Basel, 31 July 2015
Roche's Perjeta regimen approved in Europe for use before surgery in early stage aggressive breast cancer
- The approval is based on the benefit seen with the Perjeta regimen in achieving pathological complete response (pCR) in the neoadjuvant (use before surgery) treatment of HER2-positive early breast cancer (eBC)
- This is the first approval in Europe based on pCR, a clinical endpoint that has allowed Perjeta to be made available to people with this aggressive disease faster than under typical review processes
- Treating breast cancer early, before it has spread, may improve the chance of preventing the disease from returning and reaching an incurable stage
Roche (SIX: RO, ROG; OTCQX: RHHBY) today announced that the European Commission (EC) has approved the use of Perjeta® (pertuzumab) in combination with Herceptin® (trastuzumab) and chemotherapy for the neoadjuvant treatment (use before surgery) of adult patients with HER2-positive, locally advanced, inflammatory, or early stage breast cancer at high risk of recurrence. The Perjeta regimen is the first neoadjuvant breast cancer treatment approved by the EC based on pCR data.
Every year in Europe nearly 100,000 people are diagnosed with HER2-positive breast cancer, an aggressive type of the disease that is more likely to progress than HER2-negative cancer.1,2 Treating people with breast cancer early, before the cancer has spread, may improve the chance of preventing the disease from returning. Neoadjuvant treatment is given before surgery and is aimed at reducing tumour size so it is easier to surgically remove. pCR is achieved when there is no tumour tissue detectable at the time of surgery in the affected breast or in the affected breast and local lymph nodes. It is a common measure of neoadjuvant treatment effect in breast cancer and it can be assessed more quickly than traditional endpoints in eBC.
“Today’s approval is a significant milestone in the neoadjuvant treatment of HER2-positive early breast cancer, bringing Perjeta to patients years earlier than typical adjuvant treatment,” said Sandra Horning, M.D., Roche’s Chief Medical Officer and Head, Global Product Development. “We are committed to making the Perjeta regimen available to appropriate patients in the EU as early as possible.”
The EC approval is based primarily on data from the neoadjuvant Phase II NeoSphere study, which showed that nearly 40% of people receiving the combination of Perjeta, Herceptin and chemotherapy achieved pCR in the affected breast and local lymph nodes compared to 21.5% of people who received Herceptin and taxane chemotherapy alone.3 The approval was also supported by data from the Phase II neoadjuvant TRYPHAENA study, in which pCR rates ranging from 54.7% to 63.6% were achieved across the three Perjeta-containing study arms.4 Long-term safety results from the Phase III CLEOPATRA trial in people with previously untreated HER2-positive advanced breast cancer also supported the approval.5 Data from the ongoing Phase III APHINITY study in the adjuvant (post-surgery) setting will provide additional insights into the broader role of Perjeta in the treatment of HER2-positive eBC.
Follow-up data from the NeoSphere trial were presented last month at the 51st Annual Meeting of the American Society of Clinical Oncology (ASCO). These data suggested that people who received the Perjeta regimen prior to surgery were 31% less likely to experience disease worsening, recurrence or death (PFS HR=0.69; 95% CI, 0.34–1.40) compared to those who received Herceptin and chemotherapy.6 People treated with the Perjeta regimen were also 40% less likely to experience disease recurrence or death (DFS HR=0.60; 95% CI, 0.28–1.27). These new data suggest that the pCR benefit seen with the Perjeta regimen may translate into longer-term improvements in patient outcomes.6
Perjeta is already approved as neoadjuvant treatment for people with HER2-positive eBC in the U.S. and 21 other countries.
Perjeta is a medicine that targets the HER2 receptor, a protein found on the outside of many normal cells and in high quantities on the outside of cancer cells in HER2-positive cancers. Perjeta is designed specifically to prevent the HER2 receptor from pairing (or ‘dimerising’) with other HER receptors (EGFR/HER1, HER3 and HER4) on the surface of cells, a process that is believed to play a role in tumour growth and survival. Binding of Perjeta to HER2 may also signal the body’s immune system to destroy the cancer cells. The mechanisms of action of Perjeta and Herceptin are believed to complement each other, as both bind to the HER2 receptor, but to different places. The combination of Perjeta and Herceptin is thought to provide a more comprehensive blockade of HER signalling pathways, thus preventing tumour cell growth and survival.
About the NeoSphere trial
The NeoSphere trial3 (Neoadjuvant Study of Pertuzumab and Herceptin in an Early Regimen Evaluation) is a randomised, multicentre, international Phase II study in 417 people with newly diagnosed HER2-positive, operable, locally advanced, or inflammatory eBC. Participants were randomised to one of four study arms and received four cycles (12 weeks) of neoadjuvant treatment followed by surgery and a year of adjuvant treatment with Herceptin plus chemotherapy. The primary endpoint was pCR. Secondary endpoints included clinical response, time to clinical response, safety profile, PFS, DFS, breast-conserving surgery rate and biomarker assessment. Study data showed the following:
- Treatment with Perjeta, Herceptin and docetaxel chemotherapy significantly improved the rate of pCR in the affected breast and local lymph nodes by 17.8% compared to Herceptin and chemotherapy alone (39.3% vs. 21.5%, p=0.0063)
- pCR of 21.5% for Herceptin and chemotherapy
- pCR of 39.3% for Perjeta, Herceptin and chemotherapy
- pCR of 11.2% for Perjeta and Herceptin
- pCR of 17.7% for Perjeta and chemotherapy
- The Perjeta regimen was not associated with a significant increase in adverse events (AEs), compared to Herceptin and chemotherapy alone
- The most common severe (Grade 3 or higher) AEs for the Perjeta regimen were neutropenia (decrease in a certain type of white blood cell, 44.9%), febrile neutropenia (fever associated with decrease in a certain type of white blood cell, 8.4%), leukopenia (decrease in overall white blood cells, 4.7%) and diarrhoea (5.6%)
pCR means that there is no tumour tissue detectable at the time of surgery either in the affected breast or in the affected breast and local lymph nodes following completion of neoadjuvant treatment.
