Neo-adjuvant chemotherapy combined with Stereotactic Body Radiotherapy to the primary tumour +/- durvalumab (MEDI4736), +/- oleclumab (MEDI9447) in luminal B breast cancer: a phase ll randomised trial
- Conditions
- Luminal B Breast Cancer
- Registration Number
- 2024-511849-19-00
- Lead Sponsor
- Institut Jules Bordet
- Brief Summary
To demonstrate improved tumour response of the primarytumour and nodal metastases in arms 2 or 3 versus arm 1.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Ongoing, recruitment ended
- Sex
- Female
- Target Recruitment
- 147
Age ≥ 18 years old
Serum pregnancy test (for subjects of childbearing potential) negative within 2 weeks prior to first dose of study administration.
Women of childbearing potential must agree to use 1 highly effective method of contraception during the screening period, during the course of the study and at least 12 months after the last administration of study treatment. It is strongly recommended for the male partner of a female subject to also use male condom plus spermicide throughout this period
Adequate bone marrow function as defined below: • Absolute neutrophil count ≥1500/µL, i.e. 1.5x109 /L • Hemoglobin ≥ 9.0 g/dL • Platelets ≥100000/µL, i.e. 100x109 /L
Adequate liver function as defined below: • Serum total bilirubin ≤ 1.5 x ULN. In case of known Gilbert’s syndrome ≤ 3 x UNL is allowed • AST (SGOT) ≤ 3.0 x ULN • ALT (SGPT) ≤ 3.0 x ULN
Adequate renal function as defined below: • Creatinine ≤ 1.5 x UNL or eGFR≥40ml/min/1.73m2 15. Adequate coagulant function as defined below
Adequate coagulant function as defined below: • International Normalized Ratio (INR) ≤ 1.5 x ULN
Completion of all necessary screening procedures within 28 days prior to randomisation (except if written differently).
Willingness to provide tissue and blood samples for immunomonitoring and translational research activities
Left ventricular ejection fraction (LVEF) ≥ 50%. LVEF performed in routine is accepted if done within 6 months prior to beginning of screening
Signed Informed Consent form (ICF) obtained prior to any study related procedure.
Female
Inclusion criterion for phase II only (all phase II subjects): 20. Tumour sample provided for central PD-L1 IHC assessment (Testing done during screening period).
Inclusion criterion applicable to FRANCE only (Safety run-in and Phase II subjects) 21. Affiliated to the French Social Security System (applicable only to subjects treated in France)
ECOG performance status ≤ 1
Weight ≥ 35 kg
Histological diagnosis of invasive breast adenocarcinoma that is estrogen receptor-positive (ER-positive) and HER2- negative as per the updated American Society of Clinical Oncology (ASCO) - College of American Pathologists (CAP) guidelines and performed according to local testing. In addition, only tumours with Proliferation Index Ki67 ≥ 15% or histology grade III are accepted.
Agreement to perform new study related biopsies to provide tissue samples
MammaPrint genomic high risk score according to centralised testing, except for specific conditions as mentioned below. MammaPrint will only be tested for luminal B breast tumours with either Proliferation Index Ki67 ≥ 15% or histology grade III tumours. (Testing to be done during screening period)
Tumour size: • If subject is cN0: tumour size ≥ 2 cm, as determined by MRI imaging. • If subject is cN1,cN2 or cN3: tumour size: ≥ 1.5 cm, as determined by MRI imaging. The requirement for an MRI is not applicable in the case of medical contraindications to perform MRI (e.g., obesity or claustrophobia). In this situation, tumour evaluations should be performed by ultrasound.
