A Study to Compare the Safety and Efficacy of an Aromatase Inhibitor in Combination With Lapatinib, Trastuzumab or Both for the Treatment of Hormone Receptor Positive, HER2+ Metastatic Breast Cancer

March 4, 2025 updated by: Novartis Pharmaceuticals

A Phase III Trial to Compare the Safety and Efficacy of Lapatinib Plus Trastuzumab Plus an Aromatase Inhibitor (AI) vs. Trastuzumab Plus an AI vs. Lapatinib Plus an AI as 1st- or 2nd- Line Therapy in Postmenopausal Subjects With Hormone Receptor+, HER2-positive Metastatic Breast Cancer (MBC) Who Received Prior Trastuzumab and Endocrine Therapies

A study to compare the safety and efficacy of an aromatase inhibitor in combination with lapatinib, trastuzumab or both for the treatment of hormone receptor positive, HER2+ metastatic breast cancer (MBC).

Study Overview

Detailed Description

This Phase III, multicenter, open-label study randomized subjects to one of the three treatment arms:

  1. Treatment group A: lapatinib 1000 mg PO once daily + trastuzumab (loading dose of 8 mg/kg) followed by the maintenance dose of 6 mg/kg IV q3weeks + an AI (either letrozole, anastrozole, or exemestane) of Investigator's choice PO once daily.
  2. Treatment group B: trastuzumab (loading dose of 8 mg/kg) followed by maintenance dose of 6 mg/kg IV q3weeks + an AI (either letrozole, anastrozole, or exemestane) of Investigator's choice PO once daily.
  3. Treatment group C: lapatinib 1500 mg PO once daily + an AI (either letrozole, anastrozole, or exemestane) of Investigator's choice PO once daily.

Treatment continued until disease progression, death, or unacceptable toxicities, whichever came first.

Subjects who discontinued study treatment for reasons other than disease progression were followed-up every 12 weeks until disease progression or death, until the start of post-study treatment anti-cancer therapy (including radiotherapy and surgery), withdrawal of consent, or lost to follow-up, whichever came first.

Study Type

Interventional

Enrollment (Actual)

