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T-DM1 vs Paclitaxel/Trastuzumab for Breast (ATEMPT Trial)

A Randomized Phase II Study of Trastuzumab Emtansine (T-DM1) vs. Paclitaxel in Combination With Trastuzumab for Stage I HER2-Positive Breast Cancer (ATEMPT Trial)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01853748
Enrollment
512
Registered
2013-05-15
Start date
2013-05-01
Completion date
2022-06-15
Last updated
2026-02-19

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 research study is a Phase II clinical trial. Phase II clinical trials test the effectiveness of an investigational drug to learn whether the drug works in treating a specific cancer. "Investigational" means that the drug is still being studied and that research doctors are trying to find out more about it-such as the safest dose to use, the side effects it may cause, and if the drug is effective for treating different types of cancer. It also means that the FDA has not approved this drug for use patients undergoing adjuvant treatment for HER2+ breast cancer. Trastuzumab emtansine (T-DM1) is a drug that may stop cancer cells from growing. This drug has been used in other research studies and information from those other research studies suggests that this drug may help to prevent the recurrence of breast cancer in this research study. The use of T-DM1 in this research study is experimental, which means it is not approved by any regulatory authority for the adjuvant treatment of HER2-positive breast cancer. However, it FDA-approved for metastatic HER2-positive breast cancer. T-DM1 has caused cancer cells to die in laboratory studies. In preclinical studies, this drug has prevented or slowed the growth of breast cancer. The breast cancer treatments (paclitaxel and Trastuzumab) used in this study are considered part of standard-of-care regimens in early breast cancer. A standard treatment means that this is a treatment that would be accepted by the majority of the medical community as a suitable treatment for your type of breast cancer. In this research study, the investigators are looking to see if the study drug T-DM1 will have less side effects than traditional HER2-positive breast cancer treatment of trastuzumab and paclitaxel. The investigators are also hoping to learn about the long term benefits and disease-free survival of participants who take the study drug T-DM1 in comparison to those participants to take the combination of trastuzumab and paclitaxel.

Detailed description

If a participant agrees to participate in this study she will be asked to undergo some screening tests or procedures to confirm that she is eligible. Many of these tests and procedures are likely to be part of regular cancer care and may be done even if turns out that she does not take part in this research study. If she has had some of these tests or procedures recently, they may or may not have to be repeated. These tests and procedures will include: a medical history, performance status, assessment of your tumor, blood tests, cardiac tests, pregnancy test and a collection of tumor tissue. If these tests show that she is eligible to participate in the research study, she will begin the study treatment. If she does not meet the eligibility criteria, she will not be able to participate in this research study. Because no one knows which of the study options is best, the participant will be "randomized" into one of the study groups after she has had her breast surgery: Group 1 or Group 2. Randomization means that she is put into a group by chance. Neither the participant nor the research doctor will choose what group she will be in. The participant will have a one in three chance of being placed in any group. Approximately 375 study participants will receive the study drug, while 125 study participants will receive the standard therapy of trastuzumab and paclitaxel. Group 1 participants will receive the study drug T-DM1 every three weeks by IV (intravenous injection) for 17 treatments (total of 51 weeks). Group 2 participants will receive the FDA-approved drugs Paclitaxel and Trastuzumab once per week by IV for 12 weeks. Then beginning week 13, participants will receive Trastuzumab only by IV injection every three weeks for the next 13 treatments. During all cycles the participant will have a physical exam and tumor assessment. The investigators would like to keep track of the participant's medical condition for the next five years after the final dose of study drug. The investigators would like to do this by regular visits every 6 months for 3 years after completion of study treatment, and then once a year for the next two years. The investigators may ask for additional follow-up by phone after completion of these visits. Participants who undergo lumpectomy (breast conserving surgery) need to receive breast radiation therapy to participate in this study. Participants who have undergone a mastectomy may receive chest wall and lymph node radiation (as determined by discussion with their physician). Radiation Therapy will begin after the conclusion of all study paclitaxel doses, and after 12 weeks fo the study drug T-DM1.

