S Delaloge1, D Cella2, Y Ye3, M Buyse4, A Chan5, C H Barrios6, F A Holmes7, J Mansi8, H Iwata9, B Ejlertsen10, B Moy11, S K L Chia12, M Gnant13, S Smichkoska14, A Ciceniene15, N Martinez16, S Filipović17, N E Ben-Baruch18, A A Joy19, S T Langkjer20, F Senecal21, R H de Boer22, S Moran3, B Yao3, R Bryce3, A Auerbach3, L Fallowfield23, M Martin24. 1. Department of Medicine, Institut Gustave Roussy, Villejuif, France. Electronic address: suzette.delaloge@gustaveroussy.fr. 2. Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago. 3. Puma Biotechnology Inc, Los Angeles, USA. 4. International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium. 5. Breast Cancer Research Centre-WA & Curtin University, Perth, Australia. 6. Oncology Research Unit, Pontifical Catholic University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil. 7. Texas Oncology, P.A, Houston, USA. 8. Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, UK. 9. Department of Breast Oncology, Aichi Cancer Center, Chikusa-ku, Nagoya, Japan. 10. Department of Oncology, Rigshospitalet, Copenhagen, Denmark. 11. Department of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, USA. 12. Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada. 13. Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria. 14. University Clinic for Radiotherapy and Oncology, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia. 15. Oncology Institute of Vilnius University, Vilnius, Lithuania. 16. Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 17. Clinic of Oncology, Clinical Center Niš, Nis, Serbia. 18. Department of Oncology, Kaplan Medical Center, Rehovot, Israel. 19. Cross Cancer Institute, Edmonton, Canada. 20. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. 21. Northwest Medical Specialties PLLC, Tacoma, USA. 22. Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia. 23. Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK. 24. Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain.
Abstract
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.
RCT Entities:
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 humanepidermal 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.
Authors: Helena Harder; Valerie M Shilling; Shirley F May; David Cella; Peter Schmid; Lesley J Fallowfield Journal: Breast Cancer Res Treat Date: 2020-07-27 Impact factor: 4.872