369

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Cordoba, Argentina, X5004FHP
        • Novartis Investigative Site
      • La Rioja, Argentina, F5300COE
        • Novartis Investigative Site
      • Quilmes, Argentina, 1878
        • Novartis Investigative Site
      • San Miguel de Tucuman, Argentina, T4000IAK
        • Novartis Investigative Site
    • Buenos Aires
      • Berazategui, Buenos Aires, Argentina, B1880BBF
        • Novartis Investigative Site
      • Capital Federal, Buenos Aires, Argentina, C1417DTN
        • Novartis Investigative Site
      • Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina, C1050AAK
        • Novartis Investigative Site
      • Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina, C1280AEB
        • Novartis Investigative Site
      • La Plata, Buenos Aires, Argentina, B1920CMK
        • Novartis Investigative Site
    • Río Negro
      • Viedma, Río Negro, Argentina, R8500ACE
        • Novartis Investigative Site
    • Santa Fe
      • Rosario, Santa Fe, Argentina, S2000KZE
        • Novartis Investigative Site
      • Albury, Australia, 2640
        • Novartis Investigative Site
      • Douglas, Australia, 4814
        • Novartis Investigative Site
      • Leuven, Belgium, 3000
        • Novartis Investigative Site
      • Namur, Belgium, 5000
        • Novartis Investigative Site
      • Rio de Janeiro, Brazil, 20560-120
        • Novartis Investigative Site
    • Goiás
      • Goiania, Goiás, Brazil, 74605-070
        • Novartis Investigative Site
    • Rio Grande Do Sul
      • Porto Alegre, Rio Grande Do Sul, Brazil, 90470-340
        • Novartis Investigative Site
      • Porto Alegre, Rio Grande Do Sul, Brazil, 91350-200
        • Novartis Investigative Site
    • São Paulo
      • Barretos, São Paulo, Brazil, 14784-400
        • Novartis Investigative Site
      • Sao Paulo, São Paulo, Brazil, 03102-002
        • Novartis Investigative Site
      • Sao Paulo, São Paulo, Brazil, 05651-901
        • Novartis Investigative Site
      • Sao Paulo, São Paulo, Brazil, 01317-001
        • Novartis Investigative Site
      • Plovdiv, Bulgaria, 4004
        • Novartis Investigative Site
      • Sofia, Bulgaria, 1756
        • Novartis Investigative Site
      • Sofia, Bulgaria, 1330
        • Novartis Investigative Site
      • Varna, Bulgaria, 9010
        • Novartis Investigative Site
      • Harbin, China, 150081
        • Novartis Investigative Site
      • Shanghai, China, 200032
        • Novartis Investigative Site
    • Fujian
      • Fuzhou, Fujian, China, 350001
        • Novartis Investigative Site
    • Guangdong
      • Guangzhou, Guangdong, China, 510060
        • Novartis Investigative Site
    • Jilin
      • Changchun, Jilin, China, 130021
        • Novartis Investigative Site
      • Osijek, Croatia, 31000
        • Novartis Investigative Site
      • Zagreb, Croatia, 10000
        • Novartis Investigative Site
      • Besancon, France, 25030
        • Novartis Investigative Site
      • Montpellier Cedex 5, France, 34298
        • Novartis Investigative Site
      • Paris Cedex 20, France, 75970
        • Novartis Investigative Site
    • Bayern
      • Muenchen, Bayern, Germany, 81675
        • Novartis Investigative Site
    • Brandenburg
      • Furstenwalde, Brandenburg, Germany, 15517
        • Novartis Investigative Site
    • Niedersachsen
      • Goslar, Niedersachsen, Germany, 38642
        • Novartis Investigative Site
    • Nordrhein-Westfalen
      • Troisdorf, Nordrhein-Westfalen, Germany, 53840
        • Novartis Investigative Site
      • Velbert, Nordrhein-Westfalen, Germany, 42551
        • Novartis Investigative Site
      • Alexandroupolis, Greece, 68100
        • Novartis Investigative Site
      • Chania, Greece, 73100
        • Novartis Investigative Site
      • Heraklion, Greece, 71110
        • Novartis Investigative Site
      • Hong Kong, Hong Kong
        • Novartis Investigative Site
      • Kowloon, Hong Kong
        • Novartis Investigative Site
      • Tuen Mun, Hong Kong
        • Novartis Investigative Site
      • Gyor, Hungary, H-9024
        • Novartis Investigative Site
      • Gyula, Hungary, 5700
        • Novartis Investigative Site
      • Kaposvar, Hungary, 7400
        • Novartis Investigative Site
      • Miskolc, Hungary, 3526
        • Novartis Investigative Site
      • Nyiregyhaza, Hungary, 4400
        • Novartis Investigative Site
      • Pecs, Hungary, 7624
        • Novartis Investigative Site
      • Szeged, Hungary, 6720
        • Novartis Investigative Site
      • Zalaegerszeg, Hungary, H-8900
        • Novartis Investigative Site
      • Nagpur, India, 440010
        • Novartis Investigative Site
      • New Delhi, India, 110 092
        • Novartis Investigative Site
      • Haifa, Israel, 31096
        • Novartis Investigative Site
      • Jerusalem, Israel, 91120
        • Novartis Investigative Site
      • Ramat Gan, Israel, 52621
        • Novartis Investigative Site
    • Lombardia
      • Rozzano (MI), Lombardia, Italy, 20089
        • Novartis Investigative Site
      • Aichi, Japan, 464-8681
        • Novartis Investigative Site
      • Chiba, Japan, 277-8577
        • Novartis Investigative Site
      • Ehime, Japan, 791-0280
        • Novartis Investigative Site
      • Osaka, Japan, 540-0006
        • Novartis Investigative Site
      • Osaka, Japan, 537-8511
        • Novartis Investigative Site
      • Saitama, Japan, 362-0806
        • Novartis Investigative Site
      • Tokyo, Japan, 104-8560
        • Novartis Investigative Site
      • Gyeonggi-do, Korea, Republic of, 10408
        • Novartis Investigative Site
      • Seoul, Korea, Republic of, 03080
        • Novartis Investigative Site
      • Seoul, Korea, Republic of, 06351
        • Novartis Investigative Site
      • Seoul, Korea, Republic of, 05505
        • Novartis Investigative Site
      • Arequipa, Peru
        • Novartis Investigative Site
      • Lima, Peru, Lima 18
        • Novartis Investigative Site
      • Konin, Poland, 62-500
        • Novartis Investigative Site
      • Warszawa, Poland, 04-125
        • Novartis Investigative Site
      • Lisbon, Portugal, 1400-038
        • Novartis Investigative Site
      • Porto, Portugal, 4200-072
        • Novartis Investigative Site
      • Arkhangelsk, Russian Federation, 163045
        • Novartis Investigative Site
      • Kazan, Russian Federation, 420029
        • Novartis Investigative Site
      • Moscow, Russian Federation, 115478
        • Novartis Investigative Site
      • Ryazan, Russian Federation, 390011
        • Novartis Investigative Site
      • St. Petersburg, Russian Federation, 197758
        • Novartis Investigative Site
      • St. Petersburg, Russian Federation, 197022
        • Novartis Investigative Site
      • Belgrade, Serbia, 11000
        • Novartis Investigative Site
      • Sremska Kamenica, Serbia, 21204
        • Novartis Investigative Site
      • Singapore, Singapore, 308433
        • Novartis Investigative Site
      • Barcelona, Spain, 08036
        • Novartis Investigative Site
      • Castellon, Spain, 12002
        • Novartis Investigative Site
      • La Coruna, Spain, 15009
        • Novartis Investigative Site
      • Madrid, Spain, 28040
        • Novartis Investigative Site
      • Changhua, Taiwan, 500
        • Novartis Investigative Site
      • Kaohsiung, Taiwan, 833
        • Novartis Investigative Site
      • Taipei City, Taiwan, 11217
        • Novartis Investigative Site
      • Ankara, Turkey, 06200
        • Novartis Investigative Site
      • Izmir, Turkey, 35100
        • Novartis Investigative Site
      • Chernivtsi, Ukraine, 58013
        • Novartis Investigative Site
      • Kharkiv, Ukraine, 61070
        • Novartis Investigative Site
      • Lyutizh, Ukraine, 07352
        • Novartis Investigative Site
      • Sumy, Ukraine, 40005
        • Novartis Investigative Site
      • Uzhgorod, Ukraine, 88000
        • Novartis Investigative Site
      • Vinnitsia, Ukraine, 21029
        • Novartis Investigative Site
      • London, United Kingdom, SW3 6JJ
        • Novartis Investigative Site
      • Maidstone, United Kingdom, ME16 9QQ
        • Novartis Investigative Site
      • Peterborough, United Kingdom, PE3 9GZ
        • Novartis Investigative Site
    • Florida
      • Hollywood, Florida, United States, 33021
        • Novartis Investigative Site
    • Georgia
      • Augusta, Georgia, United States, 30912
        • Novartis Investigative Site
    • Tennessee
      • Germantown, Tennessee, United States, 38138
        • Novartis Investigative Site
    • Washington
      • Tacoma, Washington, United States, 98405
        • Novartis Investigative Site

