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    Clinical Trial Results:
    Ensayo clínico de fase III randomizado, doble ciego, controlado con placebo para evaluar la eficacia y seguridad de pertuzumab +trastuzumab + docetaxel frente a placebo + trastuzumab +docetaxel en pacientes con cáncer de mama metastático HER2-positivo no tratadas previamente. A Phase III, Randomized, Double-Blind, Placebo Controlled Clinical Trial To Evaluate The Efficacy And Safety Of Pertuzumab + Trastuzumab + Docetaxel Vs. Placebo + Trastuzumab + Docetaxel In Previously Untreated HER2-Positive Metastatic Breast Cancer

    Summary
    EudraCT number
    2007-002997-72
    Trial protocol
    FI   DE   GB   ES   FR   IT   LV  
    Global end of trial date

    Results information
    Results version number
    v1
    This version publication date
    14 Jul 2016
    First version publication date
    06 Aug 2015
    Other versions
    v2

    Trial information

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    Trial identification
    Sponsor protocol code
    WO20698/TOC4129g
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00567190
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    F. Hoffmann-La Roche AG
    Sponsor organisation address
    Grenzacherstrasse 124, Basel, Switzerland, CH-4070
    Public contact
    Roche Trial Information Hotline, F. Hoffmann-La Roche AG, +41 061 6878333, global.trial_information@roche.com
    Scientific contact
    Roche Trial Information Hotline, F. Hoffmann-La Roche AG, +41 061 6878333, global.trial_information@roche.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Interim
    Date of interim/final analysis
    11 Feb 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    13 May 2011
    Global end of trial reached?
    No
    General information about the trial
    Main objective of the trial
    El objetivo principal de este estudio es comparar la supervivencia libre de progresión (SLP) basándose en las evaluaciones del tumor realizadas por un grupo de revisión independiente (IRF), entre las pacientes de los dos grupos de tratamiento siguientes: placebo + trastuzumab + docetaxel frente a pertuzumab + trastuzumab + docetaxel. The primary objective was to compare progression-free survival (PFS), based on tumor assessments by an independent review facility (IRF), between participants in two treatment arms (placebo + trastuzumab + docetaxel and pertuzumab + trastuzumab + docetaxel).
    Protection of trial subjects
    This study was conducted in full conformance with the principles of the Declaration of Helsinki and its subsequent amendments or with the laws and regulations of the country in which the research was conducted, whichever afforded the greater protection to the participant. The study adhered to the principles outlined in the Guideline for Good Clinical Practice ICH Tripartite Guideline (January 1997) or with local law if it afforded greater protection to the participant. In other countries where guidelines for good clinical practice existed, the sponsor and the investigators were to strictly ensure adherence to the stated provisions. For each potential participant, written informed consent was obtained prior to the performance of any study related procedures and after the aims, methods, anticipated benefits, and potential hazards of the study were adequately explained. The protocol and any accompanying material provided to the participant (such as participant information sheets or descriptions of the study used to obtain informed consent) were approved by an Independent Ethics Committee (IEC)/Institutional Review Board (IRB) before starting the study. Protocol amendments were also approved by IECs/IRBs.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Jan 2008
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Regulatory reason
    Long term follow-up duration
    6 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Brazil: 100
    Country: Number of subjects enrolled
    Canada: 2
    Country: Number of subjects enrolled
    Argentina: 13
    Country: Number of subjects enrolled
    China: 13
    Country: Number of subjects enrolled
    Costa Rica: 6
    Country: Number of subjects enrolled
    Croatia: 4
    Country: Number of subjects enrolled
    Ecuador: 1
    Country: Number of subjects enrolled
    Finland: 5
    Country: Number of subjects enrolled
    France: 24
    Country: Number of subjects enrolled
    Germany: 44
    Country: Number of subjects enrolled
    Guatemala: 5
    Country: Number of subjects enrolled
    Hong Kong: 5
    Country: Number of subjects enrolled
    Italy: 24
    Country: Number of subjects enrolled
    Japan: 53
    Country: Number of subjects enrolled
    Latvia: 6
    Country: Number of subjects enrolled
    Macedonia, the former Yugoslav Republic of: 3
    Country: Number of subjects enrolled
    Mexico: 6
    Country: Number of subjects enrolled
    Philippines: 30
    Country: Number of subjects enrolled
    Poland: 33
    Country: Number of subjects enrolled
    Russian Federation: 71
    Country: Number of subjects enrolled
    Singapore: 20
    Country: Number of subjects enrolled
    Korea, Republic of: 94
    Country: Number of subjects enrolled
    Spain: 58
    Country: Number of subjects enrolled
    Thailand: 38
    Country: Number of subjects enrolled
    United Kingdom: 34
    Country: Number of subjects enrolled
    United States: 116
    Worldwide total number of subjects
    808
    EEA total number of subjects
    232
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    681
    From 65 to 84 years
    126
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 1196 participants aged at least 18 years with previously-untreated, (in the metastatic setting), Human Epidermal Growth Factor Receptor 2 (HER2) positive metastatic or locally recurrent unresectable breast cancer were screened. An Interactive Voice Response System used to collect screening information and track participant eligibility.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Pertuzumab + Trastuzumab + Docetaxel
    Arm description
    Participants received pertuzumab 420 milligrams (mg) intravenously (IV) every 3 weeks (q3w) plus trastuzumab 6 milligrams per kilogram (mg/kg) IV q3w plus docetaxel 75 milligrams per square meters of body surface (mg/m^2) IV q3w for at least 6 cycles.
    Arm type
    Experimental

    Investigational medicinal product name
    Pertuzumab
    Investigational medicinal product code
    Other name
    Perjeta
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Pertuzumab administered as an IV loading dose of 840 mg at Cycle 1 then at a dose of 420 mg at all subsequent cycles until investigator-assessed radiographic or clinical evidence of progressive disease (PD), unacceptable toxicity, or withdrawal of consent.

