eo-adjuvant chemotherapy combined with SBRT to the primary tumour +/- durvalumab (MEDI4736), +/- oleclumab in luminal B breast cancer: a phase ll randomized trial

Phase 1

• Conditions: uminal B Breast Cancer; MedDRA version: 20.0Level: PTClassification code 10006187Term: Breast cancerSystem Organ Class: 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps); Therapeutic area: Diseases [C] - Cancer [C04]

• Registration Number: EUCTR2018-004165-13-FR
• Lead Sponsor: Institut Jules Bordet

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2020-02-04
• Last Update Posted: 9 September 2024

Recruitment & Eligibility

• Status: Authorised-recruitment may be ongoing or finished
• Sex: Female
• Target Recruitment: 190

Inclusion Criteria

Subjects must meet all of the following criteria in order to be eligible for this study:
1.Age = 18 years old
2.Female
3.ECOG performance status = 1
4.Weight = 35 kg
5.Histological diagnosis of invasive breast adenocarcinoma that is estrogen receptor-positive, and HER2- negative as per the updated American Society of Clinical Oncology (ASCO) - College of American Pathologists (CAP) guidelines according to local testing
•ER-positive is defined as having an immunohistochemistry (IHC) of 1% or more and/or and Allred score of 3 or more
•HER2 negative is defined as having an IHC of 0 or 1+ without ISH OR IHC 2+ and ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells OR ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells [without IHC]; note: a IHC of 3+ is always considered HER2 positive, independently of the ISH result.
6.Agreement to perform new study related biopsies to provide tissue samples.
7.Confirmed Mammaprint genomic high risk score according to central testing. Mammaprint will only be tested for luminal B breast tumours with either Proliferation Index Ki67 = 15% or histology grade 3 tumours. (Testing to be done during screening period).
8.Tumour size = 1.5 cm, determined by MRI imaging.
9.N0 or N1
10.Multifocal, multicentric unilateral or bilateral breast adenocarcinoma tumours are allowed provided that all foci are ER+/HER2- according to local testing and all foci are able to receive SBRT treatment within the defined dosimetric constraints. 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.
11.Serum pregnancy test (for subjects of childbearing potential) negative within 2 weeks prior to first dose of study administration.
12.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.
13.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
14.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
15.Adequate renal function as defined below:
•Creatinine = 1.5 x UNL or eGFR=40ml/min/1.73m2
16.Adequate coagulant function as defined below:
•International Normalized Ratio (INR) = 1.5 x ULN unless subject is receiving anticoagulant therapy as long as INR and activated partial thromboplastin time (aPTT) is within therapeutic range of intended use of anticoagulants
17.Completion of all necessary screening procedures within 21 days prior to randomisation.
18.Willingness to provide tissue and blood samples for immuno-monitoring and translational research activities
19. Left ventricular ejection fraction (LVEF) = 50%. LVEF performed in routine is accepted if done within 6 months prior to
20.beginni

Exclusion Criteria

Subjects meeting one of the following criteria are not eligible for this study:
1.Pregnant and/or lactating women.
2.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.
3.TNM stage cT4 breast cancer including inflammatory breast cancer
4.Presence of any distant metastasis
5.Contra-indication for treatment by paclitaxel, doxorubicin or cyclophosphamide, or known allergy to any tested substance or excipients (e.g; chemotherapy or immunotherapy formulations)
6.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.
7.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
8.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 breast
9.Known history of, or any evidence of active, non-infectious pneumonitis.
10.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 [anti-HBc] 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.
11.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
12.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.
13.Subjects with history of venous thrombosis in the past 12 months prior to the scheduled first dose of study treatment (oleclumab)
14.
15.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)
16.Any live (attenuated) vaccine within 30 days of planned start of study therapy
17.Prior systemic immunosuppressive medication (excluding corticosteroids) within 30 days of planned start of study therapy
18.Prior radiation therapy to the ipsilateral breast.
19.Prior immunotherapy, including tumour vaccine, cytokine, anti-CTLA4, PD-1/PD-L1, including durvalumab, blockade or similar agents
20.Concomitant use of other investigational dr

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified