Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer.
Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal, Humanized
/ administration & dosage
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Breast Neoplasms
/ drug therapy
Camptothecin
/ administration & dosage
Consolidation Chemotherapy
Female
Humans
Immunoconjugates
/ administration & dosage
Intention to Treat Analysis
Kaplan-Meier Estimate
Lung Diseases, Interstitial
/ chemically induced
Middle Aged
Progression-Free Survival
Receptor, ErbB-2
/ analysis
Trastuzumab
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
13 02 2020
13 02 2020
Historique:
pubmed:
12
12
2019
medline:
3
3
2020
entrez:
12
12
2019
Statut:
ppublish
Résumé
Trastuzumab deruxtecan (DS-8201) is an antibody-drug conjugate composed of an anti-HER2 (human epidermal growth factor receptor 2) antibody, a cleavable tetrapeptide-based linker, and a cytotoxic topoisomerase I inhibitor. In a phase 1 dose-finding study, a majority of the patients with advanced HER2-positive breast cancer had a response to trastuzumab deruxtecan (median response duration, 20.7 months). The efficacy of trastuzumab deruxtecan in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab emtansine requires confirmation. In this two-part, open-label, single-group, multicenter, phase 2 study, we evaluated trastuzumab deruxtecan in adults with pathologically documented HER2-positive metastatic breast cancer who had received previous treatment with trastuzumab emtansine. In the first part of the study, we evaluated three different doses of trastuzumab deruxtecan to establish a recommended dose; in the second part, we evaluated the efficacy and safety of the recommended dose. The primary end point was the objective response, according to independent central review. Key secondary end points were the disease-control rate, clinical-benefit rate, duration of response and progression-free survival, and safety. Overall, 184 patients who had undergone a median of six previous treatments received the recommended dose of trastuzumab deruxtecan (5.4 mg per kilogram of body weight). In the intention-to-treat analysis, a response to therapy was reported in 112 patients (60.9%; 95% confidence interval [CI], 53.4 to 68.0). The median duration of follow-up was 11.1 months (range, 0.7 to 19.9). The median response duration was 14.8 months (95% CI, 13.8 to 16.9), and the median duration of progression-free survival was 16.4 months (95% CI, 12.7 to not reached). During the study, the most common adverse events of grade 3 or higher were a decreased neutrophil count (in 20.7% of the patients), anemia (in 8.7%), and nausea (in 7.6%). On independent adjudication, the trial drug was associated with interstitial lung disease in 13.6% of the patients (grade 1 or 2, 10.9%; grade 3 or 4, 0.5%; and grade 5, 2.2%). Trastuzumab deruxtecan showed durable antitumor activity in a pretreated patient population with HER2-positive metastatic breast cancer. In addition to nausea and myelosuppression, interstitial lung disease was observed in a subgroup of patients and requires attention to pulmonary symptoms and careful monitoring. (Funded by Daiichi Sankyo and AstraZeneca; DESTINY-Breast01 ClinicalTrials.gov number, NCT03248492.).
Sections du résumé
BACKGROUND
Trastuzumab deruxtecan (DS-8201) is an antibody-drug conjugate composed of an anti-HER2 (human epidermal growth factor receptor 2) antibody, a cleavable tetrapeptide-based linker, and a cytotoxic topoisomerase I inhibitor. In a phase 1 dose-finding study, a majority of the patients with advanced HER2-positive breast cancer had a response to trastuzumab deruxtecan (median response duration, 20.7 months). The efficacy of trastuzumab deruxtecan in patients with HER2-positive metastatic breast cancer previously treated with trastuzumab emtansine requires confirmation.
METHODS
In this two-part, open-label, single-group, multicenter, phase 2 study, we evaluated trastuzumab deruxtecan in adults with pathologically documented HER2-positive metastatic breast cancer who had received previous treatment with trastuzumab emtansine. In the first part of the study, we evaluated three different doses of trastuzumab deruxtecan to establish a recommended dose; in the second part, we evaluated the efficacy and safety of the recommended dose. The primary end point was the objective response, according to independent central review. Key secondary end points were the disease-control rate, clinical-benefit rate, duration of response and progression-free survival, and safety.