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria

Subjects eligible for enrollment in the study must meet all of the following criteria:

  1. Signed written informed consent. In Korea and Japan, subjects between >=18 and <20 years of age must also have a legal representative sign the written informed consent.
  2. Post-menopausal female subjects >=18 years of age. Post-menopausal as defined by any of the following:

    • Subjects at least 60 years of age.
    • Subjects under 60 years of age and amenorrhic for at least 12 consecutive months AND follicle-stimulating hormone (FSH) and estradiol levels in postmenopausal range (utilizing ranges from the local laboratory facility).
    • Prior bilateral oophorectomy.
    • Prior radiation castration with amenorrhea for at least 6 months
  3. Subjects must have a history of histologically confirmed breast cancer, with a clinically confirmed diagnosis of metastatic disease [confirmed by histology, cytology or other clinical means (e.g. CT, MRI)]. Subjects may have either measurable or non-measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST 1.1)
  4. Tumors that are ER+ and/or PgR+ by local laboratory
  5. Documentation of HER2 overexpression or gene amplification, in the invasive component of either the primary tumor or metastatic disease site as defined as:

    • 3+ by Immunohistochemistry (IHC) and/or
    • HER2/neu gene amplification by fluorescence, chromogenic or silver in situ hybridization [FISH, CISH or SISH; >6 HER2/neu gene copies per nucleus or a FISH, CISH or SISH test ratio (HER2 gene copies to chromosome 17 signals) of ≥2.0]
  6. Subject must have received at least one prior regimen containing trastuzumab in combination with chemotherapy for breast cancer:.

