A Phase 4 interventional study of Trastuzumab emtansine in HER2 Positive Breast Cancer, Metastatic Breast Cancer, Locally Advanced Breast Cancer, sponsored by Hoffmann-La Roche. Completed at 13 sites in India. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-04-02.
Sponsored by Hoffmann-La Roche · Phase 4, Interventional, and Basic science
This is a Phase IV, single-arm, multicenter, open-label clinical trial designed to assess the safety of trastuzumab emtansine in Indian patients with HER2-positive unresectable locally advanced breast cancer (LABC) or metastatic breast cancer (mBC) who have received prior treatment with trastuzumab and a taxane.
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Exclusion Criteria:
Drug: Trastuzumab emtansine
3.6 mg/kg intravenously (IV) over 30-90 minutes on day 1 of 21 day cycle, repeated every 3 weeks
Severity of Adverse Events
Adverse events (AEs) grading was completed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.03.
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Adverse Events
An AE was any untoward medical occurrence in a participant administered a pharmaceutical product and which did not necessarily have to have a causal relationship with the treatment. An adverse event was therefore any unfavourable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Pre-existing conditions which worsened during the study were also considered as adverse events.
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Serious Adverse Events (SAEs)
SAEs were defined as any AE that fulfilled any of the following criteria: fatal (resulted in death), life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/ birth defect, was medically significant or required intervention to prevent any of the other outcomes listed here.
Time frame: From cycle 1 up to approximately 3 years
Severity of SAEs as Per the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), Version 4.03
Severity refered to the intensity of an AE (e.g., rated as mild, moderate, or severe, or according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) criteria.
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Non-Serious Adverse Events of Special Interest
Non-serious AEs of special interest included cases of severe drug-induced liver injury and suspected transmission of an infectious agent by the study drug.
Time frame: From cycle 1 up to approximately 3 years
Laboratory Results Abnormalities
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Adverse Events Leading to Discontinuation of Study Medication
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Adverse Events Leading to Modification of Study Medication
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Adverse Events Leading to Interruption of Study Medication
Time frame: From cycle 1 up to approximately 3 years
Exposure to Study Drug
Exposure to study drug was the amount of study drug received over time (weeks).
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Drug-Induced Liver Injury Meeting Hy's Law Criteria
Hy's law criteria for potential drug-induced liver injury included elevated aminotransferase enzymes (ALT/AST) with concurrent elevated serum total bilirubin, gross jaundice, clinical disability and the need for hospital care.
Time frame: From cycle 1 up to approximately 3 years
Percentage of Participants With Congestive Heart Failure
Time frame: From cycle 1 up to approximately 3 years
Change in Left Ventricular Ejection Fraction (LVEF) as Measured by Echocardiogram
Time frame: From baseline to every three cycles of treatment up to Cycle 39 Day 1, and at the 2-days post-treatment, safety follow-up visits 1 and 3
Overall Response Rate (ORR)
ORR was based on the best (confirmed) overall response (BOR). ORR was defined as the number (%) of participants with confirmed complete response (CR) or partial response (PR) where the confirmation was performed no less than 4 weeks after the criteria for response were first met.
Time frame: From cycle 1 up to approximately 3 years
Progression-Free Survival (PFS)
PFS was defined as the time from the date of enrollment until the date of first documented progression of disease or the date of death (by any cause in the absence of progression) whichever occurred first.
Time frame: From cycle 1 up to approximately 3 years
Overall Survival (OS)
Overall survival was defined as the time from the date of enrollment until the date of death due to any cause. Participants not known to have died at the time of final analysis were censored based on the last recorded date on which the subject was known to be alive.
