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    Clinical Trial Results:
    A Randomized, 3 Arm, Multicenter, Phase III Study to Evaluate the Efficacy and the Safety of T-DM1 Combined With Pertuzumab or T-DM1 Combined With Pertuzumab-Placebo (Blinded for Pertuzumab), Versus the Combination of Trastuzumab Plus Taxane, as First Line Treatment in HER2 Positive Progressive or Recurrent Locally Advanced or Metastatic Breast Cancer (MBC)

    Summary
    EudraCT number
    2009-017905-13
    Trial protocol
    AT   ES   DE   FR   SE   DK   HU   CZ   GB   IT   BE   PT   GR  
    Global end of trial date
    16 Sep 2016

    Results information
    Results version number
    v2(current)
    This version publication date
    30 Aug 2017
    First version publication date
    07 Jan 2017
    Other versions
    v1
    Version creation reason

    Trial information

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    Trial identification
    Sponsor protocol code
    BO22589
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01120184
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Hoffmann-La Roche
    Sponsor organisation address
    Grenzacherstrasse 124, CH, Basel, Switzerland, Switzerland, 4070
    Public contact
    Medical Communications, Hoffmann-La Roche, +41 8008218590, genentech@druginfo.com
    Scientific contact
    Medical Communications, Hoffmann-La Roche, +41 8008218590, genentech@druginfo.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
    Final
    Date of interim/final analysis
    15 May 2016
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    16 Sep 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    This randomized, three-arm, multicenter, Phase III study was designed to evaluate the efficacy and safety of trastuzumab emtansine with and without pertuzumab, versus the combination of trastuzumab with taxane therapy, among subjects with human epidermal growth factor receptor 2 (HER2)-positive locally advanced breast cancer (LABC) or metastatic breast cancer (MBC) who had not received prior chemotherapy for their metastatic disease.
    Protection of trial subjects
    All investigators were trained according to applicable Sponsor Standard Operating Procedures (SOPs). Roche and the investigators strictly adhered to the stated provisions in these guidelines. This was documented by the investigator’s signature on the protocol agreeing to carry out all of its terms in accordance with the applicable regulations and law and to follow International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    29 Jun 2010
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Efficacy, Safety
    Long term follow-up duration
    67 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 41
    Country: Number of subjects enrolled
    Korea, Republic of: 79
    Country: Number of subjects enrolled
    Belgium: 20
    Country: Number of subjects enrolled
    Bahamas: 6
    Country: Number of subjects enrolled
    Portugal: 6
    Country: Number of subjects enrolled
    Colombia: 5
    Country: Number of subjects enrolled
    Panama: 5
    Country: Number of subjects enrolled
    Switzerland: 4
    Country: Number of subjects enrolled
    Greece: 2
    Country: Number of subjects enrolled
    Turkey: 2
    Country: Number of subjects enrolled
    Sweden: 2
    Country: Number of subjects enrolled
    United States: 131
    Country: Number of subjects enrolled
    Brazil: 88
    Country: Number of subjects enrolled
    Japan: 82
    Country: Number of subjects enrolled
    United Kingdom: 74
    Country: Number of subjects enrolled
    France: 72
    Country: Number of subjects enrolled
    Italy: 53
    Country: Number of subjects enrolled
    Russian Federation: 50
    Country: Number of subjects enrolled
    Spain: 43
    Country: Number of subjects enrolled
    Thailand: 39
    Country: Number of subjects enrolled
    Poland: 31
    Country: Number of subjects enrolled
    Bosnia and Herzegovina: 25
    Country: Number of subjects enrolled
    Canada: 23
    Country: Number of subjects enrolled
    Philippines: 23
    Country: Number of subjects enrolled
    Macedonia, the former Yugoslav Republic of: 21
    Country: Number of subjects enrolled
    Peru: 20
    Country: Number of subjects enrolled
    Czech Republic: 19
    Country: Number of subjects enrolled
    Hungary: 19
    Country: Number of subjects enrolled
    Australia: 18
    Country: Number of subjects enrolled
    Taiwan: 17
    Country: Number of subjects enrolled
    Mexico: 16
    Country: Number of subjects enrolled
    Guatemala: 12
    Country: Number of subjects enrolled
    Austria: 10
    Country: Number of subjects enrolled
    Malaysia: 10
    Country: Number of subjects enrolled
    New Zealand: 8
    Country: Number of subjects enrolled
    Denmark: 7
    Country: Number of subjects enrolled
    Romania: 6
    Country: Number of subjects enrolled
    Argentina: 6
    Worldwide total number of subjects
    1095
    EEA total number of subjects
    405
    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)
    912
    From 65 to 84 years
    179
    85 years and over
    4

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 1629 subjects were screened, of whom 1095 were randomized. There were 534 subjects who failed screening, most often due to non-centrally confirmed HER2 status or abnormal laboratory results.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    The study was considered open-label with respect to trastuzumab and trastuzumab emtansine treatment; however, subjects and investigators were blinded with respect to pertuzumab or placebo.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Trastuzumab + Taxane
    Arm description
    Subjects received trastuzumab plus either docetaxel or paclitaxel. The regimen was chosen at the investigator's discretion. Option 1: trastuzumab 8 mg/kg via IV infusion on Day 1 of Cycle 1, then 6 mg/kg IV on Day 1 of each subsequent 3-week cycle; plus a minimum of 6 cycles with docetaxel 75 or 100 mg/m^2 IV on Day 1 of each 3-week cycle. Option 2: trastuzumab 4 mg/kg IV on Day 1 of Cycle 1, then 2 mg/kg IV weekly beginning on Day 8 of Cycle 1; plus a minimum of 18 weeks with paclitaxel 80 mg/m^2 IV weekly. Treatment continued until disease progression, unacceptable toxicity, or study termination. If trastuzumab or docetaxel were discontinued for toxicity, the other agent could be continued as monotherapy.
    Arm type
    Experimental

    Investigational medicinal product name
    Trastuzumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trastuzumab was administered via IV infusion and dosed depending upon the taxane selected. Subjects received either 8 mg/kg on Day 1 of Cycle 1 followed by 6 mg/kg on Day 1 of each subsequent 3-week cycle, or 4 mg/kg on Day 1 of Cycle 1 followed by 2 mg/kg weekly beginning on Day 8 of Cycle 1.

    Investigational medicinal product name
    Docetaxel
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Docetaxel was administered via IV infusion as 75 or 100 mg/m^2 on Day 1 of each 3-week cycle.

    Investigational medicinal product name
    Paclitaxel
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Paclitaxel was administered via IV infusion as 80 mg/m^2 weekly.

    Arm title
    Trastuzumab Emtansine + Placebo
    Arm description
    Subjects received trastuzumab emtansine plus pertuzumab-placebo. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the placebo IV infusion, on Day 1 of each 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.
    Arm type
    Experimental

    Investigational medicinal product name
    Trastuzumab emtansine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion on Day 1 of each 3-week cycle.

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Subjects received the placebo equivalent to pertuzumab via IV infusion on Day 1 of each 3-week cycle.

    Arm title
    Trastuzumab Emtansine + Pertuzumab
    Arm description
    Subjects received trastuzumab emtansine plus pertuzumab. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the pertuzumab IV infusion, on Day 1 of each 3-week cycle. Pertuzumab was given as 840 mg IV on Day 1 of Cycle 1, then 420 mg IV on Day 1 of each subsequent 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.
    Arm type
    Experimental

    Investigational medicinal product name
    Pertuzumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Pertuzumab was administered via IV infusion as 840 mg on Day 1 of Cycle 1, followed by 420 mg on Day 1 of each subsequent 3-week cycle.

    Investigational medicinal product name
    Trastuzumab emtansine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion on Day 1 of each 3-week cycle.

    Number of subjects in period 1
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Started
    365
    367
    363
    Treated
    355
    365
    360
    Completed
    0
    0
    0
    Not completed
    365
    367
    363
         Physician decision
    9
    1
    3
         Adverse event, non-fatal
    -
    1
    -
         Death
    170
    176
    169
         Sponsor Decision to Terminate Study
    133
    144
    143
         Subject/ Guardian Decision to Withdraw
    32
    29
    25
         Lost to follow-up
    13
    13
    11
         Reason not Specified
    8
    3
    12

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Trastuzumab + Taxane
    Reporting group description
    Subjects received trastuzumab plus either docetaxel or paclitaxel. The regimen was chosen at the investigator's discretion. Option 1: trastuzumab 8 mg/kg via IV infusion on Day 1 of Cycle 1, then 6 mg/kg IV on Day 1 of each subsequent 3-week cycle; plus a minimum of 6 cycles with docetaxel 75 or 100 mg/m^2 IV on Day 1 of each 3-week cycle. Option 2: trastuzumab 4 mg/kg IV on Day 1 of Cycle 1, then 2 mg/kg IV weekly beginning on Day 8 of Cycle 1; plus a minimum of 18 weeks with paclitaxel 80 mg/m^2 IV weekly. Treatment continued until disease progression, unacceptable toxicity, or study termination. If trastuzumab or docetaxel were discontinued for toxicity, the other agent could be continued as monotherapy.