RESULTS
Overall, 184 patients who had undergone a median of six previous treatments received the recommended dose of trastuzumab deruxtecan (5.4 mg per kilogram of body weight). In the intention-to-treat analysis, a response to therapy was reported in 112 patients (60.9%; 95% confidence interval [CI], 53.4 to 68.0). The median duration of follow-up was 11.1 months (range, 0.7 to 19.9). The median response duration was 14.8 months (95% CI, 13.8 to 16.9), and the median duration of progression-free survival was 16.4 months (95% CI, 12.7 to not reached). During the study, the most common adverse events of grade 3 or higher were a decreased neutrophil count (in 20.7% of the patients), anemia (in 8.7%), and nausea (in 7.6%). On independent adjudication, the trial drug was associated with interstitial lung disease in 13.6% of the patients (grade 1 or 2, 10.9%; grade 3 or 4, 0.5%; and grade 5, 2.2%).
CONCLUSIONS
Trastuzumab deruxtecan showed durable antitumor activity in a pretreated patient population with HER2-positive metastatic breast cancer. In addition to nausea and myelosuppression, interstitial lung disease was observed in a subgroup of patients and requires attention to pulmonary symptoms and careful monitoring. (Funded by Daiichi Sankyo and AstraZeneca; DESTINY-Breast01 ClinicalTrials.gov number, NCT03248492.).
Identifiants
pubmed: 31825192
doi: 10.1056/NEJMoa1914510
pmc: PMC7458671
mid: NIHMS1619757
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Immunoconjugates
0
trastuzumab deruxtecan
5384HK7574
ERBB2 protein, human
EC 2.7.10.1
Receptor, ErbB-2
EC 2.7.10.1
Trastuzumab
P188ANX8CK
Camptothecin
XT3Z54Z28A
Banques de données
ClinicalTrials.gov
['NCT03248492']
Types de publication
Clinical Trial, Phase II
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
610-621Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Investigateurs
Hans Wildiers
(H)
Jean-Luc Canon
(JL)
Guy Jerusalem
(G)
Wim W Wynendaele
(WW)
Jill Wagemans
(J)
Luis Teixeira
(L)
William Jacot
(W)
Marjorie Baciuchka-Palmaro
(M)
You Benoit
(Y)
Fabrice Andre
(F)
Christophe Perrin
(C)
Claire Jamet
(C)
Elsa Curtit
(E)
Julien Grenier
(J)
Marina Cazzaniga
(M)
Luca Gianni
(L)
Giuseppe Curigliano
(G)
Giulia Bianchi
(G)
Toru Mukohara
(T)
Kenji Tamura
(K)
Yoshinori Ito
(Y)
Hiroji Iwata
(H)
Tsutomu Iwasa
(T)
Yasuaki Sagara
(Y)
Toshimi Takano
(T)
Toshinari Yamashita
(T)
Kenjiro Aogi
(K)
Eriko Tokunaga
(E)
Naoki Hayashi
(N)
Seock-Ah Im
(SA)
Yeon Hee Park
(YH)
Jee Hyun Kim
(JH)
Sung-Bae Kim
(SB)
Joo Hyuk Sohn
(JH)
Keun Seok Lee
(KS)
Kyong Hwa Park
(KH)
Yee Soo Chae
(YS)
Manuel Ruiz-Borrego
(M)
Xavier Gonzalez Farre
(X)
Ignacio Delgado Mingorance
(I)
Jose Manuel Perez Garcia
(JM)
Cristina Saura
(C)
Maria Fernandez Abad
(M)
Silvia Vazquez
(S)
Joaquin Gavila Gregori
(J)
Srinivisan Madhusudan
(S)
Timothy Crook
(T)
Peter Schmid
(P)
Peter Hall
(P)
Rebecca Roylance
(R)
Grace Wang
(G)
Ian Krop
(I)
Reshma Mahtani
(R)
Shanu Modi
(S)
Haeseong Park
(H)
Jane Raymond
(J)
Charles Redfern
(C)
Rashmi Murthy
(R)
Omkar Marathe
(O)
Musaberk Goksel
(M)
Amir Abdul Rasheed
(AA)
Haythem Yousif Ali
(H)
David Chu
(D)
Jami Fukui
(J)
Adam Brufsky
(A)
Mahmoud Charif
(M)
Julie Taguchi
(J)
Donald Richards
(D)
Rachel Swart
(R)
Cynthia Osborne
(C)
Stephen Dyar
(S)
Sara Hurvitz
(S)
Vasileios Assikis
(V)
Hope Rugo
(H)
Neelima Denduluri
(N)
Marc Matrana
(M)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Massachusetts Medical Society.
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