Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): A randomised, open-label, multicentre, phase 3 trial

José Baselga, Ian Bradbury, Holger Eidtmann, Serena Di Cosimo, Evandro De Azambuja, Claudia Aura, Henry Gómez, Phuong Dinh, Karine Fauria, Veerle Van Dooren, Gursel Aktan, Aron Goldhirsch, Tsai Wang Chang, Z. Horváth, Maria Coccia-Portugal, Julien Domont, Ling Min Tseng, Georg Kunz, Joo Hyuk Sohn, Vladimir SemiglazovGuillermo Lerzo, Marketa Palacova, Volodymyr Probachai, Lajos Pusztai, Michael Untch, Richard D. Gelber, Martine Piccart-Gebhart

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Abstract

Background: The anti-HER2 monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib have complementary mechanisms of action and synergistic antitumour activity in models of HER2-overexpressing breast cancer. We argue that the two anti-HER2 agents given together would be better than single-agent therapy. Methods: In this parallel groups, randomised, open-label, phase 3 study undertaken between Jan 5, 2008, and May 27, 2010, women from 23 countries with HER2-positive primary breast cancer with tumours greater than 2 cm in diameter were randomly assigned to oral lapatinib (1500 mg), intravenous trastuzumab (loading dose 4 mg/m 2, subsequent doses 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab. Treatment allocation was by stratified, permuted blocks randomisation, with four stratification factors. Anti-HER2 therapy alone was given for the first 6 weeks; weekly paclitaxel (80 mg/m 2) was then added to the regimen for a further 12 weeks, before definitive surgery was undertaken. After surgery, patients received adjuvant chemotherapy followed by the same targeted therapy as in the neoadjuvant phase to 52 weeks. The primary endpoint was the rate of pathological complete response (pCR), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00553358. Findings: 154 patients received lapatinib, 149 trastuzumab, and 152 the combination. pCR rate was significantly higher in the group given lapatinib and trastuzumab (78 of 152 patients [51·3; 95 CI 43·1-59·5]) than in the group given trastuzumab alone (44 of 149 patients [29·5; 22·4-37·5]; difference 21·1, 9·1-34·2, p=0·0001). We recorded no significant difference in pCR between the lapatinib (38 of 154 patients [24·7, 18·1-32·3]) and the trastuzumab (difference -4·8, -17·6 to 8·2, p=0·34) groups. No major cardiac dysfunctions occurred. Frequency of grade 3 diarrhoea was higher with lapatinib (36 patients [23·4]) and lapatinib plus trastuzumab (32 [21·1]) than with trastuzumab (three [2·0]). Similarly, grade 3 liver-enzyme alterations were more frequent with lapatinib (27 [17·5]) and lapatinib plus trastuzumab (15 [9·9]) than with trastuzumab (11 [7·4]). Interpretation: Dual inhibition of HER2 might be a valid approach to treatment of HER2-positive breast cancer in the neoadjuvant setting. Funding: GlaxoSmithKline.

Original languageEnglish
Pages (from-to)633-640
Number of pages8
JournalThe Lancet
Volume379
Issue number9816
DOIs
Publication statusPublished - Feb 2012

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Breast Neoplasms
lapatinib
Trastuzumab
Therapeutics
Adjuvant Chemotherapy
Random Allocation
Paclitaxel
Protein-Tyrosine Kinases
Diarrhea
Monoclonal Antibodies
Liver
Enzymes
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Baselga, J., Bradbury, I., Eidtmann, H., Di Cosimo, S., De Azambuja, E., Aura, C., ... Piccart-Gebhart, M. (2012). Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): A randomised, open-label, multicentre, phase 3 trial. The Lancet, 379(9816), 633-640. https://doi.org/10.1016/S0140-6736(11)61847-3

Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO) : A randomised, open-label, multicentre, phase 3 trial. / Baselga, José; Bradbury, Ian; Eidtmann, Holger; Di Cosimo, Serena; De Azambuja, Evandro; Aura, Claudia; Gómez, Henry; Dinh, Phuong; Fauria, Karine; Van Dooren, Veerle; Aktan, Gursel; Goldhirsch, Aron; Chang, Tsai Wang; Horváth, Z.; Coccia-Portugal, Maria; Domont, Julien; Tseng, Ling Min; Kunz, Georg; Sohn, Joo Hyuk; Semiglazov, Vladimir; Lerzo, Guillermo; Palacova, Marketa; Probachai, Volodymyr; Pusztai, Lajos; Untch, Michael; Gelber, Richard D.; Piccart-Gebhart, Martine.