Interventions

DRUGTrastuzumab
DRUGPaclitaxel
DRUGTrastuzumab emtansine

Sponsors

Dana-Farber Cancer Institute
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

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

Inclusion criteria

* HER2-positive Stage I histologically confirmed invasive carcinoma of the breast * ER/PR determination is required * HER2 positive, confirmed by central testing: IHC 3+, FISH HER2/CEP17 \<2.0 with an average HER2 copy number \>/=6.0, or FISH HER2/CEP17 \>/= 2.0 * Bilateral breast cancers that individually meet eligibility criteria are allowed * Subjects with multifocal or multicentric disease are eligible as long as each tumor individually meets eligibility criteria * Subjects with a history of ipsilateral DCIS are eligible if they were treated with wide-excision alone, without radiation therapy; Patients with a history of contralateral DCIS are not eligible. * Should have tumor tissue available and a tissue block of sufficient size to make 15 slides, which must be sent to a DFCI site for testing * Less than or equal to 90 days since most recent breast surgery for this breast cancer * All tumor should be removed by either a modified radical mastectomy or a segmental mastectomy (lumpectomy) with either a sentinel node biopsy or axillary dissection * All margins should be clear of invasive cancer or DCIS * May have received up to 4 weeks of tamoxifen therapy or other hormonal therapy, for adjuvant therapy for this cancer * Prior oophorectomy for cancer prevention is allowed * Subjects who have undergone partial breast radiation (duration \</= 7 days) prior to registration are eligible. Partial breast radiation must be completed prior to 2 weeks before starting protocol therapy. * Must have discontinued any investigational drug at least 2 weeks prior to participation * Willing to use one highly effective from of nonhormonal contraception or two effective forms of nonhormonal contraception while on study and for 7 months after end of study treatment * Subjects undergoing lumpectomy must have no contraindications to radiation therapy

Exclusion criteria

* Pregnant or breastfeeding * Use of potent CYP3A4 inhibitors during the study treatment period * Excessive alcohol intake (more than 3 alcoholic beverages per day) * Locally advanced tumors at diagnosis * History of previous invasive breast cancer * History of prior chemotherapy in the past 5 years * History of prior trastuzumab or prior paclitaxel therapy * Active, unresolved infection * Active liver disease * History of a different malignancy except for the following: disease free for at least 5 years and at low risk for recurrence; cervical cancer in situ, basal or squamous cell carcinoma of the skin * Active cardiac disease

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants of Clinically Relevant Toxicities (CRT)5 years after completion of study treatment or until death, whichever occurs first.Clinically relevant toxicities will include the composite incidence of grade 3 or higher non-hematologic toxicity, grade 2 or higher neurotoxicity, and grade 4 or higher hematologic toxicity. These toxicities will only be assessed at the pre-specified toxicity-assessment visits. In addition, the following events, regardless of timing of their occurrence, will also count towards the composite endpoint: febrile neutropenia, any toxicity requiring dose-delay, discontinuation of any study treatment (Paclitaxel, Trastuzumab, or T-DM1) for toxicity, and any serious adverse event (SAE).
3-year Disease Free Survival (DFS) Rate of Trastuzumab Emtansine (TDM-1)3 yearsDisease-free survival (DFS) is evaluated and defined per protocol: from the time of randomization until the to the occurrence of the first of the following events: * Local/regional recurrence: a recurrent or new invasive ipsilateral breast cancer, invasive breast cancer in the axilla, regional lymph nodes, chest wall, or skin of the ipsilateral breast. * Contralateral invasive breast cancer, * Distant recurrence: metastatic disease that has either been biopsy confirmed or clinically diagnosed as recurrent invasive breast cancer. A single new lesion on a bone scan without evidence of lytic disease on x-ray and without symptoms does not in and of itself constitute distant recurrence, but multiple new bone lesions, or increased isotope uptake associated with new bone symptoms are more likely due to metastases. Bone metastases must be documented with x-rays and clinical description. * Death from any cause

Secondary

MeasureTime frameDescription
Incidence Rate of Grade 3-4 Treatment-Related ToxicityAE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first. Median follow-up 3.1 years.All grade 3 - 4 adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv4 as reported on case report forms were counted. Incidence is the number of patients experiencing at least one treatment-related grade \>=3 AE of any type during the time of observation.
Quality of Life (QOL) FACT B Total Score at Baselineat baselineThe QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Quality of Life (QOL) FACT B Total Score at Week 3at week 3The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Quality of Life (QOL) FACT B Total Score at Week 12at week 12The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Quality of Life (QOL) FACT B Total Score at 6 Monthsat 6 monthsThe QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Quality of Life (QOL) FACT B Total Score at 1 Yearat 1 yearThe QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Quality of Life (QOL) FACT B Total Score at 18 Monthsat 18 monthsThe QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Quality of Life (QOL) FACT B Total Score at 24 Monthsat 24 monthsThe QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).
Number of Patients Has NeuropathySurveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18. The data cutoff date is 18 month.Neuropathy evaluated by Patient Neurotoxicity Questionnaire (PNQ) defined per protocol.
Percentage of Work Time Missed Because of HealthSurveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.Effects of therapy on work productivity and activity - work time missed because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.
Percentage of Impairment While Working Because of Health (Mean, SD)Surveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.Effects of therapy on work productivity and activity - Impairment While Working because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.
Percentage of Overall Work Impairment Because of HealthSurveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.Effects of therapy on work productivity and activity - Work Impairment because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.
Percentage of Activity Impairment Because of HealthSurveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.Effects of therapy on work productivity and activity - Activity Impairment because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.
Number of Patients Have AlopeciaMedian follow-up was 3.9 years. The AE data cutoff date is 21 April 2020.alopecia assessment is a 5-item questionnaire that will assess the impact alopecia has had on these patients and will be conducted electronically at pre-specified study visits. If electronic evaluation is not possible, paper evaluation will be conducted.
3-year T-DM1 iDFS Percentage by Tumor Size and Hormone Receptor (HR) Status3 yearsDisease-free survival (DFS) is evaluated in patients treated with trastuzumab emtansine, which is defined per protocol: from the time of randomization until the to the occurrence of the first of the following events: * Local/regional recurrence: a recurrent or new invasive ipsilateral breast cancer, invasive breast cancer in the axilla, regional lymph nodes, chest wall, or skin of the ipsilateral breast. * Contralateral invasive breast cancer, * Distant recurrence: metastatic disease that has either been biopsy confirmed or clinically diagnosed as recurrent invasive breast cancer. A single new lesion on a bone scan without evidence of lytic disease on x-ray and without symptoms does not in and of itself constitute distant recurrence, but multiple new bone lesions, or increased isotope uptake associated with new bone symptoms are more likely due to metastases. Bone metastases must be documented with x-rays and clinical description. * Death from any cause
Number of Incidence of Grade 3-4 Cardiac Left Ventricular DysfunctionAE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first. Median follow-up 3.1 years.All grade 3 - 4 adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv4 as reported on case report forms were counted. Incidence is the number of patients experiencing at least one treatment-related grade \>=3 AE of any type during the time of observation
Number of Incidence of T-DM1 Induced Grade 2-3 ThrombocytopeniaAE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first. Median follow-up 3.1 years.Reversible Grade 1-4 thrombocytopenia has been observed in ongoing studies with trastuzumab emtansine.
Number of SNPs With Top Associations of Trastuzumab Emtansine-induced Grade 2-4 Thrombocytopenia in the T-DM1 ArmDNA sample collected at pre-treatment. AE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks.DNA will be genotyped for SNPs and CNV markers using the Infinium Human Omni1 array (1.2 million SNP platform) from Illumina. A gene-based association analyses for thrombocytopenia or bleeding is applied with significancy (p-value). This analysis was only conducted in the T-DM1 arm.
Percentage of Patients With AmenorrheaSurveys are took at month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.All grade 3 - 4 adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv4 as reported on case report forms were counted. Incidence is the number of patients experiencing at least one treatment-related grade \>=3 AE of any type during the time of observation. For those who were premenopausal pre-chemotherapy, at each follow-up visit (every six months) in order to assess for duration of amenorrhea and also premature ovarian failure.
Gene Mutation Assessed Using High-throughput Mutation Profiling System (Oncomap)After treatmentArchival tumor tissue from all patients will be assessed using a high-throughput mutation profiling system (Oncomap) to query a large panel of cancer gene mutations.
Median Overall Survival (OS)Reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first.OS is evaluated in patients with Stage I HER2-positive breast cancer treated with trastuzumab emtansine

Countries

United States

Contacts

PRINCIPAL_INVESTIGATORSara Tolaney, MD, MPH

Dana-Farber Cancer Institute

Participant flow

Participants by arm

ArmCount
Trastuzumab Emtansine (T-DM1)
T-DM1 3.6mg/kg every three weeks by IV for 17 doses for a total of 51 weeks
383
Paclitaxel + Trastuzumab (TH)
paclitaxel 80 mg/m2 IV weekly and trastuzumab 4 mg/kg IV load, followed by 2 mg/kg IV weekly for 12 weeks, followed by trastuzumab 6 mg/kg IV every 3 weeks for 13 treatments
114
Total497

