Effects of neratinib on health-related quality of life in women with HER2-positive early-stage breast cancer: longitudinal analyses from the randomized phase III ExteNET trial

BACKGROUND

We report longitudinal health-related quality-of-life (HRQoL) data from the international, randomized, double-blind, placebo-controlled phase III ExteNET study, which demonstrated an invasive disease-free survival benefit of extended adjuvant therapy with neratinib over placebo in human epidermal growth factor receptor-2-positive early-stage breast cancer.

PATIENTS AND METHODS

Women (N  = 2840) with early-stage HER2-positive breast cancer who had completed trastuzumab-based adjuvant therapy were randomly assigned to neratinib 240  mg/day or placebo for 12  months. HRQoL was an exploratory end point. Patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) and EuroQol 5-Dimensions (EQ-5D) questionnaires at baseline and months 1, 3, 6, 9, and 12. Changes from baseline were compared using analysis of covariance with no imputation for missing values. Sensitivity analyses used alternative methods. Changes in HRQoL scores were regarded as clinically meaningful if they exceeded previously reported important differences (IDs).

RESULTS

Of the 2840 patients (intention-to-treat population), 2407 patients were evaluable for FACT-B (neratinib, N  = 1171; placebo, N  = 1236) and 2427 patients for EQ-5D (neratinib, N  = 1186; placebo, N  = 1241). Questionnaire completion rates exceeded 85%. Neratinib was associated with a decrease in global HRQoL scores at month 1 compared with placebo (adjusted mean differences: FACT-B total, -2.9 points; EQ-5D index, -0.02), after which between-group differences diminished at later time-points. Except for the FACT-B physical well-being (PWB) subscale at month 1; all between-group differences were less than reported IDs. The FACT-B breast cancer-specific subscale showed small improvements with neratinib at months 3-9, but all were less than IDs. Sensitivity analyses exploring missing data did not change the results.

CONCLUSIONS

Extended adjuvant neratinib was associated with a transient, reversible decrease in HRQoL during the first month of treatment, possibly linked to treatment-related diarrhea. With the exception of the PWB subscale at month 1, all neratinib-related HRQoL changes did not reach clinically meaningful thresholds. ClinicalTrials.gov: NCT00878709.

Abstract P4-21-17: BELIS: Safety and tolerability of at home administration of trastuzumab (Herceptin®) subcutaneous for the treatment of patients with HER2-positive early breast cancer

Background: Trastuzumab (Herceptin®; H) is a standard component of adjuvant treatment in patients with HER2+ early breast cancer (eBC) and is supported by all major treatment guidelines. The efficacy and safety of Herceptin intravenous (H IV) and Herceptin subcutaneous (H SC) have been shown to be comparable. The main advantage of SC administration is its shorter administration time. Administration at home for selected patients will allow greater independence and may lead to an improved quality of life. In this study, we assessed the safety and tolerability of H SC administered at home by a healthcare professional (HCP) in patients with HER2+ eBC.

Methods: Patients with HER2+ eBC who previously completed 6 cycles of H IV could be included in the study to receive 12 additional cycles of H for a total of 18 cycles. The 12 additional 3-week cycles consisted of 3 cycles of H IV in the hospital (6 mg/kg; cycles 7 to 9; period 1); 3 cycles of H SC in the hospital (600 mg; cycles 10 to 12; period 2); and 6 cycles of H SC administered in the home by a HCP (600 mg; cycles 13 to 18; period 3). Patients are being followed for a total of 24 months after their last treatment. Safety is being assessed from the adverse events (AEs) reported during the study. Patient-reported outcomes were obtained from validated questionnaires for: the satisfaction and quality of the treatments and care, and for symptom severity (0 [absent] to 10 [worst]). HCPs also reported on their experiences with both treatments.

Results: A total of 102 patients were treated in the study between November 2013 and July 2015 and will be followed for safety and efficacy through July 2017. The primary analysis reported here was done after the last 4-week post-treatment follow-up was completed (September 2015). Patient mean age at baseline was 54.4±12.3 (SD) years. A total of 91 (89%) patients reported 549 AEs: 535 (97%) of these were grade 1 or 2 and 194 (35%) were considered treatment related. The proportions of patients with at least one related AE were 7% for H IV period 1, 32% for H SC period 2, and 47% for H SC period 3, which was twice as long as periods 1 or 2. A total of 8 serious AEs were reported in 8 patients (2 each in periods 1 and 2; 4 in period 3). Prior to the first at-home SC administration (cycle 13), 99% of patients were satisfied to a large or very large extent with the IV and SC treatments at the hospital. At cycle 17, 100% of patients were satisfied to a large or very large extent with the SC treatment at home, and 100% of patients thought treatment at home was beneficial to a large or very large extent. In all 3 treatment periods, maximum mean scores were 3.0−3.8 for the most severe symptoms (fatigue, disturbed sleep, and numbness or tingling). All HCPs considered both administration routes to be fairly easy or very easy, and SC administration to be quicker and require fewer preparation resources.