In: The Lancet, Vol. 379, No. 9816, 02.2012, p. 633-640.

Research output: Contribution to journalArticle

Baselga, J, Bradbury, I, Eidtmann, H, Di Cosimo, S, De Azambuja, E, Aura, C, Gómez, H, Dinh, P, Fauria, K, Van Dooren, V, Aktan, G, Goldhirsch, A, Chang, TW, Horváth, Z, Coccia-Portugal, M, Domont, J, Tseng, LM, Kunz, G, Sohn, JH, Semiglazov, V, Lerzo, G, Palacova, M, Probachai, V, Pusztai, L, Untch, M, Gelber, RD & Piccart-Gebhart, M 2012, 'Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): A randomised, open-label, multicentre, phase 3 trial', The Lancet, vol. 379, no. 9816, pp. 633-640. https://doi.org/10.1016/S0140-6736(11)61847-3
Baselga, José ; Bradbury, Ian ; Eidtmann, Holger ; Di Cosimo, Serena ; De Azambuja, Evandro ; Aura, Claudia ; Gómez, Henry ; Dinh, Phuong ; Fauria, Karine ; Van Dooren, Veerle ; Aktan, Gursel ; Goldhirsch, Aron ; Chang, Tsai Wang ; Horváth, Z. ; Coccia-Portugal, Maria ; Domont, Julien ; Tseng, Ling Min ; Kunz, Georg ; Sohn, Joo Hyuk ; Semiglazov, Vladimir ; Lerzo, Guillermo ; Palacova, Marketa ; Probachai, Volodymyr ; Pusztai, Lajos ; Untch, Michael ; Gelber, Richard D. ; Piccart-Gebhart, Martine. / Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO) : A randomised, open-label, multicentre, phase 3 trial. In: The Lancet. 2012 ; Vol. 379, No. 9816. pp. 633-640.
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TY - JOUR

T1 - Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO)

T2 - A randomised, open-label, multicentre, phase 3 trial

AU - Baselga, José

AU - Bradbury, Ian

AU - Eidtmann, Holger

AU - Di Cosimo, Serena

AU - De Azambuja, Evandro

AU - Aura, Claudia

AU - Gómez, Henry

AU - Dinh, Phuong

AU - Fauria, Karine

AU - Van Dooren, Veerle

AU - Aktan, Gursel

AU - Goldhirsch, Aron

AU - Chang, Tsai Wang

AU - Horváth, Z.

AU - Coccia-Portugal, Maria

AU - Domont, Julien

AU - Tseng, Ling Min

AU - Kunz, Georg

AU - Sohn, Joo Hyuk

AU - Semiglazov, Vladimir

AU - Lerzo, Guillermo

AU - Palacova, Marketa

AU - Probachai, Volodymyr

AU - Pusztai, Lajos

AU - Untch, Michael

AU - Gelber, Richard D.

