PErsonalized TREatment of High-risk MAmmary Cancer - the PETREMAC Trial
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 200
- 试验地点
- 7
- 主要终点
- Predictive and prognostic value of mutations in 300 cancer-related genes assessed in breast cancer tissue by next generation sequencing before starting neoadjuvant therapy.
研究概览
简要总结
Breast cancer is an optimal "model disease" for studying personalized medicine. Breast cancer was the first malignancy for which a predictive factor forecasting response to therapy was identified nearly 50 years ago; the expression of the estrogen receptor (ER). Furthermore, breast cancer is by far the malignancy in which prognostic and predictive factors have been most extensively studied. Primary medical treatment (pre-surgical medical therapy) offers a unique setting to explore predictive factors due to the fact that primary breast cancers are easily accessible to repeated tissue sampling and evaluation of therapy response both clinically and radiologically. For many years, the investigators have studied predictive factors in primary medical treatment of breast cancer. In the present project, the investigators will implement a new trial concept where the current knowledge from previous trials with respect to predictive markers (hormone receptors, HER2; TP53, CHEK2 and RB1), will be combined with massive parallel sequencing (MPS). Thereby, the investigators aim to design the "next-generation" primary medical treatment where 1) therapy regimens are individualized based on a limited number of known predictive factors and, 2) MPS is used to explore additional predictive factors and their co-regulators in order to fully identify the mechanisms of drug sensitivity / resistance across individual tumours and pave the way for further personalized breast cancer therapy in the future. As for the new era of "genomic medicine", the current trial concept will allow individual tumours to be characterized by their unique gene mutation / epigenetic modification profile upfront, to allocate patients to their optimal personalized medicine as compared to "classical" drug testing through phase II/III trials.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Single Group
- 主要目的
- Basic Science
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Previously untreated, histologically confirmed non-inflammatory breast cancer, >4 cm in diameter and /or metastatic ipsilateral axillary deposits for which the smallest diameter of the largest node >2 cm by CT or ultrasound scan.
- •WHO performance status 0-1
- •Known tumor ER, PGR, HER2 and TP53 status.
- •Known tumor Ki67 percentage (if ER/PGR>50% and TP53 wt status).
- •Distant metastasis not suspected. Patients will undergo radiology exams during screening phase, after signing the informed consent.
- •Age >18 years
- •Patients must have clinically and/or radiographically documented measurable breast cancer according to RECIST.
- •Radiology studies (CT thorax/abdomen and bone scintigraphy/bone scan) must be performed within 28 days prior to registration.
- •Absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
- •Before patient registration/randomization, written informed consent must be given according to national and local regulations.
- •For arms B-H:
- •Neutrophils > 1.5 x 109/L
- •Platelets > 100 x 109/L
- •Bilirubin < 2 x upper limit normal (ULN). For patients with Gilbert´s syndrome bilirubin >2 x ULN is accepted if there is no evidence of biliary obstruction.
- •Serum creatinine < 1.5 x ULN
- •ALT and Alk Phos (ALP) <2.5 x ULN
- •INR < 1.5
排除标准
- •Unstable angina pectoris or heart failure
- •Other co-morbidity that, based on the assessment of the treating physician, may preclude the use of chemotherapy at actual doses.
- •Pregnant or lactating patients can not be included.
- •Clinical evidence of serious coagulopathy. Prior arterial/venous thrombosis or embolism does not exclude patients from inclusion, unless patient is considered unfit by study oncologist.
- •Patient not able to give an informed consent or comply with study regulations as deemed by study investigator.