Baseline characteristics

CharacteristicTrastuzumab Emtansine (T-DM1)Paclitaxel + Trastuzumab (TH)Total
Age, Continuous56 Years55 Years56 Years
Race/Ethnicity, Customized
Asian
22 Participants4 Participants26 Participants
Race/Ethnicity, Customized
Black or African American
21 Participants7 Participants28 Participants
Race/Ethnicity, Customized
More than one race
2 Participants1 Participants3 Participants
Race/Ethnicity, Customized
Other
11 Participants9 Participants20 Participants
Race/Ethnicity, Customized
White
327 Participants93 Participants420 Participants
Region of Enrollment
United States
383 participants114 participants497 participants
Sex: Female, Male
Female
383 Participants114 Participants497 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
6 / 3831 / 114
other
Total, other adverse events
383 / 383114 / 114
serious
Total, serious adverse events
62 / 38326 / 114

Outcome results

Primary

3-year Disease Free Survival (DFS) Rate of Trastuzumab Emtansine (TDM-1)

Disease-free survival (DFS) is evaluated and defined per protocol: from the time of randomization until the to the occurrence of the first of the following events: * Local/regional recurrence: a recurrent or new invasive ipsilateral breast cancer, invasive breast cancer in the axilla, regional lymph nodes, chest wall, or skin of the ipsilateral breast. * Contralateral invasive breast cancer, * Distant recurrence: metastatic disease that has either been biopsy confirmed or clinically diagnosed as recurrent invasive breast cancer. A single new lesion on a bone scan without evidence of lytic disease on x-ray and without symptoms does not in and of itself constitute distant recurrence, but multiple new bone lesions, or increased isotope uptake associated with new bone symptoms are more likely due to metastases. Bone metastases must be documented with x-rays and clinical description. * Death from any cause

Time frame: 3 years

ArmMeasureValue (NUMBER)
Trastuzumab Emtansine (T-DM1)3-year Disease Free Survival (DFS) Rate of Trastuzumab Emtansine (TDM-1)0.978 proportion of participants
Paclitaxel + Trastuzumab3-year Disease Free Survival (DFS) Rate of Trastuzumab Emtansine (TDM-1)0.934 proportion of participants
Primary

Number of Participants of Clinically Relevant Toxicities (CRT)

Clinically relevant toxicities will include the composite incidence of grade 3 or higher non-hematologic toxicity, grade 2 or higher neurotoxicity, and grade 4 or higher hematologic toxicity. These toxicities will only be assessed at the pre-specified toxicity-assessment visits. In addition, the following events, regardless of timing of their occurrence, will also count towards the composite endpoint: febrile neutropenia, any toxicity requiring dose-delay, discontinuation of any study treatment (Paclitaxel, Trastuzumab, or T-DM1) for toxicity, and any serious adverse event (SAE).

Time frame: 5 years after completion of study treatment or until death, whichever occurs first.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Grade 4 or higher hematologic toxicity4 Participants
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Any toxicity requiring dose delay106 Participants
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Grade 2 or higher neurotoxicity42 Participants
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Any toxicity requiring early discontinuation of protocol therapy67 Participants
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Febrile neutropenia0 Participants
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Serious adverse event11 Participants
Trastuzumab Emtansine (T-DM1)Number of Participants of Clinically Relevant Toxicities (CRT)Grade 3 or higher non-hematologic toxicity36 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Serious adverse event6 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Grade 3 or higher non-hematologic toxicity13 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Grade 2 or higher neurotoxicity26 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Grade 4 or higher hematologic toxicity0 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Febrile neutropenia2 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Any toxicity requiring dose delay30 Participants
Paclitaxel + TrastuzumabNumber of Participants of Clinically Relevant Toxicities (CRT)Any toxicity requiring early discontinuation of protocol therapy7 Participants
Secondary

3-year T-DM1 iDFS Percentage by Tumor Size and Hormone Receptor (HR) Status

Disease-free survival (DFS) is evaluated in patients treated with trastuzumab emtansine, which is defined per protocol: from the time of randomization until the to the occurrence of the first of the following events: * Local/regional recurrence: a recurrent or new invasive ipsilateral breast cancer, invasive breast cancer in the axilla, regional lymph nodes, chest wall, or skin of the ipsilateral breast. * Contralateral invasive breast cancer, * Distant recurrence: metastatic disease that has either been biopsy confirmed or clinically diagnosed as recurrent invasive breast cancer. A single new lesion on a bone scan without evidence of lytic disease on x-ray and without symptoms does not in and of itself constitute distant recurrence, but multiple new bone lesions, or increased isotope uptake associated with new bone symptoms are more likely due to metastases. Bone metastases must be documented with x-rays and clinical description. * Death from any cause

Time frame: 3 years

ArmMeasureValue (NUMBER)
Trastuzumab Emtansine (T-DM1)3-year T-DM1 iDFS Percentage by Tumor Size and Hormone Receptor (HR) Status98.7 percentage of participants
Paclitaxel + Trastuzumab3-year T-DM1 iDFS Percentage by Tumor Size and Hormone Receptor (HR) Status97.2 percentage of participants
Secondary

Gene Mutation Assessed Using High-throughput Mutation Profiling System (Oncomap)

Archival tumor tissue from all patients will be assessed using a high-throughput mutation profiling system (Oncomap) to query a large panel of cancer gene mutations.