Conclusions: The safety analyses and patient-reported outcomes recorded in this study indicate that H SC administered by a HCP at home instead of at the hospital was not associated with any new safety signals and was considered beneficial by the patients and HCPs.

Citation Format: Cocquyt VF, Martinez-Mena CL, Martens MT, D'Hondt RG, Graas M-PL, Evron E, Fried G, Ben-Baruch NE, Dijkstra AC, Van De Walle EI. BELIS: Safety and tolerability of at home administration of trastuzumab (Herceptin®) subcutaneous for the treatment of patients with HER2-positive early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-17.

Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer

BACKGROUND

Niraparib is an oral poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) 1/2 inhibitor that has shown clinical activity in patients with ovarian cancer. We sought to evaluate the efficacy of niraparib versus placebo as maintenance treatment for patients with platinum-sensitive, recurrent ovarian cancer.

METHODS

In this randomized, double-blind, phase 3 trial, patients were categorized according to the presence or absence of a germline BRCA mutation (gBRCA cohort and non-gBRCA cohort) and the type of non-gBRCA mutation and were randomly assigned in a 2:1 ratio to receive niraparib (300 mg) or placebo once daily. The primary end point was progression-free survival.

RESULTS

Of 553 enrolled patients, 203 were in the gBRCA cohort (with 138 assigned to niraparib and 65 to placebo), and 350 patients were in the non-gBRCA cohort (with 234 assigned to niraparib and 116 to placebo). Patients in the niraparib group had a significantly longer median duration of progression-free survival than did those in the placebo group, including 21.0 vs. 5.5 months in the gBRCA cohort (hazard ratio, 0.27; 95% confidence interval [CI], 0.17 to 0.41), as compared with 12.9 months vs. 3.8 months in the non-gBRCA cohort for patients who had tumors with homologous recombination deficiency (HRD) (hazard ratio, 0.38; 95% CI, 0.24 to 0.59) and 9.3 months vs. 3.9 months in the overall non-gBRCA cohort (hazard ratio, 0.45; 95% CI, 0.34 to 0.61; P<0.001 for all three comparisons). The most common grade 3 or 4 adverse events that were reported in the niraparib group were thrombocytopenia (in 33.8%), anemia (in 25.3%), and neutropenia (in 19.6%), which were managed with dose modifications.

CONCLUSIONS

Among patients with platinum-sensitive, recurrent ovarian cancer, the median duration of progression-free survival was significantly longer among those receiving niraparib than among those receiving placebo, regardless of the presence or absence of gBRCA mutations or HRD status, with moderate bone marrow toxicity. (Funded by Tesaro; ClinicalTrials.gov number, NCT01847274 .).

Abstract P1-02-07: Discordance for low and intermediate levels (1+ or 2+ by IHC) of HER2 protein expression in the phase III PRESENT trial

Background

Significant discordance has been described between different laboratories and between testing methodologies for HER2 overexpression and gene amplification. Concern has focused on missing patients who might benefit from treatment with HER2 targeted therapy. Concordance rates between local and central testing for tumors selected for HER2 0-2+ is not well described. We describe discordance rates between local and central testing performed to identify tumors with 1 and 2+ HER2 expression.

Methods

The PRESENT study is a multicenter, multinational, prospective, randomized, double-blind, controlled Phase 3 study assessing efficacy and safety of the peptide vaccine NeuVax, in HLA-A2 and/or A3 positive patients with early stage, node positive breast cancer expressing low and intermediate levels (1/2+ by IHC) of HER2 protein. PRESENT 2-step screening includes HLA testing followed by central lab confirmation of HER2 1 or 2+ expression using the DAKO HercepTest.

Results

215 patients underwent central IHC testing for HER2. Discordance between local and central testing was seen in 54% (117/215); 34% (65/192) of those eligible by local results were ineligible on central testing, and 48% (11/23) of those not eligible by local results were eligible on central testing.

Local testingCentral testing (IHC (%))IHC (n)01+2+3+0 (15)5 (33%)7 (47%3 (20%)—1+ (127)39 (31%)68 (53%)15 (12%)5 (4%)2+ (65)11 (17%)23 (35%)21 (32%)10 (16%)3+ (8)3 (38%)—1 (12%)4 (50%)

Of those with 1 or 2+ local results, 8% (15/192) were found to be 3+ on central testing. Discordant rates varied by geographic location with higher rates seen in Eastern Europe and Russia.

Conclusion

Significant discordance exists between local and central laboratory test results for HER2 expression by IHC even at lower levels of expression, and current tests are defined by their ability to determine 3+ positivity. In order to improve accuracy of testing and to develop a companion diagnostic for NeuVax, the Leica Bond Oracle HER2 IHC System will be incorporated into future HER2 screening for the PRESENT trial.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-02-07.