Efficacy and Safety of the Proposed Biosimilar Pertuzumab (PERT-IJS) Versus EU-Perjeta® Along With Trastuzumab and Chemotherapy (Carboplatin and Docetaxel) as Neoadjuvant Treatment in Chemotherapy naïve Patients With Early Stage or Locally Advanced HR Negative and HER2 Positive Breast Cancer

Phase 3

Not yet recruiting

• Conditions: HR Negative HER2 Positive Early Breast Cancer or Locally Advanced Breast Cancer Patients
• Interventions: Biological: Perjeta plus trastuzumab, carboplatin and docetaxel; Biological: PERT-IJS plus trastuzumab, carboplatin and docetaxel

• Registration Number: NCT06038539
• Lead Sponsor: Biocon Biologics UK Ltd

Brief Summary

To compare the efficacy and safety of PERT-IJS (Proposed biosimilar Pertuzumab) plus trastuzumab and chemotherapy (carboplatin and docetaxel) versus EU-Perjeta plus trastuzumab and chemotherapy (carboplatin and docetaxel) in neoadjuvant treatment of patients with HR-ve and HER-2 positive early stage or locally advanced breast cancer.

Detailed Description

This study is designed to compare the efficacy and safety of proposed biosimilar PERT-IJS plus trastuzumab, carboplatin and docetaxel versus EU-Perjeta plus trastuzumab, carboplatin and docetaxel in neoadjuvant treatment of HR-ve HER2-positive Early Breast Cancer (EBC) (invasive breast cancer without distant metastasis) or locally advanced breast cancer patients.

Study Timeline

• Study First Submitted: 2023-08-23
• Study First Submitted QC: 2023-09-12
• Study First Posted: 2023-09-15
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-16
• Last Update Posted: 2024-12-17
• Study Start: 2025-01-31
• Primary Completion: 2026-03-15
• Study Completion: 2026-11-15

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: Female
• Target Recruitment: 382

Inclusion Criteria

1. Patient willing and able to sign informed consent and to follow the protocol requirements

2. Female patients aged ≥ 18 years at the time of Screening

3. Patient with Eastern Cooperative Oncology Group (ECOG) Performance Status < 2

4. Patients with breast cancer that meets the following criteria:

   1. A known case of histologically confirmed invasive breast carcinoma with a primary tumor size of > 2 cm by standard local assessment technique
   2. stage at presentation: early stage (T2-3, N0-1, M0) or locally advanced (T2-3, N2 or N3, M0; T4a-c, any N, M0) or inflammatory (T4d, any N, M0)

5. Patients with HER2 overexpression by Immunohistochemistry (IHC) (defined as IHC 3+, or IHC 2+ with Fluorescence In Situ Hybridization (FISH) confirmation) as per the American Society of Clinical Oncology/College of American Pathologist (ASCO-CAP) guidelines prior to Screening and confirmed centrally before randomization

6. Patients with known HR-ve status (ER-negative and PR-negative) as per local laboratory prior to Screening and confirmed centrally before randomization

7. Patient willing to undergo mastectomy or breast-conserving surgery after neoadjuvant therapy

8. Patient who completes all necessary baseline laboratory and radiologic investigations prior to randomization as per Schedule of assessment (SoA)

9. Patient with baseline left ventricular ejection fraction (LVEF) ≥ 55% measured by echocardiography (ECHO; preferred) or multiple-gated acquisition (MUGA) scan

10. Patient is eligible to participant if she is not pregnant, not breastfeeding, and at least one of the following conditions applies:

Exclusion Criteria

1. Patients with metastatic or recurrent bilateral breast cancer, or bilateral breast cancer

2. Patients with a history of concurrent or previously treated non-breast malignancies. A patient with previous invasive non-breast cancer is eligible provided she has been disease free for more than 5 years

3. Patients who have received any previous systemic therapy (including chemotherapy, immunotherapy, HER2-targeted agents, and antitumor vaccines) for treatment or prevention of breast cancer, or radiation therapy for treatment of cancer

