Capecitabine plus pembrolizumab in patients with triple negative breast cancer after chemoimmunotherapy and surgery
- Conditions
- Triple Negative Breast Cancer with residual disease after neoadjuvant chemo-immunotherapy.
- Interventions
- Registration Number
- 2023-505291-30-01
- Lead Sponsor
- Unicancer
- Brief Summary
To evaluate the efficacy of post-operative capecitabine added to pembrolizumab on the invasive disease-free survival (iDFS) as assessed by investigator in subjects with Triple Negative Breast Cancer and residual disease after neoadjuvant chemotherapy associated with pembrolizumab.
- Detailed Description
We propose to evaluate the benefit in 2-year iDFS and safety of adding capecitabine to pembrolizumab in post-operative phase of pembrolizumab-containing treatment, in the subgroup of localized TNBC patients with residual disease.
An external cohort with patients treated with pembrolizumab as part of standard care after surgery, for localized TNBC without pCR after NAC, and with similar eligibility criteria, will be registered in an ambispective way, allowing comparisons between the experimental arm and this external cohort. All the centers involved in the study will participate in the registration of the needed information concerning this cohort.
Recruitment & Eligibility
- Status
- Ongoing, recruiting
- Sex
- Not specified
- Target Recruitment
- 220
Experimental arm : Patient must have signed a written informed consent prior to any trial specific procedures. When the patient is physically unable to give their written consent, a trusted person of their choice, independent from the investigator or the sponsor, can confirm in writing the patient’s consent;
Experimental arm : TNBC patients previously treated by standard neoadjuvant chemotherapy with a minimum of 6 cycles of immunochemotherapy containing pembrolizumab, per standard of care (and pembrolizumab label) and anthracyclines and/or taxanes (with/without carboplatin). Other drugs may be acceptable following discussion with the sponsor (with the exclusion of capecitabine);
Experimental arm : Complete resection of the breast tumor(s) (and of any invaded lymph node);
Experimental arm : No complete pathological response, defined as RCB Class I, II or III (per local assessment);
Experimental arm : Available representative formalin-fixed paraffin-embedded (FFPE) tumor block from surgery specimen with its histological report;
Experimental arm : Eastern Cooperative Oncology Group (ECOG) Performance Status ≤2;
Experimental arm : Adequate organ and bone marrow function. All screening lab tests should be performed within 28 days before randomization;
External Cohort : Patient information prior to study entry and non-opposition to data collection
External Cohort : Subject ≥18 years of age ;
External Cohort : Histologically proven TNBC defined as follows: a. HER2 negativity (ASCO/CAP criteria) b. AND less than 10% of cells stained by immunohistochemistry (IHC) for ER and PgR;
External Cohort : TNBC patients previously treated by standard neoadjuvant chemotherapy with a minimum of 6 cycles of immunochemotherapy containing pembrolizumab, per standard of care (and pembrolizumab label) and anthracyclines and/or taxanes (with/without carboplatin). Other drugs may be acceptable following discussion with the sponsor (with the exclusion of capecitabine);
Experimental arm : Resolution to at least grade 1 of all acute toxicities from previous therapies including immune related toxicity due to pembrolizumab, except alopecia and grade 2 immune-related endocrinopathies controlled by hormone replacement which are allowed;
External Cohort : Complete resection of the breast tumor(s) (and of any invaded lymph node);
External Cohort : No complete pathological response, defined as RCB Class I, II or III (per local assessment);
External Cohort : Patient should have received at least one injection of pembrolizumab as post-surgery treatment (concomitantly or after radiotherapy).
Experimental arm : Minimal/maximal period for prior treatments (i.e. minimal delay from last dose of prior treatment to C1D1): breast surgery (the wound must have healed prior to C1D1) ≥2 weeks (maximum 10 weeks); last pembrolizumab injection ≥3 weeks;
Experimental arm : Women of child-bearing potential must have a negative serum pregnancy test within 7 days before C1D1;
Experimental arm : Women of child-bearing potential and male patients must agree to use 1 effective form of contraception from the time of the negative pregnancy test up to 4 months after the last dose of study drugs;
Experimental arm : Patient should be able and willing to comply with study visits and procedures as per protocol;
Experimental arm : Patients must be affiliated to a Social Security System (or equivalent).
