Randomized trial that compares, with the clinical practice monitoring, an adjuvant or neoadjuvant treatment with an anti PD L1 antibody in breast cancer patients with negative receptors.
- Conditions
- Triple negative breast cancerMedDRA version: 20.0Level: PTClassification code 10075566Term: Triple negative breast cancerSystem Organ Class: 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps)Therapeutic area: Diseases [C] - Cancer [C04]
- Registration Number
- EUCTR2016-000189-45-IT
- Lead Sponsor
- DIPARTIMENTO SCIENZE CHIRURGICHE, ONCOLOGICHE E GASTROENTEROLOGICHE (DISCOG) - UNIVERSITA' DI PADOVA
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Authorised-recruitment may be ongoing or finished
- Sex
- All
- Target Recruitment
- 474
Male or female subjects aged > 18 years
Signed written informed consent before any trial-related procedure is undertaken that is not part of the standard patient management
Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
Non-metastatic, histologically confirmed primary invasive breast carcinoma
Triple negative breast cancer: hormone receptor negative (ER < 10% and PgR < 10%) and HER2 negative (IHC 0/1+ or ISH non-amplified), as defined by the local pathology laboratory. In case of discordance between pre-operative core-biopsy and the surgical sample, the receptor assessment performed on the surgical sample has to be considered for inclusion criteria evaluation.
Patients must have completed treatment with curative intent including: surgery, adjuvant chemotherapy.
Adequately excised: patients must have undergone either breast-conserving surgery or mastectomy/nipple- or skin-sparing mastectomy.
Pathological node staging (Union for International Cancer Control–American Joint Committee on Cancer [UICC/AJCC] 7th edition): patients must have had axillary lymph node dissection for evaluation of pathologic nodal status. Only patients with
- if 4 or more metastatic lymph nodes, any pT
- if 1 to 3 metastatic lymph nodes, pT >2 cm
- if no metastatic lymph nodes, pT >5 cm
Patients must have completed adjuvant chemotherapy including at least 3 courses of an anthracycline agent and 3 courses of a taxane agent. Patients who received dose-dense regimens and those who received carboplatin as part of the adjuvant treatment are eligible.
No more than 10 weeks may elapse between the completion of last adjuvant treatment (adjuvant chemotherapy or radiotherapy if indicated) and randomization.
Normal organ and marrow function
a.White blood count (WBC) greater than or equal to 2.5 x109/L
b.Absolute neutrophil count (ANC) greater than or equal to 1.5 x109/L
c.Absolute lymphocyte count greater or equal to 0.5 x109/L
d.Platelet count greater than or equal to 100 x109/L
e.Hemoglobin greater than or equal to 9 g/dL
f.Serum creatinine less or equal to 1.25 x the upper limit of laboratory normal range (ULN)
g.Adequate hepatic function defined by a total bilirubin level less or equal to 1.5 x ULN range and AST and ALT levels less or equal than 2.5 x ULN for all subjects. For patients with known Gilbert’s syndrome, total bilirubin levels less or equal than 2 x ULN range (with direct bilirubin less than ULN) will be accepted.
Highly effective contraception (i.e. methods with a failure rate of less than 1 % per year) for both male and female subjects if the risk of conception exists (Note: The effects of the trial treatment on the developing human fetus are unknown; thus, women of childbearing potential and men must agree to use highly effective contraception, defined in Appendix A or as stipulated in national or local guidelines. Highly effective contraception must be used 28 days prior to first trial treatment administration, for the duration of trial treatment, and at least for 60 days after stopping trial treatment. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this trial, the treating physician should be informed immediately).
Ability to understand and willingness to sign a written informed consent.
Clinical stage at presentation: T1–4, N0–3, M0 (Exception: Patients with T1a/bN0 tumors at presentation will not be eligible).
Pathologic evidence of residual invasive carcinoma
Stage IV breast cancer.
History of any prior (ipsi- and/or contralateral) invasive breast carcinoma diagnosed within 10 years.
Synchronous bilateral breast cancer, unless both tumors confirmed as triple negative disease.
History of non-breast malignancies within the 5 years prior to study entry, except for the following: Carcinoma in situ (CIS) of the cervix, CIS of the colon, Basal cell and squamous cell carcinomas of the skin.
Prior organ transplantation, including allogeneic stem-cell transplantation.
Prior or concomitant treatment with any other investigational agents.
Prior therapy with any antibody / drug targeting T-cell coregulatory proteins such as PD-1, PD-L1, or cytotoxic T-lymphocyte antigen-4 (CTLA-4).
Concurrent anticancer treatment
Major surgery for any reason, within 4 weeks of randomization and / or if the subject has not fully recovered from the surgery within 4 weeks of randomization.
Concomitant treatment with all herbal (alternative) remedies with immunostimulating properties or known to potentially interfere with major organ function.
Subjects receiving immunosuppressive agents for any reason should be tapered off these drugs before initiation of the trial treatment (with the exception of subjects with adrenal insufficiency, who may continue corticosteroids at physiologic replacement dose, equivalent to = 10 mg prednisone daily).
Significant acute or chronic infections including, among others:
a.Known history of testing positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome.
b.Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening
Active autoimmune disease that might deteriorate when receiving an immunostimulatory agent:
a.Subjects with diabetes type I, vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible.
b.Subjects requiring hormone replacement with corticosteroids are eligible if the steroids are administered only for the purpose of hormonal replacement and at doses = 10 mg or equivalent prednisone per day.
c.Administration of steroids through a route known to result in a minimal systemic exposure (topical, intranasal, intro-ocular, or inhalation) are acceptable.
Administration of steroids through a route known to result in a minimal systemic exposureare acceptable.
Previous or ongoing administration of systemic steroids for the management of an acute allergic phenomenon is acceptable as long as it is anticipated that the administration of steroids will be completed in 14 days, or that the daily dose after 14 days will be = 10 mg per day of equivalent prednisone.
Known severe hypersensitivity reactions to monoclonal antibodies , any history of anaphylaxis, or uncontrolled asthma (that is, 3 or more features of partially controlled asthma).
Clinically significant (that is, active) cardiovascular disease: cerebral vascular accident /stroke (< 6 months prior to enrollment), myocardial infarction (< 6 months prior to enrollment), unstable angina, congestive heart failure (New York Heart Association Classification Class = II), or serious uncontrolled cardiac arrhythmia requiring medication.
All other significant diseases which, in the opinion of the Investigator, might impair the subject’s tolerance of trial treatment.
Any psychiatric condition that would prohibit the understanding or rendering of informed consent.
Vaccination within 4 weeks of the first dose of avelumab and while on trial is
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method