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Harbeck N, Wrobel D, Zaiss M, Terhaag J, Guth D, Distelrath A, Zahn MO, Wuerstlein R, Lorenz A, Bartsch R, Breitenstein U, Schwitter M, Balic M, Jackisch C, Müller V, Rinnerthaler G, Schmidt M, Zaman K, Schinköthe T, Resch A, Valenti R, Lüftner D. Neratinib as Extended Adjuvant Treatment of HER2-Positive/HR-Positive Early Breast Cancer Patients in Germany, Austria, and Switzerland: Interim Results of the Prospective, Observational ELEANOR Study. Breast Care (Basel) 2024; 19:1-9. [PMID: 38384488 PMCID: PMC10878708 DOI: 10.1159/000533657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/15/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Prognosis of patients diagnosed with HER2+ early breast cancer (eBC) has substantially improved, but distant recurrences impacting quality of life and survival still occur. One treatment option for extended adjuvant treatment of patients with HER2+/HR+ eBC is neratinib, available in Europe for patients who completed adjuvant trastuzumab-based therapy within 1 year. The ELEANOR study is investigating the real-world use of neratinib in Germany, Austria, and Switzerland. Results from an interim analysis of the first 200 patients observed for ≥3 months are reported. Methods The primary objective of this prospective, multicenter, observational study is to assess patient adherence to neratinib (defined as the percentage of patients taking neratinib on ≥75% prescribed days). Secondary objectives are patient characteristics and treatment outcomes. Results At cut-off (May 2, 2022), a total of 202 patients had been observed for ≥3 months, with neratinib treatment documented for 187 patients (median age: 53.0 years; 67.9% at increased risk of disease recurrence). In total, 151 (80.7%) patients had received prior neoadjuvant treatment; of these, 82 (54.3%) patients achieved a pathologically complete response. Neratinib was initiated at a median 3.6 months after trastuzumab-based treatment, with 36.4% starting at a dose <240 mg/day. Treatment is ongoing for 46.0% of patients, with median treatment duration of 11.2 (interquartile range 0.9-12.0) months. Diarrhea was the most common adverse event (78.6% any grade, 20.3% grade ≥3); pharmacologic prophylaxis was used in 85.6% of patients. Conclusions The pattern of anti-HER2 pretreatment observed reflected the current treatment for HER2+/HR+ eBC in Germany, Austria, and Switzerland. These interim results suggest that neratinib as an extended adjuvant is a feasible option after various anti-HER2 pretreatments and that its tolerability can be managed and improved with proactive diarrhea management.
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Affiliation(s)
- Nadia Harbeck
- Department of Obstetrics and Gynecology and CCC Munich, Breast Center, LMU University Hospital, Munich, Germany
| | - Denise Wrobel
- Sozialstiftung Bamberg Klinikum am Bruderwald, Bamberg, Germany
| | - Matthias Zaiss
- Praxis fuer Interdisziplinaere Onkologie, Freiburg, Germany
| | | | - Dagmar Guth
- Gyneco-Oncological Practice Dr. Guth, Plauen, Germany
| | | | | | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology and CCC Munich, Breast Center, LMU University Hospital, Munich, Germany
| | - Andreas Lorenz
- Gyneco-Oncological Practice Dr. Lorenz, Hildburghausen, Germany
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | | | - Marija Balic
- Divison of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Klinikum Offenbach, Offenbach, Germany
| | - Volkmar Müller
- Department of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Marcus Schmidt
- Department of Gynecology, University Hospital Mainz, Mainz, Germany
| | - Khalil Zaman
- Breast Center, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | | | - Anna Resch
- Pierre Fabre Pharma GmbH, Freiburg, Germany
| | | | - Diana Lüftner
- Immanuel Hospital Märkische Schweiz & Medical University of Brandenburg Theodor-Fontane, Brandenburg, Germany
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Lüftner D, Tesch H, Schmidt M, Hartkopf AD, Streicher S, Resch A, Genovese L, Rosé C, Valenti R, Harbeck N. Neratinib as extended adjuvant therapy in patients with copositive early breast cancer: German health technology assessment-driven analyses from the ExteNET study. Eur J Cancer 2021; 150:268-277. [PMID: 33971386 DOI: 10.1016/j.ejca.2021.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neratinib is approved in the European Union for extended adjuvant treatment of human epidermal growth factor receptor 2-positive/hormone receptor-positive (copositive) early breast cancer ≤1 year of completion of prior trastuzumab-based therapy. Here, we report analyses of the hormone receptor-positive subgroup (N = 1631) from the ExteNET trial performed for the German health technology assessment (HTA). RESULTS With 2 years of median follow-up, HTA analyses revealed a significant advantage in disease-free survival (DFS) for neratinib vs. placebo (absolute/relative risk reduction: 4.1/48.2%; hazard ratio [HR] [95% confidence interval {CI}]: 0.45 [0.29; 0.69]; p = 0.0002), consistent with distant DFS (absolute/relative risk reduction: 3.1/46.3%; HR [95% CI]: 0.52 [0.32; 0.84]; p = 0.0082). The 5-year follow-up confirmed this outcome.Quality of life analyses did not show clinically relevant differences over all time points. Only at month 1, the Functional Assessment of Cancer Therapy - General total score revealed a statistically relevant difference to the disadvantage of neratinib classified as clinically relevant. The tolerability profile of neratinib was dominated by gastrointestinal events, mainly diarrhoea (all grades: 94.4%; grade III: 39.4%; no systematic antidiarrhoeal prophylaxis), nausea (all grades/grade III: 43.9/1.6%), vomiting (26.6/3.2%), abdominal pain (23.8/1.9%), fatigue (28.1/1.9%) and rash (14.3/0.4%). No cumulative or irreversible toxicities were observed. As shown in the CONTROL study and instituted via a risk management plan, diarrhoea management can reduce frequency, cumulative duration and severity of diarrhoea. CONCLUSION Extended adjuvant neratinib provides a clinically relevant benefit with further incremental reduction of relapse risk in the curative setting. Accordingly, the German HTA authority has granted an added benefit for this new treatment option.
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Affiliation(s)
- Diana Lüftner
- University Hospital Charité, Dept. Hematology, Oncology, Tumor Immunology, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Hans Tesch
- Center for Hematology and Oncology Bethanien, Im Prüfling 17-19, Frankfurt/Main, 60389, Germany.
| | - Marcus Schmidt
- University Medical Center Mainz, Dept. Gynecology, Langenbeckstr. 1, Mainz, 55131, Germany.
| | - Andreas D Hartkopf
- University Hospital Tübingen, Dept. Women's Health, Calwerstr. 7, Tübingen, 72076, Germany.
| | - Sarah Streicher
- AMS Advanced Medical Services GmbH, Rosa-Bavarese-Str. 5, München, 80639, Germany.
| | - Anna Resch
- Pierre Fabre Pharma GmbH, Jechtinger Str. 13, Freiburg, 79111, Germany.
| | - Luca Genovese
- Pierre Fabre Pharma GmbH, Jechtinger Str. 13, Freiburg, 79111, Germany.
| | - Christian Rosé
- Pierre Fabre Pharma GmbH, Jechtinger Str. 13, Freiburg, 79111, Germany.
| | - Roberta Valenti
- Pierre Fabre Médicament, 45 Place Abel Gance, Boulogne-Billancourt, 92100, France.
| | - Nadia Harbeck
- LMU University Hospital, Breast Center, Dept. OB&GYN, Marchioninistr. 15, Munich, 81377, Germany.
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