4. Concurrent anti-cancer treatment in another investigational study, including hormone therapy or immunotherapy

5. Major surgical procedure that is unrelated to breast cancer within 4 weeks prior to randomization or from which the patient has not fully recovered

6. Serious cardiac illness or medical condition including but not limited to the following as per Investigator's discretion:

   1. Patients with ≥ Class II stage of heart failure as per New York Heart Association Classification
   2. High risk uncontrolled arrhythmia, such as atrial tachycardia with a heart rate > 100 bpm at rest, significant ventricular arrhythmia (e.g., ventricular tachycardia) required treatment, or higher-grade atrioventricular (AV) block (i.e., Mobitz II second-degree AV block or third-degree AV block)
   3. History of myocardial infarction or unstable angina pectoris within 1 year of randomization or angina pectoris requiring anti-anginal medication
   4. Evidence of transmural infarction on ECG
   5. Clinically significant valvular heart disease
   6. Poorly controlled hypertension (systolic blood pressure > 180 mmHg and/or diastolic blood pressure > 100 mmHg) in patients on anti-hypertensive medications

7. Other concurrent serious diseases that may interfere with study primary endpoint and other study assessments, including, but not limited to, severe pulmonary conditions/illness, active liver disease (for example, active viral hepatitis infection [i.e., hepatitis B or hepatitis C]), autoimmune disorders, history of or known patient of sclerosing cholangitis, or infection with Human immune deficiency virus (HIV)

8. Patients with a history of any contraindication to the study treatment regimens

9. Any of the following abnormal laboratory test results prior to randomization:

   1. Total bilirubin > upper limit of normal (ULN) or, for cases of known Gilbert's syndrome, total bilirubin > 2 × ULN
   2. Aspartate aminotransferase and/or alanine aminotransferase > 1.5 × ULN, if considered clinically significant by Investigator
   3. Alkaline phosphatase >2.5 × ULN, if considered clinically significant by Investigator
   4. Serum creatinine > 1.5 × ULN
   5. Creatinine clearance < 60 mL/min
   6. Total white blood cells count < 2500 cells/μL
   7. Absolute neutrophil count < 2000 cells/μL
   8. Platelet count < 100,000 cells/μL

10. Participation in any clinical study with an investigational drug, biologic, or device within 1 month prior or within five half-lives (of the drug/ biologic) prior to the enrolment (whichever is longer)

11. Have taken any live vaccines 30 days prior to the 1st dose of study treatment

12. Any known hypersensitivity to any of the study medications, any of the ingredients or excipients of these medications, or benzyl alcohol

13. Patients unwilling to follow the study requirements.

14. Presence of an uncontrolled, unstable, clinically significant medical condition that, in the opinion of the Investigator, may interfere with the interpretation of efficacy and safety parameters or has a medical condition for which the treatment should take precedence over study participation or will interfere with study participation

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment Arm B: EU-Perjeta plus trastuzumab, carboplatin and docetaxel	Perjeta plus trastuzumab, carboplatin and docetaxel	Part 1 (Cycle 1 to 6): Initial loading dose of EU- Perjeta is 840 mg administered as approximately 60-minute IV infusion followed every 3 weeks by a maintenance dose of 420 mg administered as an IV infusion over a period of approximately 30 to 60 minutes. Trastuzumab: Initial dose of trastuzumab is 8 mg/kg administered as approximately 90-minute IV infusion followed every 3 weeks by 6 mg/kg IV infusion over 30 to 90 minutes Carboplatin: Area under the curve 6 for Cycles 1 to 6 Docetaxel: 75 mg/m2 by IV infusion every 3 weeks for Cycles 1 to 6 Part 2 (Cycle 7 onwards till end of 01 year from Cycle 1 day 1): The patients will be re-randomized (1:1) to receive EU- Perjeta + trastuzumab or PERT-IJS + trastuzumab. Initial loading dose of PERT-IJS is 840 mg administered as approximately 60-minute IV infusion followed every 3 weeks by a maintenance dose of 420 mg administered as an IV infusion over a period of approximately 30 to 60 minutes. Trastuzumab: As mentioned in part 1
Treatment Arm A: PERT-IJS plus trastuzumab, carboplatin and docetaxel	PERT-IJS plus trastuzumab, carboplatin and docetaxel	Part 1 (Cycle 1 to 6): Initial loading dose of PERT-IJS is 840 mg administered as an approximately 60-minute IV infusion followed every 3 weeks by a maintenance dose of 420 mg administered as an IV infusion over a period of approximately 30 to 60 minutes. Trastuzumab: Initial dose of trastuzumab is 8 mg/kg administered as approximately 90-minute IV infusion followed every 3 weeks by 6 mg/kg IV infusion over 30 to 90 minutes Carboplatin: Area Under the Curve (AUC) 6 for Cycles 1 to 6 Docetaxel: 75 mg/m2 by IV infusion every 3 weeks for Cycles 1 to 6 Part 2 (Cycle 7 - till end of 1 year from Cycle 1 day 1): Initial loading dose of PERT-IJS is 840 mg administered as approximately 60-minute IV infusion followed every 3 weeks by a maintenance dose of 420 mg administered as an IV infusion over a period of approximately 30 to 60 minutes. Trastuzumab: As mentioned in part 1