    Reporting group title
    Trastuzumab Emtansine + Placebo
    Reporting group description
    Subjects received trastuzumab emtansine plus pertuzumab-placebo. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the placebo IV infusion, on Day 1 of each 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Reporting group title
    Trastuzumab Emtansine + Pertuzumab
    Reporting group description
    Subjects received trastuzumab emtansine plus pertuzumab. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the pertuzumab IV infusion, on Day 1 of each 3-week cycle. Pertuzumab was given as 840 mg IV on Day 1 of Cycle 1, then 420 mg IV on Day 1 of each subsequent 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Reporting group values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab Total
    Number of subjects
    365 367 363 1095
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0
        Newborns (0-27 days)
    0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    303 306 303 912
        From 65-84 years
    59 61 59 179
        85 years and over
    3 0 1 4
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    54.2 ± 11.3 52.6 ± 11.4 52.2 ± 12 -
    Gender, Male/Female
    Units: Subjects
        Female
    362 365 361 1088
        Male
    3 2 2 7

    End points

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    End points reporting groups
    Reporting group title
    Trastuzumab + Taxane
    Reporting group description
    Subjects received trastuzumab plus either docetaxel or paclitaxel. The regimen was chosen at the investigator's discretion. Option 1: trastuzumab 8 mg/kg via IV infusion on Day 1 of Cycle 1, then 6 mg/kg IV on Day 1 of each subsequent 3-week cycle; plus a minimum of 6 cycles with docetaxel 75 or 100 mg/m^2 IV on Day 1 of each 3-week cycle. Option 2: trastuzumab 4 mg/kg IV on Day 1 of Cycle 1, then 2 mg/kg IV weekly beginning on Day 8 of Cycle 1; plus a minimum of 18 weeks with paclitaxel 80 mg/m^2 IV weekly. Treatment continued until disease progression, unacceptable toxicity, or study termination. If trastuzumab or docetaxel were discontinued for toxicity, the other agent could be continued as monotherapy.

    Reporting group title
    Trastuzumab Emtansine + Placebo
    Reporting group description
    Subjects received trastuzumab emtansine plus pertuzumab-placebo. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the placebo IV infusion, on Day 1 of each 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Reporting group title
    Trastuzumab Emtansine + Pertuzumab
    Reporting group description
    Subjects received trastuzumab emtansine plus pertuzumab. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the pertuzumab IV infusion, on Day 1 of each 3-week cycle. Pertuzumab was given as 840 mg IV on Day 1 of Cycle 1, then 420 mg IV on Day 1 of each subsequent 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Subject analysis set title
    Trastuzumab + Taxane
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects received trastuzumab plus either docetaxel or paclitaxel. The regimen was chosen at the investigator's discretion. Option 1: trastuzumab 8 mg/kg via IV infusion on Day 1 of Cycle 1, then 6 mg/kg IV on Day 1 of each subsequent 3-week cycle; plus a minimum of 6 cycles with docetaxel 75 or 100 mg/m^2 IV on Day 1 of each 3-week cycle. Option 2: trastuzumab 4 mg/kg IV on Day 1 of Cycle 1, then 2 mg/kg IV weekly beginning on Day 8 of Cycle 1; plus a minimum of 18 weeks with paclitaxel 80 mg/m^2 IV weekly. Treatment continued until disease progression, unacceptable toxicity, or study termination. If trastuzumab or docetaxel were discontinued for toxicity, the other agent could be continued as monotherapy.

    Subject analysis set title
    Trastuzumab Emtansine + Placebo
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects received trastuzumab emtansine plus pertuzumab-placebo. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the placebo IV infusion, on Day 1 of each 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Subject analysis set title
    Trastuzumab Emtansine + Pertuzumab
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects received trastuzumab emtansine plus pertuzumab. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the pertuzumab IV infusion, on Day 1 of each 3-week cycle. Pertuzumab was given as 840 mg IV on Day 1 of Cycle 1, then 420 mg IV on Day 1 of each subsequent 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Primary: Percentage of Subjects with Death or Disease Progression According to Independent Review Facility (IRF) Assessment

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    End point title
    Percentage of Subjects with Death or Disease Progression According to Independent Review Facility (IRF) Assessment [1]
    End point description
    Tumor assessments were performed according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. Disease progression was defined as a greater than or equal to (≥) 20 percent (%) and 5-millimeter (mm) increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). The percentage of subjects with death or disease progression was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Primary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Descriptive statistics only
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: percentage of subjects
        number (not applicable)
    63.3
    64.3
    59.8
    No statistical analyses for this end point

    Primary: Progression-Free Survival (PFS) According to IRF Assessment

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    End point title
    Progression-Free Survival (PFS) According to IRF Assessment
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. PFS was defined as the time from randomization to first documented disease progression or death from any cause. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). Median duration of PFS was estimated using Kaplan-Meier analysis, and corresponding confidence intervals (CIs) were computed using the Brookmeyer-Crowley method. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Primary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: months
        median (confidence interval 95%)
    13.7 (12.4 to 14.9)
    14.1 (10.9 to 16.8)
    15.2 (12.5 to 18.8)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    732
    Analysis specification
    Pre-specified
    Analysis type
    [2]
    P-value
    = 0.3125 [3]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.91
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.73
         upper limit
    1.13
    Notes
    [2] - The study was powered for superiority with target hazard ratio (HR) equal to 0.75, as well as for non-inferiority with HR equal to 1.1765 for comparison between each of the trastuzumab emtansine-containing arms and the trastuzumab + taxane arm. Non-inferiority was established if the upper bound of the 97.5% CI was less than (<) 1.1765. Superiority was achieved if the upper bound of the 97.5% CI was <1.00.
    [3] - Test and p-value apply for superiority test. Two-sided significance level of 2.5% was used to adjust for independent comparison between each of the trastuzumab emtansine-containing arms and the trastuzumab + taxane arm.
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    728
    Analysis specification
    Pre-specified
    Analysis type
    [4]
    P-value
    = 0.1407 [5]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.87
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.69
         upper limit
    1.08
    Notes
    [4] - The study was powered for superiority with target HR equal to 0.75, as well as for non-inferiority with HR equal to 1.1765 for comparison between each of the trastuzumab emtansine-containing arms and the trastuzumab + taxane arm. Non-inferiority was established if the upper bound of the 97.5% CI was <1.1765. Superiority was achieved if the upper bound of the 97.5% CI was <1.00.
    [5] - Test and p-value apply for superiority test. Two-sided significance level of 2.5% was used to adjust for independent comparison between each of the trastuzumab emtansine-containing arms and the trastuzumab + taxane arm.
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab versus Trastuzumab Emtansine + Placebo. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab Emtansine + Placebo v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    730
    Analysis specification
    Pre-specified
    Analysis type
    [6]
    P-value
    = 0.3075 [7]
    Method
    Logrank
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.91
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.73
         upper limit
    1.13
    Notes
    [6] - Formal comparison planned depending on superiority for trastuzumab emtansine + pertuzumab versus trastuzumab + taxane. The study was powered for superiority with target HR equal to 0.75, as well as for non-inferiority with HR equal to 1.1765 for comparison between each of the trastuzumab emtansine-containing arms and the trastuzumab + taxane arm.
    [7] - Test and p-value apply for superiority test. Primary endpoint did not meet superiority of PFS for trastuzumab emtansine + pertuzumab versus trastuzumab + taxane (two-sided significance level 2.5%); thus, tests and p-value are considered descriptive.

    Secondary: Percentage of Subjects Who Died Prior to Clinical Cutoff

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    End point title
    Percentage of Subjects Who Died Prior to Clinical Cutoff
    End point description
    The percentage of subjects who died prior to clinical cutoff was calculated as [number of subjects with event divided by the number analyzed multiplied by 100]. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    Up to 70 months from randomization until clinical cutoff of 15-May-2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: percentage of subjects
        number (not applicable)
    46.3
    47.7
    46.3
    No statistical analyses for this end point

    Secondary: Overall Survival (OS) at Clinical Cutoff

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    End point title
    Overall Survival (OS) at Clinical Cutoff
    End point description
    OS was defined as the time from randomization to death from any cause. Median duration of OS was estimated using Kaplan-Meier analysis, and corresponding CIs were computed using the Brookmeyer-Crowley method. Here, "9999" represents that the value is not applicable because Median duration of OS was not reached due to insufficient follow-up. Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Up to 70 months from randomization until clinical cutoff of 15-May-2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: months
        median (confidence interval 95%)
    50.86 (44.75 to 60.75)
    53.68 (48.36 to 64.36)
    51.78 (47.87 to 9999)
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab versus Trastuzmab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    728
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.86
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.67
         upper limit
    1.11
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    732
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.93
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.73
         upper limit
    1.2

    Secondary: Percentage of Subjects with Death or Disease Progression According to Investigator Assessment

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    End point title
    Percentage of Subjects with Death or Disease Progression According to Investigator Assessment
    End point description
    Tumor assessments were performed by the investigator according to RECIST version 1.1. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). The percentage of subjects with death or disease progression was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: percentage of subjects
        number (not applicable)
    72.1
    70.3
    67.5
    No statistical analyses for this end point

    Secondary: PFS According to Investigator Assessment

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    End point title
    PFS According to Investigator Assessment
    End point description
    Tumor assessments were performed by the investigator according to RECIST version 1.1. PFS was defined as the time from randomization to first documented disease progression or death from any cause. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). Median duration of PFS was estimated using Kaplan-Meier analysis, and corresponding CIs were computed using the Brookmeyer-Crowley method. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: months
        median (confidence interval 95%)
    12.5 (10.5 to 13.6)
    14.1 (12.2 to 16.7)
    14.8 (12.4 to 17.8)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    732
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.85
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.69
         upper limit
    1.04
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    728
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.77
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.63
         upper limit
    0.95

    Secondary: Percentage of Subjects Experiencing Treatment Failure

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    End point title
    Percentage of Subjects Experiencing Treatment Failure
    End point description
    Treatment failure was defined as the discontinuation of all study medications in the treatment arm for any reason including disease progression, treatment toxicity, death, physician decision, or subject withdrawal. The percentage of subjects with treatment failure was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: percentage of subjects
        number (not applicable)
    85.8
    82.6
    80.2
    No statistical analyses for this end point

    Secondary: Time to Treatment Failure (TTF)

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    End point title
    Time to Treatment Failure (TTF)
    End point description
    Treatment failure was defined as the discontinuation of all study medications in the treatment arm for any reason including disease progression, treatment toxicity, death, physician decision, or subject withdrawal. TTF was defined as the time from randomization to treatment failure. Median TTF was estimated using Kaplan-Meier analysis, and corresponding CIs were computed using the Brookmeyer-Crowley method. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: months
        median (confidence interval 95%)
    10.2 (9.2 to 11.8)
    12.1 (9.9 to 13.9)
    11.8 (9.9 to 14.2)
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    728
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.78
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.65
         upper limit
    0.95
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo versus Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    732
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.8
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.66
         upper limit
    0.97