    Investigational medicinal product name
    Trastuzumab
    Investigational medicinal product code
    Other name
    Herclon, Herceptin
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trastuzumab administered as an IV loading dose of 8 mg/kg in Cycle 1 and at a dose of 6 mg/kg at all subsequent cycles until investigator-assessed radiographic or clinical evidence of PD, unacceptable toxicity, or withdrawal of consent.

    Investigational medicinal product name
    Docetaxel
    Investigational medicinal product code
    Other name
    Taxotere, Docecad, Docefrez
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Docetaxel administered as an IV dose of 75 mg/m^2 for at least 6 cycles. For participants who tolerated at least one cycle without any significant toxicity, the docetaxel dose was increased to 100 mg/m^2 at the Investigator’s discretion. On or prior to Cycle 6, docetaxel was only discontinued for PD or unacceptable toxicity. After Cycle 6, continuation of docetaxel treatment was at the discretion of the participant and treating physician.

    Arm title
    Placebo + Trastuzumab + Docetaxel
    Arm description
    Participants received placebo IV q3w plus trastuzumab 6 mg/kg IV q3w plus docetaxel 75 mg/m^2 IV q3w for at least 6 cycles.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    The placebo formulation is equivalent to pertuzumab without the active agent. Participants received placebo IV q3w until investigator-assessed radiographic or clinical evidence of PD, unacceptable toxicity, or withdrawal of consent.

    Investigational medicinal product name
    Trastuzumab
    Investigational medicinal product code
    Other name
    Herclon, Herceptin
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trastuzumab administered as an IV loading dose of 8 mg/kg in Cycle 1 and at a dose of 6 mg/kg at all subsequent cycles until investigator-assessed radiographic or clinical evidence of PD, unacceptable toxicity, or withdrawal of consent.

    Investigational medicinal product name
    Docetaxel
    Investigational medicinal product code
    Other name
    Taxotere, Docecad, Docefrez
    Pharmaceutical forms
    Concentrate and solvent for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Docetaxel administered as an IV dose of 75 mg/m^2 for at least 6 cycles. For participants who tolerated at least one cycle without any significant toxicity, the docetaxel dose was increased to 100 mg/m^2 at the Investigator’s discretion. On or prior to Cycle 6, docetaxel was only discontinued for PD or unacceptable toxicity. After Cycle 6, continuation of docetaxel treatment was at the discretion of the participant and treating physician.

    Number of subjects in period 1
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Started
    402
    406
    Completed
    0
    0
    Not completed
    402
    406
         Withdrew Consent or Lost to Follow-up
    42
    43
         Death
    168
    221
         Alive and on study treatment
    67
    37
         Alive and in survival follow-up
    125
    105

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Pertuzumab + Trastuzumab + Docetaxel
    Reporting group description
    Participants received pertuzumab 420 milligrams (mg) intravenously (IV) every 3 weeks (q3w) plus trastuzumab 6 milligrams per kilogram (mg/kg) IV q3w plus docetaxel 75 milligrams per square meters of body surface (mg/m^2) IV q3w for at least 6 cycles.

    Reporting group title
    Placebo + Trastuzumab + Docetaxel
    Reporting group description
    Participants received placebo IV q3w plus trastuzumab 6 mg/kg IV q3w plus docetaxel 75 mg/m^2 IV q3w for at least 6 cycles.

    Reporting group values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel Total
    Number of subjects
    402 406 808
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    53.4 ± 10.94 53.5 ± 11.35 -
    Gender categorical
    Units: Subjects
        Female
    402 404 806
        Male
    0 2 2

    End points

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    End points reporting groups
    Reporting group title
    Pertuzumab + Trastuzumab + Docetaxel
    Reporting group description
    Participants received pertuzumab 420 milligrams (mg) intravenously (IV) every 3 weeks (q3w) plus trastuzumab 6 milligrams per kilogram (mg/kg) IV q3w plus docetaxel 75 milligrams per square meters of body surface (mg/m^2) IV q3w for at least 6 cycles.

    Reporting group title
    Placebo + Trastuzumab + Docetaxel
    Reporting group description
    Participants received placebo IV q3w plus trastuzumab 6 mg/kg IV q3w plus docetaxel 75 mg/m^2 IV q3w for at least 6 cycles.

