Abstract P1-14-01: Final analysis of overall survival (OS) for the epoetin alfa (EPO) phase 3 study, EPO-ANE-3010, of EPO plus standard supportive care (SOC) versus SOC in anemic patients with metastatic breast cancer (MBC) receiving standard chemotherapy

Abstract

Background: In the interim analysis of study EPO-ANE-3010, for the primary endpoint of progression-free survival (PFS), the non-inferiority objective in ruling out a 15% increased risk in progressive death (PD) or death per investigator-determined PD was not achieved (JCO 34:1197-1207, 2016). PFS, based on independent review committee (IRC)-determined PD, however, met the non-inferiority criteria. At the interim analysis, OS with 1,337 deaths was reported; we now report the final analysis at 1,653 deaths and the updated PFS. Methods: This multinational (19 countries and 132 participating sites), phase 3, randomized, open-label noninferiority study included anemic (≤11.0 g/dL hemoglobin) women receiving first- or second-line standard chemotherapy for MBC (Eastern Cooperative Oncology Group performance status of 0 or 1). Subjects were randomized (1:1) to receive either standard SOC for treatment of anemia plus EPO (40,000 IU subcutaneous) weekly up to 4 weeks after the last dose of cytotoxic chemotherapy, or SOC alone. The primary endpoint was PFS (using Cox's regression model). Secondary endpoints included OS, time to tumor progression (TPP), overall response rate (ORR) and safety assessments. Results: A total of 2,098 subjects were enrolled (EPO plus SOC: n=1,050; SOC alone: n=1048). Demographic and baseline characteristics were well-balanced across the groups; median age was 52 years, most were white (67.5%) or Asian (30.5%) and median BMI was 26.0 kg/m2. Primary efficacy analysis (based on investigator-determined PD) showed a median PFS of 7.4 months for both groups (hazard ratio [HR], 1.094; 95% CI: 0.996, 1.201);upper bound exceeded prespecified noninferiority margin of 1.15. A 9% increased risk for PD/death in the EPO plus SOC group was observed and did not statistically rule out a 15% increased risk. Median PFS per IRC-determined PD was 7.6 months in both groups (HR, 1.028; 95% CI: 0.922, 1.146), this met pre-defined non-inferiority margin of 1.15 with a 3% risk increase in PD/death in EPO plus SOC group. At the final analysis for OS, median OS was 17.8 months in the EPO plus SOC group and 18.0 months in the SOC group; HR: 1.073 (95% CI: 0.974, 1.182); median TPP was 7.5 months in both groups (HR, 1.099; 95% CI, 0.998 to 1.210), and ORR was 50% in the EPO plus SOC group and 51% in the SOC group (odds ratio, 0.939; 95% CI, 0.789, 1.117). Red blood cell (RBC) transfusions were 5.8% versus 11.5% (P<0.001), and thrombotic vascular events were 2.8% versus 1.4% (P=0.038), respectively, in EPO plus SOC group and SOC group. The incidence of death due to PD were similar in both groups (EPO plus SOC: 93%; SOC: 91%). Conclusion:The primary endpoint, PFS based on investigator-determined PD, did not meet noninferiority criteria but for PFS based on IRC-determined PD, noninferiority criteria was met. Overall, this study did not statistically rule-out a 15% increased risk in PD/death. The final analysis did not show statistically different OS in the EPO plus SOC group versus the SOC group. No new safety signals were noted with EPO treatment and the results are consistent with the known safety profile of EPO. Citation Format: Leyland-Jones B, Bondarenko I, Nemsadze G, Smirnov V, Litvin I, Kokhreidze I, Abshilava L, Janjalia M, Li R, Lakshmaiah KC, Samkharadze B, Tarasova O, Shparyk Y, Polenkov S, Vladimirov V, Han J, Safonov I, Appiani C, Leitz G. Final analysis of overall survival (OS) for the epoetin alfa (EPO) phase 3 study, EPO-ANE-3010, of EPO plus standard supportive care (SOC) versus SOC in anemic patients with metastatic breast cancer (MBC) receiving standard chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-14-01.

A Randomized, Double-Blind, Placebo-Controlled, Phase III Noninferiority Study of the Long-Term Safety and Efficacy of Darbepoetin Alfa for Chemotherapy-Induced Anemia in Patients With Advanced NSCLC

“…18 A 7% risk increase in the epoetin alfa plus SOC group was observed, and noninferiority criteria were not met (HR ¼ 1.073; 95% CI: 0.974-1.182). 18 Point estimates for median PFS and OS in the EPO-ANE-3010 study were therefore very similar between the groups. The median duration of ESA treatment was less than 3 months, and the PFS and OS curves only differed after 12 months.…”

“…epoetin alfa plus SOC group was observed, the noninferiority criteria were met (HR ¼ 1.028; 95% CI: 0.922-1.146). 18 In the final analysis of OS, median OS was 17.8 months in the epoetin alfa plus SOC group and 18.0 months in the SOC group. 18 A 7% risk increase in the epoetin alfa plus SOC group was observed, and noninferiority criteria were not met (HR ¼ 1.073; 95% CI: 0.974-1.182).…”

“…18 In the final analysis of OS, median OS was 17.8 months in the epoetin alfa plus SOC group and 18.0 months in the SOC group. 18 A 7% risk increase in the epoetin alfa plus SOC group was observed, and noninferiority criteria were not met (HR ¼ 1.073; 95% CI: 0.974-1.182). 18 Point estimates for median PFS and OS in the EPO-ANE-3010 study were therefore very similar between the groups.…”

“…17 In contrast to our study, the primary endpoint of EPO-ANE-3010 was PFS, and noninferiority of epoetin alfa to best SOC was not shown (HR ¼ 1.094; 95% CI: 0.996-1.201) because the upper limit exceeded 1.150. 17,18 In the final analysis of EPO-ANE-3010, PFS and OS were further assessed by an independent review committee. 18 Median PFS was the same for each group (7.6 months), and although a 3% risk increase in the Figure 3.…”

“…17,18 In the final analysis of EPO-ANE-3010, PFS and OS were further assessed by an independent review committee. 18 Median PFS was the same for each group (7.6 months), and although a 3% risk increase in the Figure 3. Progression-free survival (PFS).…”