Time frame: After treatment

Population: no genomic data were collected using the Oncomap system

Secondary

Incidence Rate of Grade 3-4 Treatment-Related Toxicity

All grade 3 - 4 adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv4 as reported on case report forms were counted. Incidence is the number of patients experiencing at least one treatment-related grade \>=3 AE of any type during the time of observation.

Time frame: AE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first. Median follow-up 3.1 years.

ArmMeasureValue (NUMBER)
Trastuzumab Emtansine (T-DM1)Incidence Rate of Grade 3-4 Treatment-Related Toxicity0.16 proportion of participants
Paclitaxel + TrastuzumabIncidence Rate of Grade 3-4 Treatment-Related Toxicity0.23 proportion of participants
Secondary

Median Overall Survival (OS)

OS is evaluated in patients with Stage I HER2-positive breast cancer treated with trastuzumab emtansine

Time frame: Reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first.

ArmMeasureValue (NUMBER)
Trastuzumab Emtansine (T-DM1)Median Overall Survival (OS)NA months
Paclitaxel + TrastuzumabMedian Overall Survival (OS)NA months
Secondary

Number of Incidence of Grade 3-4 Cardiac Left Ventricular Dysfunction

All grade 3 - 4 adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv4 as reported on case report forms were counted. Incidence is the number of patients experiencing at least one treatment-related grade \>=3 AE of any type during the time of observation

Time frame: AE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first. Median follow-up 3.1 years.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Trastuzumab Emtansine (T-DM1)Number of Incidence of Grade 3-4 Cardiac Left Ventricular Dysfunction3 Participants
Paclitaxel + TrastuzumabNumber of Incidence of Grade 3-4 Cardiac Left Ventricular Dysfunction2 Participants
Secondary

Number of Incidence of T-DM1 Induced Grade 2-3 Thrombocytopenia

Reversible Grade 1-4 thrombocytopenia has been observed in ongoing studies with trastuzumab emtansine.

Time frame: AE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks, then follow-up up to 5 years after completion of study treatment or until death, whichever occurs first. Median follow-up 3.1 years.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Trastuzumab Emtansine (T-DM1)Number of Incidence of T-DM1 Induced Grade 2-3 Thrombocytopenia42 Participants
Paclitaxel + TrastuzumabNumber of Incidence of T-DM1 Induced Grade 2-3 Thrombocytopenia1 Participants
p-value: 0.0001Fisher Exact
Secondary

Number of Patients Has Neuropathy

Neuropathy evaluated by Patient Neurotoxicity Questionnaire (PNQ) defined per protocol.

Time frame: Surveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18. The data cutoff date is 18 month.

Population: The PNQ analysis was done on patients that completed at least baseline questionnaires and at least one follow-up questionnaire. Some patients did not complete this questionnaire at either baseline or follow-up. This is the reason for the reduced number of patients when reporting PNQ results.

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Trastuzumab Emtansine (T-DM1)Number of Patients Has NeuropathyNo, mild, or moderate neuropathy267 Participants
Trastuzumab Emtansine (T-DM1)Number of Patients Has NeuropathyModerate to severe and severe neuropathy24 Participants
Paclitaxel + TrastuzumabNumber of Patients Has NeuropathyModerate to severe and severe neuropathy17 Participants
Paclitaxel + TrastuzumabNumber of Patients Has NeuropathyNo, mild, or moderate neuropathy64 Participants
T-DM1 With Any Baseline NeuropathyNumber of Patients Has NeuropathyNo, mild, or moderate neuropathy36 Participants
T-DM1 With Any Baseline NeuropathyNumber of Patients Has NeuropathyModerate to severe and severe neuropathy22 Participants
TH With Any Baseline NeuropathyNumber of Patients Has NeuropathyNo, mild, or moderate neuropathy11 Participants
TH With Any Baseline NeuropathyNumber of Patients Has NeuropathyModerate to severe and severe neuropathy12 Participants
p-value: 0.0012Mantel Haenszel
Secondary

Number of Patients Have Alopecia

alopecia assessment is a 5-item questionnaire that will assess the impact alopecia has had on these patients and will be conducted electronically at pre-specified study visits. If electronic evaluation is not possible, paper evaluation will be conducted.