Time frame: From cycle 1 up to approximately 3 years
The study was conducted at 13 centres across India.
| Milestone | Trastuzumab Emtansine |
|---|---|
| Started | 70 |
| Completed | 13 |
| Not completed | 57 |
| Withdrew: Adverse event | 2 |
| Withdrew: Death | 4 |
| Withdrew: Lost to follow-up | 7 |
| Withdrew: Withdrawal of consent | 16 |
| Withdrew: Disease progression | 28 |
Adverse events (AEs) grading was completed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.03.
| Participants | Trastuzumab Emtansine |
|---|---|
| Grade 1 | 53 |
| Grade 2 | 40 |
| Grade 3 | 18 |
| Grade 4 | 2 |
| Grade 5 | 12 |
An AE was any untoward medical occurrence in a participant administered a pharmaceutical product and which did not necessarily have to have a causal relationship with the treatment. An adverse event was therefore any unfavourable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Pre-existing conditions which worsened during the study were also considered as adverse events.
| Percentage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Adverse Events | 90.0 |
SAEs were defined as any AE that fulfilled any of the following criteria: fatal (resulted in death), life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/ birth defect, was medically significant or required intervention to prevent any of the other outcomes listed here.
| Percentage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Serious Adverse Events (SAEs) | 40 |
Severity refered to the intensity of an AE (e.g., rated as mild, moderate, or severe, or according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) criteria.
| Participants | Trastuzumab Emtansine |
|---|---|
| Grade 1 | 1 |
| Grade 2 | 13 |
| Grade 3 | 10 |
| Grade 4 | 3 |
| Grade 5 | 6 |
Non-serious AEs of special interest included cases of severe drug-induced liver injury and suspected transmission of an infectious agent by the study drug.
| Percentage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Non-Serious Adverse Events of Special Interest | 2.9 |
| Number of Participants | Trastuzumab Emtansine |
|---|---|
| Basophils - High | 1 |
| Basophils/Leukocytes - Low | 13 |
| Basophils/Leukocytes - High | 6 |
| Monocytes - High | 2 |
| Hematocrit - Low | 57 |
| Hematocrit - High | 1 |
| Lymphocytes/Leukocytes - Low | 38 |
| Lymphocytes/Leukocytes - High | 19 |
| Monocytes/Leukocytes - Low | 8 |
| Monocytes/Leukocytes - High | 21 |
| Neutrophils/Leukocytes - Low | 14 |
| Neutrophils/Leukocytes - High | 13 |
| Other Cells - High | 3 |
| Other Cells/Leukocytes - High | 6 |
| Erythrocytes - Low | 41 |
| Erythrocytes - High | 15 |
| Eosinophils/Leukocytes - Low | 33 |
| Eosinophils/Leukocytes - High | 13 |
| Bilirubin - Low | 5 |
| Bilirubin - High | 22 |
| Bicarbonate - Low | 4 |
| Bicarbonate - High | 11 |
| Direct Bilirubin - High | 27 |
| Blood Urea Nitrogen - Low | 21 |
| Blood Urea Nitrogen - High | 10 |
| Chloride - Low | 20 |
| Chloride - High | 30 |
| Lactate Dehydrogenase - Low | 8 |
| Lactate Dehydrogenase - High | 52 |
| Protein - Low | 10 |
| Protein - High | 30 |
| Urea - Low | 21 |
| Urea - High | 10 |
| Partial Thromboplastin Time - Low | 22 |
| Partial Thromboplastin Time - High | 37 |
| Percentage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Adverse Events Leading to Discontinuation of Study Medication | 8.6 |
| Participants | Trastuzumab Emtansine |
|---|---|
| Dose Reduced | 1 |
| Drug Interrupted | 11 |
| Percentage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Adverse Events Leading to Interruption of Study Medication | 15.7 |
Exposure to study drug was the amount of study drug received over time (weeks).
| Weeks | Trastuzumab Emtansine |
|---|---|
| Exposure to Study Drug | 39.60 ± 32.00 |
Hy's law criteria for potential drug-induced liver injury included elevated aminotransferase enzymes (ALT/AST) with concurrent elevated serum total bilirubin, gross jaundice, clinical disability and the need for hospital care.
