B: Capecitabine + Trastuzumab + PertuzumabOverall Objective Response Rate (ORR)Partial Response (PR) - IRF assessment38.7 Percentage of participants
Secondary

Overall Survival (OS)

Overall Survival (OS) was defined as the time from the date of randomization to the date of death from any cause. The results of the final OS analysis are presented here. Participants who were alive or lost to follow-up at the time of the analysis were censored at the last known alive date. Participants with no postbaseline information were censored at the time of randomization plus 1 day. Prior to the final data analysis cut-off, it was ensured that all participants who were in survival follow-up had been contacted as recently as possible within the last 3 months to confirm current survival status.

Time frame: From randomization until death from any cause (up to 7.5 years).

Population: All randomized participants.

ArmMeasureValue (MEDIAN)
A: Capecitabine + TrastuzumabOverall Survival (OS)28.1 Months
B: Capecitabine + Trastuzumab + PertuzumabOverall Survival (OS)37.2 Months
Secondary

Overall Survival (OS) Rate Based on a 2-year Truncated Analysis

The Overall Survival (OS) 2-year truncated analysis is the Kaplan-Meier estimate of the percentage of participants who were surviving at 2 years. OS is defined as the time from the date of randomization to the date of death from any cause, with censoring of all events and follow-up beyond the end of the second year.

Time frame: From randomization until death from any cause (up to 2 years)

Population: All randomized participants.

ArmMeasureValue (NUMBER)
A: Capecitabine + TrastuzumabOverall Survival (OS) Rate Based on a 2-year Truncated Analysis55.0 Percentage of participants
B: Capecitabine + Trastuzumab + PertuzumabOverall Survival (OS) Rate Based on a 2-year Truncated Analysis74.9 Percentage of participants
Secondary

Time to Progression (TTP) Based Upon Independent Review Facility (IRF) Assessment

Time to Progression (TTP) was defined as time between randomization and the first occurrence of progressive disease (PD), based on IRF assessment.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).

Population: All randomized participants.

ArmMeasureValue (MEDIAN)
A: Capecitabine + TrastuzumabTime to Progression (TTP) Based Upon Independent Review Facility (IRF) Assessment39.0 Weeks
B: Capecitabine + Trastuzumab + PertuzumabTime to Progression (TTP) Based Upon Independent Review Facility (IRF) Assessment50.6 Weeks
Secondary

Time to Treatment Failure (TTF) Based Upon Independent Review Facility (IRF) Assessment

Time to Treatment Failure (TTF) was defined as time between randomization and date of disease progression based on independent review, death, or withdrawal of treatment due to adverse events, withdrawn informed consent, refusal of treatment/failure to cooperate, or failure to return, whichever occurred first.

Time frame: Tumor assessments every 9 weeks from randomization until Week 27, then every 12 weeks thereafter, until IRF-determined PD, initiation of alternative anticancer medication, or death (up to 5.5 years).

Population: All randomized participants.

ArmMeasureValue (MEDIAN)
A: Capecitabine + TrastuzumabTime to Treatment Failure (TTF) Based Upon Independent Review Facility (IRF) Assessment39.0 Weeks
B: Capecitabine + Trastuzumab + PertuzumabTime to Treatment Failure (TTF) Based Upon Independent Review Facility (IRF) Assessment50.9 Weeks

Source: ClinicalTrials.gov · Data processed: Mar 22, 2026