    Primary: Progression-free Survival Determined by an Independent Review Facility

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    End point title
    Progression-free Survival Determined by an Independent Review Facility
    End point description
    PFS was defined as the time from randomization to first documented PD using Response Evaluation Criteria in Solid Tumors (RECIST) v1.0 or death from any cause (within 18 weeks of last tumor assessment), whichever occurred first. For target lesions, PD was defined as at least a 20 percent (%) increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions. Target lesions were selected on the basis of their size (those with the longest diameter) and their suitability for accurate repeated measurements by imaging techniques or clinically. All measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total, representative of all involved organs, were identified as target lesions.
    End point type
    Primary
    End point timeframe
    Baseline to primary data cut-off 13 May 2011 (up to 3 years, 3 months)
    End point values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Number of subjects analysed
    402 [1]
    406 [2]
    Units: Months
        median (confidence interval 95%)
    18.5 (15 to 23)
    12.4 (10 to 13)
    Notes
    [1] - Intent-to-Treat (ITT) Population: all randomized participants are included in the ITT population
    [2] - ITT Population
    Statistical analysis title
    Progression-free Survival by IRF
    Comparison groups
    Pertuzumab + Trastuzumab + Docetaxel v Placebo + Trastuzumab + Docetaxel
    Number of subjects included in analysis
    808
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Confidence interval

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    Overall survival (OS) was defined as the time from randomization to death from any cause.
    End point type
    Secondary
    End point timeframe
    Baseline to the third data cut-off (11 February 2014) at 389 deaths (approximately 43 months after enrollment of last participant)
    End point values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Number of subjects analysed
    402 [3]
    406 [4]
    Units: Months
        median (confidence interval 95%)
    56.5 (49 to 99999)
    40.8 (36 to 48)
    Notes
    [3] - ITT Population: 99999=not evaluable more than 50% of participants were censored for this evaluation
    [4] - ITT Population
    No statistical analyses for this end point

    Secondary: Progression-free Survival Determined by the Investigator

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    End point title
    Progression-free Survival Determined by the Investigator
    End point description
    PFS was defined as the time from randomization to first documented PD using RECIST v1.0 or death from any cause (within 18 weeks of last tumor assessment), whichever occurred first. For target lesions, PD was defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions. Target lesions were selected on the basis of their size (those with the longest diameter) and their suitability for accurate repeated measurements by imaging techniques or clinically. All measurable lesions up to a maximum of 5 lesions per organ and 10 lesions in total, representative of all involved organs, were identified as target lesions.
    End point type
    Secondary
    End point timeframe
    Baseline to the third data cut-off (11 February 2014) at 389 deaths (approximately 43 months after enrollment of last participant)
    End point values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Number of subjects analysed
    402 [5]
    406 [6]
    Units: Months
        median (confidence interval 95%)
    18.7 (17 to 22)
    12.4 (10 to 14)
    Notes
    [5] - ITT Population
    [6] - ITT Population
    No statistical analyses for this end point

    Secondary: Objective Response Determined by an Independent Review Facility

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    End point title
    Objective Response Determined by an Independent Review Facility
    End point description
    A participant had an objective response if they had a complete response (CR) or a partial response (PR) determined on two consecutive occasions greater than or equal to (≥) 4 weeks apart as determined by the investigator using RECIST v1.0. For target lesions, a CR was defined as the disappearance of all target lesions; a PR was defined as at least a 30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum longest diameter. For non-target lesions, a CR was defined as the disappearance of all non-target lesions; a PR was defined as the persistence of 1 or more non-target lesions.
    End point type
    Secondary
    End point timeframe
    Baseline to primary data cut-off on 13 May 2011
    End point values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Number of subjects analysed
    343 [7]
    336 [8]
    Units: Percentage of Participants
        number (confidence interval 95%)
    80.2 (75.6 to 84.3)
    69.3 (64.1 to 74.2)
    Notes
    [7] - ITT Population: only particpants with measurable disease at baseline were included in the analysis
    [8] - ITT Population: only particpants with measurable disease at baseline were included in the analysis
    No statistical analyses for this end point

    Secondary: Duration of Objective Response Determined by an Independent Review Facility

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    End point title
    Duration of Objective Response Determined by an Independent Review Facility
    End point description
    Duration of objective response was defined as the time from the initial response to documented PD or death from any cause, whichever occurred first.
    End point type
    Secondary
    End point timeframe
    Baseline to primary data cut-off on 13 May 2011
    End point values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Number of subjects analysed
    275 [9]
    233 [10]
    Units: Weeks
        median (confidence interval 95%)
    87.6 (71 to 106)
    54.1 (46 to 64)
    Notes
    [9] - ITT Population: only participants with an objective response were included in the analysis
    [10] - ITT Population: only participants with an objective response were included in the analysis
    No statistical analyses for this end point