Time frame: Median follow-up was 3.9 years. The AE data cutoff date is 21 April 2020.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Trastuzumab Emtansine (T-DM1)Number of Patients Have Alopecia157 Participants
Paclitaxel + TrastuzumabNumber of Patients Have Alopecia0 Participants
p-value: 0.0001Regression, Linear
Secondary

Number of SNPs With Top Associations of Trastuzumab Emtansine-induced Grade 2-4 Thrombocytopenia in the T-DM1 Arm

DNA will be genotyped for SNPs and CNV markers using the Infinium Human Omni1 array (1.2 million SNP platform) from Illumina. A gene-based association analyses for thrombocytopenia or bleeding is applied with significancy (p-value). This analysis was only conducted in the T-DM1 arm.

Time frame: DNA sample collected at pre-treatment. AE is reported every 3 weeks for the first 12 weeks, then every 9 weeks for the subsequent 39 weeks.

ArmMeasureValue (NUMBER)
Trastuzumab Emtansine (T-DM1)Number of SNPs With Top Associations of Trastuzumab Emtansine-induced Grade 2-4 Thrombocytopenia in the T-DM1 Arm54 number of SNPs
Secondary

Percentage of Activity Impairment Because of Health

Effects of therapy on work productivity and activity - Activity Impairment because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.

Time frame: Surveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.

ArmMeasureGroupValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Percentage of Activity Impairment Because of Health3 weeks12 percentage of timeStandard Deviation 19
Trastuzumab Emtansine (T-DM1)Percentage of Activity Impairment Because of Health6 months15 percentage of timeStandard Deviation 21
Trastuzumab Emtansine (T-DM1)Percentage of Activity Impairment Because of HealthBaseline14 percentage of timeStandard Deviation 22
Trastuzumab Emtansine (T-DM1)Percentage of Activity Impairment Because of Health12 months15 percentage of timeStandard Deviation 21
Trastuzumab Emtansine (T-DM1)Percentage of Activity Impairment Because of Health18 months7 percentage of timeStandard Deviation 17
Trastuzumab Emtansine (T-DM1)Percentage of Activity Impairment Because of Health12 weeks13 percentage of timeStandard Deviation 19
Paclitaxel + TrastuzumabPercentage of Activity Impairment Because of Health18 months15 percentage of timeStandard Deviation 27
Paclitaxel + TrastuzumabPercentage of Activity Impairment Because of HealthBaseline22 percentage of timeStandard Deviation 26
Paclitaxel + TrastuzumabPercentage of Activity Impairment Because of Health3 weeks22 percentage of timeStandard Deviation 27
Paclitaxel + TrastuzumabPercentage of Activity Impairment Because of Health12 weeks33 percentage of timeStandard Deviation 31
Paclitaxel + TrastuzumabPercentage of Activity Impairment Because of Health6 months17 percentage of timeStandard Deviation 22
Paclitaxel + TrastuzumabPercentage of Activity Impairment Because of Health12 months14 percentage of timeStandard Deviation 23
Secondary

Percentage of Impairment While Working Because of Health (Mean, SD)

Effects of therapy on work productivity and activity - Impairment While Working because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.

Time frame: Surveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.

ArmMeasureGroupValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Percentage of Impairment While Working Because of Health (Mean, SD)Baseline10 percentage of timeStandard Deviation 18
Trastuzumab Emtansine (T-DM1)Percentage of Impairment While Working Because of Health (Mean, SD)3 weeks9 percentage of timeStandard Deviation 16
Trastuzumab Emtansine (T-DM1)Percentage of Impairment While Working Because of Health (Mean, SD)12 weeks11 percentage of timeStandard Deviation 18
Trastuzumab Emtansine (T-DM1)Percentage of Impairment While Working Because of Health (Mean, SD)6 months9 percentage of timeStandard Deviation 14
Trastuzumab Emtansine (T-DM1)Percentage of Impairment While Working Because of Health (Mean, SD)12 months12 percentage of timeStandard Deviation 20
Trastuzumab Emtansine (T-DM1)Percentage of Impairment While Working Because of Health (Mean, SD)18 months3 percentage of timeStandard Deviation 8
Paclitaxel + TrastuzumabPercentage of Impairment While Working Because of Health (Mean, SD)12 months9 percentage of timeStandard Deviation 18
Paclitaxel + TrastuzumabPercentage of Impairment While Working Because of Health (Mean, SD)Baseline20 percentage of timeStandard Deviation 26
Paclitaxel + TrastuzumabPercentage of Impairment While Working Because of Health (Mean, SD)6 months11 percentage of timeStandard Deviation 19
Paclitaxel + TrastuzumabPercentage of Impairment While Working Because of Health (Mean, SD)3 weeks21 percentage of timeStandard Deviation 25
Paclitaxel + TrastuzumabPercentage of Impairment While Working Because of Health (Mean, SD)18 months8 percentage of timeStandard Deviation 17
Paclitaxel + TrastuzumabPercentage of Impairment While Working Because of Health (Mean, SD)12 weeks21 percentage of timeStandard Deviation 26
Secondary

