Abstract
Importance: ERRB2 (formerly HER2)-positive advanced breast cancer (ABC) remains typically incurable with optimal treatment undefined in later lines of therapy. The chimeric antibody margetuximab shares ERBB2 specificity with trastuzumab but incorporates an engineered Fc region to increase immune activation. Objective: To compare the clinical efficacy of margetuximab vs trastuzumab, each with chemotherapy, in patients with pretreated ERBB2-positive ABC. Design, Setting, and Participants: The SOPHIA phase 3 randomized open-label trial of margetuximab plus chemotherapy vs trastuzumab plus chemotherapy enrolled 536 patients from August 26, 2015, to October 10, 2018, at 166 sites in 17 countries. Eligible patients had disease progression on 2 or more prior anti-ERBB2 therapies and 1 to 3 lines of therapy for metastatic disease. Data were analyzed from February 2019 to October 2019. Interventions: Investigators selected chemotherapy before 1:1 randomization to margetuximab, 15 mg/kg, or trastuzumab, 6 mg/kg (loading dose, 8 mg/kg), each in 3-week cycles. Stratification factors were metastatic sites (≤2, >2), lines of therapy (≤2, >2), and chemotherapy choice. Main Outcomes and Measures: Sequential primary end points were progression-free survival (PFS) by central blinded analysis and overall survival (OS). All α was allocated to PFS, followed by OS. Secondary end points were investigator-assessed PFS and objective response rate by central blinded analysis. Results: A total of 536 patients were randomized to receive margetuximab (n = 266) or trastuzumab (n = 270). The median age was 56 (27-86) years; 266 (100%) women were in the margetuximab group, while 267 (98.9%) women were in the trastuzumab group. Groups were balanced. All but 1 patient had received prior pertuzumab, and 489 (91.2%) had received prior ado-trastuzumab emtansine. Margetuximab improved primary PFS over trastuzumab with 24% relative risk reduction (hazard ratio [HR], 0.76; 95% CI, 0.59-0.98; P =.03; median, 5.8 [95% CI, 5.5-7.0] months vs 4.9 [95% CI, 4.2-5.6] months; October 10, 2018). After the second planned interim analysis of 270 deaths, median OS was 21.6 months with margetuximab vs 19.8 months with trastuzumab (HR, 0.89; 95% CI, 0.69-1.13; P =.33; September 10, 2019), and investigator-assessed PFS showed 29% relative risk reduction favoring margetuximab (HR, 0.71; 95% CI, 0.58-0.86; P <.001; median, 5.7 vs 4.4 months; September 10, 2019). Margetuximab improved objective response rate over trastuzumab: 22% vs 16% (P =.06; October 10, 2018), and 25% vs 14% (P <.001; September 10, 2019). Incidence of infusion-related reactions, mostly in cycle 1, was higher with margetuximab (35 [13.3%] vs 9 [3.4%]); otherwise, safety was comparable. Conclusions and Relevance: In this phase 3 randomized clinical trial, margetuximab plus chemotherapy had acceptable safety and a statistically significant improvement in PFS compared with trastuzumab plus chemotherapy in ERBB2-positive ABC after progression on 2 or more prior anti-ERBB2 therapies. Final OS analysis is expected in 2021. Trial Registration: ClinicalTrials.gov Identifier: NCT02492711.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 573-584 |
| Number of pages | 12 |
| Journal | JAMA Oncology |
| Volume | 7 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2021 |
Funding
receiving grants from MacroGenics during the conduct of the study; and grants from Roche, Pfizer, Novartis, Lilly, Merck, Seattle Genetics, Odonate Therapeutics, Eisai, Sermonix Pharmaceuticals, Immunomedics, and Daiichi Sankyo and personal fees from Puma and Samsung outside the submitted work. Dr Im reported receiving grants from Daewoong Pharmaceutical; grants and personal fees from AstraZeneca, Pfizer, and Roche; and personal fees from Amgen, Eisai, Hanmi Pharmaceutical, Novartis, Lilly, and Merck Sharp & Dohme outside the submitted work. Dr Cardoso reported receiving personal fees from MacroGenics during the conduct of the study; and personal fees from Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi Sankyo, Eisai, GE Oncology, Genentech, GlaxoSmithKline, MacroGenics, Medscape, Merck Sharp & Dohme, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre Fabre, prIME Oncology, Roche, Sanofi, Samsung Bioepis, Seattle Genetics, and Teva outside the submitted work. Dr Cortés reported receiving personal fees from Roche, Celgene, AstraZeneca, Cellestia, Biothera Pharmaceuticals, Merus, Seattle Genetics, Daiichi Sankyo, Erytech Pharma, Athenex, Polyphor, Lilly, Servier, Merck Sharp & Dohme, GlaxoSmithKline, Leuko, Bioasis Technologies, Clovis Oncology, Boehringer Ingelheim, Novartis, Eisai, Pfizer, and Samsung Bioepis; honoraria from Samsung Bioepis, Pfizer, Eisai, Novartis, Roche, Celgene, Daiichi Sankyo, Lilly, Merck Sharp & Dohme; serving on advisory boards for Boehringer Ingelheim, Clovis