Multifocal, multicentric unilateral or bilateral breast adenocarcinoma tumours are allowed provided that all biopsiable foci are ER+/HER2- according to local testing and all foci are able to receive SBRT treatment within the defined dosimetric constraints. In some cases a separate biopsy of every focus is not mandatory, but only if every of the following conditions are present. • small focal lesion • lesion in close proximity to the main primary cancer from which a biopsy was taken • the investigator and the radiologist consider the lesion to be clearly related to the main primary breast cancer from which a biopsy was taken • the lesion will be removed during the same lumpectomy than the main primary breast cancer For bilateral, multifocal or multicentric disease, the site selected for pre-treatment biopsy should correspond to the site of largest measurable disease meeting eligibility criteria. The location of tumour biopsy site (laterality, quadrant, position from the nipple and type of imaging modality to guide biopsy) should be collected.
Pregnant and/or lactating women.
Active infection including: • Tuberculosis (TB) (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice) • Hepatitis B (known positive HBV surface antigen (HBsAg) result). Subjects with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [antiHBc] and absence of HBsAg) are eligible. • Hepatitis C. Subjects positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA
Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction transient ischemic attack, or stroke within the previous 3 months, unstable arrhythmias, and/or unstable angina
Medical condition requiring current systemic anticoagulation, or a history of congenital hypercoagulable condition. Subjects taking aspirin at doses < 325 mg per day are eligible provided that prothrombin time is within the institutional range of normal. Use of local anticoagulation for port maintenance is permitted.
Subjects with history of venous thrombosis in the past 12 months prior to the scheduled first dose of study treatment (oleclumab)
Diabetes mellitus Type 1 or poorly controlled Type 2 diabetes mellitus defined as a screening hemoglobin A1C ≥ 8 % or a fasting plasma glucose ≥ 160 mg/dL (or 8.8 mmol/L)
Any live (attenuated) vaccine within 30 days of planned start of study therapy
Prior systemic immunosuppressive medication (excluding corticosteroids) within 30 days of planned start of study therapy
Prior radiation therapy to the ipsilateral breast
Prior immunotherapy, including tumour vaccine, cytokine, antiCTLA4, PD-1/PD-L1, including durvalumab, blockade or similar agents
Concomitant use of other investigational drugs
Subject with a significant medical, neuro-psychiatric, substance abuse or surgical condition, currently uncontrolled by treatment, which, in the principal investigator’s opinion, may interfere with completion of the study.
Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria. Subjects with Grade ≥2 neuropathy will be evaluated on a case-by-case basis after consultation with the Study Physician. Subjects with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab or oleclumab may be included only after consultation with the Study Physician
Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the subject to give written informed consent
History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject’s participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator
Prior organ transplantation
Subjects with urinary outflow obstruction
Exclusion criterion applicable to FRANCE only (Safety run-in and Phase II subjects). Vulnerable persons according to the article L.1121-6 of the CSP, adults who are the subject of a measure of legal protection or unable to express their consent according to article L.1121-8 of the CSP
TNM stage cT4 breast cancer including inflammatory breast cancer
Presence of any distant metastasis
Contra-indication for treatment by paclitaxel, doxorubicin or cyclophosphamide, or known allergy to any tested substance or excipients (e.g; chemotherapy or immunotherapy formulations). Contra-indication for subjects with known sensitivity to acetaminophen/paracetamol, diphenhydramine or equivalent antihistamine (this is a contra-indication for treatment with oleclumab).
Previously known contra-indication for treatment by radiation therapy such as rare genetic disorders associated with DNA repair disorders such as ataxia-telangiectasia (A-T), Nijmegen Breakage Syndrome (NBS) and Fanconi anemia.
Active or prior documented autoimmune disease (including inflammatory bowel disease, celiac disease, Wegener’s granulomatosis) within the past 3 years. NOTE: Subjects with childhood atopy or asthma, vitiligo, alopecia, Grave’s disease, Hashimoto’s thyroiditis, or psoriasis not requiring systemic treatment (within the past 2 years) are not excluded
Prior malignancy active within the previous 5 years, except for localised cancers that are considered to have been cured and in the opinion of the investigator present a low risk for recurrence. Examples include basal or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix or breas
Known history of, or any evidence of active, non-infectious pneumonitis.
