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Findings from three trials evaluating chemo plus trastuzumab versus trastuzumab followed by chemo in HER2-positive metastatic breast cancer

Findings from three trials evaluating chemo plus trastuzumab versus trastuzumab followed by chemo in HER2-positive metastatic breast cancer
  HERTAX (n = 101)[1] JO17360 (n = 112)[2] SAKK 22/99 (n = 175)[3]
Treatment schema Tr + Doc (comb)
versus
Tr → Doc (seq)
Tr + Doc (comb)
versus
Tr → Tr + Doc (seq)
Tr + chemo (comb)
versus
Tr → Tr + chemo (seq)
Line of treatment First line First line First, second, or third line
Median first PFS during Tr monotherapy 3.9 mo 3.7 mo 3.7 mo
Median PFS or TTP following both Tr and chemo PFS 9.4 mo (comb)
versus
PFS 9.9 mo (seq)
PFS 14.6 mo (comb)
versus
PFS 12.4 mo (seq)
TTP 10.3 mo (comb)
versus
TTP 12.2 mo (seq)
RECIST RR following both Tr and chemo 58 (comb)
versus
38% (seq)
67.9 (comb)
versus
47.2% (seq)
Not reported
Median OS 30.5 mo (comb)
versus
19.7 mo (seq)
Not reached, but HR 2.72 with p = 0.04 in favor of comb 36.3 mo (comb)
versus
35.6 mo (seq)
Trial caveats Tr was not continued along with docetaxel in the sequential arm Study closed early due to presumption of inferiority of sequential arm at interim analysis Accrual over 13 years; many censored patients due to off protocol endocrine therapy added; study design changed during conduct; chemo regimens not reported
Tr: trastuzumab; Doc: docetaxel; comb: combination; seq: sequential; PFS: progression-free survival; mo: month; TTP: time to tumor progression; RECIST: Response Evaluation Criteria in Solid Tumors; RR: response rate; OS: overall survival; HR: hazard ratio.
References:
  1. Hamberg P, Bos MM, Braun HJ, et al. Randomized phase II study comparing efficacy and safety of combination-therapy trastuzumab and docetaxel vs. sequential therapy of trastuzumab followed by docetaxel alone at progression as first-line chemotherapy in patients with HER2+ metastatic breast cancer: HERTAX trial. Clin Breast Cancer 2011; 11:103.
  2. Inoue K, Nakagami K, Mizutani M, et al. Randomized phase III trial of trastuzumab monotherapy followed by trastuzumab plus docetaxel versus trastuzumab plus docetaxel as first-line therapy in patients with HER2-positive metastatic breast cancer: the JO17360 Trial Group. Breast Cancer Res Treat 2010; 119:127.
  3. Pagani O, Klingbiel D, Ruhstaller T, et al. Do all patients with advanced HER2 positive breast cancer need upfront-chemo when receiving trastuzumab? Randomized phase III trial SAKK 22/99. Ann Oncol 2017; 28:305.
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