Experimental arm : Subject ≥18 years of age on day of signing informed consent form (ICF);
Experimental arm : Histologically proven TNBC defined as follows: a. HER2 negativity (ASCO/CAP criteria) b. AND less than 10% of cells stained by immunohistochemistry (IHC) for ER and PgR;
Experimental arm : Radiological or clinical evidence of metastatic disease documented by imaging or clinical examination performed during screening period;
Experimental arm : Patients having received brivudine within 4 weeks prior to inclusion;
Experimental arm : Require the use of one of the following forbidden treatments during the study treatment period: Any investigational anticancer therapy other than the protocol specified treatment; Any concurrent chemotherapy, immunotherapy, biologic for cancer treatment, other than the ones stated in the protocol;
Experimental arm : Pregnant women or women who are breast-feeding;
Experimental arm : Patients unwilling or unable to comply with the medical follow-up required by the trial because of geographic, familial, social, or psychological reasons;
Experimental arm : Persons deprived of their liberty or under protective custody or guardianship;
Experimental arm : Participation in another therapeutic trial within the 30 days prior to randomization.
External Cohort : Radiological or clinical evidence of metastatic disease documented by imaging or clinical examination after surgery.
External Cohort : Has received capecitabine or other ICI than pembrolizumab in the NAC regimen;
External Cohort : Has a known additional malignancy, excepted skin basal cell carcinoma, squamous cell carcinoma of the skin, or in situ cervical cancer or previously treated malignancy with no evidence of disease for ≥2 years;
External Cohort : Any investigational anticancer therapy (chemotherapy, immunotherapy, biologic for cancer treatment) other than pembrolizumab only as adjuvant treatment.
Experimental arm : Has received capecitabine or other ICI than pembrolizumab in the NAC regimen;
Experimental arm : Has a known additional malignancy, excepted skin basal cell carcinoma, squamous cell carcinoma of the skin, or in situ cervical cancer or previously treated malignancy with no evidence of disease for ≥2 years;
Experimental arm : Presents a contraindication to continue pembrolizumab treatment as per respective SmPC including known hypersensitivity;
Experimental arm : Previous immune-related adverse event of any grade due to pembrolizumab that led to permanent discontinuation of pembrolizumab;
Experimental arm : Presents a contraindication to capecitabine treatment as per SmPC (See EMA website for most recent edition of SmPC);
Experimental arm : Complete DPD (Dihydropyrimidine Dehydrogenase) deficiency (a systematic screening of DPD deficiency must be performed);
Experimental arm : Patient with active infection ;
Experimental arm : Patients with history of uncontrolled or symptomatic cardiac disease ;
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Experimental arm : Pembrolizumab and capecitabine Pembrolizumab injection * Pembrolizumab will be administered at a fixed dose of 200 mg every 3 weeks (Q3W), with a total of 9 cycles at adjuvant phase of the treatment; * Capecitabine will be administrated at a dose of 1250 mg/m² twice a day (BID) (14 days on / 7 days off) for a total of 8 cycles, with a dose reduction at 825 mg/m² BID during radiotherapy if indicated * Local radiotherapy will be performed as per standard practice if indicated. Experimental arm : Pembrolizumab and capecitabine Capecitabine tablets * Pembrolizumab will be administered at a fixed dose of 200 mg every 3 weeks (Q3W), with a total of 9 cycles at adjuvant phase of the treatment; * Capecitabine will be administrated at a dose of 1250 mg/m² twice a day (BID) (14 days on / 7 days off) for a total of 8 cycles, with a dose reduction at 825 mg/m² BID during radiotherapy if indicated * Local radiotherapy will be performed as per standard practice if indicated. Experimental arm : Pembrolizumab and capecitabine Local radiotherapy * Pembrolizumab will be administered at a fixed dose of 200 mg every 3 weeks (Q3W), with a total of 9 cycles at adjuvant phase of the treatment; * Capecitabine will be administrated at a dose of 1250 mg/m² twice a day (BID) (14 days on / 7 days off) for a total of 8 cycles, with a dose reduction at 825 mg/m² BID during radiotherapy if indicated * Local radiotherapy will be performed as per standard practice if indicated. Standard of care (SOC) treated external cohort Pembrolizumab injection A standard of care treated external cohort with patients treated with pembrolizumab as postoperative treatment for localized TNBC without pCR after NAC, and with similar eligibility criteria will be registered in an ambispective way, allowing comparisons between the experimental arm and this external cohort. All the centres involved in the study will participate the registration of the needed information concerning this cohort. Standard of care (SOC) treated external cohort Local radiotherapy A standard of care treated external cohort with patients treated with pembrolizumab as postoperative treatment for localized TNBC without pCR after NAC, and with similar eligibility criteria will be registered in an ambispective way, allowing comparisons between the experimental arm and this external cohort. All the centres involved in the study will participate the registration of the needed information concerning this cohort.
- Primary Outcome Measures
Name Time Method 2-year Invasive disease free survival (iDFS). 2-year Invasive disease free survival (iDFS).
- Secondary Outcome Measures
Name Time Method Efficacy: Overall Survival (OS) is defined as the time from the date of inclusion to the date of death due to any cause. For patients alive, OS will be censored at date of last contact. Efficacy: Overall Survival (OS) is defined as the time from the date of inclusion to the date of death due to any cause. For patients alive, OS will be censored at date of last contact.
Efficacy: Distant disease-free survival (DDFS) is defined as the time from the date of inclusion to the date of distant relapse or death due to any cause. For patients alive without distant relapse, DDFS will be censored at date of last contact. Efficacy: Distant disease-free survival (DDFS) is defined as the time from the date of inclusion to the date of distant relapse or death due to any cause. For patients alive without distant relapse, DDFS will be censored at date of last contact.
Efficacy : iDFS, OS and DDFS will also be compared to the external cohort of TNBC patients without pCR after NAC and treated with adjuvant pembrolizumab as part of standard of care after surgery Efficacy : iDFS, OS and DDFS will also be compared to the external cohort of TNBC patients without pCR after NAC and treated with adjuvant pembrolizumab as part of standard of care after surgery
Safety : Safety and tolerability assessed by Adverse Events (AEs) as per the National Cancer Institute Common Toxicity Criteria for Adverse Events version 5.0 (CTCAE v5.0). Safety : Safety and tolerability assessed by Adverse Events (AEs) as per the National Cancer Institute Common Toxicity Criteria for Adverse Events version 5.0 (CTCAE v5.0).
Trial Locations
- Locations (24)
Centre Leon Berard
🇫🇷Lyon, France
Hospi Grand Ouest
🇫🇷St Nazaire, France
Centre Hospitalier Departemental Vendee
🇫🇷La Roche Sur Yon Cedex 9, France
Institut De Cancerologie Strasbourg Europe
🇫🇷Strasbourg, France
Institut Paoli-Calmettes
🇫🇷Marseille, France
Centre Hospitalier Universitaire Grenoble Alpes
🇫🇷Grenoble Cedex 9, France
Sainte Catherine Institut Du Cancer Avignon-Provence
🇫🇷Avignon Cedex 9, France
Institut Universitaire Du Cancer Toulouse-Oncopole
🇫🇷Toulouse Cedex 9, France
Centre Francois Baclesse
🇫🇷Caen Cedex 5, France
Centr Georges Francois Leclerc
🇫🇷Dijon, France
Scroll for more (14 remaining)Centre Leon Berard🇫🇷Lyon, FranceOlivier TREDANSite contact+33478785916olivier.tredan@lyon.unicancer.fr