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NCT01566721: SafeHER

A Safety and Tolerability Study of Assisted and Self-Administered Subcutaneous (SC) Herceptin (Trastuzumab) as Adjuvant Therapy in Early Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Breast Cancer

Completed Phase 3 Results posted Last updated 27 April 2021
What this trial tests

Phase 3 trial testing Herceptin in Breast Neoplasms in 2,577 participants. Completed in 19 February 2020.

Timeline
17 May 2012
Primary endpoint
10 March 2015
19 February 2020

Quick facts

Lead sponsorHoffmann-La Roche
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationnon randomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment2,577
Start date17 May 2012
Primary completion10 March 2015
Estimated completion19 February 2020
Sites437 locations across Hong Kong, Colombia, Italy, Panama, Ecuador, Malaysia, Taiwan, Ireland

Drugs / interventions tested

Conditions studied

Sponsor

Hoffmann-La Roche — full company profile →

Who can join

18 and older, any sex, with Breast Neoplasms. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Percentage of Participants With At Least 1 Adverse Event (AE) During the Treatment Period Primary · From Day 1 up to 19 cycles (cycle length 3 weeks) (approximately 1 year)

Participants were planned to receive a total of 18 cycles of SC Herceptin. An AE was defined as any untoward medical occurrence in a participant administered SC Herceptin. Examples included unfavorable/unintended signs and symptoms, new or exacerbated disease, recurrence of intermittent condition, deterioration in laboratory value or other clinical test, or adverse procedure-related events. The percentage of participants with at least 1 AE during the treatment period (regardless of severity or seriousness) was reported.

GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe88.6
Cohort B: SC Herceptin by SID89.0
Percentage of Participants With a Grade 3 or Higher AE During the Treatment Period Primary · From Day 1 up to 19 cycles (cycle length 3 weeks) (approximately 1 year)

Participants were planned to receive a total of 18 cycles of SC Herceptin. An AE was defined as any untoward medical occurrence in a participant administered SC Herceptin. Examples included unfavorable/unintended signs and symptoms, new or exacerbated disease, recurrence of intermittent condition, deterioration in laboratory value or other clinical test, or adverse procedure-related events. AEs were graded according to National Cancer Institute Common Terminology Criteria Version 4.0. Grade 3 AEs were those considered severe or medically significant but not immediately life-threatening. Grade

GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe24.022.1 – 26.0
Cohort B: SC Herceptin by SID21.018.1 – 24.2
Percentage of Participants With Treatment Interruption Due to an AE Primary · From Day 1 up to 19 cycles (cycle length 3 weeks) (approximately 1 year)

Participants were planned to receive a total of 18 cycles of SC Herceptin. An AE was defined as any untoward medical occurrence in a participant administered SC Herceptin. Examples included unfavorable/unintended signs and symptoms, new or exacerbated disease, recurrence of intermittent condition, deterioration in laboratory value or other clinical test, or adverse procedure-related events. The percentage of participants with SC Herceptin treatment interrupted to assess or treat AEs was reported.

GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe9.8
Cohort B: SC Herceptin by SID10.4
Number of Herceptin Cycles Received Primary · From Day 1 up to 19 cycles (cycle length 3 weeks) (approximately 1 year)

Participants were planned to receive a total of 18 cycles of SC Herceptin. The median number of cycles actually received was reported.

GroupValue95% CI
Cohort B: SC Herceptin by SID (Self-Administered)16.01 – 17
Cohort A: SC Herceptin by Needle/Syringe18.01 – 19
Cohort B: SC Herceptin by SID18.01 – 18
Percentage of Participants by Total Number of Herceptin Cycles Received Primary · From Day 1 up to 19 cycles (cycle length 3 weeks) (approximately 1 year)

Participants were planned to receive a total of 18 cycles of SC Herceptin. The percentage of participants was reported by the total number of cycles actually received. Because the data are presented non-cumulatively, this table reflects participant distribution by the highest number of cycles received.