    Secondary: One-Year Survival Rate

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    End point title
    One-Year Survival Rate
    End point description
    The percentage of subjects alive at 1 year after randomization was estimated as the one-year survival rate using Kaplan-Meier analysis, and corresponding CIs were computed using Greenwood's estimate of the standard error. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    From randomization until 1 year
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: percentage probability of being alive
        number (confidence interval 95%)
    91.4 (88.44 to 94.41)
    92.4 (89.62 to 95.15)
    91.9 (89 to 94.77)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Grade ≥3 Adverse Events

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    End point title
    Percentage of Subjects with Grade ≥3 Adverse Events
    End point description
    Adverse events were graded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Grade 3: Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care activity of daily living with inability to perform bathing, dressing and undressing, feeding self, using the toilet, taking medications but not bedridden. Grade 4: An immediate threat to life. Urgent medical intervention is required in order to maintain survival. Grade 5: Death. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Up to 50 months from randomization until clinical cutoff of 16-Sept-2014 (continuously until 28 days after last dose ]
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    353
    361
    366
    Units: percentage of subjects
        number (not applicable)
    54.1
    45.4
    46.2
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Who Died at 2 Years

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    End point title
    Percentage of Subjects Who Died at 2 Years
    End point description
    Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    From randomization until 2 years
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: percentage of subjects
        number (not applicable)
    20.3
    20.2
    19.6
    No statistical analyses for this end point

    Secondary: Overall Survival Truncated at 2 Years

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    End point title
    Overall Survival Truncated at 2 Years
    End point description
    Overall Survival truncated at 2 years was defined as the time from the date of randomization to the date of death from any cause. Subjects who were alive at 2 years had been censored at 2 years. Overall survival truncated at 2 years was estimated using Kaplan-Meier analyses. Here, "9999" represents that data was not applicable because median was not reached at 2 years as most of the subjects were alive at that time point. Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    From randomization until 2 years
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: months
        median (confidence interval 95%)
    9999 (9999 to 9999)
    9999 (9999 to 9999)
    9999 (9999 to 9999)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Grade 5 Adverse Events

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    End point title
    Percentage of Subjects with Grade 5 Adverse Events
    End point description
    Adverse events were graded according to NCI CTCAE version 4.0. Grade 5 adverse events are those events which led to death. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Up to 50 months from randomization until clinical cutoff of 16-Sept-2014 (continuously until 28 days after last dose
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    353
    361
    366
    Units: percentage of subjects
        number (not applicable)
    1.7
    1.1
    1.9
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Grade 3-4 Laboratory Parameters

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    End point title
    Percentage of Subjects with Grade 3-4 Laboratory Parameters
    End point description
    Laboratory results were graded according to NCI CTCAE version 4.0. Grade 3: Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care activity of daily living with inability to perform bathing, dressing and undressing, feeding self, using the toilet, taking medications but not bedridden. Grade 4: An immediate threat to life. Urgent medical intervention is required in order to maintain survival. Analysis was performed on ITT population (all subjects randomized in the study).
    End point type
    Secondary
    End point timeframe
    Day 1, 8, and 15 of Cycle 1–3 and on Day 1 of each subsequent cycle up to 50 months from randomization until clinical cutoff of 16-Sept-2014
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    353
    361
    366
    Units: percentage of subjects
    number (not applicable)
        Hemoglobin-Low: Grade 3
    4.3
    5.8
    6.9
        Neutrophils-Low: Grade 3
    20.2
    5.5
    5
        Neutrophils-Low: Grade 4
    43.8
    1.9
    0.8
        Platelets-Low: Grade 3
    0.9
    12.7
    12.9
        Platelets-Low: Grade 4
    0.3
    2.8
    2.5
        Alkaline Phosphate-High: Grade 3
    1.1
    3.9
    3
        Alanine Transaminase-High: Grade 3
    3.4
    9.1
    8
        Alanine Transaminase-High: Grade 4
    0
    0.3
    0.6
        Aspartate Aminotransferase-High: Grade 3
    1.1
    11.9
    6.9
        Aspartate Aminotransferase-High: Grade 4
    0
    0.3
    0.3
        Creatinine-High: Grade 3
    0.9
    0.3
    1.1
        Creatinine-High: Grade 4
    0
    0
    0.3
        Potassium-Low: Grade 3
    4.3
    4.7
    5.2
        Potassium-Low: Grade 4
    0.6
    1.7
    0.6
        Total Bilirubin-High: Grade 3
    0.3
    0.3
    0.3
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Decline of ≥2 points from Baseline in Eastern Cooperative Oncology Group (ECOG) Performance Status

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    End point title
    Percentage of Subjects with Decline of ≥2 points from Baseline in Eastern Cooperative Oncology Group (ECOG) Performance Status
    End point description
    The ECOG performance status is a scale used to quantify cancer subjects' general well-being and activities of daily life. The scale ranges from 0 to 5, with 0 denoting perfect health and 5 indicating death. The 6 categories are 0=Asymptomatic (Fully active, able to carry on all predisease activities without restriction), 1=Symptomatic but completely ambulatory (Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature), 2=Symptomatic, < 50% in bed during the day (Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours), 3=Symptomatic, > 50% in bed, but not bedbound (Capable of only limited self-care, confined to bed or chair 50% or more of waking hours), 4=Bedbound (Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair), 5=Death. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Baseline, Day 1 of every Cycle up to Clinical Data Cut (up to 48 months)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    353
    361
    366
    Units: percentage of subjects
        number (not applicable)
    7.6
    6.1
    7.9
    No statistical analyses for this end point

    Secondary: Hospitalization Days

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    End point title
    Hospitalization Days
    End point description
    Hospitalization was defined as a non-administration-related hospitalization due to serious adverse event, while on study treatment. Reported values represent number of days admitted per subjects. Analysis was performed on safety population. Number of subjects analyzed=subjects with hospitalization and data available for calculation of the parameter.
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    353
    361
    366
    Units: days
        median (full range (min-max))
    6 (1 to 50)
    5 (1 to 117)
    8 (1 to 381)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Hospitalization

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    End point title
    Percentage of Subjects with Hospitalization
    End point description
    Hospitalization was defined as a non-administration-related hospitalization due to serious adverse event, while on study treatment. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    353
    361
    366
    Units: percentage of subjects
        number (confidence interval 95%)
    21.8 (17.62 to 26.36)
    20.2 (16.2 to 24.71)
    22.1 (18.03 to 26.7)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with Objective Response According to IRF Assessment

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    End point title
    Percentage of Subjects with Objective Response According to IRF Assessment
    End point description
    Objective response was defined as having complete response (CR) or partial response (PR), assessed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. CR was defined as the disappearance of all target and non-target lesions and short-axis reduction in pathological lymph nodes to <10 mm. PR was defined as a ≥30% decrease in sum of diameters of target lesions, taking as reference the Baseline sum. Response was determined using 2 consecutive tumor assessments at least 4 weeks apart. The percentage of subjects with a best overall response of CR or PR (ie, the objective response rate [ORR]) was calculated as [number of subjects meeting the respective criteria divided by the number analyzed] multiplied by 100. Corresponding CIs computed using the Blyth-Still-Casella exact method. Analysis performed on ITT population with measurable disease by IRF at Baseline.
    End point type
    Secondary
    End point timeframe
    Up to 46 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    287
    303
    299
    Units: percentage of subjects
        number (confidence interval 95%)
    67.9 (62.26 to 73.31)
    59.7 (54.07 to 65.3)
    64.2 (58.62 to 69.65)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo versus Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    590
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Response Rate
    Point estimate
    -8.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -15.9
         upper limit
    -0.5
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    586
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Response Rate
    Point estimate
    -3.7
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -11.4
         upper limit
    3.9
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab Emtansine + Placebo
    Comparison groups
    Trastuzumab Emtansine + Placebo v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    602
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Response Rate
    Point estimate
    4.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.3
         upper limit
    12.2

    Secondary: Percentage of Subjects with Objective Response According to Investigator Assessment

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    End point title
    Percentage of Subjects with Objective Response According to Investigator Assessment
    End point description
    Objective response was defined as having CR or PR, assessed according to RECIST version 1.1, by investigator. CR was defined as the disappearance of all target and non-target lesions and short-axis reduction in pathological lymph nodes to <10 mm. PR was defined as a ≥30% decrease in sum of diameters of target lesions, taking as reference the Baseline sum. Response was determined using 2 consecutive tumor assessments at least 4 weeks apart. The percentage of subjects with a best overall response of CR or PR (ie, the ORR) was calculated as [number of subjects meeting the respective criteria divided by the number analyzed] multiplied by 100. Corresponding CIs were computed using the Blyth-Still-Casella exact method. Analysis was performed on ITT population (all subjects randomized in the study). Only subjects with measurable disease by investigator at Baseline were included.
    End point type
    Secondary
    End point timeframe
    Up to 46 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    293
    314
    311
    Units: percentage of subjects
        number (confidence interval 95%)
    69.3 (63.74 to 74.52)
    64.6 (59.12 to 69.87)
    67.5 (62.17 to 72.68)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo v Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    607
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Response Rate
    Point estimate
    -4.6
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -12.1
         upper limit
    2.8
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    604
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Response Rate
    Point estimate
    -1.8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -9.2
         upper limit
    5.7
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab Emtansine + Placebo
    Comparison groups
    Trastuzumab Emtansine + Placebo v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    625
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Response Rate
    Point estimate
    2.9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.5
         upper limit
    10.3