Oncology, Bioasis, Leuko, GlaxoSmithKline, Merck Sharp & Dohme, Servier, Lilly, Polyphor, Athenex, Erytech, Daiichi Sankyo, Seattle Genetics, Merus, Biothera, Cellestia, AstraZeneca, Celgene, and Roche; and owning stock from MedSIR outside the submitted work; and travel, accommodation, and expenses from Roche, Novartis, Eisai, Pfizer, and Daiichi Sankyo. Dr Curigliano reported receiving travel grants from Roche; serving on advisory boards for Pfizer, Seattle Genetics, Novartis, AstraZeneca, Lilly, Merck Sharp & Dohme, Daichi Sankyo, Genomic Health, and Ellipsis; and serving as a steering committee member for Bristol Myers Squibb outside the submitted work. Dr Musolino reported receiving personal fees from MacroGenics during the conduct of the study; and grants and personal fees from Roche and Eisai and personal fees from Novartis and Lilly outside the submitted work. Dr Pegram reported receiving personal fees from MacroGenics and Roche during the conduct of the study. Dr Wright reported receiving payment to Sarah Cannon Research Institute for conduct of clinical trial from MacroGenics during the conduct of the study; and payment to Sarah Cannon Research Institute for conduct of clinical trial from AbbVie, Incyte, Genentech, Novartis, Lilly, Janssen, Astellas, Celgene, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, G1 Therapeutics, Medivation, Merrimack, Pfizer, Tesaro, and Odonate Therapeutics outside the submitted work. Dr Saura reported receiving personal fees from AstraZeneca, Celgene, Daiichi Sankyo, Eisai, F. Hoffmann-La Roche Ltd, Genomic Health, Merck, Sharp and Dohme España SA, Novartis, Odonate Therapeutics, Pfizer, Philips HealthWork, Pierre Fabre, prIME Oncology, Puma, Synthon, and Sanofi Aventis outside the submitted work. Dr Escrivá-de-Romaní reported receiving grants from MacroGenics during the conduct of the study; and grants from Synthon and Zymeworks; grants, personal fees, and nonfinancial support from Roche; personal fees and nonfinancial support from Pierre Fabre; personal fees from Eisai, Kyowa Kirin, and Esteve; and nonfinancial support from Daiichi Sankyo outside the submitted work. Dr De Laurentiis reported receiving grants from MacroGenics during the conduct of the study; and grants from Daiichi Sankyo; grants and personal fees from Roche, Novartis, Pfizer, Eli Lilly, Pierre Fabre, and AstraZeneca; personal fees from Celgene, Eisai, Genomic Health, and Amgen outside the submitted work. Dr Brown-Glaberman reported receiving personal fees from Novartis, Eisai, Biotheranostics, and Seattle Genetics outside the submitted work. Dr de Boer reported receiving grants from Parexel during the conduct of the study; and grants from Novartis, Pfizer, and Eli Lilly and grants and personal fees from Roche outside the submitted work. Dr Kim reported participation as a consultant in advisory boards for Novartis, AstraZeneca, Lilly, Enzychem Lifesciences, Dae Hwa Pharmaceutical Co Ltd, ISU Abxis, and Daiichi Sankyo and receiving research funding (paid to institution) from Novartis, Sanofi-Aventis, and DongKook Pharmaceutical Co Ltd outside the submitted work. Dr Petráková reported receiving personal fees from Novartis, Roche, Merck Sharp & Dohme, and Pfizer outside the submitted work. Dr Yardley reported a consultant/advisory role (paid to institution) for Bristol Myers Squibb, Genentech/ Roche, Eisai, Biotheranostics, Daiichi Sankyo/Lilly, Celgene, Novartis, NanoString Technology, and MacroGenics; research funding (paid to institution) from Daiichi Sankyo, Clovis Oncology, AstraZeneca, Genentech/Roche, InventisBio, Syndax, Lilly, MedImmune, Pfizer, Eisai, Novartis, Medivation, Tesaro, Immunomedics, AbbVie, Merck, and Oncothyreon; and participation in speakers bureaus and travel/accommodations/expenses for Novartis and Genentech/Roche outside the submitted work. Dr Jakobsen reported receiving financial support from Cascadian Therapeutics during the conduct of the study; and grants from Cascadian Therapeutics and grants and personal fees from Roche, Novartis, Lilly, and Pfizer outside the submitted work. Dr Kaufman reported receiving personal fees from Pfizer and AstraZeneca outside the submitted work. Dr Fasching reported receiving personal fees from MacroGenics during the conduct of the study; and grants from Cepheid and personal fees from Novartis, Pfizer, Daiichi Sankyo, AstraZeneca, Eisai, Merck Sharp & Dohme, Lilly, Pierre Fabre, and Seattle Genetics outside the submitted work. Dr Bonvini reported receiving salary, stocks, and stock options from MacroGenics as compensation as a condition of employment. Dr Koenig is an employee of MacroGenics and reported holding a patent to US20180298100 pending and a patent to US20160257761 pending. Drs Nordstrom, Hong, and Rock and Mr Edlich are or were employees of MacroGenics. No other disclosures were reported.
ASJC Scopus subject areas
- Oncology
- Cancer Research
