Trastuzumab emtansine for residual invasive HER2-positive breast cancer
Journal
New England Journal of Medicine
Journal Volume
380
Journal Issue
7
Pages
617-628
Date Issued
2019
Author(s)
Von Minckwitz G.
Mano M.S.
Loibl S.
Mamounas E.P.
Untch M.
Wolmark N.
Rastogi P.
Schneeweiss A.
Redondo A.
Fischer H.H.
Jacot W.
Conlin A.K.
Arce-Salinas C.
Wapnir I.L.
Jackisch C.
DiGiovanna M.P.
Fasching P.A.
Crown J.P.
W?lfing P.
Shao Z.
Caremoli E.R.
Wu H.
Lam L.H.
Tesarowski D.
Smitt M.
Douthwaite H.
Singel S.M.
Geyer C.E.
Jr.
Abstract
Patients who have residual invasive breast cancer after receiving neoadjuvant chemotherapy plus human epidermal growth factor receptor 2 (HER2)-targeted therapy have a worse prognosis than those who have no residual cancer. Trastuzumab emtansine (T-DM1), an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine (DM1), a maytansine derivative and microtubule inhibitor, provides benefit in patients with metastatic breast cancer that was previously treated with chemotherapy plus HER2-targeted therapy. METHODS We conducted a phase 3, open-label trial involving patients with HER2-positive early breast cancer who were found to have residual invasive disease in the breast or axilla at surgery after receiving neoadjuvant therapy containing a taxane (with or without anthracycline) and trastuzumab. Patients were randomly assigned to receive adjuvant T-DM1 or trastuzumab for 14 cycles. The primary end point was invasive disease-free survival (defined as freedom from ipsilateral invasive breast tumor recurrence, ipsilateral locoregional invasive breast cancer recurrence, contralateral invasive breast cancer, distant recurrence, or death from any cause). RESULTS At the interim analysis, among 1486 randomly assigned patients (743 in the T-DM1 group and 743 in the trastuzumab group), invasive disease or death had occurred in 91 patients in the T-DM1 group (12.2%) and 165 patients in the trastuzumab group (22.2%). The estimated percentage of patients who were free of invasive disease at 3 years was 88.3% in the T-DM1 group and 77.0% in the trastuzumab group. Invasive disease-free survival was significantly higher in the T-DM1 group than in the trastuzumab group (hazard ratio for invasive disease or death, 0.50; 95% confidence interval, 0.39 to 0.64; P<0.001). Distant recurrence as the first invasive-disease event occurred in 10.5% of patients in the T-DM1 group and 15.9% of those in the trastuzumab group. The safety data were consistent with the known safety profile of T-DM1, with more adverse events associated with T-DM1 than with trastuzumab alone. CONCLUSIONS Among patients with HER2-positive early breast cancer who had residual invasive disease after completion of neoadjuvant therapy, the risk of recurrence of invasive breast cancer or death was 50% lower with adjuvant T-DM1 than with trastuzumab alone. ? 2018 Massachusetts Medical Society.
SDGs
Other Subjects
alanine aminotransferase; aspartate aminotransferase; bilirubin; placebo; trastuzumab emtansine; epidermal growth factor receptor 2; ERBB2 protein, human; immunological antineoplastic agent; maytansine; trastuzumab; trastuzumab emtansine; adult; adverse outcome; aged; alanine aminotransferase blood level; anemia; Article; aspartate aminotransferase blood level; bilirubin blood level; brain hemorrhage; cancer recurrence; cancer survival; controlled study; disease free survival; dose response; drug dose reduction; drug efficacy; drug safety; fatigue; female; heart ejection fraction; human; human epidermal growth factor receptor 2 positive breast cancer; hypertension; hypokalemia; major clinical study; minimal residual disease; multicenter study; multiple cycle treatment; open study; outcome assessment; overall survival; peripheral neuropathy; phase 3 clinical trial; platelet count; priority journal; radiation injury; radiation pneumonia; randomized controlled trial; sensory neuropathy; skin injury; survival analysis; survival rate; adjuvant chemotherapy; analogs and derivatives; breast tumor; cancer staging; chemically induced; clinical trial; comparative study; lymph node metastasis; metabolism; metastasis; middle aged; minimal residual disease; mortality; neoadjuvant therapy; peripheral neuropathy; radiotherapy; treatment outcome; very elderly; young adult; Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Immunological; Breast Neoplasms; Chemotherapy, Adjuvant; Disease-Free Survival; Female; Humans; Lymphatic Metastasis; Maytansine; Middle Aged; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasm Staging; Neoplasm, Residual; Peripheral Nervous System Diseases; Radiotherapy; Receptor, ErbB-2; Trastuzumab; Treatment Outcome; Young Adult
Publisher
Massachussetts Medical Society
Type
journal article