Seattle genetics announces positive topline results from pivotal trial of tucatinib in locally advanced or metastatic her2-positive breast cancer

Seattle genetics, inc. announced positive topline results from the her2climb trial, a randomized, double-blind, placebo-controlled, active comparator pivotal trial evaluating tucatinib. the trial compared tucatinib in combination with trastuzumab and capecitabine to trastuzumab and capecitabine alone in patients with locally advanced unresectable or metastatic her2-positive breast cancer. patients had previously received trastuzumab, pertuzumab and ado-trastuzumab emtansine (t-dm1), and 47% of the patients enrolled in the trial had brain metastases at the time of enrollment. tucatinib is an oral, small molecule tyrosine kinase inhibitor (tki) that is highly selective for her2. the trial met the primary endpoint of progression-free survival (pfs), showing that the addition of tucatinib was superior to trastuzumab and capecitabine alone, with a 46% reduction in the risk of disease progression or death (hazard ratio (hr)=0.54 (95% confidence interval (ci): 0.42, 0.71); p<0.00001). the trial also met the two key secondary endpoints at interim analysis. the tucatinib arm demonstrated an improvement in overall survival, with a 34 % reduction in the risk of death (hr=0.66 (95% ci: 0.50, 0.88); p=0.0048) compared to trastuzumab and capecitabine alone. for patients with brain metastases at baseline, the tucatinib arm also demonstrated superior pfs, with a 52 % reduction in the risk of disease progression or death compared to those who received trastuzumab and capecitabine alone (hr=0.48 (95% ci: 0.34, 0.69); p<0.00001). tucatinib in combination with trastuzumab and capecitabine was generally well tolerated with a manageable safety profile. the most frequent adverse events in the tucatinib arm included diarrhea, palmar-plantar erythrodysaesthesia syndrome (ppe), nausea, fatigue, and vomiting. grade 3 or greater adverse events in the tucatinib arm compared to the control arm included diarrhea (12.9 vs. 8.6%), increased aspartate aminotransferase (ast) (4.5 vs. 0.5%), increased alanine aminotransferase (alt) (5.4 vs. 0.5%) and increased bilirubin (0.7 vs. 2.5%). there was no requirement for prophylactic antidiarrheals. adverse events leading to discontinuations were infrequent in both the tucatinib arm and the control arm (5.7 and 3.0%). additional results are scheduled to be presented on december 11 at the 2019 san antonio breast cancer symposium.
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