1 Cycle Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)2.7
Cohort A: SC Herceptin by Needle/Syringe1.0
Cohort B: SC Herceptin by SID0.8
2 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)1.3
Cohort A: SC Herceptin by Needle/Syringe0.5
Cohort B: SC Herceptin by SID0.4
3 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)1.1
Cohort A: SC Herceptin by Needle/Syringe0.5
Cohort B: SC Herceptin by SID0.1
4 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)1.6
Cohort A: SC Herceptin by Needle/Syringe1.2
Cohort B: SC Herceptin by SID0.7
5 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)1.3
Cohort A: SC Herceptin by Needle/Syringe0.8
Cohort B: SC Herceptin by SID0.6
6 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)1.6
Cohort A: SC Herceptin by Needle/Syringe0.5
Cohort B: SC Herceptin by SID0.1
7 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)2.2
Cohort A: SC Herceptin by Needle/Syringe0.7
Cohort B: SC Herceptin by SID0.8
8 Cycles Received
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)2.2
Cohort A: SC Herceptin by Needle/Syringe0.9
Cohort B: SC Herceptin by SID0.3
Percentage of Participants Who Received Concomitant Cancer Therapy Primary · From Baseline to data cutoff of 10 March 2015 (up to approximately 3 years)

Concomitant cancer treatment included chemotherapy, radiotherapy, and hormone therapy administered during the study. The percentage of participants who received any of these concomitant therapies was reported.

Chemotherapy
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe58.2
Cohort B: SC Herceptin by SID63.9
Radiotherapy
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe51.3
Cohort B: SC Herceptin by SID48.5
Hormone Therapy
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe53.5
Cohort B: SC Herceptin by SID50.4
Percentage of Participants Who Received Concomitant Non-Cancer Therapy Primary · From Baseline to data cutoff of 10 March 2015 (up to approximately 3 years)

Concomitant non-cancer treatment included any pharmacologic interventions administered during the study other than chemotherapy, radiotherapy, or hormone therapy. The percentage of participants who received any concomitant non-cancer therapies was reported.

GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe89.1
Cohort B: SC Herceptin by SID89.7
Percentage of Participants Who Died by Data Cutoff of 10 March 2015 Secondary · From Baseline to time of event (maximum follow-up approximately 3 years as of data cutoff of 10 March 2015)

The percentage of participants who died from any cause was reported.

GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe1.5
Cohort B: SC Herceptin by SID0.8
Percentage of Participants Who Died During the Safety Follow-up Period Secondary · From Baseline to Time of Event, Safety Follow-Up Period (Up to 6 Years)

The percentage of participants who died from any cause was reported during the safety follow-up period.

GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe6.8
Cohort B: SC Herceptin by SID7.3
Disease-Free Survival Rate Secondary · From Baseline to time of event (up to approximately 8 years)

DFS is defined as the time from first dose of SC Herceptin to the first event of local, regional or distant recurrence, contralateral invasive breast cancer (including ipsilateral ductal carcinoma in situ) or death due to any cause. Time from the date of first dose to any DFS event was expressed in Kaplan-Meier survival probability estimates. Patients without an event will be censored at the last assessment date.

0.5 Year
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9900.984 – 0.993
Cohort B: SC Herceptin by SID0.9870.976 – 0.993
1 Year
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9750.967 – 0.981
Cohort B: SC Herceptin by SID0.9760.961 – 0.985
1.5 Year
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9600.950 – 0.968
Cohort B: SC Herceptin by SID0.9570.939 – 0.970
2 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9340.921 – 0.944
Cohort B: SC Herceptin by SID0.9390.918 – 0.955
3 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9040.889 – 0.917
Cohort B: SC Herceptin by SID0.8960.870 – 0.916
4 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.8810.865 – 0.896
Cohort B: SC Herceptin by SID0.8740.847 – 0.897
5 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.8680.851 – 0.883
Cohort B: SC Herceptin by SID0.8630.835 – 0.887
6 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.8510.833 – 0.867
Cohort B: SC Herceptin by SID0.8530.824 – 0.878
Overall Survival Rate Secondary · From Baseline to Time of Event (Up to Approximately 6 Years)

Overall survival was defined as the time from randomization to death from any cause. Time from the date of randomization to the date of death was expressed in Kaplan-Meier survival probability estimates. Patients without an event will be censored at the last assessment date.