    Secondary: Time to Symptom Progression

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    End point title
    Time to Symptom Progression
    End point description
    Time to symptom progression was defined as the time from randomization to the first symptom progression as measured by the Functional Assessment of Cancer Therapy-for participants with Breast Cancer (FACT-B) questionnaire with the Trial Outcomes Index-Physical/Functional/Breast (TOI-PFB) subscale. The FACT-B TOI-PFB subscale contains 24 items from 3 subsections of the FACT-B questionnaire: Physical well-being, functional well-being, and additional concerns for breast cancer participants (breast cancer subscale [BCS]). All items in the questionnaire were rated by the patient on a 5-point scale ranging from 0 (“not at all”) to 4 (“very much”). The total score ranged from 0 to 96. A higher score indicates better perceived quality of life. A positive change score from baseline indicates improvement. Symptom progression was defined as a decrease from baseline of 5 points or more.
    End point type
    Secondary
    End point timeframe
    Baseline to primary data cut-off on 13 May 2011
    End point values
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel
    Number of subjects analysed
    402 [11]
    404 [12]
    Units: Weeks
        median (confidence interval 95%)
    18.4 (18 to 27)
    18.3 (18 to 27)
    Notes
    [11] - ITT Population: analysis included only female participants
    [12] - ITT Population: analysis included only female participants
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    First treatment dose (12 February 2008) through final data analysis cut-off (11 February 2014) for a total safety analysis time frame of 6 years. The AE data derived from a snapshot taken on 24 March 2014 of the final analysis dataset (11 February 2014).
    Adverse event reporting additional description
    Of those who started the study (pertuzumab [Ptz]=402, placebo[Pla]=406), 2 patients in each group received no treatment (total of 4), 9 Pla patients received at least 1 dose of Ptz, 1 Ptz patient received Pla at every cycle; resulting in Ptz=408 (402-2+9-1) and Pla=396 (406-2-9+1)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    Pertuzumab + Trastuzumab + Docetaxel
    Reporting group description
    Participants received pertuzumab 420 mg IV q3w plus trastuzumab 6 mg/kg IV q3w plus docetaxel 75 mg/m^2 IV q3w for at least 6 cycles.

    Reporting group title
    Placebo + Trastuzumab + Docetaxel
    Reporting group description
    Patients received placebo IV q3w plus trastuzumab 6 mg/kg IV q3w plus docetaxel 75 mg/m^2 IV q3w for at least 6 cycles. For the 48 patients that crossed over to the pertuzumab treatment group, AEs were analyzed from the day of their first placebo dose (Day 1) through the day just prior to their first pertuzumab dose. Any AEs occurring on, or after, the day of their first dose of pertuzumab were included in the Crossover treatment group analysis.

    Reporting group title
    Crossover From Placebo to Pertuzumab
    Reporting group description
    Forty-eight of 406 participants (11.8%) randomized to the placebo treatment group whose disease had not progressed crossed over to an open-label pertuzumab treatment group between July 2012 and November 2012. Participants received pertuzumab administered as an IV loading dose of 840 mg at cycle 1 then 420 mg IV every q3w until investigator-assessed radiographic or clinical evidence of PD, unacceptable toxicity, or withdrawal of consent. Trastuzumab and docetaxel doses continued in accordance with the pre-crossover placebo treatment regimens and according to dosing specifications indicated in the study protocol.