    Secondary: Duration of Response According to IRF Assessment

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    End point title
    Duration of Response According to IRF Assessment
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. Duration of response was defined as the time from confirmed PR or CR to first documented disease progression or death from any cause. CR was defined as the disappearance of all target lesions and non-target lesions and short-axis reduction in pathological lymph nodes to <10 mm. PR was defined as a ≥30% decrease in sum of diameters of target lesions, taking as reference the Baseline sum. Response was determined using 2 consecutive tumor assessments at least 4 weeks apart. Median duration of response was estimated using Kaplan-Meier analysis, and corresponding CIs were computed using the Brookmeyer-Crowley method. Analysis was performed on ITT population. Only subjects achieving CR or PR were included in the analysis.
    End point type
    Secondary
    End point timeframe
    Up to 46 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    195
    181
    192
    Units: months
        median (confidence interval 95%)
    12.5 (10.5 to 16.6)
    20.7 (14.8 to 25)
    21.2 (15.8 to 29.3)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo v Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    376
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.6
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.43
         upper limit
    0.84
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    387
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.62
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.45
         upper limit
    0.85

    Secondary: Percentage of Subjects with a Best Overall Response of CR, PR, or Stable Disease (SD) According to IRF Assessment

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    End point title
    Percentage of Subjects with a Best Overall Response of CR, PR, or Stable Disease (SD) According to IRF Assessment
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. CR was defined as the disappearance of all target and non-target lesions and short-axis reduction in pathological lymph nodes to <10 mm. PR was defined as a ≥30% decrease in sum of diameters of target lesions, taking as reference the Baseline sum. SD was defined as neither sufficient shrinkage to quality for PR nor sufficient (20%) increase to qualify for disease progression. Response was determined using 2 consecutive tumor assessments at least 4 weeks apart. The percentage of subjects with a best overall response of CR, PR, or SD was calculated as [number of subjects meeting the respective criteria divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Up to 46 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    0 [8]
    0 [9]
    0 [10]
    Units: percentage of subjects
    Notes
    [8] - This outcome was removed because it was redundant to another prespecified secondary endpoint.
    [9] - This outcome was removed because it was redundant to another prespecified secondary endpoint.
    [10] - This outcome was removed because it was redundant to another prespecified secondary endpoint.
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Experiencing a Clinically Significant Increase in Taxane-Related Treatment Symptoms as Measured by Taxane Subscale of the Functional Assessment of Cancer Therapy (FACT) Taxane (FACT-TaxS) Score

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    End point title
    Percentage of Subjects Experiencing a Clinically Significant Increase in Taxane-Related Treatment Symptoms as Measured by Taxane Subscale of the Functional Assessment of Cancer Therapy (FACT) Taxane (FACT-TaxS) Score
    End point description
    The FACT-Taxane is a self-reported instrument which measures the health-related quality of life (HRQOL) of subjects receiving taxane-containing chemotherapy. The FACT-TaxS consists of 16 items including 11 neurotoxicity-related questions and 5 additional questions assessing arthralgia, myalgia, and skin discoloration. Items are rated from 0 (not at all) to 4 (very much) and a total score is inversely derived. Scores may range from 0 to 64, with higher scores indicating fewer/no symptoms. A minimally clinically important difference in treatment-related symptoms was defined as a ≥5% decrease (ie, 3.2 points) in FACT-TaxS score from Baseline. The percentage of subjects with treatment-related symptoms was calculated using following formula: [number of subjects meeting the above threshold divided by the number analyzed] multiplied by 100. Corresponding CIs computed using the Blyth-Still-Casella exact method. Analysis included randomized subjects who entered after Protocol Amendment C.
    End point type
    Secondary
    End point timeframe
    Up to 39 months from randomization until clinical cutoff of 16-Sept-2014 (at Baseline, on Day 1 of Cycles 2 to 8 and every even-numbered cycle thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    173
    171
    154
    Units: percentage of subjects
        number (confidence interval 95%)
    93.1 (88.48 to 96.06)
    60.8 (53.39 to 67.93)
    68.8 (61.32 to 75.92)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo v Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    344
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Symptom Rate
    Point estimate
    -32.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -40
         upper limit
    -24
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    327
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Symptom Rate
    Point estimate
    -24.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -32
         upper limit
    -16
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab v Trastuzumab Emtansine + Placebo. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab Emtansine + Placebo v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    325
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Difference in Symptom Rate
    Point estimate
    8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.3
         upper limit
    18.4

    Secondary: Percentage of Subjects Reporting Nausea According to the Relevant Single Items of The FACT Colorectal Cancel (FACT-C) Module

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    End point title
    Percentage of Subjects Reporting Nausea According to the Relevant Single Items of The FACT Colorectal Cancel (FACT-C) Module
    End point description
    The FACT-C is a self-reported instrument which measures HRQOL pertaining to colorectal cancer. Response options on each question may range from 0 (not at all) to 4 (very much). The percentage of subjects with nausea was calculated using following formula: [number of subjects with any level of either symptom divided by the number analyzed] multiplied by 100. Analyses were performed on the Protocol Amendment C Subpopulation. Only subjects with a FACTC score at the designated visit (n) were included in the analysis.
    End point type
    Secondary
    End point timeframe
    At Baseline, Day 8 of Cycle 1, and Days 1 and 8 of Cycle 2
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    173
    171
    154
    Units: percentage of subjects
    number (not applicable)
        Nausea, Baseline (n=166,166,150)
    22.3
    14.5
    21.3
        Nausea, Cycle 1 Day 8 (n=121,114,95)
    38
    36
    52.6
        Nausea, Cycle 2 Day 1 (n=147,151,138)
    27.2
    20.5
    36.2
        Nausea, Cycle 2 Day 8 (n=122,121,105)
    35.2
    28.1
    45.7
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Reporting Diarrhea According to the Relevant Single Items of The FACT-C Module

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    End point title
    Percentage of Subjects Reporting Diarrhea According to the Relevant Single Items of The FACT-C Module
    End point description
    The FACT-C is a self-reported instrument which measures HRQOL pertaining to colorectal cancer. Response options on each question may range from 0 (not at all) to 4 (very much). The percentage of subjects with diarrhea was calculated using following formula: [number of subjects with any level of either symptom divided by the number analyzed] multiplied by 100. Analyses were performed on the Protocol Amendment C Subpopulation. Only subjects with a FACTC score at the designated visit (n) were included in the analysis.
    End point type
    Secondary
    End point timeframe
    At Baseline, Day 8 of Cycle 1, and Days 1 and 8 of Cycle 2
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    173
    171
    154
    Units: percentage of subjects
    number (not applicable)
        Diarrhea, Baseline (n=173,170,153)
    15
    7.6
    11.8
        Diarrhea, Cycle 1 Day 8 (n=124,117,98)
    34.7
    17.9
    34.7
        Diarrhea, Cycle 2 Day 1 (n=161,160,144)
    24.2
    11.3
    39.6
        Diarrhea, Cycle 2 Day 8 (n=125,123,107)
    34.4
    8.1
    41.1
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with a Clinically Significant Deterioration in Health Related Quality of Life (HRQoL) as measured by FACT Breast (FACT-B) Trial Outcome Index-Physical Function Breast (TOI-PFB) Score

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    End point title
    Percentage of Subjects with a Clinically Significant Deterioration in Health Related Quality of Life (HRQoL) as measured by FACT Breast (FACT-B) Trial Outcome Index-Physical Function Breast (TOI-PFB) Score
    End point description
    The FACT-B is a self-reported instrument which measures HRQOL of subjects with breast cancer. It consists of 5 subscales including physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and a breast cancer subscale (BCS). The TOI-PFB score is taken by adding the scores from the PWB (7 items), FWB (7 items), and BCS (9 items) subscales. Items are rated from 0 (not at all) to 4 (very much) and a total score is derived. Scores may range from 0 to 92, with higher scores indicating better HRQOL. A 5 point change has been identified as the clinically minimal important difference (CMID) on the FACT-TOI-PFB scale. The percentage of subjects with deterioration was calculated as [number of subjects meeting the above threshold divided by the number analyzed] multiplied by 100. Analysis was performed on the ITT population with baseline and at least one post baseline FACT-B TOI-PFB score.
    End point type
    Secondary
    End point timeframe
    Up to 39 months from randomization until clinical cutoff of 16-Sept-2014 (at Baseline, on Day 1 of Cycles 2 to 8 and every even-numbered cycle thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    327
    352
    338
    Units: percentage of subjects
        number (not applicable)
    61.8
    50.9
    50.6
    No statistical analyses for this end point

    Secondary: Time to Deterioration in HRQoL as Assessed by FACT-B TOI-PFB Score

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    End point title
    Time to Deterioration in HRQoL as Assessed by FACT-B TOI-PFB Score
    End point description
    The FACT-B is a self-reported instrument which measures HRQOL of subjects with breast cancer. It consists of 5 subscales including PWB, SWB, EWB, FWB, and BCS. The TOI-PFB score is taken by adding the scores from the PWB (7 items), FWB (7 items), and BCS (9 items) subscales. Items are rated from 0 (not at all) to 4 (very much) and a total score is derived. Scores may range from 0 to 92, with higher scores indicating better HRQOL. A 5 point change has been identified as the clinically minimal important difference (CMID) on the FACT-TOI-PFB scale. Time to deterioration was defined as the time from Baseline until the first decrease in FACT-B TOI-PFB score. Median time to deterioration was estimated using Kaplan-Meier analysis, and corresponding CIs were computed using the Brookmeyer-Crowley method. Analysis was performed on the ITT population with baseline and at least one post baseline FACT-B TOI-PFB score.
    End point type
    Secondary
    End point timeframe
    Baseline up to 39 months from randomization until clinical cutoff of 16-Sept-2014
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    327
    352
    338
    Units: months
        median (confidence interval 95%)
    3.6 (3 to 4.4)
    7.7 (6.2 to 11.9)
    9 (5.1 to 14.5)
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Pertuzumab vs Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Pertuzumab
    Number of subjects included in analysis
    665
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.68
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.55
         upper limit
    0.84
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo vs Trastuzumab + Taxane. Stratified Analysis: Stratification factors included world region (United States, Western Europe/Canada/Australia-Pacific, Eastern Europe, Asia, others); prior adjuvant/neoadjuvant therapy (no, yes [trastuzumab and/or lapatinib], yes [no trastuzumab and/or lapatinib]), and visceral disease (present, absent).
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    679
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.7
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.57
         upper limit
    0.86