| Percentage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Drug-Induced Liver Injury Meeting Hy's Law Criteria | 0 |
| Percetnage of Participants | Trastuzumab Emtansine |
|---|---|
| Percentage of Participants With Congestive Heart Failure | 0 |
| Percentage of LVEF | Trastuzumab Emtansine |
|---|---|
| Baseline | 59.49 ± 3.33 |
| Cycle 03 Day 1 | 0.08 ± 3.26 |
| Cycle 06 Day 1 | 0.20 ± 4.50 |
| Cycle 09 Day 1 | 0.23 ± 3.76 |
| Cycle 12 Day 1 | 0.06 ± 4.24 |
| Cycle 15 Day 1 | 0.38 ± 4.40 |
| Cycle 18 Day 1 | 0.15 ± 5.98 |
| Cycle 21 Day 1 | 2.50 ± 3.78 |
| Cycle 24 Day 1 | 0.23 ± 2.89 |
| Cycle 27 Day 1 | -0.60 ± 3.86 |
| Cycle 30 Day 1 | -0.17 ± 1.33 |
| Cycle 33 Day 1 | -1.20 ± 2.39 |
| Cycle 36 Day 1 | 0 ± NA |
| Cycle 39 Day 1 | 0 ± NA |
| Safety Follow-Up 1 | 1.28 ± 3.80 |
| Safety Follow-Up 3 | 1.38 ± 4.00 |
ORR was based on the best (confirmed) overall response (BOR). ORR was defined as the number (%) of participants with confirmed complete response (CR) or partial response (PR) where the confirmation was performed no less than 4 weeks after the criteria for response were first met.
| Participants | Trastuzumab Emtansine |
|---|---|
| Overall Response Rate (ORR) | 16 |
PFS was defined as the time from the date of enrollment until the date of first documented progression of disease or the date of death (by any cause in the absence of progression) whichever occurred first.
| Months | Trastuzumab Emtansine |
|---|---|
| Progression-Free Survival (PFS) | 14.0 (8.0 to 17.0) |
Overall survival was defined as the time from the date of enrollment until the date of death due to any cause. Participants not known to have died at the time of final analysis were censored based on the last recorded date on which the subject was known to be alive.
| Months | Trastuzumab Emtansine |
|---|---|
| Overall Survival (OS) | NA (25.00 to NA) |
Collected over From cycle 1 up to approximately 3 years. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Trastuzumab Emtansine | 12/70 (17.1%) | 28/70 (40%) | 51/70 (72.9%) |
| Event | Trastuzumab Emtansine |
|---|---|
| THROMBOCYTOPENIABlood and lymphatic system disorders | 4/70 |
| DEATHGeneral disorders | 4/70 |
| GENERALISED TONIC-CLONIC SEIZURENervous system disorders | 2/70 |
| HYDROCEPHALUSNervous system disorders | 2/70 |
| SEIZURENervous system disorders | 2/70 |
| ACUTE KIDNEY INJURYRenal and urinary disorders | 2/70 |
| DYSPNOEARespiratory, thoracic and mediastinal disorders | 2/70 |
| EPISTAXISRespiratory, thoracic and mediastinal disorders | 2/70 |
| CARDIAC ARRESTCardiac disorders | 1/70 |
| CARDIO-RESPIRATORY ARRESTCardiac disorders | 1/70 |
| Event | Trastuzumab Emtansine |
|---|---|
| PYREXIAGeneral disorders | 19/70 |
| ANAEMIABlood and lymphatic system disorders | 11/70 |
| HEADACHENervous system disorders | 11/70 |
| EPISTAXISRespiratory, thoracic and mediastinal disorders | 11/70 |
| ASTHENIAGeneral disorders | 8/70 |
| PAINGeneral disorders | 8/70 |
| COUGHRespiratory, thoracic and mediastinal disorders | 8/70 |
| PLATELET COUNT DECREASEDInvestigations | 7/70 |
| THROMBOCYTOPENIABlood and lymphatic system disorders | 6/70 |
| ABDOMINAL PAINGastrointestinal disorders | 6/70 |
Intent-to-treat (ITT) population included all participants enrolled in the study.
| Age, Continuous(Years) | Trastuzumab Emtansine |
|---|---|
| Mean | 50 ± 11.50 |
| Sex: Female, Male(Participants) | Trastuzumab Emtansine |
|---|---|
| Female | 70 |
| Male | 0 |
| Race (NIH/OMB)(Participants) | Trastuzumab Emtansine |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 70 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 0 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
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