This is a randomized, open-label, multi-center, Phase II clinical study to evaluate the efficacy and safety of margetuximab plus chemotherapy compared with trastuzumab plus chemotherapy in Chinese patients (Mainland, Hong Kong and Taiwan) with advanced HER2+ breast cancer who have received at least 2 prior lines of anti-HER2 directed therapy in the metastatic setting (mandatory including trastuzumab). The primary endpoint of this study is PFS evaluated by BICR. The secondary endpoints are OS, PFS evaluated by investigator, ORR, DoR, CBR, safety and tolerability, the impact of ADA, and the popPK profile
Approximately 120 Chinese subjects will be enrolled and randomized to treatment group and control group in 1:1 fashion, approximately 60 subjects in each group. Eligible subjects are HER2 positive, metastatic breast cancer who has received at least 2 prior lines of anti-HER2 directed therapy in the metastatic setting (mandatory to have trastuzumab, and other anti-HER2 agents e.g. lapatinib, pyrotinib, and pertuzumab; in case of having received (neo)adjuvant anti-HER2 therapy) in Chinese patients (Mainland, Hong Kong and Taiwan). Subjects should Have received treatment with at least one, and no more than three, lines of therapy overall in the metastatic setting (including anti-HER2 directed therapy and chemotherapy, and patients must have progressed on or following, the most recent line of therapy, based on RECIST 1.1. Eligible subjects will be randomized 1:1 to receive margetuximab plus chemotherapy compared with trastuzumab plus chemotherapy. The dosage and administering of margetuximab is 15 mg/kg IV Q3W. Trastuzumab was administered 8 mg/kg loading dose, 6 mg/kg subsequent doses, IV Q3W. Prior to randomization to either margetuximab or trastuzumab, investigators selected one of four backbone chemotherapy regimens given at standard doses: capecitabine, vinorelbine or gemcitabine. Capecitabine and vinorelbine should be selected in priority. Gemcitabine could be selected only if capecitabine and vinorelbine were used in previous treatment. Subject will receive the treatment until disease progression, unacceptable toxicity, withdrawal of consent, initiation of subsequent anti-tumor treatment therapy, or death (whichever occurs first). Subject is not allowed to crossover after disease progression. Randomization was stratified by number of metastatic sites (≤2, \>2) and chemotherapy chosen. The definition of HER2 positive is to have at least once 3+ by IHC, FISH positive or CISH positive in the pathological test/retesting. Subject should provide original biopsy/surgical excision tissue sample/latest follow-up sample after randomization, for the centralized test and review when necessary.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
123
Margetuximab IV
Trastuzumab IV
Capecitabine tablet
Vinorelbine IV
Gemcitabine IV
National Taiwan University Hospital
Taipei, Taiwan
PFS assessed by BICR (RECIST 1.1)
the time from randomization date to the date of first documented disease progression or death from any cause, whichever occurs first. The confirmation of disease progression is per RECIST 1.1, and evaluation made by BICR
Time frame: Approximately 18 months after the first subject is randomized; anticipated evaluation Jul 2020.
Overal Survival (OS)
the time from randomization date to the date of death from any cause
Time frame: Approximately 15 months after the last subject is randomized
PFS assessed by Investigator
the time from randomization date to the date of first documented disease progression or death from any cause, whichever occurs first. The confirmation of disease progression is per RECIST 1.1, and evaluation made by investigator
Time frame: Approximately 18 months
Objective Response Rate (ORR) assessed by BICR
the proportion of subjects in the response evaluable population achieving a best response of CR or PR when such responses are confirmed 6 weeks after initial observation of response. Subjects who have no assessment will be considered as non-responders
Time frame: Approximately 18 months
Duration of Response (DoR) assessed by BICR
To evaluate the DoR assessed by BICR
Time frame: the time from initial response to date of first documented disease progression or death from any cause, whichever occurs first
Clinical Beneficial Rate (CBR)
the proportion of subjects in the response evaluable population achieving a best response of CR, PR, or SD
Time frame: Approximately 18 months
FcγR
To evaluate the effects of allelic variation in FcγR on the efficacy of margetuximab in all patients receiving study treatment
Time frame: at baseline (before first dose of treatment)
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