    Serious adverse events
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel Crossover From Placebo to Pertuzumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    149 / 408 (36.52%)
    116 / 396 (29.29%)
    6 / 48 (12.50%)
         number of deaths (all causes)
    168
    220
    1
         number of deaths resulting from adverse events
    8
    12
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Breast cancer
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colon cancer
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Endometrial cancer
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Glioblastoma multiforme
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ocular neoplasm
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pituitary tumour benign
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tumour haemorrhage
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine leiomyoma
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    3 / 408 (0.74%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypertension
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aortic stenosis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haematoma
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypertensive crisis
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypotension
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Venous thrombosis limb
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Surgical and medical procedures
    Abortion induced
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Abortion spontaneous
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    6 / 408 (1.47%)
    3 / 396 (0.76%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    2 / 6
    2 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Chest pain
         subjects affected / exposed
    1 / 408 (0.25%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    2 / 408 (0.49%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Influenza like illness
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Mucosal inflammation
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Death
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    Drowning
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Immune system disorders
    Drug hypersensitivity
         subjects affected / exposed
    3 / 408 (0.74%)
    3 / 396 (0.76%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    3 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypersensitivity
         subjects affected / exposed
    3 / 408 (0.74%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaphylactic reaction
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Breast haemorrhage
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metrorrhagia
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vaginal haemorrhage
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    2 / 408 (0.49%)
    4 / 396 (1.01%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 5
    0 / 5
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    5 / 408 (1.23%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    2 / 5
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Dyspnoea
         subjects affected / exposed
    2 / 408 (0.49%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumothorax
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Asthma
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 6
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemoptysis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia aspiration
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicide attempt
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Investigations
    Blood electrolytes abnormal
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood glucose increased
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ejection fraction decreased
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Femur fracture
         subjects affected / exposed
    3 / 408 (0.74%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Compression fracture
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Contusion
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fracture
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Post procedural discomfort
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Scapula fracture
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tendon injury
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Thermal burn
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tibia fracture
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Left ventricular dysfunction
         subjects affected / exposed
    6 / 408 (1.47%)
    7 / 396 (1.77%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    6 / 6
    7 / 7
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    0 / 408 (0.00%)
    3 / 396 (0.76%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    0 / 408 (0.00%)
    3 / 396 (0.76%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    1 / 3
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Coronary artery disease
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocardial ischaemia
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ventricular fibrillation
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    Convulsion
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Monoparesis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peripheral sensorimotor neuropathy
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Somnolence
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Spinal cord compression
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    VIIth nerve paralysis
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    46 / 408 (11.27%)
    20 / 396 (5.05%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    48 / 48
    22 / 23
    0 / 0
         deaths causally related to treatment / all
    3 / 3
    1 / 1
    0 / 0
    Neutropenia
         subjects affected / exposed
    18 / 408 (4.41%)
    19 / 396 (4.80%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    23 / 23
    20 / 20
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaemia
         subjects affected / exposed
    3 / 408 (0.74%)
    3 / 396 (0.76%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    3 / 4
    3 / 3
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Granulocytopenia
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Leukopenia
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Cataract
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    13 / 408 (3.19%)
    5 / 396 (1.26%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    12 / 16
    3 / 5
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    2 / 408 (0.49%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Constipation
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intestinal perforation
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    2 / 2
    0 / 0
    Oesophagitis
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Duodenal ulcer
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Duodenal ulcer haemorrhage
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Enteritis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Haemorrhoidal haemorrhage
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemorrhoids
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intestinal ischaemia
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intestinal obstruction