0.5 Year
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9990.996 – 1.000
Cohort B: SC Herceptin by SIDE0.9960.987 – 0.999
1 Year
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9980.994 – 0.999
Cohort B: SC Herceptin by SIDE0.9940.985 – 0.998
1.5 Year
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9930.988 – 0.996
Cohort B: SC Herceptin by SIDE0.9900.979 – 0.995
2 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9850.979 – 0.990
Cohort B: SC Herceptin by SIDE0.9850.973 – 0.992
3 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9680.958 – 0.975
Cohort B: SC Herceptin by SIDE0.9600.942 – 0.972
4 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9470.935 – 0.956
Cohort B: SC Herceptin by SIDE0.9500.931 – 0.965
5 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9370.925 – 0.948
Cohort B: SC Herceptin by SIDE0.9290.907 – 0.947
6 Years
GroupValue95% CI
Cohort A: SC Herceptin by Needle/Syringe0.9270.913 – 0.938
Cohort B: SC Herceptin by SIDE0.9210.897 – 0.939
Percentage of Participants by Item Response to SID Satisfaction Questionnaire Secondary · Cycle 4 (cycle length 3 weeks) and last safety follow-up (LSFU) (approximately 1 year)

The SID satisfaction questionnaire was administered twice during the study and asked participants to respond to five statements using a Likert scale from "Strongly Disagree" to "Strongly Agree". Questionnaire items were as follows: "I felt comfortable injecting the study drug by myself" (Comfortable), "The SID was convenient and easy to use" (Easy to Use), "I am confident giving myself an injection in the thigh with the SID" (Confident), "Taking all things into account I find self-administration using the SID satisfactory" (Satisfactory), "If given the opportunity I would choose to continue se

Cycle 4: Comfortable, Strongly Disagree (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)4.7
Cycle 4: Comfortable, Disagree (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)2.3
Cycle 4: Comfortable, Unsure (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)7.6
Cycle 4: Comfortable, Agree (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)41.6
Cycle 4: Comfortable, Strongly Agree (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)43.6
Cycle 4: Comfortable, Response Missing (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)0.2
Cycle 4: Easy to Use, Strongly Disagree (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)3.7
Cycle 4: Easy to Use, Disagree (n=514)
GroupValue95% CI
Cohort B: SC Herceptin by SID (Self- Administered)0.6

Adverse events — posted to ClinicalTrials.gov

Time frame: Treatment Period: From Day 1 up to 19 cycles (approximately 1 year) 15 March 2015 Data Cutoff Safety Follow-up Period (SFU): From Day 1 to safety follow-up period (up to approximately 8 years). Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Cohort A: SC Herceptin by Needle/Syringe
Serious: 242/1864 (13%)
Deaths:
Cohort B: SC Herceptin by SID
Serious: 84/709 (12%)
Deaths:
Cohort A: SC Herceptin by Needle/Syringe Safety Follow-up
Serious: 202/1862 (11%)
Deaths:
Cohort B: SC Herceptin by SID Safety Follow-up
Serious: 53/707 (7%)
Deaths:

Serious adverse events (345 terms)

ReactionSystemCohort A: SC Herceptin by …Cohort B: SC Herceptin by …Cohort A: SC Herceptin by …Cohort B: SC Herceptin by …
Febrile neutropeniaBlood and lymphatic system disorders
Breast cancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)
PyrexiaGeneral disorders
Cardiac failure congestiveCardiac disorders
Neutropenic sepsisInfections and infestations
NeutropeniaBlood and lymphatic system disorders
PneumoniaInfections and infestations
DiarrhoeaGastrointestinal disorders
Device related infectionInfections and infestations
DeathGeneral disorders
Atrial fibrillationCardiac disorders
Myocardial InfarctionCardiac disorders
NauseaGastrointestinal disorders
MastitisInfections and infestations
CellulitisInfections and infestations
Lower respiratory tract infectionInfections and infestations
Pulmonary embolismRespiratory, thoracic and mediastinal disorders
Urinary tract infectionInfections and infestations
GastroenteritisInfections and infestations
AnaemiaBlood and lymphatic system disorders
PancreatitisGastrointestinal disorders
Acute myocardial infarctionCardiac disorders
Ejection fraction decreasedInvestigations
Uterine polypReproductive system and breast disorders
CholelithiasisHepatobiliary disorders
Other adverse events (44 terms — click to expand)