    Secondary: Change from Baseline in Rotterdam Symptom Checklist (RSCL) Activity Level Scale Score

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    End point title
    Change from Baseline in Rotterdam Symptom Checklist (RSCL) Activity Level Scale Score
    End point description
    The RSCL is a self-reported instrument which consists of 4 domains including physical symptom distress, psychological distress, activity level, and overall global life quality. Only the activity level scale was collected and assessed. Scores may range from 0 to 100, with higher scores indicating increased burden of disease. Mean RSCL activity scale score changes were calculated as [mean score at the assessment visit minus mean score at Baseline]. The higher the score, the higher the level of impairment or burden. Analysis was performed on ITT population. Only subjects with available data at baseline and Cycle 7 (Week 18) were included.
    End point type
    Secondary
    End point timeframe
    Baseline, Cycle 7 (Week 18)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    365
    367
    363
    Units: units on a scale
    arithmetic mean (confidence interval 95%)
        Baseline (n=344,355,344)
    85 (82.9 to 87.2)
    85.5 (83.3 to 87.8)
    85.7 (83.5 to 87.8)
        Change From Baseline at Cycle 7 (n=261,252,261)
    -1.6 (-4.2 to 1)
    2.3 (0.4 to 4.2)
    -0.2 (-2.1 to 1.6)
    No statistical analyses for this end point

    Secondary: Change From Baseline in Work Productivity According to Work Productivity and Activity Impairment (WPAI) Questionnaire Score

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    End point title
    Change From Baseline in Work Productivity According to Work Productivity and Activity Impairment (WPAI) Questionnaire Score
    End point description
    The WPAI is a patient-reported measure which assesses the effect of general health and symptom severity on work productivity and regular activities. The General Health questionnaire asks subjects to estimate the number of hours missed from work due to reasons related and unrelated to their health problems, as well as the total number of hours actually worked in the preceding 7-day period. The percentage of subjects reporting that they were employed (working for pay) was assessed at baseline was assessed along with Absenteeism (work time missed), Presenteeism (impairment at work / reduced on-the-job effectiveness), Work productivity loss (overall work impairment / absenteeism plus presenteeism), and Activity Impairment. The reported changes represent change from baseline at Cycle 7. The score range for the scales of the WPAI is between 0 (no effect) to 100% (max effect). Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Baseline, Cycle 7 (Week 18)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    67
    64
    67
    Units: percent of work
    arithmetic mean (confidence interval 95%)
        % Work Time Missed at Baseline (n=66,63,67)
    15.3 (9.2 to 21.4)
    9.5 (4.2 to 14.8)
    13.6 (7.7 to 19.6)
        Change in % Work Time Missed (n=35,33,36)
    0.4 (-7.3 to 8.2)
    0 (-4.5 to 4.5)
    -4.3 (-13 to 4.6)
        % Impairment While Working at Baseline(n=67,64,67)
    20 (14.1 to 25.9)
    15.3 (9.5 to 21.1)
    19.9 (13.6 to 26.1)
        Change in % Impairment While Working (n=34,32,35)
    8.8 (2 to 15.6)
    -0.3 (-11 to 10.5)
    -2.7 (-11 to 5.2)
        % Overall Work Impairment at Baseline (n=65,62,66)
    28.5 (20.7 to 36.2)
    21.2 (13.8 to 28.7)
    28.1 (20.3 to 35.9)
        Change in % Overall Work Impairment (n=34,31,35)
    9.1 (-0.4 to 18.6)
    -1.1 (-13 to 11)
    -4.6 (-14 to 5)
    No statistical analyses for this end point

    Secondary: Change From Baseline in Activity Impairment According to Work Productivity and Activity Impairment (WPAI) Questionnaire Score

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    End point title
    Change From Baseline in Activity Impairment According to Work Productivity and Activity Impairment (WPAI) Questionnaire Score
    End point description
    The WPAI is a patient-reported measure which assesses the effect of general health and symptom severity on work productivity and regular activities. The General Health questionnaire asks subjects to estimate the number of hours missed from work due to reasons related and unrelated to their health problems, as well as the total number of hours actually worked in the preceding 7-day period. The percentage of subjects reporting that they were employed (working for pay) was assessed at baseline was assessed along with Absenteeism (work time missed), Presenteeism (impairment at work / reduced on-the-job effectiveness), Work productivity loss (overall work impairment / absenteeism plus presenteeism), and Activity Impairment. The reported changes represent change from baseline at Cycle 7. The score range for the scales of the WPAI is between 0 (no effect) to 100% (max effect). Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Baseline, Cycle 7 (Week 18)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    312
    334
    321
    Units: units on a scale
    arithmetic mean (confidence interval 95%)
        % Activity Impairment at Baseline (n=312,334,321)
    32.9 (29.6 to 36.3)
    33.6 (30.2 to 37)
    32.7 (29.5 to 36)
        Change in % Activity Impairment (n=227,222,234)
    4.5 (0.2 to 8.7)
    -5.3 (-9.5 to -1.1)
    -3.7 (-7.2 to -0.1)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects with a Best Overall Response of CR or PR According to IRF Assessment Among Those with High Human Epidermal Growth Factor Receptor 2 (HER2) Messenger Ribonucleic Acid (mRNA) Levels

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    End point title
    Percentage of Subjects with a Best Overall Response of CR or PR According to IRF Assessment Among Those with High Human Epidermal Growth Factor Receptor 2 (HER2) Messenger Ribonucleic Acid (mRNA) Levels
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. CR was defined as the disappearance of all target and non-target lesions and short-axis reduction in pathological lymph nodes to <10 mm. PR was defined as a ≥30% decrease in sum of diameters of target lesions, taking as reference the Baseline sum. Response was determined using 2 consecutive tumor assessments at least 4 weeks apart. The percentage of subjects with a best overall response of CR or PR (ie, the ORR) was calculated as [number of subjects meeting the respective criteria divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population with above the median HER2 mRNA expression (value greater than [>] 59.71). Only subjects with measurable disease at Baseline were included in the analysis.
    End point type
    Secondary
    End point timeframe
    Up to 46 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    132
    136
    147
    Units: percentage of subjects
        number (not applicable)
    75
    66.9
    63.9
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo v Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    268
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.67
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.4
         upper limit
    1.15

    Secondary: Percentage of Subjects with a Best Overall Response of CR or PR According to IRF Assessment Among Those with Low HER2 mRNA Levels

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    End point title
    Percentage of Subjects with a Best Overall Response of CR or PR According to IRF Assessment Among Those with Low HER2 mRNA Levels
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. CR was defined as the disappearance of all target and non-target lesions and short-axis reduction in pathological lymph nodes to <10 mm. PR was defined as a ≥30% decrease in sum of diameters of target lesions, taking as reference the Baseline sum. Response was determined using 2 consecutive tumor assessments at least 4 weeks apart. The percentage of subjects with a best overall response of CR or PR (ie, the ORR) was calculated as [number of subjects meeting the respective criteria divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population with below the median HER2 mRNA expression (value less than or equal to [≤] 59.71). Only subjects with measurable disease at Baseline were included in the analysis.
    End point type
    Secondary
    End point timeframe
    Up to 46 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    126
    147
    127
    Units: percentage of subjects
        number (not applicable)
    61.9
    51.7
    66.1
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo" vs Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    273
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.66
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.41
         upper limit
    1.07

    Secondary: Percentage of Subjects with Death or Disease Progression According to IRF Assessment Among Those with High HER2 mRNA Levels

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    End point title
    Percentage of Subjects with Death or Disease Progression According to IRF Assessment Among Those with High HER2 mRNA Levels
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). The percentage of subjects with death or disease progression was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT Population (High HER2 mRNA Subpopulation).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    160
    165
    173
    Units: percentage of subjects
        number (not applicable)
    59.4
    57.6
    56.1
    No statistical analyses for this end point

    Secondary: PFS According to IRF Assessment Among Those with High HER2 mRNA Levels

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    End point title
    PFS According to IRF Assessment Among Those with High HER2 mRNA Levels
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. PFS was defined as the time from randomization to first documented disease progression or death from any cause. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). Median duration of PFS was estimated using Kaplan-Meier analysis. Analysis was performed on ITT Population (High HER2 mRNA Subpopulation).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    160
    165
    173
    Units: months
        median (full range (min-max))
    15.9 (0.1 to 46.4)
    18.6 (0.1 to 46)
    18.7 (0.1 to 48.1)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo v Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    325
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.9
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.65
         upper limit
    1.25

    Secondary: Percentage of Subjects with Death or Disease Progression According to IRF Assessment Among Those with Low HER2 mRNA Levels

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    End point title
    Percentage of Subjects with Death or Disease Progression According to IRF Assessment Among Those with Low HER2 mRNA Levels
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). The percentage of subjects with death or disease progression was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT Population (Low HER2 mRNA Subpopulation).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    170
    174
    157
    Units: percentage of subjects
        number (not applicable)
    66.5
    70.1
    62.4
    No statistical analyses for this end point

    Secondary: PFS According to IRF Assessment Among Those with Low HER2 mRNA Levels

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    End point title
    PFS According to IRF Assessment Among Those with Low HER2 mRNA Levels
    End point description
    Tumor assessments were performed according to RECIST version 1.1, using radiographic images submitted to the IRF up to and including the confirmatory tumor assessment 4 to 6 weeks after study drug discontinuation. PFS was defined as the time from randomization to first documented disease progression or death from any cause. Disease progression was defined as a ≥20% and 5-mm increase in sum of diameters of target lesions, taking as reference the smallest sum obtained during the study, or appearance of new lesion(s). Median duration of PFS was estimated using Kaplan-Meier analysis. Analysis was performed on ITT Population (Low HER2 mRNA Subpopulation).
    End point type
    Secondary
    End point timeframe
    Up to 48 months from randomization until clinical cutoff of 16-Sept-2014 (at Screening, every 9 weeks for 81 weeks, then every 12 weeks thereafter and/or up to 42 days after last dose)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    170
    174
    157
    Units: months
        median (full range (min-max))
    12.4 (0.1 to 47.3)
    10.2 (0.1 to 43.6)
    14.5 (0.1 to 40.7)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Direction of comparison: Trastuzumab Emtansine + Placebo v Trastuzumab + Taxane
    Comparison groups
    Trastuzumab + Taxane v Trastuzumab Emtansine + Placebo
    Number of subjects included in analysis
    344
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1
    Confidence interval
         level
    97.5%
         sides
    2-sided
         lower limit
    0.74
         upper limit
    1.34