    • Subject has ONLY received prior trastuzumab in combination with chemotherapy as neoadjuvant and/or adjuvant treatment. OR
    • Subject has received ONE prior trastuzumab-containing regimen for metastatic disease (and has progressed), and may or may not have received prior trastuzumab in combination with chemotherapy as neoadjuvant and/or adjuvant treatment.
  7. Subject must have received prior endocrine therapy (such as aromatase inhibitors or selective estrogen receptor modulators). 8. Subjects who have a life expectancy of > 6 months as assessed by the treating investigator

9. Subjects must have baseline Left Ventricular Ejection Fraction (LVEF) ≥50% measured by echocardiography (ECHO) or multi-gated acquisition scan (MUGA) 10. Subject must have an ECOG performance status of 0-1 11. All prior treatment related toxicities must be CTCAE (Version 4.0) ≤ Grade 1 at the time of randomization 12. Completion of screening assessments 13. Adequate baseline organ function. 14. Subjects must meet all of the following criteria:

  • QTc <450msec or
  • QTc <480msec for subjects with bundle branch block The QTc is the QT interval corrected for heart rate according to either Bazett's formula (QTcB) or to Fridericia's formula (QTcF), machine or manual over read, for males and females. The specific formula that will be used in a protocol should be determined prior to initiation of the study, and the formula used to determine inclusion and discontinuation should be the same throughout the study. The QTc should be based on single or averaged QTc values of triplicate electrocardiograms (ECGs) obtained over a brief recording period

Exclusion criteria:

  1. History of another malignancy. Exception: Subjects who have been disease-free for 5 years, or subjects with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible.
  2. Subjects with extensive symptomatic visceral disease including hepatic involvement and pulmonary lymphangitic spread of tumor, or the disease is considered by the investigator to be rapidly progressing or life threatening (subjects who are intended for chemotherapy)
  3. Serious cardiac illness or medical condition including but not confined to:

    • Uncontrolled arrhythmias
    • Uncontrolled or symptomatic angina
    • History of congestive heart failure (CHF)
    • Documented myocardial infarction <6 months from study entry
  4. Known history of, or clinical evidence of, central nervous system (CNS) metastases or leptomeningeal carcinomatosis
  5. Have acute or currently active/requiring anti-viral therapy hepatic or biliary disease (with the exception of subjects with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment)
  6. Have a concurrent disease or condition that may interfere with study participation, or any serious medical disorder that would interfere with the subject's safety (for example, active or uncontrolled infection or any psychiatric condition prohibiting understanding or rendering of informed consent)
  7. Have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels
  8. Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to any of the study agents or their excipients that, in the opinion of the Investigator or GSK medical monitor, contraindicates their participation
  9. Any prohibited medication.
  10. Administration of an investigational drug within 30 days or 5 half-lives, whichever is longer, preceding the first dose of study treatment.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Treatment group A
Lapatinib 1000 mg PO once daily + Trastuzumab (loading dose of 8 mg/kg) followed by the maintenance dose of 6 mg/kg IV every 3 weeks (q3weeks) + an Aromatase Inhibitor (AI) of Investigator's choice PO once daily.
1000 mg by mouth once a day
Loading dose of 8 mg/kg IV followed by the maintenance dose of 6 mg/kg IV every 3 weeks (q3weeks)
Aromatase inhibitor (either letrozole, anastrozole, or exemestane) of investigator's choice given by mouth once daily
1500 mg by mouth once daily
Active Comparator: Treatment group B
Trastuzumab (loading dose of 8 mg/kg) followed by maintenance dose of 6 mg/kg IV every 3 weeks (q3weeks) + an Aromatase Inhibitor (AI) of Investigator's choice PO once daily.
Loading dose of 8 mg/kg IV followed by the maintenance dose of 6 mg/kg IV every 3 weeks (q3weeks)
Aromatase inhibitor (either letrozole, anastrozole, or exemestane) of investigator's choice given by mouth once daily
Active Comparator: Treatment Group C
Lapatinib 1500 mg PO once daily + an Aromatase Inhibitor (AI) of Investigator's choice PO once daily.
1000 mg by mouth once a day
Aromatase inhibitor (either letrozole, anastrozole, or exemestane) of investigator's choice given by mouth once daily
1500 mg by mouth once daily

