Show simple item record

dc.contributor.authorEarl, H
dc.contributor.authorHiller, L
dc.contributor.authorVallier, A-L
dc.contributor.authorLoi, S
dc.contributor.authorMcAdam, K
dc.contributor.authorHughes-Davies, L
dc.contributor.authorRea, D
dc.contributor.authorHowe, D
dc.contributor.authorRaynes, K
dc.contributor.authorHiggins, HB
dc.contributor.authorWilcox, M
dc.contributor.authorPlummer, C
dc.contributor.authorMahler-Araujo, B
dc.contributor.authorProvenzano, E
dc.contributor.authorChhabra, A
dc.contributor.authorGasson, S
dc.contributor.authorBalmer, C
dc.contributor.authorAbraham, JE
dc.contributor.authorCaldas, C
dc.contributor.authorHall, P
dc.contributor.authorShinkins, B
dc.contributor.authorMcCabe, C
dc.contributor.authorHulme, C
dc.contributor.authorMiles, D
dc.contributor.authorWardley, AM
dc.contributor.authorCameron, DA
dc.contributor.authorDunn, JA
dc.date.accessioned2020-09-11T10:22:34Z
dc.date.issued2020-09-02
dc.description.abstractBackground The addition of adjuvant trastuzumab to chemotherapy has significantly improved outcomes for people with human epidermal growth factor receptor 2 (HER2)-positive, early, potentially curable breast cancer. Twelve months’ trastuzumab, tested in registration trials, was adopted as standard adjuvant treatment in 2006. Subsequently, similar outcomes were demonstrated using 9 weeks of trastuzumab. Shorter durations were therefore tested for non-inferiority. Objectives To establish whether or not 6 months’ adjuvant trastuzumab is non-inferior to 12 months’ in the treatment of HER2-positive early breast cancer using a primary end point of 4-year disease-free survival. Design This was a Phase III randomised controlled non-inferiority trial. Setting The setting was 152 NHS hospitals. Participants A total of 4088 patients with HER2-positive early breast cancer who it was planned would receive both chemotherapy and trastuzumab took part. Intervention Randomisation (1 : 1) to 6 months’ or 12 months’ trastuzumab treatment. Main outcomes The primary end point was disease-free survival. The secondary end points were overall survival, cost-effectiveness and cardiac function during treatment with trastuzumab. Assuming a 4-year disease-free survival rate of 80% with 12 months’ trastuzumab, 4000 patients were required to demonstrate non-inferiority of 6 months’ trastuzumab (5% one-sided significance, 85% power), defining the non-inferiority limit as no worse than 3% below the standard arm. Costs and quality-adjusted life-years were estimated using a within-trial analysis and a lifetime decision-analytic model. Results Between 4 October 2007 and 31 July 2015, 2045 patients were randomised to 12 months’ trastuzumab and 2043 were randomised to 6 months’ trastuzumab. Sixty-nine per cent of patients had ER-positive disease; 90% received anthracyclines (49% with taxanes; 41% without taxanes); 10% received taxanes without anthracyclines; 54% received trastuzumab sequentially after chemotherapy; and 85% received adjuvant chemotherapy (58% were node negative). At 6.1 years’ median follow-up, with 389 (10%) deaths and 566 (14%) disease-free survival events, the 4-year disease-free survival rates for the 4088 patients were 89.5% (95% confidence interval 88.1% to 90.8%) in the 6-month group and 90.3% (95% confidence interval 88.9% to 91.5%) in the 12-month group (hazard ratio 1.10, 90% confidence interval 0.96 to 1.26; non-inferiority p = 0.01), demonstrating non-inferiority of 6 months’ trastuzumab. Congruent results were found for overall survival (non-inferiority p = 0.0003) and landmark analyses 6 months from starting trastuzumab [non-inferiority p = 0.03 (disease-free-survival) and p = 0.006 (overall survival)]. Six months’ trastuzumab resulted in fewer patients reporting adverse events of severe grade [365/1929 (19%) vs. 460/1935 (24%) for 12-month patients; p = 0.0003] or stopping early because of cardiotoxicity [61/1977 (3%) vs. 146/1941 (8%) for 12-month patients; p < 0.0001]. Health economic analysis showed that 6 months’ trastuzumab resulted in significantly lower lifetime costs than and similar lifetime quality-adjusted life-years to 12 months’ trastuzumab, and thus there is a high probability that 6 months’ trastuzumab is cost-effective compared with 12 months’ trastuzumab. Patient-reported experiences in the trial highlighted fatigue and aches and pains most frequently. Limitations The type of chemotherapy and timing of trastuzumab changed during the recruitment phase of the study as standard practice altered. Conclusions PERSEPHONE demonstrated that, in the treatment of HER2-positive early breast cancer, 6 months’ adjuvant trastuzumab is non-inferior to 12 months’. Six months’ treatment resulted in significantly less cardiac toxicity and fewer severe adverse events. Future work Ongoing translational work investigates patient and tumour genetic determinants of toxicity, and trastuzumab efficacy. An individual patient data meta-analysis with PHARE and other trastuzumab duration trials is planned.en_GB
dc.description.sponsorshipNational Institute for Health Research (NIHR)en_GB
dc.identifier.citationVol. 24 (40)en_GB
dc.identifier.doi10.3310/hta24400
dc.identifier.urihttp://hdl.handle.net/10871/122828
dc.language.isoenen_GB
dc.publisherNIHR Journals Libraryen_GB
dc.rights© Queen’s Printer and Controller of HMSO 2020. This work was produced by Earl et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.en_GB
dc.titleSix versus 12 months’ adjuvant trastuzumab in patients with HER2-positive early breast cancer: the PERSEPHONE non-inferiority RCTen_GB
dc.typeArticleen_GB
dc.date.available2020-09-11T10:22:34Z
dc.identifier.issn1366-5278
dc.descriptionThis is the final version. Available on open access from the NIHR Journals Library via the DOI in this recorden_GB
dc.identifier.journalHealth Technology Assessmenten_GB
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserveden_GB
dcterms.dateAccepted2020-01
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2020-09-02
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2020-09-11T10:19:23Z
refterms.versionFCDVoR
refterms.dateFOA2020-09-11T10:22:40Z
refterms.panelAen_GB


Files in this item

This item appears in the following Collection(s)

Show simple item record