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Phase III, Double-Blind, Randomized Trial That Compared Maintenance Lapatinib Versus Placebo After First-Line Chemotherapy in Patients With Human Epidermal Growth Factor Receptor 1/2-Positive Metastatic Bladder Cancer.

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Date
2017-01
ICR Author
Huddart, Robert
Author
Powles, T
Huddart, RA
Elliott, T
Sarker, S-J
Ackerman, C
Jones, R
Hussain, S
Crabb, S
Jagdev, S
Chester, J
Hilman, S
Beresford, M
Macdonald, G
Santhanam, S
Frew, JA
Stockdale, A
Hughes, S
Berney, D
Chowdhury, S
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Type
Journal Article
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Abstract
Purpose To establish whether maintenance lapatinib after first-line chemotherapy is beneficial in human epidermal growth factor receptor (HER) 1/HER2-positive metastatic urothelial bladder cancer (UBC). Methods Patients with metastatic UBC were screened centrally for HER1/HER2 overexpression. Patients who screened positive for HER1/2 and who did not have progressive disease during chemotherapy (four to eight cycles) were randomly assigned one to one to lapatinib or placebo after completion of first-line/initial chemotherapy for metastatic disease. The primary end point was progression-free survival (PFS). Results Between 2007 and 2013, 446 patients with UBC were screened, and 232 with HER1- or HER2-positive disease were randomly assigned. The median PFS for lapatinib and placebo was 4.5 (95% CI, 2.8 to 5.4) and 5.1 (95% CI, 3.0 to 5.8) months, respectively (hazard ratio, 1.07; 95% CI, 0.81 to 1.43; P = .63). The overall survival for lapatinib and placebo was 12.6 (95% CI, 9.0 to 16.2) and 12.0 (95% CI, 10.5 to 14.9) months, respectively (hazard ratio, 0.96; 95% CI, 0.70 to 1.31; P = .80). Discontinuation due to adverse events were similar in both arms (6% lapatinib and 5% placebo). The rate of grade 3 to 4 adverse events for lapatinib and placebo was 8.6% versus 8.1% ( P = .82). Preplanned subset analysis of patients strongly positive for HER1/HER2 (3+ on immunohistochemistry; n = 111), patients positive for only HER1 (n = 102), and patients positive for only HER2 (n = 42) showed no significant benefit with lapatinib in terms of PFS and overall survival ( P > .05 for each). Conclusion This trial did not find significant improvements in outcome by the addition of maintenance lapatinib to standard of care.
URI
https://repository.icr.ac.uk/handle/internal/361
DOI
https://doi.org/10.1200/jco.2015.66.3468
Collections
  • Radiotherapy and Imaging
Subject
Humans
Carcinoma, Transitional Cell
Cisplatin
Quinazolines
Receptor, erbB-2
Antineoplastic Combined Chemotherapy Protocols
Disease-Free Survival
Double-Blind Method
Aged
Middle Aged
Female
Male
Urinary Bladder Neoplasms
Maintenance Chemotherapy
Response Evaluation Criteria in Solid Tumors
ErbB Receptors
Lapatinib
Research team
Clinical Academic Radiotherapy (Huddart)
Language
eng
Date accepted
2016-10-31
License start date
2017-01
Citation
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017, 35 (1), pp. 48 - 55

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