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lower gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rectal haemorrhage
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis acute
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatic failure
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Skin and subcutaneous tissue disorders
    Dermatitis allergic
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Drug eruption
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash maculo-papular
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal failure acute
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute prerenal failure
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haematuria
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nephrolithiasis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal failure chronic
         subjects affected / exposed
    0 / 408 (0.00%)
    0 / 396 (0.00%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    2 / 408 (0.49%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myalgia
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Mobility decreased
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Muscular weakness
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neck pain
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Osteonecrosis of jaw
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    5 / 408 (1.23%)
    9 / 396 (2.27%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    2 / 5
    2 / 9
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
    Cellulitis
         subjects affected / exposed
    10 / 408 (2.45%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    4 / 10
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutropenic infection
         subjects affected / exposed
    4 / 408 (0.98%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    3 / 4
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    2 / 408 (0.49%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Herpes zoster
         subjects affected / exposed
    1 / 408 (0.25%)
    3 / 396 (0.76%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    3 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    4 / 408 (0.98%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    3 / 4
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 408 (0.25%)
    3 / 396 (0.76%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    1 / 1
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    3 / 408 (0.74%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    3 / 3
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Appendicitis
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bronchopneumonia
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutropenic sepsis
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pharyngitis
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 408 (0.25%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    2 / 408 (0.49%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Viral infection
         subjects affected / exposed
    0 / 408 (0.00%)
    2 / 396 (0.51%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute sinusitis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anal abscess
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Breast abscess
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Breast cellulitis
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Campylobacter gastroenteritis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Catheter site infection
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Coccidioidomycosis
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diarrhoea infectious
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal infection
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    H1N1 influenza
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Onychomycosis
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oral candidiasis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Osteomyelitis
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Osteomyelitis chronic
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia staphylococcal
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Postoperative wound infection
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pyelonephritis acute
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rash pustular
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory tract infection viral
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sepsis syndrome
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin infection
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Soft tissue infection
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Wound infection
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Wound infection staphylococcal
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis gangrenous
         subjects affected / exposed
    0 / 408 (0.00%)
    0 / 396 (0.00%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lymph node tuberculosis
         subjects affected / exposed
    0 / 408 (0.00%)
    0 / 396 (0.00%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Device related infection
         subjects affected / exposed
    2 / 408 (0.49%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 408 (0.25%)
    2 / 396 (0.51%)
    1 / 48 (2.08%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Decreased appetite
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diabetes mellitus
         subjects affected / exposed
    0 / 408 (0.00%)
    1 / 396 (0.25%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fluid retention
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypoglycaemia
         subjects affected / exposed
    1 / 408 (0.25%)
    0 / 396 (0.00%)
    0 / 48 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Pertuzumab + Trastuzumab + Docetaxel Placebo + Trastuzumab + Docetaxel Crossover From Placebo to Pertuzumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    400 / 408 (98.04%)
    386 / 396 (97.47%)
    39 / 48 (81.25%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    45 / 408 (11.03%)
    32 / 396 (8.08%)
    0 / 48 (0.00%)
         occurrences all number
    70
    94
    0
    Hot flush
         subjects affected / exposed
    23 / 408 (5.64%)
    21 / 396 (5.30%)
    0 / 48 (0.00%)
         occurrences all number
    26
    39
    0
    Lymphoedema
         subjects affected / exposed
    24 / 408 (5.88%)
    16 / 396 (4.04%)
    0 / 48 (0.00%)
         occurrences all number
    25
    18
    0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    154 / 408 (37.75%)
    148 / 396 (37.37%)
    4 / 48 (8.33%)
         occurrences all number
    315
    290
    8
    Asthenia
         subjects affected / exposed
    112 / 408 (27.45%)
    122 / 396 (30.81%)
    0 / 48 (0.00%)
         occurrences all number
    260
    268
    0
    Oedema peripheral
         subjects affected / exposed
    98 / 408 (24.02%)
    111 / 396 (28.03%)
    0 / 48 (0.00%)
         occurrences all number
    134
    163
    0
    Mucosal inflammation
         subjects affected / exposed
    111 / 408 (27.21%)
    78 / 396 (19.70%)
    0 / 48 (0.00%)
         occurrences all number
    184
    111
    0
    Pyrexia
         subjects affected / exposed
    78 / 408 (19.12%)
    72 / 396 (18.18%)
    3 / 48 (6.25%)
         occurrences all number
    126
    94
    4
    Oedema
         subjects affected / exposed
    48 / 408 (11.76%)
    49 / 396 (12.37%)
    0 / 48 (0.00%)
         occurrences all number
    82
    76
    0
    Chills
