Please use this identifier to cite or link to this item: http://hdl.handle.net/20.500.12857/140523
Title: Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): A phase 3, open-label, randomised controlled trial
Authors: Bang, Yung Jue
Van Cutsem, Eric
Feyereislova, Andrea
Chung, Hyun C.
Shen, Lin
Sawaki, Akira
Lordick, Florian
Ohtsu, Atsushi
Omuro, Yasushi
Satoh, Taroh
Aprile, Giuseppe 
Kulikov, Evgeny
Hill, Julie
Lehle, Michaela
Rüschoff, Josef
Kang, Yoon Koo
Keywords Plus: METASTATIC BREAST-CANCER;ADJUVANT CHEMOTHERAPY;GENE AMPLIFICATION;1ST-LINE THERAPY;SUPPORTIVE CARE;III TRIAL;PLUS;HER2;FLUOROURACIL;PROGNOSIS
Issue Date: 28-Aug-2010
Publisher: ELSEVIER SCIENCE INC
Journal: The Lancet 
Abstract: 
Background Trastuzumab, a monoclonal antibody against human epidermal growth factor receptor 2 (HER2; also known as ERBB2), was investigated in combination with chemotherapy for first-line treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer. Methods ToGA (Trastuzumab for Gastric Cancer) was an open-label, international, phase 3, randomised controlled trial undertaken in 122 centres in 24 countries. Patients with gastric or gastro-oesophageal junction cancer were eligible for inclusion if their tumours showed overexpression of HER2 protein by immunohistochemistry or gene amplification by fluorescence in-situ hybridisation. Participants were randomly assigned in a 1:1 ratio to receive a chemotherapy regimen consisting of capecitabine plus cisplatin or fluorouracil plus cisplatin given every 3 weeks for six cycles or chemotherapy in combination with intravenous trastuzumab. Allocation was by block randomisation stratified by Eastern Cooperative Oncology Group performance status, chemotherapy regimen, extent of disease, primary cancer site, and measurability of disease, implemented with a central interactive voice recognition system. The primary endpoint was overall survival in all randomised patients who received study medication at least once. This trial is registered with ClinicalTrials.gov, number NCT01041404. Findings 594 patients were randomly assigned to study treatment (trastuzumab plus chemotherapy, n=298; chemotherapy alone, n=296), of whom 584 were included in the primary analysis (n=294; n=290). Median follow-up was 18·6 months (IQR 11-25) in the trastuzumab plus chemotherapy group and 17·1 months (9-25) in the chemotherapy alone group. Median overall survival was 13·8 months (95 CI 12-16) in those assigned to trastuzumab plus chemotherapy compared with 11·1 months (10-13) in those assigned to chemotherapy alone (hazard ratio 0·74; 95 CI 0·60-0·91; p=0·0046). The most common adverse events in both groups were nausea (trastuzumab plus chemotherapy, 197 [67] vs chemotherapy alone, 184 [63]), vomiting (147 [50] vs 134 [46]), and neutropenia (157 [53] vs 165 [57]). Rates of overall grade 3 or 4 adverse events (201 [68] vs 198 [68]) and cardiac adverse events (17 [6] vs 18 [6]) did not differ between groups. Interpretaion Trastuzumab in combination with chemotherapy can be considered as a new standard option for patients with HER2-positive advanced gastric or gastro-oesophageal junction cancer. Funding F Hoffmann-La Roche. © 2010 Elsevier Ltd.
URI: http://hdl.handle.net/20.500.12857/140523
ISSN: 01406736
DOI: 10.1016/S0140-6736(10)61121-X
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