ReactionSystemCohort A: SC Herceptin by …Cohort B: SC Herceptin by …Cohort A: SC Herceptin by …Cohort B: SC Herceptin by …
FatigueGeneral disorders
DiarrhoeaGastrointestinal disorders
ArthralgiaMusculoskeletal and connective tissue disorders
NauseaGastrointestinal disorders
MyalgiaMusculoskeletal and connective tissue disorders
HeadacheNervous system disorders
AstheniaGeneral disorders
Pain in extremityMusculoskeletal and connective tissue disorders
CoughRespiratory, thoracic and mediastinal disorders
PyrexiaGeneral disorders
RashSkin and subcutaneous tissue disorders
Hot flushVascular disorders
AlopeciaSkin and subcutaneous tissue disorders
Radiation skin injuryInjury, poisoning and procedural complications
Oedema peripheralGeneral disorders
ErythemaSkin and subcutaneous tissue disorders
ConstipationGastrointestinal disorders
NasopharyngitisInfections and infestations
HypertensionVascular disorders
Neuropathy peripheralNervous system disorders
AnaemiaBlood and lymphatic system disorders
VomitingGastrointestinal disorders
Injection site erythemaGeneral disorders
Injection site painGeneral disorders
StomatitisGastrointestinal disorders
PruritusSkin and subcutaneous tissue disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Back painMusculoskeletal and connective tissue disorders
Upper respiratory tract infectionInfections and infestations
ParaesthesiaNervous system disorders
DizzinessNervous system disorders
EpistaxisRespiratory, thoracic and mediastinal disorders
InsomniaPsychiatric disorders
Mucosal inflammationGeneral disorders
Injection site reactionGeneral disorders
NeutropeniaBlood and lymphatic system disorders
Peripheral sensory neuropathyNervous system disorders
Urinary tract infectionInfections and infestations
Musculoskeletal painMusculoskeletal and connective tissue disorders
Abdominal painGastrointestinal disorders

Most-reported serious reactions: Febrile neutropenia, Breast cancer, Pyrexia, Cardiac failure congestive, Neutropenic sepsis, Neutropenia, Pneumonia, Diarrhoea.

Data from ClinicalTrials.gov NCT01566721 adverse events section.

Sponsor's own description

This multicenter, two-cohort, non-randomized, open-label study will evaluate the safety and tolerability of assisted and self-administered SC Herceptin as adjuvant therapy in participants with early HER2-positive breast cancer following tumor excision. Participants will receive Herceptin 600 milligrams (mg) SC every 3 weeks for 18 cycles, either by an assisted administration using a conventional syringe and needle/vial formulation (Cohort A) or with assisted and self-administration using a single-use injection device (SID) in selected participants (Cohort B).

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Subcutaneous administration of rituximab (MabThera) and trastuzumab (Herceptin) using hyaluronidase.
    Shpilberg O, Jackisch C. · · 2013 · cited 88× · PMID 24002601 · DOI 10.1038/bjc.2013.371
  2. Subcutaneous Administration of Monoclonal Antibodies in Oncology.
    Jackisch C, Müller V, Maintz C, Hell S, et al · · 2014 · cited 65× · PMID 25076790 · DOI 10.1055/s-0034-1368173
  3. Safety and tolerability of subcutaneous trastuzumab for the adjuvant treatment of human epidermal growth factor receptor 2-positive early breast cancer: SafeHer phase III study's primary analysis of 2573 patients.
    Gligorov J, Ataseven B, Verrill M, De Laurentiis M, et al · · 2017 · cited 36× · PMID 28625777 · DOI 10.1016/j.ejca.2017.05.010
  4. Medical resource utilization for administration of trastuzumab in a New Zealand oncology outpatient setting: a time and motion study.
    North RT, Harvey VJ, Cox LC, Ryan SN. · · 2015 · cited 36× · PMID 26251623 · DOI 10.2147/ceor.s85599
  5. Subcutaneous Trastuzumab for HER2-positive Breast Cancer - Evidence and Practical Experience in 7 German Centers.
    Jackisch C, Müller V, Dall P, Neumeister R, et al · · 2015 · cited 35× · PMID 26166837 · DOI 10.1055/s-0035-1546172
  6. Evolving landscape of human epidermal growth factor receptor 2-positive breast cancer treatment and the future of biosimilars.
    Jackisch C, Lammers P, Jacobs I. · · 2017 · cited 32× · PMID 28236776 · DOI 10.1016/j.breast.2017.01.010
  7. A multidisciplinary perspective on the subcutaneous administration of trastuzumab in HER2-positive breast cancer.
    Dent S, Ammendolea C, Christofides A, Edwards S, et al · · 2019 · cited 26× · PMID 30853812 · DOI 10.3747/co.26.4220
  8. Subcutaneous trastuzumab: development of a new formulation for treatment of HER2-positive early breast cancer.
    Hamizi S, Freyer G, Bakrin N, Henin E, et al · · 2013 · cited 16× · PMID 23430730 · DOI 10.2147/ott.s27733

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