    Secondary: Percentage of Subjects Who Died Prior to Clinical Cutoff Among Those with High HER2 mRNA Levels

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    End point title
    Percentage of Subjects Who Died Prior to Clinical Cutoff Among Those with High HER2 mRNA Levels
    End point description
    The percentage of subjects who died prior to clinical cutoff was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population (High HER2 mRNA Subpopulation).
    End point type
    Secondary
    End point timeframe
    Up to 70 months from randomization until clinical cutoff of 15-May-2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    160
    165
    173
    Units: percentage of subjects
        number (not applicable)
    38.8
    41.2
    45.1
    No statistical analyses for this end point

    Secondary: OS at Clinical Cutoff Among Those with High HER2 mRNA Levels

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    End point title
    OS at Clinical Cutoff Among Those with High HER2 mRNA Levels
    End point description
    OS was defined as the time from randomization to death from any cause. Median duration of OS was estimated using Kaplan-Meier analysis. Here, "9999" represents that the value is not applicable because Median duration of OS was not reached due to insufficient follow up. Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Up to 70 months from randomization until clinical cutoff of 15-May-2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    160
    165
    173
    Units: months
        median (full range (min-max))
    9999 (50.86 to 9999)
    65.97 (54.54 to 67.98)
    55.39 (45.23 to 9999)
    No statistical analyses for this end point

    Secondary: Percentage of Subjects Who Died Prior to Clinical Cutoff Among Those with Low HER2 mRNA Levels

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    End point title
    Percentage of Subjects Who Died Prior to Clinical Cutoff Among Those with Low HER2 mRNA Levels
    End point description
    The percentage of subjects who died prior to clinical cutoff was calculated as [number of subjects with event divided by the number analyzed] multiplied by 100. Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Up to 70 months from randomization until clinical cutoff of 15-May-2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    170
    174
    157
    Units: percentage of subjects
        number (not applicable)
    51.8
    52.9
    45.2
    No statistical analyses for this end point

    Secondary: OS at Clinical Cutoff Among Those with Low HER2 mRNA Levels

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    End point title
    OS at Clinical Cutoff Among Those with Low HER2 mRNA Levels
    End point description
    OS was defined as the time from randomization to death from any cause. Median duration of OS was estimated using Kaplan-Meier analysis. Reported upper bound of confidence interval for "Trastuzumab Emtansine + Placebo" and confidence interval values for "Trastuzumab + Taxane" and "Trastuzumab Emtansine + Pertuzumab" are censored values. Here, "9999" represents that the value is not applicable because Median duration of OS was not reached due to insufficient follow up. Analysis was performed on ITT population.
    End point type
    Secondary
    End point timeframe
    Up to 70 months from randomization until clinical cutoff of 15-May-2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination)
    End point values
    Trastuzumab + Taxane Trastuzumab Emtansine + Placebo Trastuzumab Emtansine + Pertuzumab
    Number of subjects analysed
    170
    174
    157
    Units: months
        median (full range (min-max))
    43.96 (37.19 to 54.87)
    47.84 (42.09 to 53.85)
    53.29 (46.75 to 9999)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Up to 70 months from randomization until clinical cutoff of 16 September 2016 (every 3 months until death, loss to follow-up, withdrawal, or study termination).
    Adverse event reporting additional description
    Safety Population: All randomized subjects who received at least one dose of study treatment. Subjects were analyzed based on the treatment received.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Trastuzumab Emtansine + Placebo
    Reporting group description
    Subjects received trastuzumab emtansine plus pertuzumab-placebo. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the placebo IV infusion, on Day 1 of each 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Reporting group title
    Trastuzumab + Taxane
    Reporting group description
    Subjects received trastuzumab plus either docetaxel or paclitaxel. The regimen was chosen at the investigator's discretion. Option 1: trastuzumab 8 mg/kg via IV infusion on Day 1 of Cycle 1, then 6 mg/kg IV on Day 1 of each subsequent 3-week cycle; plus a minimum of 6 cycles with docetaxel 75 or 100 mg/m^2 IV on Day 1 of each 3-week cycle. Option 2: trastuzumab 4 mg/kg IV on Day 1 of Cycle 1, then 2 mg/kg IV weekly beginning on Day 8 of Cycle 1; plus a minimum of 18 weeks with paclitaxel 80 mg/m^2 IV weekly. Treatment continued until disease progression, unacceptable toxicity, or study termination. If trastuzumab or docetaxel were discontinued for toxicity, the other agent could be continued as monotherapy.

    Reporting group title
    Trastuzumab Emtansine + Pertuzumab
    Reporting group description
    Subjects received trastuzumab emtansine plus pertuzumab. Trastuzumab emtansine was administered as 3.6 mg/kg via IV infusion, following completion of the pertuzumab IV infusion, on Day 1 of each 3-week cycle. Pertuzumab was given as 840 mg IV on Day 1 of Cycle 1, then 420 mg IV on Day 1 of each subsequent 3-week cycle. Treatment continued until disease progression, unacceptable toxicity, or study termination.