         subjects affected / exposed
    34 / 408 (8.33%)
    15 / 396 (3.79%)
    0 / 48 (0.00%)
         occurrences all number
    36
    18
    0
    Chest pain
         subjects affected / exposed
    14 / 408 (3.43%)
    21 / 396 (5.30%)
    0 / 48 (0.00%)
         occurrences all number
    16
    24
    0
    Influenza like illness
         subjects affected / exposed
    22 / 408 (5.39%)
    9 / 396 (2.27%)
    0 / 48 (0.00%)
         occurrences all number
    39
    11
    0
    Pain
         subjects affected / exposed
    26 / 408 (6.37%)
    22 / 396 (5.56%)
    0 / 48 (0.00%)
         occurrences all number
    30
    27
    0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    26 / 408 (6.37%)
    21 / 396 (5.30%)
    0 / 48 (0.00%)
         occurrences all number
    31
    29
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    96 / 408 (23.53%)
    79 / 396 (19.95%)
    3 / 48 (6.25%)
         occurrences all number
    135
    117
    4
    Dyspnoea
         subjects affected / exposed
    61 / 408 (14.95%)
    62 / 396 (15.66%)
    0 / 48 (0.00%)
         occurrences all number
    91
    87
    0
    Epistaxis
         subjects affected / exposed
    41 / 408 (10.05%)
    35 / 396 (8.84%)
    0 / 48 (0.00%)
         occurrences all number
    55
    47
    0
    Oropharyngeal pain
         subjects affected / exposed
    32 / 408 (7.84%)
    27 / 396 (6.82%)
    0 / 48 (0.00%)
         occurrences all number
    51
    32
    0
    Rhinorrhoea
         subjects affected / exposed
    32 / 408 (7.84%)
    23 / 396 (5.81%)
    0 / 48 (0.00%)
         occurrences all number
    41
    29
    0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    64 / 408 (15.69%)
    55 / 396 (13.89%)
    0 / 48 (0.00%)
         occurrences all number
    86
    72
    0
    Depression
         subjects affected / exposed
    26 / 408 (6.37%)
    20 / 396 (5.05%)
    0 / 48 (0.00%)
         occurrences all number
    32
    23
    0
    Anxiety
         subjects affected / exposed
    16 / 408 (3.92%)
    20 / 396 (5.05%)
    0 / 48 (0.00%)
         occurrences all number
    21
    28
    0
    Investigations
    Weight decreased
         subjects affected / exposed
    36 / 408 (8.82%)
    19 / 396 (4.80%)
    0 / 48 (0.00%)
         occurrences all number
    50
    22
    0
    Weight increased
         subjects affected / exposed
    16 / 408 (3.92%)
    22 / 396 (5.56%)
    0 / 48 (0.00%)
         occurrences all number
    20
    35
    0
    Cardiac disorders
    Left ventricular dysfunction
         subjects affected / exposed
    22 / 408 (5.39%)
    27 / 396 (6.82%)
    0 / 48 (0.00%)
         occurrences all number
    32
    33
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    105 / 408 (25.74%)
    76 / 396 (19.19%)
    6 / 48 (12.50%)
         occurrences all number
    175
    127
    8
    Neuropathy peripheral
         subjects affected / exposed
    91 / 408 (22.30%)
    79 / 396 (19.95%)
    0 / 48 (0.00%)
         occurrences all number
    131
    114
    0
    Dysgeusia
         subjects affected / exposed
    75 / 408 (18.38%)
    62 / 396 (15.66%)
    0 / 48 (0.00%)
         occurrences all number
    95
    116
    0
    Dizziness
         subjects affected / exposed
    61 / 408 (14.95%)
    53 / 396 (13.38%)
    0 / 48 (0.00%)
         occurrences all number
    123
    73
    0
    Peripheral sensory neuropathy
         subjects affected / exposed
    50 / 408 (12.25%)
    59 / 396 (14.90%)
    0 / 48 (0.00%)
         occurrences all number
    90
    82
    0
    Paraesthesia
         subjects affected / exposed
    40 / 408 (9.80%)
    41 / 396 (10.35%)
    0 / 48 (0.00%)
         occurrences all number
    49
    60
    0
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    209 / 408 (51.23%)
    191 / 396 (48.23%)
    0 / 48 (0.00%)
         occurrences all number
    848
    797
    0
    Anaemia
         subjects affected / exposed
    96 / 408 (23.53%)
    77 / 396 (19.44%)
    5 / 48 (10.42%)
         occurrences all number
    141
    143
    7
    Leukopenia
         subjects affected / exposed
    75 / 408 (18.38%)
    82 / 396 (20.71%)
    0 / 48 (0.00%)
         occurrences all number
    288
    344
    0
    Eye disorders
    Lacrimation increased
         subjects affected / exposed
    60 / 408 (14.71%)
    55 / 396 (13.89%)
    0 / 48 (0.00%)
         occurrences all number
    72
    63
    0
    Conjunctivitis
         subjects affected / exposed
    31 / 408 (7.60%)
    17 / 396 (4.29%)
    0 / 48 (0.00%)
         occurrences all number
    41
    20
    0
    Dry eye
         subjects affected / exposed
    23 / 408 (5.64%)
    8 / 396 (2.02%)
    0 / 48 (0.00%)
         occurrences all number
    26
    8
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    277 / 408 (67.89%)
    193 / 396 (48.74%)
    22 / 48 (45.83%)
         occurrences all number
    949
    431
    95
    Nausea
         subjects affected / exposed
    183 / 408 (44.85%)
    168 / 396 (42.42%)
    4 / 48 (8.33%)
         occurrences all number
    388
    359
    4
    Vomiting
         subjects affected / exposed
    105 / 408 (25.74%)
    96 / 396 (24.24%)
    5 / 48 (10.42%)
         occurrences all number
    176
    150
    5
    Constipation
         subjects affected / exposed
    65 / 408 (15.93%)
    100 / 396 (25.25%)
    0 / 48 (0.00%)
         occurrences all number
    130
    179
    0
    Stomatitis
         subjects affected / exposed
    81 / 408 (19.85%)
    63 / 396 (15.91%)
    3 / 48 (6.25%)
         occurrences all number
    153
    138
    3
    Abdominal pain
         subjects affected / exposed
    62 / 408 (15.20%)
    48 / 396 (12.12%)
    0 / 48 (0.00%)
         occurrences all number
    84
    64
    0
    Dyspepsia
         subjects affected / exposed
    54 / 408 (13.24%)
    48 / 396 (12.12%)
    3 / 48 (6.25%)
         occurrences all number
    77
    72
    6
    Abdominal pain upper
         subjects affected / exposed
    43 / 408 (10.54%)
    43 / 396 (10.86%)
    0 / 48 (0.00%)
         occurrences all number
    68
    54
    0
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    248 / 408 (60.78%)
    240 / 396 (60.61%)
    0 / 48 (0.00%)
         occurrences all number
    264
    256
    0
    Rash
         subjects affected / exposed
    153 / 408 (37.50%)
    95 / 396 (23.99%)
    8 / 48 (16.67%)
         occurrences all number
    273
    184
    13
    Nail disorder
         subjects affected / exposed
    96 / 408 (23.53%)
    92 / 396 (23.23%)
    0 / 48 (0.00%)
         occurrences all number
    103
    105
    0
    Pruritus
         subjects affected / exposed
    72 / 408 (17.65%)
    40 / 396 (10.10%)
    0 / 48 (0.00%)
         occurrences all number
    110
    67
    0
    Dry skin
         subjects affected / exposed
    46 / 408 (11.27%)
    24 / 396 (6.06%)
    3 / 48 (6.25%)
         occurrences all number
    52
    25
    3
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    28 / 408 (6.86%)
    22 / 396 (5.56%)
    0 / 48 (0.00%)
         occurrences all number
    38
    25
    0
    Erythema
         subjects affected / exposed
    24 / 408 (5.88%)
    20 / 396 (5.05%)
    0 / 48 (0.00%)
         occurrences all number
    29
    27
    0
    Renal and urinary disorders
    Dysuria
         subjects affected / exposed
    23 / 408 (5.64%)
    11 / 396 (2.78%)
    0 / 48 (0.00%)
         occurrences all number
    27
    12
    0
    Musculoskeletal and connective tissue disorders
    Myalgia