AU - Piccart-Gebhart, Martine

PY - 2012/2

Y1 - 2012/2

N2 - Background: The anti-HER2 monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib have complementary mechanisms of action and synergistic antitumour activity in models of HER2-overexpressing breast cancer. We argue that the two anti-HER2 agents given together would be better than single-agent therapy. Methods: In this parallel groups, randomised, open-label, phase 3 study undertaken between Jan 5, 2008, and May 27, 2010, women from 23 countries with HER2-positive primary breast cancer with tumours greater than 2 cm in diameter were randomly assigned to oral lapatinib (1500 mg), intravenous trastuzumab (loading dose 4 mg/m 2, subsequent doses 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab. Treatment allocation was by stratified, permuted blocks randomisation, with four stratification factors. Anti-HER2 therapy alone was given for the first 6 weeks; weekly paclitaxel (80 mg/m 2) was then added to the regimen for a further 12 weeks, before definitive surgery was undertaken. After surgery, patients received adjuvant chemotherapy followed by the same targeted therapy as in the neoadjuvant phase to 52 weeks. The primary endpoint was the rate of pathological complete response (pCR), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00553358. Findings: 154 patients received lapatinib, 149 trastuzumab, and 152 the combination. pCR rate was significantly higher in the group given lapatinib and trastuzumab (78 of 152 patients [51·3; 95 CI 43·1-59·5]) than in the group given trastuzumab alone (44 of 149 patients [29·5; 22·4-37·5]; difference 21·1, 9·1-34·2, p=0·0001). We recorded no significant difference in pCR between the lapatinib (38 of 154 patients [24·7, 18·1-32·3]) and the trastuzumab (difference -4·8, -17·6 to 8·2, p=0·34) groups. No major cardiac dysfunctions occurred. Frequency of grade 3 diarrhoea was higher with lapatinib (36 patients [23·4]) and lapatinib plus trastuzumab (32 [21·1]) than with trastuzumab (three [2·0]). Similarly, grade 3 liver-enzyme alterations were more frequent with lapatinib (27 [17·5]) and lapatinib plus trastuzumab (15 [9·9]) than with trastuzumab (11 [7·4]). Interpretation: Dual inhibition of HER2 might be a valid approach to treatment of HER2-positive breast cancer in the neoadjuvant setting. Funding: GlaxoSmithKline.

AB - Background: The anti-HER2 monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib have complementary mechanisms of action and synergistic antitumour activity in models of HER2-overexpressing breast cancer. We argue that the two anti-HER2 agents given together would be better than single-agent therapy. Methods: In this parallel groups, randomised, open-label, phase 3 study undertaken between Jan 5, 2008, and May 27, 2010, women from 23 countries with HER2-positive primary breast cancer with tumours greater than 2 cm in diameter were randomly assigned to oral lapatinib (1500 mg), intravenous trastuzumab (loading dose 4 mg/m 2, subsequent doses 2 mg/kg), or lapatinib (1000 mg) plus trastuzumab. Treatment allocation was by stratified, permuted blocks randomisation, with four stratification factors. Anti-HER2 therapy alone was given for the first 6 weeks; weekly paclitaxel (80 mg/m 2) was then added to the regimen for a further 12 weeks, before definitive surgery was undertaken. After surgery, patients received adjuvant chemotherapy followed by the same targeted therapy as in the neoadjuvant phase to 52 weeks. The primary endpoint was the rate of pathological complete response (pCR), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00553358. Findings: 154 patients received lapatinib, 149 trastuzumab, and 152 the combination. pCR rate was significantly higher in the group given lapatinib and trastuzumab (78 of 152 patients [51·3; 95 CI 43·1-59·5]) than in the group given trastuzumab alone (44 of 149 patients [29·5; 22·4-37·5]; difference 21·1, 9·1-34·2, p=0·0001). We recorded no significant difference in pCR between the lapatinib (38 of 154 patients [24·7, 18·1-32·3]) and the trastuzumab (difference -4·8, -17·6 to 8·2, p=0·34) groups. No major cardiac dysfunctions occurred. Frequency of grade 3 diarrhoea was higher with lapatinib (36 patients [23·4]) and lapatinib plus trastuzumab (32 [21·1]) than with trastuzumab (three [2·0]). Similarly, grade 3 liver-enzyme alterations were more frequent with lapatinib (27 [17·5]) and lapatinib plus trastuzumab (15 [9·9]) than with trastuzumab (11 [7·4]). Interpretation: Dual inhibition of HER2 might be a valid approach to treatment of HER2-positive breast cancer in the neoadjuvant setting. Funding: GlaxoSmithKline.

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