    Serious adverse events
    Trastuzumab Emtansine + Placebo Trastuzumab + Taxane Trastuzumab Emtansine + Pertuzumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    86 / 361 (23.82%)
    81 / 353 (22.95%)
    93 / 366 (25.41%)
         number of deaths (all causes)
    174
    170
    170
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute leukaemia
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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 neoplasm
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Chronic myeloid leukaemia
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Colon neoplasm
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Lung adenocarcinoma
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myelodysplastic syndrome
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Squamous cell carcinoma of the cervix
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tumour haemorrhage
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Uterine leiomyoma
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Basal Cell Carcinoma
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intracranial Tumour Haemorrhage
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (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
    Haematoma
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    0 / 366 (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
    Haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Hypertensive crisis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypotension
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Aneurysm
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypovolaemic Shock
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Orthostatic Hypotension
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    4 / 361 (1.11%)
    2 / 353 (0.57%)
    5 / 366 (1.37%)
         occurrences causally related to treatment / all
    3 / 5
    0 / 2
    2 / 6
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 361 (0.28%)
    3 / 353 (0.85%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    2 / 3
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Non-cardiac chest pain
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Death
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    General physical health deterioration
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Pain
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Asthenia
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Catheter site haematoma
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Malaise
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Oedema
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Peripheral swelling
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Adverse Drug Reaction
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sudden Death
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaphylactic reaction
         subjects affected / exposed
    0 / 361 (0.00%)
    2 / 353 (0.57%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cytokine release syndrome
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaphylactic Shock
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Anaphylactoid Reaction
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Menorrhagia
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endometrial hypertrophy
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vaginal haemorrhage
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    1 / 361 (0.28%)
    3 / 353 (0.85%)
    3 / 366 (0.82%)
         occurrences causally related to treatment / all
    0 / 1
    2 / 3
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    2 / 361 (0.55%)
    4 / 353 (1.13%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 2
    1 / 4
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 361 (0.28%)
    2 / 353 (0.57%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Epistaxis
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    3 / 366 (0.82%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    Pneumothorax
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute respiratory failure
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Alveolitis allergic
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypoxia
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Nasal turbinate hypertrophy
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Pneumonitis
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Pulmonary fibrosis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Respiratory failure
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Acute Pulmonary Oedema
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Psychiatric disorders
    Confusional state
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Depression
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anxiety
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Suicide Attempt
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Mental Status Changes
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Product issues
    Device Breakage
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aspartate aminotransferase increased
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Body temperature increased
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    International normalised ratio increased
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Oxygen saturation decreased
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Injury, poisoning and procedural complications
    Infusion related reaction
         subjects affected / exposed
    7 / 361 (1.94%)
    1 / 353 (0.28%)
    13 / 366 (3.55%)
         occurrences causally related to treatment / all
    8 / 9
    1 / 1
    13 / 13
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Femur fracture
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    3 / 366 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pubis fracture
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Arterial injury
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Fall
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    0 / 366 (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
    Femoral neck fracture
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal stoma complication
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Hip fracture
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Radiation retinopathy
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Spinal compression fracture
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Subdural haematoma
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Wound secretion
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Abdominal Injury
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Foot Fracture
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Fracture
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Stomal Hernia
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Uncoded serious adverse event
    Additional description: Per investigator, this serious adverse event was, "gamma nail implant broke (status after femur fracture)."
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Supraventricular tachycardia
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ventricular tachycardia
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute Myocardial Infarction
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Haemorrhage intracranial
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cognitive disorder
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Depressed level of consciousness
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Guillain-Barre syndrome
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lacunar infarction
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Paraparesis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peripheral sensory neuropathy
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Presyncope
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Somnolence
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular dementia
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Cerebral Haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Neuropathy Peripheral
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sciatica
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Seizure
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    0 / 361 (0.00%)
    13 / 353 (3.68%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    15 / 15
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaemia
         subjects affected / exposed
    5 / 361 (1.39%)
    1 / 353 (0.28%)
    6 / 366 (1.64%)
         occurrences causally related to treatment / all
    3 / 6
    0 / 1
    3 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutropenia
         subjects affected / exposed
    0 / 361 (0.00%)
    5 / 353 (1.42%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    5 / 5
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypercoagulation
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Leukopenia
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Blindness transient
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Macular hole
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Ocular hypertension
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    0 / 361 (0.00%)
    4 / 353 (1.13%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    4 / 6
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    4 / 366 (1.09%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 361 (0.28%)
    2 / 353 (0.57%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastritis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rectal haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Anal fistula
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colitis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Diverticulum
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Gastric haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Gastric ulcer
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Gastritis erosive
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Large intestine perforation
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Lower gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Mallory-Weiss syndrome
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Mouth haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nausea
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Splenic artery aneurysm
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Umbilical hernia
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
    Abdominal Discomfort
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ascites
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Gastrointestinal Haemorrhage
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Haemorrhoidal Haemorrhage
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatic Fibrosis
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Hepatic Haematoma
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    0 / 366 (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
    Dermatomyositis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peau d’orange
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Cutaneous Lupus Erythematosus
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Calculus urinary
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    2 / 361 (0.55%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bone pain
         subjects affected / exposed
    1 / 361 (0.28%)
    2 / 353 (0.57%)
    0 / 366 (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
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (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
    Exostosis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Musculoskeletal chest pain
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Musculoskeletal pain
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Neck pain
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Pain in extremity
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Pathological fracture
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Rotator cuff syndrome
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Tenosynovitis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    3 / 361 (0.83%)
    4 / 353 (1.13%)
    5 / 366 (1.37%)
         occurrences causally related to treatment / all
    2 / 3
    2 / 4
    1 / 6
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    1 / 1
    Cellulitis
         subjects affected / exposed
    3 / 361 (0.83%)
    3 / 353 (0.85%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 4
    1 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    4 / 366 (1.09%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Device related infection
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    2 / 366 (0.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infection
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neutropenic sepsis
         subjects affected / exposed
    0 / 361 (0.00%)
    3 / 353 (0.85%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    4 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Septic shock
         subjects affected / exposed
    1 / 361 (0.28%)
    2 / 353 (0.57%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 2
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
    Bronchitis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    3 / 366 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Herpes zoster
         subjects affected / exposed
    0 / 361 (0.00%)
    2 / 353 (0.57%)
    0 / 366 (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
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (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
    Urinary tract infection
         subjects affected / exposed
    0 / 361 (0.00%)
    2 / 353 (0.57%)
    0 / 366 (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
    Wound infection
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Arthritis infective
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Atypical pneumonia
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Breast abscess
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Chorioretinitis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Clostridium difficile colitis
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Clostridium difficile infection
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cystitis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Empyema
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Erysipelas
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Escherichia sepsis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Gastroenteritis viral
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 361 (0.28%)
    1 / 353 (0.28%)
    0 / 366 (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
    Klebsiella sepsis
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Localised infection
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Lung infection
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Mastitis
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Nasopharyngitis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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 pneumococcal
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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 abscess
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Streptococcal sepsis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Tooth infection
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urosepsis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Abscess Limb
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    Appendicitis Perforated
         subjects affected / exposed
    1 / 361 (0.28%)
    0 / 353 (0.00%)
    0 / 366 (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
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin Infection
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hyperglycaemia
         subjects affected / exposed
    2 / 361 (0.55%)
    0 / 353 (0.00%)
    0 / 366 (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
    Decreased appetite
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Diabetic ketoacidosis