Percentage of Overall Work Impairment Because of Health

Effects of therapy on work productivity and activity - Work Impairment because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.

Time frame: Surveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.

ArmMeasureGroupValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Percentage of Overall Work Impairment Because of HealthBaseline19 percentage of timeStandard Deviation 26
Trastuzumab Emtansine (T-DM1)Percentage of Overall Work Impairment Because of Health3 weeks14 percentage of timeStandard Deviation 23
Trastuzumab Emtansine (T-DM1)Percentage of Overall Work Impairment Because of Health12 weeks16 percentage of timeStandard Deviation 22
Trastuzumab Emtansine (T-DM1)Percentage of Overall Work Impairment Because of Health6 months13 percentage of timeStandard Deviation 18
Trastuzumab Emtansine (T-DM1)Percentage of Overall Work Impairment Because of Health12 months16 percentage of timeStandard Deviation 24
Trastuzumab Emtansine (T-DM1)Percentage of Overall Work Impairment Because of Health18 months4 percentage of timeStandard Deviation 12
Paclitaxel + TrastuzumabPercentage of Overall Work Impairment Because of Health12 months13 percentage of timeStandard Deviation 22
Paclitaxel + TrastuzumabPercentage of Overall Work Impairment Because of HealthBaseline31 percentage of timeStandard Deviation 31
Paclitaxel + TrastuzumabPercentage of Overall Work Impairment Because of Health6 months14 percentage of timeStandard Deviation 22
Paclitaxel + TrastuzumabPercentage of Overall Work Impairment Because of Health3 weeks30 percentage of timeStandard Deviation 29
Paclitaxel + TrastuzumabPercentage of Overall Work Impairment Because of Health18 months9 percentage of timeStandard Deviation 18
Paclitaxel + TrastuzumabPercentage of Overall Work Impairment Because of Health12 weeks29 percentage of timeStandard Deviation 29
Secondary

Percentage of Patients With Amenorrhea

All grade 3 - 4 adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv4 as reported on case report forms were counted. Incidence is the number of patients experiencing at least one treatment-related grade \>=3 AE of any type during the time of observation. For those who were premenopausal pre-chemotherapy, at each follow-up visit (every six months) in order to assess for duration of amenorrhea and also premature ovarian failure.

Time frame: Surveys are took at month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.

ArmMeasureGroupValue (NUMBER)
Trastuzumab Emtansine (T-DM1)Percentage of Patients With Amenorrhea6 months80 percentage of participants
Trastuzumab Emtansine (T-DM1)Percentage of Patients With Amenorrhea1 year71 percentage of participants
Trastuzumab Emtansine (T-DM1)Percentage of Patients With Amenorrhea18 months64 percentage of participants
Trastuzumab Emtansine (T-DM1)Percentage of Patients With Amenorrhea24 months74 percentage of participants
Trastuzumab Emtansine (T-DM1)Percentage of Patients With Amenorrhea30 months60 percentage of participants
Trastuzumab Emtansine (T-DM1)Percentage of Patients With Amenorrhea36 months45 percentage of participants
Paclitaxel + TrastuzumabPercentage of Patients With Amenorrhea30 months11 percentage of participants
Paclitaxel + TrastuzumabPercentage of Patients With Amenorrhea6 months21 percentage of participants
Paclitaxel + TrastuzumabPercentage of Patients With Amenorrhea24 months15 percentage of participants
Paclitaxel + TrastuzumabPercentage of Patients With Amenorrhea1 year22 percentage of participants
Paclitaxel + TrastuzumabPercentage of Patients With Amenorrhea36 months9 percentage of participants
Paclitaxel + TrastuzumabPercentage of Patients With Amenorrhea18 months20 percentage of participants
Secondary

Percentage of Work Time Missed Because of Health

Effects of therapy on work productivity and activity - work time missed because of health, evaluated using the Work Productivity and Activity Impairment Questionnaire (WPAI-SHP), which defined per protocol.

