Breast cancer: EMBRACA trial

Abbreviations

No EU-CTR

  • EMBRACA references
    2018-08-23
    Jennifer K. Litton
    Talazoparib in Patients with Advanced Breast Cancer and a Germline BRCA Mutation
Investigated (inv)
Comparator (comp)

TALA

chemo

287

144

Phase:

3

Randomisation:

Open label

Primary tumour:

Breast

Subtype (biomarker):

BRCA1/2 MT

Stage:

meta

Line of therapy:

L3

Primary
TALA
chemo
HR
p
PSF
8.6 mo
5.6 mo
0.54 (0.41-0.71)
<0.001
Secondaries
TALA
chemo
HR
p
ORR
62.6%
27.2%
5.0 (2.9-8.8)
<0.001
DoR
5.4 mo
3.1 mo
0.43 (0.27-0.70)
(all grades, %)
TALA
chemo
p
Hematologic AE grade 3-4
55%
38%
NA
Non-hematologic AE grade 3-4
32%
38%
NA
Anemia
53%
18%
NA
Neutropenia
35%
43%
NA
Thrombocytopenia
27%
7%
NA
Leukopenia
17%
14%
NA
Lymphopenia
7%
3%
NA
Fatigue
50%
43%
NA
Nausea
49%
47%
NA
Vomiting
25%
23%
NA
Diarrhea
22%
26%
NA
Constipation
22%
21%
NA
PPE syndrome
1.4%
22.2%
NA
Pleural effusion
2.1%
8.7%
NA
  • Inclusion
  • Exclusion

- Histologically or cytologically confirmed carcinoma of the breast - Locally advanced breast cancer that is not amenable to curative radiation or surgical cure and/or metastatic disease appropriate for systemic single cytotoxic chemotherapy - Documentation of a deleterious, suspected deleterious, or pathogenic germline BRCA1 or BRCA2 mutation from Myriad Genetics or other laboratory approved by the Sponsor - No more than 3 prior chemotherapy-inclusive regimens for locally advanced and/or metastatic disease (no limit on prior hormonal therapies or targeted anticancer therapies such as mechanistic target of rapamycin (mTOR) or CDK4/6 inhibitors, immune-oncology agents, tyrosine kinase inhibitors, or monoclonal antibodies against CTL4 or VEGF) - Prior treatment with a taxane and/or anthracycline in the neoadjuvant, adjuvant, locally advanced, or metastatic setting unless medically contraindicated - Have measurable or non-measurable, evaluable disease by the revised response evaluation criteria in solid tumors (RECIST) v.1.1 - Eastern Cooperative Oncology Group (ECOG) performance status ≤2

- First-line locally advanced and/or metastatic breast cancer with no prior adjuvant chemotherapy unless the Investigator determines that one of the 4 cytotoxic chemotherapy agents in the control arm would otherwise be offered to the subject - Prior treatment with a PARP inhibitor (not including iniparib) - Not a candidate for treatment with at least 1 of the treatments of protocol-specific physician's choice (ie, capecitabine, eribulin, gemcitabine, vinorelbine) - Subjects who had objective disease progression while receiving platinum chemotherapy administered for locally advanced or metastatic disease; subjects who received low-dose platinum therapy administered in combination with radiation therapy are not excluded - Subjects who have received platinum in the adjuvant or neoadjuvant setting are eligible; however, subjects may not have relapsed within 6 months of the last dose of prior platinum therapy - Cytotoxic chemotherapy within 14 days before randomization - Radiation or anti-hormonal therapy or other targeted anticancer therapy within 14 days before randomization - HER2 positive breast cancer - Active inflammatory breast cancer - CNS metastases • Exception: Adequately treated brain metastases documented by baseline CT or MRI scan that has not progressed since previous scans and that does not require corticosteroids (except prednisone ≤5 mg/day or equivalent) for management of CNS symptoms. A repeat CT or MRI following the identification of CNS metastases (obtained at least 2 weeks after definitive therapy) must document adequately treated brain metastases. • Subjects with leptomeningeal carcinomatosis are not permitted Prior malignancy except for any of the following: • Prior BRCA-associated cancer as long as there is no current evidence of the cancer • Carcinoma in situ or non-melanoma skin cancer • A cancer diagnosed and definitively treated ≥5 years before randomization with no subsequent evidence of recurrence - Known to be human immunodeficiency virus positive - Known active hepatitis C virus, or known active hepatitis B virus - Known hypersensitivity to any of the components of talazoparib

Characteristics
TALA
chemo
Agedc-comma sex
Median age (range) yr
45 (27–84)
50 (24–88)
<50 yr - no(%)
182 (63.4)
67 (46.5)
Female
98.6%
97.9%
ECOG PS score
0
53.3%
58.3%
1
44.3%
39.6%
2
2.1%
1.4%
Breast cancer stage - no(%)
Locally advanced
15 (5.2)
9 (6.2)
Metastatic
271 (94.4)
135 (93.8)
Hormone-receptor status - no(%)
Triple-negative
130 (45.3)
60 (41.7)
Hormone-receptor–positive
157 (54.7)
84 (58.3)
BRCA status - no(%)
BRCA1dc-plus
133 (46.3)
63 (43.8)
BRCA2+
154 (53.7)
81 (56.2)
Previous cytotoxic regimens for advanced breast cancer - no(%)
0
111 (38.7)
54 (37.5)
1
107 (37.3)
54 (37.5)
2
57 (19.9)
28 (19.4)
3
12 (4.2)
8 (5.6)
Other characteristics
Measurable disease assessed by investigator - no(%)
219 (76.3)
114 (79.2)
History of CNS metastases - no(%)
43 (15.0)
20 (13.9)
Visceral disease - no(%)
200 (69.7)
103 (71.5)
<12mo disease-free interval from initial diagnosis
108 (37.6)
42 (29.2)
Other characteristics
Previous adjuvant or neoadjuvant therapy - no(%)
238 (82.9)
121 (84.0)
Previous platinum therapy - no(%)
46 (16.0)
30 (20.8)
Ad-hoc:
no.pts inv.
no.pts comp.
TALA
chemo
HR
p
ORR BRCA1 MT
92
50
64.1%
22.0%
SS
ORR TNBC
102
48
61.8%
12.5%
SS
ORR bone only meta
217
113
63.1%
26.5%
SS
  • PSF
analisys of PSF
TALA
chemo
HR (95% CI)
BRCA mutation type
BRCA1
0.59 (0.39–0.90)
BRCA2
0.47 (0.32–0.70)
HR status according to most recent biopsy
Triple-negative
0.60 (0.41–0.87)
Hormone-receptor positive
0.47 (0.32–0.71)
History of CNS metastasis
Yes
0.32 (0.15–0.68)
No
0.58 (0.43–0.78)
Visceral disease assessed by investigator
Yes
0.51 (0.37–0.70)
No
0.59 (0.34–1.02)
Previous platinum treatment
Yes
0.76 (0.40–1.45)
No
0.52 (0.39–0.71)
Previous regimens of chemo for advanced breast cancer
0
0.57 (0.34–0.95)
1
0.51 (0.33–0.80)
Previous regimens of chemo for advanced breast cancer
≥2
0.56 (0.34–0.95)
analisys of
TALA
chemo
HR (95% CI)