Primary Outcome Measures

Name	Time	Method
Efficacy endpoint - Total pathologic complete response between Treatment arm A and Treatment Arm B	Week 18	Total pathologic complete response (tpCR; ypT0/Tis,ypN0) in breast and axillary nodes after neoadjuvant treatment by Independent Review Committee (IRC)

Secondary Outcome Measures

Name	Time	Method
Efficacy endpoint-EFS rate of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout	1 Year	EFS rate
Efficacy endpoint- Overall survival rate between Treatment Arm A and Treatment Arm B as neoadjuvant treatment regimen	Week 18	Overall survival (OS) rate
Efficacy endpoint-Total pathologic complete response between Treatment Arm A and Treatment Arm B as neoadjuvant treatment regimen	Week 18	Total pathologic complete response (tpCR; ypT0/Tis, ypN0) in breast and axillary nodes after neoadjuvant treatment by local histopathologist
Efficacy endpoint: Pathologic complete response between Treatment Arm A and Treatment Arm B	Week 18	Pathologic complete response (pCR; ypT0/ypN0) after neoadjuvant treatment by IRC and local histopathologist
Efficacy endpoint-Event free survival rate between Treatment Arm A and Treatment Arm B as neoadjuvant treatment regimen	Week 18	Event free survival (EFS) rate
Efficacy Endpoint: EFS rate after the single switch from EU-Perjeta to PERT-IJS+trastuzumab compared with those continuing on Treatment B	1 year	EFS rate after switching of treatment from EU-Perjeta to PERT-IJS + trastuzumab
Efficacy Endpoint: Disease free survival rate after the single switch from from EU-Perjeta to PERT-IJS+trastuzumab compared with those continuing on EU-Perjeta+trastuzumab	1 year	Disease free survival (DFS) rate after switching of treatment from EU-Perjeta to PERT-IJS + trastuzumab versus those continuing on EU-Perjeta + trastuzumab
Efficacy endpoint- Breast pathologic complete response between Treatment Arm A and Treatment Arm B as neoadjuvant treatment regimen	Week 18	Breast pathologic complete response (bpCR; ypT0/Tis) after neoadjuvant treatment by IRC and local histopathologist
Efficacy endpoint-Objective response rate between Treatment Arm A and Treatment Arm B as neoadjuvant treatment regimen	Week 18	Objective response rate (ORR) after neoadjuvant treatment in accordance with Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1)
Efficacy endpoint - Overall Survival rate of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout	1 Year	Overall survival rate
Efficacy endpoint - Overall Response Rate of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout	1 Year	Overall Response Rate
Efficacy Endpoint: Overall survival rate after the single switch from from EU-Perjeta to PERT-IJS+trastuzumab compared with those continuing on EU-Perjeta+trastuzumab	1 year	OS rate after switching of treatment from EU-Perjeta to PERT-IJS + trastuzumab versus those continuing on EU-Perjeta + trastuzumab
Pharmacokinetic (PK) endpoint-The trough serum concentration	1 Year	The trough serum concentration (Ctrough)
Safety Endpoint: treatment-emergent adverse events and serious adverse events	week 18	Incidence and severity of treatment emergent adverse events (TEAEs) and serious adverse events (SAEs)
Safety Endpoint: left ventricular ejection fraction	week 18	Incidence of patients with a decline in left ventricular ejection fraction (LVEF) of ≥ 10% from baseline to \< 50%
Safety Endpoint: Vital signs	week 18	Number of subjects with clinically significant changes in Vital signs
Safety Endpoint-ECG PR Interval	week 18	Number of subjects with clinically significant changes in ECG PR Interval
Safety Endpoint-ECG QRS Interval	week 18	Number of subjects with clinically significant changes in ECG QRS Interval