Time frame: Surveys are took at week 3, 12 and month 6 and 12 during treatment, and month 18, 24, 30 and 36 during follow up.

ArmMeasureGroupValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Percentage of Work Time Missed Because of HealthBaseline22 percentage of timeStandard Deviation 35
Trastuzumab Emtansine (T-DM1)Percentage of Work Time Missed Because of Health3 weeks13 percentage of timeStandard Deviation 28
Trastuzumab Emtansine (T-DM1)Percentage of Work Time Missed Because of Health12 weeks9 percentage of timeStandard Deviation 21
Trastuzumab Emtansine (T-DM1)Percentage of Work Time Missed Because of Health6 months8 percentage of timeStandard Deviation 21
Trastuzumab Emtansine (T-DM1)Percentage of Work Time Missed Because of Health12 months8 percentage of timeStandard Deviation 21
Trastuzumab Emtansine (T-DM1)Percentage of Work Time Missed Because of Health18 months3 percentage of timeStandard Deviation 13
Paclitaxel + TrastuzumabPercentage of Work Time Missed Because of Health12 months8 percentage of timeStandard Deviation 20
Paclitaxel + TrastuzumabPercentage of Work Time Missed Because of HealthBaseline25 percentage of timeStandard Deviation 34
Paclitaxel + TrastuzumabPercentage of Work Time Missed Because of Health6 months7 percentage of timeStandard Deviation 18
Paclitaxel + TrastuzumabPercentage of Work Time Missed Because of Health3 weeks27 percentage of timeStandard Deviation 36
Paclitaxel + TrastuzumabPercentage of Work Time Missed Because of Health18 months4 percentage of timeStandard Deviation 16
Paclitaxel + TrastuzumabPercentage of Work Time Missed Because of Health12 weeks22 percentage of timeStandard Deviation 33
Secondary

Quality of Life (QOL) FACT B Total Score at 18 Months

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at 18 months

Population: not all patients required to complete the QOL

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at 18 Months126.42 score on a scaleStandard Deviation 15.67
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at 18 Months117.93 score on a scaleStandard Deviation 23.55
Secondary

Quality of Life (QOL) FACT B Total Score at 1 Year

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at 1 year

Population: not all patients required to complete the QOL

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at 1 Year123.29 score on a scaleStandard Deviation 16.44
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at 1 Year120.3 score on a scaleStandard Deviation 20.88
Secondary

Quality of Life (QOL) FACT B Total Score at 24 Months

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at 24 months

Population: not all patients required to complete the QOL

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at 24 Months127.19 score on a scaleStandard Deviation 16.16
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at 24 Months121.73 score on a scaleStandard Deviation 22
Secondary

Quality of Life (QOL) FACT B Total Score at 6 Months

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at 6 months

Population: not all patients required to complete the QOL

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at 6 Months123 score on a scaleStandard Deviation 16.71
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at 6 Months118.16 score on a scaleStandard Deviation 21.73
Secondary

Quality of Life (QOL) FACT B Total Score at Baseline

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at baseline

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at Baseline126.25 score on a scaleStandard Deviation 14.29
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at Baseline116.69 score on a scaleStandard Deviation 19.03
Secondary

Quality of Life (QOL) FACT B Total Score at Week 12

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at week 12

Population: not all patients required to complete the QOL

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at Week 12124.36 score on a scaleStandard Deviation 16.3
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at Week 12108.25 score on a scaleStandard Deviation 23.33
Secondary

Quality of Life (QOL) FACT B Total Score at Week 3

The QOL assessments questionnaire should be completed via the tablet provided by the study or on any available computer with an internet connection. The FACT-B questionnaire consists of five subscale, listed below: Physical well being(PWB): range 0-28 Social/Family well being(SWB): range 0-28 Emotional well being(EWB): range 0-24 Functional well being(FWB): range 0-28 Breast cancer subscale(BCS): range 0-40 The total score (FACTB) is calculated by summarizing all the subscales listed above, therefore it ranges from 0 to 148. The higher the score the better the outcome (applies to all sub-scales as well).

Time frame: at week 3

Population: not all patients required to complete the QOL

ArmMeasureValue (MEAN)Dispersion
Trastuzumab Emtansine (T-DM1)Quality of Life (QOL) FACT B Total Score at Week 3127.07 score on a scaleStandard Deviation 14.52
Paclitaxel + TrastuzumabQuality of Life (QOL) FACT B Total Score at Week 3116.6 score on a scaleStandard Deviation 18.9

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