Article
Author: Di Cosimo, S. ; McConnell, R ; Chumsri, S ; Ellard, S.L. ; Kroep, J.R. ; Di Cosimo, S ; Cameron, D. ; Krop, I ; Ellard, S L ; Chumsri, S. ; van Duijnhoven, F ; Colleoni, M. ; Gralow, J ; Lombard, J ; de Azambuja, E ; Moscetti, L ; McConnell, R. ; Krop, I. ; Townend, J ; Choudhury, A ; Rodeheffer, R ; Tujakowski, J ; Untch, M ; Kelly, C.M. ; Kuemmel, S. ; Kroep, J R ; Moscetti, L. ; Lang, I ; Holtschmidt, J ; Ferro, A ; Roylance, R. ; Xu, B. ; Piccart-Gebhart, M ; Vicente, M. ; Cameron, D ; Gelber, R.D. ; Knop, A.S. ; Hillman, D W ; Baruch, N.B. ; Townend, J. ; Huang, C.-S. ; Boyle, F. ; Gelber, R D ; Fielding, S. ; Werutsky, G. ; Korde, L. ; Piccart-Gebhart, M. ; Rodeheffer, R. ; Hillman, D.W. ; Choudhury, A. ; Gralow, J. ; Korde, L ; Holtschmidt, J. ; Colleoni, M ; Bliss, J ; Werutsky, G ; van Duijnhoven, F. ; Xu, B ; de Azambuja, E. ; El-Abed, S ; Kelly, C M ; Kim, S.-B. ; Roylance, R ; Tujakowski, J. ; Baruch, N B ; El-Abed, S. ; Kim, S-B ; Huang, C-S ; Gomez, H. ; Untch, M. ; Fielding, S ; Bliss, J. ; Moreno-Aspitia, A. ; Moreno-Aspitia, A ; Knop, A S ; Lombard, J. ; Boyle, F ; Wolff, A C ; Gomez, H ; Kuemmel, S ; Lang, I. ; Wolff, A.C. ; Ferro, A. ; Vicente, M
BACKGROUND:Dual anti-human epidermal growth factor receptor 2 (HER2) blockade has improved the outcomes of patients with early and metastatic HER2-positive breast cancer. Here we present the final 10-year analysis of the ALTTO trial.
PATIENTS AND METHODS:The ALTTO trial (NCT00490139) is a prospective randomized, phase III, open-label, multicenter study that investigated the role of adjuvant chemotherapy and trastuzumab alone, in combination or sequentially with lapatinib. The primary endpoint was disease-free survival (DFS) and secondary endpoints included overall survival (OS), time to distant recurrence and safety.
RESULTS:Overall, 6281 patients with HER2-positive early breast cancer were included in the final efficacy analysis in three treatment groups: trastuzumab (T), lapatinib + trastuzumab (L + T) and trastuzumab followed by lapatinib (T→L). Baseline characteristics were well balanced between groups. At a median follow-up of 9.8 years, the addition of lapatinib to trastuzumab and chemotherapy did not significantly improve DFS nor OS. The 10-year DFS was 77% in T, 79% in L + T and 79% in T→L, and the 10-year OS was 87%, 89% and 89%, respectively. The incidence of any cardiac event was low and similar in the three treatment groups.
CONCLUSIONS:With a longer follow-up, no significant improvement was observed in DFS in patients treated with dual anti-HER2 blockade with lapatinib + trastuzumab compared to trastuzumab alone. The 10-year survival rates for the combination group are consistent with other studies that have explored dual anti-HER2 therapy.