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression Free Survival (PFS) Events in Lapatinib + Trastuzumab + Aromatase Inhibitor (AI) vs. Trastuzumab + Aromatase Inhibitor (AI)
Time Frame: From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up approximately 5 years
The Number of Participants with Progression free survival (PFS) events in the Lapatinib + Trastuzumab + Aromatase Inhibitor (AI) arm vs. Trastuzumab + Aromatase Inhibitor (AI) arm was based on assessments by the Investigator.
From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up approximately 5 years
Median Kaplan Meier Estimates for PFS in Lapatinib + Trastuzumab + Aromatase Inhibitor (AI) vs. Trastuzumab + Aromatase Inhibitor (AI)
Time Frame: From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up approximately 5 years
Progression free survival (PFS) was defined as the interval of time between the date of randomization and the earliest date of disease progression (with radiological evidence) or death from any cause, or to the date of censor. Disease progression was based on assessments by the Investigator.
From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up approximately 5 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression Free Survival (PFS)
Time Frame: From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up approximately 11 years
Progression free survival (PFS) was defined as the interval of time between the date of randomization and the earliest date of disease progression (with radiological evidence) or death from any cause, or to the date of censor. Disease progression was based on assessments by the Investigator.
From date of randomization until date of progression or date of death from any cause, whichever comes first, assessed up approximately 11 years
Overall Survival (OS)
Time Frame: From date of randomization until date of death from any cause, assessed up approximately 11 years
The Number of Participants with Overall Survival (OS) events was based on assessments by the Investigator.
From date of randomization until date of death from any cause, assessed up approximately 11 years
Overall Response Rate (ORR)
Time Frame: Up approximately 11 years
Overall Response Rate (ORR) was defined as the proportion of participants achieving either a Complete Response (CR) or Partial Response (PR). The ORR was calculated from the Investigator's assessment of response based on RECIST 1.1. Subjects with an unknown or missing response were treated as non-responders; i.e. they were included in the denominator when calculating the percentages. Subjects who do not have measurable disease contributed to the Response Rate based analyses, for the evaluation of CR, SD and PD.
Up approximately 11 years
Clinical Benefit Rate (CBR)
Time Frame: Up approximately 11 years
Clinical Benefit Rate (CBR) was defined as the percentage of patients with evidence of Complete Response (CR), Partial Response (PR), or maintaining Stable Disease (SD) for at least 6 months while on study, according to the investigator assessment of response per RECIST 1.1 criteria.
Up approximately 11 years
Time to Response
Time Frame: From date of randomization until the earliest date of Complete Response (CR) or Partial Response (PR), assessed up approximately 11 years
Time to Response (TTR) was defined as the time from randomization to the earliest date of Complete Response (CR) or Partial Response (PR)
From date of randomization until the earliest date of Complete Response (CR) or Partial Response (PR), assessed up approximately 11 years
Duration of Response (DoR)
Time Frame: From first documented evidence of CR or PR (the response prior to confirmation) until time of documented disease progression or death due to any cause, whichever comes first, assessed up approximately 11 years
Duration of Response (DOR) was defined as the duration between the date of first documented Complete Response (CR) or Partial Response (PR) and the date of first documented sign of Progressive Disease or Death, or to the date of censor.
From first documented evidence of CR or PR (the response prior to confirmation) until time of documented disease progression or death due to any cause, whichever comes first, assessed up approximately 11 years
Mean Change in the Quality of Life (QoL) Status Relative to Baseline FACT-B Overall and Subscale Scores at Last On Treatment Assessment
Time Frame: Day 1 (pre-dose), up approximately 11 years
Quality of life was assessed using the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire. It is a 37-item (27 general questions and 10 breast cancer specific questions) self-reporting instrument consisting of 5 dimensions: physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and a breast cancer subscale (BCS). The followings were the score ranges for each self-reporting subscale: • PWB : 0-28 • SWB : 0-28 • EWB : 0-24 • FWB : 0-28 • BCS : 0-40 FACT-B Total Outcome Index (TOI) = PWB + FWB + BCS (range:0 - 96) FACT-B Total Score = PWB + SWB + EWB + FWB + BCS (range:0-148) FACT-G Total Score = PWB + SWB + EWB + FWB (range:0-108). For all the FACIT scales and symptom indices, the higher the score the better QoL
Day 1 (pre-dose), up approximately 11 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Study Director: Novartis Pharmaceuticals, Novartis Pharmaceuticals

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 5, 2011

Primary Completion (Actual)

March 11, 2016

Study Completion (Actual)

June 6, 2022

Study Registration Dates

First Submitted

July 1, 2010

First Submitted That Met QC Criteria

July 8, 2010

First Posted (Estimated)

July 12, 2010

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

March 4, 2025

Last Verified

March 1, 2025

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations.

This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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