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Hypercalcaemia
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Hypokalaemia
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Hyponatraemia
         subjects affected / exposed
    0 / 361 (0.00%)
    1 / 353 (0.28%)
    0 / 366 (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
    Diabetes Mellitus
         subjects affected / exposed
    0 / 361 (0.00%)
    0 / 353 (0.00%)
    1 / 366 (0.27%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         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
    Trastuzumab Emtansine + Placebo Trastuzumab + Taxane Trastuzumab Emtansine + Pertuzumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    352 / 361 (97.51%)
    342 / 353 (96.88%)
    352 / 366 (96.17%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    37 / 361 (10.25%)
    19 / 353 (5.38%)
    43 / 366 (11.75%)
         occurrences all number
    87
    27
    70
    Hot flush
         subjects affected / exposed
    16 / 361 (4.43%)
    27 / 353 (7.65%)
    12 / 366 (3.28%)
         occurrences all number
    22
    32
    19
    Lymphoedema
         subjects affected / exposed
    7 / 361 (1.94%)
    27 / 353 (7.65%)
    8 / 366 (2.19%)
         occurrences all number
    8
    35
    10
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    120 / 361 (33.24%)
    128 / 353 (36.26%)
    130 / 366 (35.52%)
         occurrences all number
    273
    247
    276
    Pyrexia
         subjects affected / exposed
    96 / 361 (26.59%)
    59 / 353 (16.71%)
    118 / 366 (32.24%)
         occurrences all number
    156
    85
    184
    Asthenia
         subjects affected / exposed
    62 / 361 (17.17%)
    57 / 353 (16.15%)
    63 / 366 (17.21%)
         occurrences all number
    205
    163
    211
    Chills
         subjects affected / exposed
    55 / 361 (15.24%)
    14 / 353 (3.97%)
    97 / 366 (26.50%)
         occurrences all number
    69
    15
    125
    Oedema peripheral
         subjects affected / exposed
    37 / 361 (10.25%)
    98 / 353 (27.76%)
    35 / 366 (9.56%)
         occurrences all number
    56
    177
    44
    Mucosal inflammation
         subjects affected / exposed
    29 / 361 (8.03%)
    40 / 353 (11.33%)
    36 / 366 (9.84%)
         occurrences all number
    46
    56
    54
    Influenza like illness
         subjects affected / exposed
    31 / 361 (8.59%)
    17 / 353 (4.82%)
    32 / 366 (8.74%)
         occurrences all number
    49
    33
    73
    Non-cardiac chest pain
         subjects affected / exposed
    25 / 361 (6.93%)
    24 / 353 (6.80%)
    27 / 366 (7.38%)
         occurrences all number
    36
    29
    35
    Pain
         subjects affected / exposed
    26 / 361 (7.20%)
    29 / 353 (8.22%)
    19 / 366 (5.19%)
         occurrences all number
    29
    38
    24
    Oedema
         subjects affected / exposed
    11 / 361 (3.05%)
    31 / 353 (8.78%)
    3 / 366 (0.82%)
         occurrences all number
    14
    51
    5
    Reproductive system and breast disorders
    Breast pain
         subjects affected / exposed
    13 / 361 (3.60%)
    18 / 353 (5.10%)
    16 / 366 (4.37%)
         occurrences all number
    13
    27
    19
    Respiratory, thoracic and mediastinal disorders
    Epistaxis
         subjects affected / exposed
    113 / 361 (31.30%)
    53 / 353 (15.01%)
    127 / 366 (34.70%)
         occurrences all number
    266
    85
    295
    Cough
         subjects affected / exposed
    72 / 361 (19.94%)
    74 / 353 (20.96%)
    79 / 366 (21.58%)
         occurrences all number
    103
    132
    118
    Dyspnoea
         subjects affected / exposed
    42 / 361 (11.63%)
    56 / 353 (15.86%)
    53 / 366 (14.48%)
         occurrences all number
    73
    89
    74
    Oropharyngeal pain
         subjects affected / exposed
    31 / 361 (8.59%)
    29 / 353 (8.22%)
    30 / 366 (8.20%)
         occurrences all number
    36
    36
    41
    Rhinorrhoea
         subjects affected / exposed
    21 / 361 (5.82%)
    26 / 353 (7.37%)
    32 / 366 (8.74%)
         occurrences all number
    26
    43
    36
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    51 / 361 (14.13%)
    51 / 353 (14.45%)
    52 / 366 (14.21%)
         occurrences all number
    77
    62
    77
    Anxiety
         subjects affected / exposed
    26 / 361 (7.20%)
    22 / 353 (6.23%)
    33 / 366 (9.02%)
         occurrences all number
    33
    42
    41
    Depression
         subjects affected / exposed
    34 / 361 (9.42%)
    17 / 353 (4.82%)
    20 / 366 (5.46%)
         occurrences all number
    42
    18
    23
    Investigations
    Aspartate aminotransferase increased
         subjects affected / exposed
    54 / 361 (14.96%)
    9 / 353 (2.55%)
    28 / 366 (7.65%)
         occurrences all number
    80
    11
    56
    Alanine aminotranseferase increased
         subjects affected / exposed
    41 / 361 (11.36%)
    10 / 353 (2.83%)
    35 / 366 (9.56%)
         occurrences all number
    67
    12
    57
    Weight decreased
         subjects affected / exposed
    24 / 361 (6.65%)
    7 / 353 (1.98%)
    30 / 366 (8.20%)
         occurrences all number
    44
    10
    41
    Ejection fraction decreased
         subjects affected / exposed
    7 / 361 (1.94%)
    31 / 353 (8.78%)
    16 / 366 (4.37%)
         occurrences all number
    8
    36
    18
    Gamma- glutamyltranseferase increased
         subjects affected / exposed
    30 / 361 (8.31%)
    1 / 353 (0.28%)
    17 / 366 (4.64%)
         occurrences all number
    38
    1
    23
    Nervous system disorders
    Headache
         subjects affected / exposed
    116 / 361 (32.13%)
    80 / 353 (22.66%)
    120 / 366 (32.79%)
         occurrences all number
    281
    165
    261
    Neuropathy peripheral
         subjects affected / exposed
    52 / 361 (14.40%)
    99 / 353 (28.05%)
    69 / 366 (18.85%)
         occurrences all number
    84
    171
    129
    Peripheral sensory neuropathy
         subjects affected / exposed
    47 / 361 (13.02%)
    70 / 353 (19.83%)
    46 / 366 (12.57%)
         occurrences all number
    69
    125
    74
    Dysgeusia
         subjects affected / exposed
    30 / 361 (8.31%)
    54 / 353 (15.30%)
    50 / 366 (13.66%)
         occurrences all number
    44
    67
    81
    Paraesthesia
         subjects affected / exposed
    31 / 361 (8.59%)
    41 / 353 (11.61%)
    43 / 366 (11.75%)
         occurrences all number
    51
    57
    74
    Dizziness
         subjects affected / exposed
    38 / 361 (10.53%)
    35 / 353 (9.92%)
    38 / 366 (10.38%)
         occurrences all number
    67
    48
    77
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    44 / 361 (12.19%)
    74 / 353 (20.96%)
    37 / 366 (10.11%)
         occurrences all number
    186
    174
    152
    Anaemia
         subjects affected / exposed
    48 / 361 (13.30%)
    39 / 353 (11.05%)
    59 / 366 (16.12%)
         occurrences all number
    74
    61
    142
    Thrombocytopenia
         subjects affected / exposed
    52 / 361 (14.40%)
    0 / 353 (0.00%)
    61 / 366 (16.67%)
         occurrences all number
    145
    0
    185
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    17 / 361 (4.71%)
    11 / 353 (3.12%)
    21 / 366 (5.74%)
         occurrences all number
    33
    15
    28
    Eye disorders
    Lacrimation increased
         subjects affected / exposed
    13 / 361 (3.60%)
    48 / 353 (13.60%)
    19 / 366 (5.19%)
         occurrences all number
    19
    58
    22
    Dry eye
         subjects affected / exposed
    25 / 361 (6.93%)
    13 / 353 (3.68%)
    24 / 366 (6.56%)
         occurrences all number
    26
    14
    28
    Vision Blurred
    alternative assessment type: Systematic
         subjects affected / exposed
    13 / 361 (3.60%)
    10 / 353 (2.83%)
    19 / 366 (5.19%)
         occurrences all number
    15
    15
    24
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    174 / 361 (48.20%)
    131 / 353 (37.11%)
    192 / 366 (52.46%)
         occurrences all number
    526
    308
    633
    Diarrhoea
         subjects affected / exposed
    92 / 361 (25.48%)
    173 / 353 (49.01%)
    178 / 366 (48.63%)
         occurrences all number
    151
    466
    550
    Vomiting
         subjects affected / exposed
    80 / 361 (22.16%)
    69 / 353 (19.55%)
    111 / 366 (30.33%)
         occurrences all number
    136
    146
    215
    Constipation
         subjects affected / exposed
    82 / 361 (22.71%)
    72 / 353 (20.40%)
    71 / 366 (19.40%)
         occurrences all number
    150
    119
    138
    Stomatitis
         subjects affected / exposed
    37 / 361 (10.25%)
    57 / 353 (16.15%)
    42 / 366 (11.48%)
         occurrences all number
    51
    76
    65
    Dyspepsia
         subjects affected / exposed
    33 / 361 (9.14%)
    38 / 353 (10.76%)
    48 / 366 (13.11%)
         occurrences all number
    55
    48
    94
    Abdominal pain upper
         subjects affected / exposed
    39 / 361 (10.80%)
    31 / 353 (8.78%)
    46 / 366 (12.57%)
         occurrences all number
    62
    53
    70
    Dry mouth
         subjects affected / exposed
    52 / 361 (14.40%)
    13 / 353 (3.68%)
    45 / 366 (12.30%)
         occurrences all number
    74
    21
    55
    Abdominal pain
         subjects affected / exposed
    35 / 361 (9.70%)
    31 / 353 (8.78%)
    41 / 366 (11.20%)
         occurrences all number
    51
    44
    70
    Gingival bleeding
         subjects affected / exposed
    31 / 361 (8.59%)
    4 / 353 (1.13%)
    25 / 366 (6.83%)
         occurrences all number
    50
    5
    44
    Haemorrhoids
         subjects affected / exposed
    12 / 361 (3.32%)
    9 / 353 (2.55%)
    22 / 366 (6.01%)
         occurrences all number
    20
    9
    44
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    26 / 361 (7.20%)
    212 / 353 (60.06%)
    33 / 366 (9.02%)
         occurrences all number
    28
    250
    34
    Rash
         subjects affected / exposed
    62 / 361 (17.17%)
    86 / 353 (24.36%)
    89 / 366 (24.32%)
         occurrences all number
    109
    150
    139
    Pruritus
         subjects affected / exposed
    28 / 361 (7.76%)
    32 / 353 (9.07%)
    51 / 366 (13.93%)
         occurrences all number
    46
    40
    85
    Nail disorder
         subjects affected / exposed
    11 / 361 (3.05%)
    39 / 353 (11.05%)
    19 / 366 (5.19%)
         occurrences all number
    12
    45
    20
    Dry skin
         subjects affected / exposed
    24 / 361 (6.65%)
    24 / 353 (6.80%)
    29 / 366 (7.92%)
         occurrences all number
    26
    30
    41
    Erythema
         subjects affected / exposed
    13 / 361 (3.60%)
    24 / 353 (6.80%)
    20 / 366 (5.46%)
         occurrences all number
    14
    37
    27
    Dermatitis acneiform
         subjects affected / exposed
    16 / 361 (4.43%)
    6 / 353 (1.70%)
    27 / 366 (7.38%)
         occurrences all number
    16
    6
    41
    Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    6 / 361 (1.66%)
    26 / 353 (7.37%)
    11 / 366 (3.01%)
         occurrences all number
    7
    29
    14
    Nail discolouration
         subjects affected / exposed
    5 / 361 (1.39%)
    25 / 353 (7.08%)
    1 / 366 (0.27%)
         occurrences all number
    5
    25
    1
    Onychoclasis
         subjects affected / exposed
    19 / 361 (5.26%)
    13 / 353 (3.68%)
    17 / 366 (4.64%)
         occurrences all number
    24
    16
    20
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    83 / 361 (22.99%)
    91 / 353 (25.78%)
    71 / 366 (19.40%)
         occurrences all number
    138
    145
    103
    Myalgia
         subjects affected / exposed
    66 / 361 (18.28%)
    82 / 353 (23.23%)
    61 / 366 (16.67%)
         occurrences all number
    152
    163
    117
    Back pain
         subjects affected / exposed
    60 / 361 (16.62%)
    46 / 353 (13.03%)
    63 / 366 (17.21%)
         occurrences all number
    77
    65
    87
    Pain in extremity
         subjects affected / exposed
    53 / 361 (14.68%)
    48 / 353 (13.60%)
    54 / 366 (14.75%)
         occurrences all number
    82
    67
    77
    Muscle spasms
         subjects affected / exposed
    32 / 361 (8.86%)
    15 / 353 (4.25%)
    62 / 366 (16.94%)
         occurrences all number
    42
    20
    106
    Musculoskeletal pain
         subjects affected / exposed
    30 / 361 (8.31%)
    23 / 353 (6.52%)
    37 / 366 (10.11%)
         occurrences all number
    38
    29
    50
    Bone pain
         subjects affected / exposed
    17 / 361 (4.71%)
    33 / 353 (9.35%)
    29 / 366 (7.92%)
         occurrences all number
    21
    51
    69
    Musculoskeletal chest pain
         subjects affected / exposed
    13 / 361 (3.60%)
    17 / 353 (4.82%)
    20 / 366 (5.46%)
         occurrences all number
    16
    21
    21
    Neck Pain
         subjects affected / exposed
    12 / 361 (3.32%)
    12 / 353 (3.40%)
    24 / 366 (6.56%)
         occurrences all number
    13
    13
    31
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    50 / 361 (13.85%)
    55 / 353 (15.58%)
    66 / 366 (18.03%)
         occurrences all number
    85
    104
    147
    Nasopharyngitis
         subjects affected / exposed
    52 / 361 (14.40%)
    49 / 353 (13.88%)
    66 / 366 (18.03%)
         occurrences all number
    87
    100
    147
    Urinary tract infection
         subjects affected / exposed
    31 / 361 (8.59%)
    29 / 353 (8.22%)
    41 / 366 (11.20%)
         occurrences all number
    55
    43
    72
    Rhinitis
         subjects affected / exposed
    25 / 361 (6.93%)
    18 / 353 (5.10%)
    24 / 366 (6.56%)
         occurrences all number
    29
    23
    32
    Influenza
         subjects affected / exposed
    22 / 361 (6.09%)
    14 / 353 (3.97%)
    25 / 366 (6.83%)
         occurrences all number
    24
    19
    36
    Paronychia
         subjects affected / exposed
    8 / 361 (2.22%)
    22 / 353 (6.23%)
    30 / 366 (8.20%)
         occurrences all number
    11
    31
    56
    Pharyngitis
         subjects affected / exposed
    19 / 361 (5.26%)
    14 / 353 (3.97%)
    17 / 366 (4.64%)
         occurrences all number
    21
    14
    18
    Conjunctivitis
         subjects affected / exposed
    14 / 361 (3.88%)
    21 / 353 (5.95%)
    17 / 366 (4.64%)
         occurrences all number
    18
    25
    20
    Bronchitis
    alternative assessment type: Systematic
         subjects affected / exposed
    9 / 361 (2.49%)
    14 / 353 (3.97%)
    20 / 366 (5.46%)
         occurrences all number
    9
    15
    22
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    84 / 361 (23.27%)
    76 / 353 (21.53%)
    84 / 366 (22.95%)
         occurrences all number
    164
    129
    156
    Hypokalaemia
         subjects affected / exposed
    19 / 361 (5.26%)
    15 / 353 (4.25%)
    30 / 366 (8.20%)
         occurrences all number
    23
    18
    40

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    07 Mar 2011
    Updates to the protocol included truncation of OS at 2 years as a secondary endpoint, addition of several quality of life assessments including FACT instruments, changes in the assessment schedule, clarification of the study population and eligibility criteria, and addition of treatment guidelines for cases of study drug discontinuation.
    11 Oct 2011
    The protocol was amended to remove an interim futility analysis and to specify the new nonproprietary name 'trastuzumab emtansine' (formerly T-DM1).
    29 May 2013
    The protocol was revised in order to allow for formal comparison of both trastuzumab emtansine arms, specify statistical assumptions, evaluate OS within high and low HER2 mRNA subsets, remove the clinical benefit rate (CR/PR/SD) as a redundant secondary endpoint, clarify committee procedures, further update the schedule of assessments, and add the option for subjects to cross over to the best treatment arm if OS was more favorable in one of the trastuzumab emtansine arms.
    01 Nov 2013
    The protocol was modified to add safety guidance on hepatotoxicity, including updated language for hemorrhage and Hy's Law.

    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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