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout- ECG PR Interval	1 year	Number of subjects with clinically significant changes in ECG PR Interval
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout-ECG QRS Interval	1 year	Number of subjects with clinically significant changes in ECG QRS Interval
Safety Endpoint: treatment-emergent adverse events and serious adverse events of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta	1 year	Incidence and severity of treatment emergent adverse events (TEAEs) and serious adverse events (SAEs)
Safety Endpoint: left ventricular ejection fraction of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout	1 year	Incidence of patients with a decline in left ventricular ejection fraction (LVEF) of ≥ 10% from baseline to \< 50%
Safety Endpoint-ECG QT Interval	week 18	Number of subjects with clinically significant changes in ECG QT Interval
Safety Endpoint- ECG corrected QT interval (QTc) Interval	week 18	Number of subjects with clinically significant changes in ECG QTc Interval
Safety Endpoint-clinical laboratory assessments	week 18	Number of subjects with clinically significant changes in Clinical laboratory assessments
Safety Endpoint-pregnancy test	week 18	Number of subjects with Pregnancy outcome
Safety Endpoint-physical examination	week 18	Number of subjects with clinically significant changes in Physical examination
Immunogenicity Endpoint	week 18	Immunogenicity (anti-drug antibodies (ADA) and neutralizing antibodies (nAb) titers)
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS -throughout compared to patients randomized to EU-Perjeta throughout- Vital signs	1 year	Number of subjects with clinically significant changes in Vital signs
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout-ECG QT Interval	1 year	Number of subjects with clinically significant changes in ECG QT Interval
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout- ECG QTc Interval	1 year	Number of subjects with clinically significant changes in ECG QTc Interval
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout-Clinical laboratory assessments	1 year	Number of subjects with clinically significant changes in Clinical laboratory assessments
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout- Pregnancy test	1 year	Number of subjects with Pregnancy outcome
Safety Endpoint: Routine safety parameters of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout-Physical examination	1 year	Number of subjects with clinically significant changes in Physical examination
Immunogenicity Endpoint of patients randomized to PERT-IJS throughout compared to patients randomized to EU-Perjeta throughout	1 year	Immunogenicity (anti-drug antibodies (ADA) and neutralizing antibodies (nAb) titers)
Safety Endpoint: Incidence of TEAEs and SAEs after the single switch from EU-Perjeta to PERT-IJS+trastuzumab versus those continuing on EU-Perjeta+trastuzumab throughout	1 Year	Incidence of TEAEs and SAEs after switching of treatment from EU-Perjeta to PERT-IJS + trastuzumab versus those continuing on EU-Perjeta + trastuzumab
Immunogenicity End Point: after the single switch from EU-Perjeta to PERT-IJS+trastuzumab versus those continuing on EU-Perjeta+trastuzumab	1 Year	Immunogenicity (ADA titer and nAb titer) after switching of treatment from EU-Perjeta to PERT-IJS plus trastuzumab versus those continuing on EU-Perjeta + trastuzumab
Safety End Point :left ventricular ejection fraction incidences after the single switch from EU-Perjeta to PERT-IJS+trastuzumab versus those continuing on EU-Perjeta+trastuzumab	1 year	Incidence of patients with a decline in left ventricular ejection fraction (LVEF) of ≥ 10% from baseline to \< 50%