- •Active cystitis (to be treated upfront)
- •Active bacterial infections
- •Urinary obstruction
研究组 & 干预措施
A
ER/PGR>50% TP53 wt
干预措施: Neoadjuvant tamoxifen + goserelin (premenopausal women) (Drug)
A
ER/PGR>50% TP53 wt
干预措施: Adjuvant palbociclib (if palbociclib given neoadjuvant) (Drug)
A
ER/PGR>50% TP53 wt
干预措施: Adjuvant Epirubicin+ Cyclophosphamide (Drug)
B
ER/PGR>50% TP53 mutated
干预措施: Neoadjuvant docetaxel + cyclophosphamide (Drug)
E
HER2+ TP53 wt
干预措施: Adjuvant letrozole (postmenopausal women) (Drug)
E
HER2+ TP53 wt
干预措施: Adjuvant tamoxifen + goserelin (premenopausal women) (Drug)
F
HER2+ TP53 mutated
干预措施: Adjuvant trastuzumab (Drug)
F
HER2+ TP53 mutated
干预措施: Neoadjuvant docetaxel + cyclophosphamide + trastuzumab + pertuzumab (Drug)
F
HER2+ TP53 mutated
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
F
HER2+ TP53 mutated
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
A
ER/PGR>50% TP53 wt
干预措施: Neoadjuvant letrozole (postmenopausal women) (Drug)
A
ER/PGR>50% TP53 wt
干预措施: Neoadjuvant endocrine therapy + palbociclib (if lack of response to endocrine therapy alone) (Drug)
A
ER/PGR>50% TP53 wt
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
A
ER/PGR>50% TP53 wt
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
A
ER/PGR>50% TP53 wt
干预措施: Adjuvant letrozole (postmenopausal women) (Drug)
A
ER/PGR>50% TP53 wt
干预措施: Adjuvant tamoxifen + goserelin (premenopausal women) (Drug)
B
ER/PGR>50% TP53 mutated
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
B
ER/PGR>50% TP53 mutated
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
B
ER/PGR>50% TP53 mutated
干预措施: Adjuvant letrozole (postmenopausal women) (Drug)
B
ER/PGR>50% TP53 mutated
干预措施: Adjuvant tamoxifen + goserelin (premenopausal women) (Drug)
C
ER/PGR<50% TP53 wt
干预措施: Neoadjuvant docetaxel (Drug)
C
ER/PGR<50% TP53 wt
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
C
ER/PGR<50% TP53 wt
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
C
ER/PGR<50% TP53 wt
干预措施: Adjuvant letrozole (postmenopausal women) (Drug)
E
HER2+ TP53 wt
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
C
ER/PGR<50% TP53 wt
干预措施: Adjuvant tamoxifen + goserelin (premenopausal women) (Drug)
D
ER/PGR<50% TP53 mutated
干预措施: Neoadjuvant docetaxel + cyclophosphamide (Drug)
D
ER/PGR<50% TP53 mutated
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
D
ER/PGR<50% TP53 mutated
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
D
ER/PGR<50% TP53 mutated
干预措施: Adjuvant letrozole (postmenopausal women) (Drug)
D
ER/PGR<50% TP53 mutated
干预措施: Adjuvant tamoxifen + goserelin (premenopausal women) (Drug)
E
HER2+ TP53 wt
干预措施: Neoadjuvant docetaxel + trastuzumab + pertuzumab (Drug)
E
HER2+ TP53 wt
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
E
HER2+ TP53 wt
干预措施: Adjuvant trastuzumab (Drug)
F
HER2+ TP53 mutated
干预措施: Adjuvant letrozole (postmenopausal women) (Drug)
F
HER2+ TP53 mutated
干预措施: Adjuvant tamoxifen + goserelin (premenopausal women) (Drug)
G
Triple negative breast cancer TP53 wt
干预措施: Neoadjuvant cyclophosphamide (after 10 weeks of olaparib alone) (Drug)
G
Triple negative breast cancer TP53 wt
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
G
Triple negative breast cancer TP53 wt
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
H
Triple negative breast cancer TP53 mutated
干预措施: Neoadjuvant cyclophosphamide (after 10 weeks of olaparib alone) (Drug)
H
Triple negative breast cancer TP53 mutated
干预措施: Breast conserving surgery or mastectomy + SNB/axillary dissection (Procedure)
H
Triple negative breast cancer TP53 mutated
干预措施: Postoperative radiotherapy breast/chest wall + regional lymph nodes (Radiation)
H
Triple negative breast cancer TP53 mutated
干预措施: Neoadjuvant olaparib (Drug)
G
Triple negative breast cancer TP53 wt
干预措施: Neoadjuvant olaparib (Drug)
结局指标
主要结局
Predictive and prognostic value of mutations in 300 cancer-related genes assessed in breast cancer tissue by next generation sequencing before starting neoadjuvant therapy.
时间窗: Ten years
Primary endpoint
次要结局
- Tumor Ki67 reduction after 2 and 5 weeks of treatment in Arm A(Assessment for each patient after 2 and 5 weeks of treatment. Four years - summary of all patients in arm A.)
- To estimate recurrence-free and overall survival when patients are treated with the optimal personalized treatment available as of 2015, using historical data for comparison(Ten years)
- To evaluate the percentage of patients completing neoadjuvant treatment and completing surgery(Four years)
- Breast conserving surgery rate (potential to avoid mastectomy)(Four years)
- Number of participants with treatment-related adverse events as assessed by CTCAE v4.0(Ten years)
- To assess genetic/epigenetic changes within the tumor tissue during therapy(Before vs. 16-24 wks after treatment start. Four years: summary of all patients treated.)
- The objective response rate (ORR) of personalized medicine, compared to ORR for best standard-of-care using historical data for comparison(Four years)