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Residual cancer burden (RCB 0-1 vs. RCB 2-3) at time of surgery. RCB 0 is defined as pathological complete response (pCR) and RCB 1 is defined as minimal residual disease. RCB is calculated as a continuous index combining pathologic measurements of the primary tumour (size and cellularity) and nodal metastases (number and size) as defined by Symmans et al. (15). Residual cancer burden (RCB 0-1 vs. RCB 2-3) at time of surgery. RCB 0 is defined as pathological complete response (pCR) and RCB 1 is defined as minimal residual disease. RCB is calculated as a continuous index combining pathologic measurements of the primary tumour (size and cellularity) and nodal metastases (number and size) as defined by Symmans et al. (15).
- Secondary Outcome Measures
Name Time Method At surgery: • Rate of pCR - ypT0/Tis ypN0, defined as the absence of residual invasive cancer at the time of definitive surgery. At surgery: • Rate of pCR - ypT0/Tis ypN0, defined as the absence of residual invasive cancer at the time of definitive surgery.
Rate of pCR - no DCIS (yp DCIS (ypT0 ypN0), defined as the absence of residual invasive and in situ cancer at time of definitive surgery Rate of pCR - no DCIS (yp DCIS (ypT0 ypN0), defined as the absence of residual invasive and in situ cancer at time of definitive surgery
Complete pathologic response rate (pCR) of the primary tumour (ypT0/ Tis), irrespective of the response rate of the resected nodal metastases. Complete pathologic response rate (pCR) of the primary tumour (ypT0/ Tis), irrespective of the response rate of the resected nodal metastases.
Complete pathologic response rate (pCR) of the resected nodal metastases (ypN0), irrespective of the response rate of the primary tumour. Complete pathologic response rate (pCR) of the resected nodal metastases (ypN0), irrespective of the response rate of the primary tumour.
% of breast conservation surgery in arms 2 and 3 versus arm 1 % of breast conservation surgery in arms 2 and 3 versus arm 1
Change in TIL levels between baseline and the week 6 biopsy. Change in TIL levels between baseline and the week 6 biopsy.
Follow-up Phase: Efficacy endpoints at 3 years and 5 years after surgery will be measured, as defined by the Standardized Definitions for Efficacy End Points in Neoadjuvant Breast Cancer Clinical Trials (NeoSTEEP) (88). The following endpoints will be assessed: event-free survival (EFS), breast cancer event-free survival (BC-EFS), overall survival (OS) and distant recurrence-free survival (DRFS). Furthermore, the occurrence of ipsilateral locoregional recurrence (breast, chestwall or lo Follow-up Phase: Efficacy endpoints at 3 years and 5 years after surgery will be measured, as defined by the Standardized Definitions for Efficacy End Points in Neoadjuvant Breast Cancer Clinical Trials (NeoSTEEP) (88). The following endpoints will be assessed: event-free survival (EFS), breast cancer event-free survival (BC-EFS), overall survival (OS) and distant recurrence-free survival (DRFS). Furthermore, the occurrence of ipsilateral locoregional recurrence (breast, chestwall or lo
Trial Locations
- Locations (7)
Institut Curie
🇫🇷Paris, France
Centr Georges Francois Leclerc
🇫🇷Dijon, France
Ziekenhuis Aan De Stroom
🇧🇪Antwerp, Belgium
Centre Hospitalier Universitaire Dinant Godinne Sainte-Elisabeth-UCL-Namur
🇧🇪Namur, Belgium
Cliniques Universitaires Saint-Luc
🇧🇪Sint-Lambrechts-Woluwe, Belgium
UZ Leuven
🇧🇪Leuven, Belgium
Institut Jules Bordet
🇧🇪Anderlecht, Belgium
Institut Curie🇫🇷Paris, FranceEmanuela RomanoSite contact0172389335emanuela.romano@curie.fr