About the TRYPHAENA trial
The TRYPHAENA trial4 (ToleRabilitY of Pertuzumab, Herceptin and AnthracyclinEs in NeoAdjuvant breast cancer) is a randomised, multicentre Phase II study that was conducted in 225 people with HER2-positive, operable, locally advanced or inflammatory eBC with tumours greater than two centimetres. Participants were randomised to one of three neoadjuvant Perjeta regimens. The primary endpoint was cardiac safety. Secondary endpoints included pCR, clinical response, breast-conserving surgery rate, DFS, PFS, overall survival (OS) and biomarker assessment. Study data showed the following:
- The study was not powered to compare the three study arms. The rates of total pCR in the breast and local lymph nodes in the three arms were as follows:
- pCR of 56.2% for Perjeta, Herceptin and anthracycline-based chemotherapy, followed by Perjeta, Herceptin and chemotherapy
- pCR of 54.7% for anthracycline-based chemotherapy, followed by Perjeta, Herceptin and chemotherapy
- pCR of 63.6% for the anthracycline-free arm (Perjeta, Herceptin, chemotherapy and carboplatin chemotherapy)
- No new or unexpected cardiac AEs, or other AEs, were observed in any of the study arms. AEs observed were consistent with those seen in previous studies of Perjeta, Herceptin and chemotherapy, either in combination or alone.
- The most common severe (Grade 3 or higher) AEs in any of the three study arms were:
- In the concurrent arm: neutropenia (47.2%), leukopenia (19.4%) and febrile neutropenia (18.1%)
- In the sequential arm: neutropenia (42.7%), leukopenia (12.0%), febrile neutropenia (9.3%), diarrhoea (5.3%) and left ventricular dysfunction (4.0%)
- In the anthracycline-free arm: neutropenia (46.1%), febrile neutropenia (17.1%), anaemia (decrease in red blood cells, 17.1%); the AEs of diarrhoea, leukopenia, anaemia and thrombocytopenia (decrease in platelets) all had an incidence of 11.8%
About Roche’s medicines for HER2-positive breast cancer
Roche has been leading research into the HER2 pathway for over 30 years and is committed to improving the health, quality of life and survival of people with both early and advanced HER2-positive disease. Roche has developed three innovative medicines that have helped transform the treatment of HER2-positive breast cancer: Herceptin, Perjeta and Kadcyla. HER2-positive breast cancer is a particularly aggressive form of the disease that affects approximately 20% of patients.2 Over the past 15 years, the outlook for people with HER2-positive disease has improved to the extent that those with this form of the disease treated with these innovative medicines now typically experience better outcomes than people with less aggressive HER2-negative disease.7
Eligibility for treatment with Roche’s HER2-targeted medicines is determined via a diagnostic test, saving time from the outset by identifying patients who will likely benefit from these medicines at the onset of their disease.
Headquartered in Basel, Switzerland, Roche is a leader in research-focused healthcare with combined strengths in pharmaceuticals and diagnostics. Roche is the world’s largest biotech company, with truly differentiated medicines in oncology, immunology, infectious diseases, ophthalmology and neuroscience. Roche is also the world leader in in vitro diagnostics and tissue-based cancer diagnostics, and a frontrunner in diabetes management. Roche’s personalised healthcare strategy aims at providing medicines and diagnostics that enable tangible improvements in the health, quality of life and survival of patients. Founded in 1896, Roche has been making important contributions to global health for more than a century. Twenty-nine medicines developed by Roche are included in the World Health Organization Model Lists of Essential Medicines, among them life-saving antibiotics, antimalarials and chemotherapy.
In 2014, the Roche Group employed 88,500 people worldwide, invested 8.9 billion Swiss francs in R&D and posted sales of 47.5 billion Swiss francs. Genentech, in the United States, is a wholly owned member of the Roche Group. Roche is the majority shareholder in Chugai Pharmaceutical, Japan. For more information, please visit www.roche.com.
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1 - World Health Organization. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx [Accessed 10 July 2015]
2 - Wolff AC, et al. J Clin Oncol 2013; 31(31):3997-4013
3 - Gianni L, et al. Lancet Oncol 2012; 13:25-32
4 - Schneeweiss A, et al. Ann Oncol 2013; 24:2278-84
5 - Swain S, et al. N Engl J Med 2015; 372:724-34
6 - Gianni L, et al. American Society for Clinical Oncology 2015; Abstract #505
7 - Dawood S, et al. J Clin Oncol 2010; 28:92-98