         subjects affected / exposed
    98 / 408 (24.02%)
    98 / 396 (24.75%)
    0 / 48 (0.00%)
         occurrences all number
    200
    209
    0
    Arthralgia
         subjects affected / exposed
    79 / 408 (19.36%)
    69 / 396 (17.42%)
    3 / 48 (6.25%)
         occurrences all number
    123
    121
    3
    Pain in extremity
         subjects affected / exposed
    73 / 408 (17.89%)
    53 / 396 (13.38%)
    0 / 48 (0.00%)
         occurrences all number
    107
    80
    0
    Back pain
         subjects affected / exposed
    65 / 408 (15.93%)
    48 / 396 (12.12%)
    3 / 48 (6.25%)
         occurrences all number
    86
    58
    7
    Musculoskeletal pain
         subjects affected / exposed
    38 / 408 (9.31%)
    38 / 396 (9.60%)
    0 / 48 (0.00%)
         occurrences all number
    45
    64
    0
    Bone pain
         subjects affected / exposed
    37 / 408 (9.07%)
    34 / 396 (8.59%)
    0 / 48 (0.00%)
         occurrences all number
    47
    59
    0
    Muscle spasms
         subjects affected / exposed
    42 / 408 (10.29%)
    20 / 396 (5.05%)
    0 / 48 (0.00%)
         occurrences all number
    73
    24
    0
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    85 / 408 (20.83%)
    57 / 396 (14.39%)
    5 / 48 (10.42%)
         occurrences all number
    150
    93
    8
    Nasopharyngitis
         subjects affected / exposed
    69 / 408 (16.91%)
    59 / 396 (14.90%)
    11 / 48 (22.92%)
         occurrences all number
    118
    103
    25
    Urinary tract infection
         subjects affected / exposed
    36 / 408 (8.82%)
    29 / 396 (7.32%)
    0 / 48 (0.00%)
         occurrences all number
    53
    39
    0
    Influenza
         subjects affected / exposed
    26 / 408 (6.37%)
    22 / 396 (5.56%)
    4 / 48 (8.33%)
         occurrences all number
    37
    33
    4
    Paronychia
         subjects affected / exposed
    31 / 408 (7.60%)
    16 / 396 (4.04%)
    0 / 48 (0.00%)
         occurrences all number
    42
    23
    0
    Rhinitis
         subjects affected / exposed
    20 / 408 (4.90%)
    22 / 396 (5.56%)
    3 / 48 (6.25%)
         occurrences all number
    45
    35
    11
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    120 / 408 (29.41%)
    106 / 396 (26.77%)
    0 / 48 (0.00%)
         occurrences all number
    228
    176
    0
    Hypokalaemia
         subjects affected / exposed
    37 / 408 (9.07%)
    21 / 396 (5.30%)
    0 / 48 (0.00%)
         occurrences all number
    59
    28
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    03 Sep 2007
    AMENDMENT A Key Elements: - Increased the study sample size from 600 participants to 800 participants - Added participant exclusion criterion for a history of systemic breast cancer treatment - Revised the cardiac safety monitoring plan - Revised the Docetaxel dose adjustments to be at the discretion of the treating physician based on tolerability - Added a substudy allowing for an evaluation of the corrected QT Interval (QTc) prolongation based on tolerability at selected sites - Added assessment for anti-therapeutic antibodies (ATA) to pertuzumab - Revised the definition of the primary endpoint of PFS - Defined the censoring of PFS data - Revised the collection of radiographic tumor assessment data until IRF confirmed PD - Changed the interim and final analysis timelines for OS - Removed clinical benefit rate from the secondary endpoints - Added an Interim safety analysis occurring when 100 participants enrolled and followed for at least four months - Implemented block randomization with two stratification factors instead of the dynamic randomization
    12 Dec 2007
    AMENDMENT B key elements: - Modified inclusion criterion 4 to include the collection of historic left ventricular ejection fraction (LVEF) values - Added LVEF assessments during follow-up to allow long-term follow-up of cardiac function - Aligned the reporting and grading of symptomatic left ventricular dysfunction (LVSD) with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 3.0 - Increased surveillance of anti-pertuzumab antibodies - Updated statistical analysis plan in relation to objective response, and statistical considerations and the analytical plan were further clarified - Added a hematology test on Day 8 of each treatment cycle during chemotherapy - Described with more accuracy the tumor assessment scans required at baseline
    23 Jun 2009
    AMENDMENT C key elements: - Updated definition of postmenopausal women and the contraceptive requirements for women of childbearing potential, male participants with partners of childbearing potential, and pregnant partners to align with Medicines and Health Care Products Regulatory Agency (MHRA) recommendations, in accordance with the International Conference on Harmonization (ICH) M3 guideline - Added pregnancy testing requirements after discontinuation of study treatment - Clarified eligibility for enrollment into the study for participants with bone-only metastases - Clarified prior hormonal therapy in the metastatic breast cancer (MBC) setting and exclusion criterion 6 was amended to allow enrollment of participants with a history of squamous cell carcinoma - Clarified non-eligibility for participants in other interventional and non-interventional studies - Added clarification to exclusion criterion 14 regarding acceptable transaminases and alkaline phosphatase levels for inclusion into the study - Updated the schedule of assessments, deleting unnecessary assessments and correcting time points at which an assessment was required - Clarified use of positron emission tomography/computed tomography (PET/CT) scans when bone scans could not performed due to isotope shortages - Clarified the administration and discontinuation of docetaxel - Clarified the follow-up period for LVEF assessments following discontinuation of study treatment
    26 Aug 2011
    AMENDMENT D key elements: - Continuation of tumor assessments until investigator-determined PD (instead of IRF-determined PD) or until 15 April 2012 (with the exception of sites in Japan) - Continuation of sites in Japan to perform tumor assessments until IRF-determined disease progression and send tumor assessment data to the IRF until notified by the Study Management Team - Maintained the study blinding procedures to reduce the chances of bias or crossover occurring after disease progression - Updated timelines for the quality-of-life assessment (FACT-B questionnaire), sampling for antibodies to pertuzumab, and Eastern Cooperative Oncology Group (ECOG) performance status assessments - Eliminated sampling for shed HER2 extracellular domain (ECD) and HER ligands
    04 May 2012
    AMENDMENT E key elements: - Inserted information relating to the second interim OS analysis as requested by regulatory authorities - Added an open-label pertuzumab crossover treatment group offered to participants in the placebo treatment group who had not experienced disease progression and were still receiving study treatment. The addition of the open-label pertuzumab crossover treatment group was subject to the results of the second interim OS analysis and was allowed because a statistical significance was achieved at the second interim OS analysis. - Added a change in serious adverse event (SAE) reporting that all SAEs should be reported to the Sponsor within 24 hours of the investigator becoming aware of the event to comply with European regulations

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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