Study to Compare Neoadjuvant Combination of Trastuzumab and Pertuzumab With Concurrent Taxane Chemotherapy or Endocrine Therapy and Quality of Life Assessment Under Adjuvant Therapy in Operable HER2+/HR+ Breast Cancer Patients
- Conditions
- Breast Neoplasms
- Interventions
- Registration Number
- NCT03272477
- Lead Sponsor
- Palleos Healthcare GmbH
- Brief Summary
This is a prospective, phase IIa, multicenter, randomized, open-label study comparing a pre-surgical combination of trastuzumab and pertuzumab with concurrent weekly paclitaxel chemotherapy or endocrine therapy given for 12 weeks with a quality of life assessment for 40 additional weeks in patients with operable HER2+/HR+ breast cancer.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 257
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Female patients, age at diagnosis 18 years and older
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Histologically confirmed unilateral primary invasive carcinoma of the breast
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Patients must qualify for neoadjuvant treatment as follows:
- No clinical evidence for distant metastasis (M0)
- Clinical cT1c-T4a-c (participation of patients with tumors > cT2 is strongly recommended) and no evidence for distant metastases (M0)
- All clinical N (participation of patients with cN+, also in case of cT1c, is strongly recommended)
- Known positive HR-status and centrally confirmed HER2+-status by IHC/FISH
- Patients need to fulfill adequate blood count and organ function to receive chemotherapy (see exclusion criteria).
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Tumor block available for central pathology review
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Performance Status ECOG ≤ 1 or KI ≥ 80%
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Negative pregnancy test (urine or serum) within 7 days prior to registration in premenopausal patients
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Patients of childbearing potential must accept to implement a highly effective (less than 1% failure rate according to Pearl index) non-hormonal contraceptive measures during the study treatment and for 6 months following the last dose of study treatment (trastuzumab and pertuzumab) such as:
- Intrauterine device (IUD)
- bilateral tubal occlusion
- vasectomised partner
- sexual abstinence
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Written informed consent prior to beginning specific protocol procedures, including expected cooperation of the patients for the treatment and follow-up, must be obtained and documented according to the local regulatory requirements
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The patient must be accessible for treatment and follow-up
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LVEF > 55%; LVEF within normal limits of each institution measured by echocardiography (within 42 days prior to randomization)
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Normal ECG (within 42 days prior to randomization)
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Known hypersensitivity reaction to the compounds or incorporated substances
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Prior malignancy with a disease-free survival of < 10 years, except curatively treated basalioma of the skin, pTis of the cervix uteri
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Non-operable breast cancer including inflammatory breast cancer
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Previous or concurrent treatment with cytotoxic agents for any reason
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Concurrent treatment with other experimental drugs and participation in another clinical trial or clinical research project within 30 days prior to study entry is excluded
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Male breast cancer
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Concurrent pregnancy
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Breastfeeding
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Sequential breast cancer
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Reasons indicating risk of poor compliance
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Known polyneuropathy ≥ grade 2
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Severe and relevant co-morbidity that would interact with the application of cytotoxic agents or the participation in the study including but not confined to:
- Uncompensated chronic heart failure or systolic dysfunction (LVEF < 55%, CHF NYHA classes II-IV),
- unstable arrhythmias requiring treatment i.e., atrial tachycardia with a heart rate ≥ 100/min at rest, significant ventricular arrhythmia (ventricular tachycardia) or higher-grade AV-block,
- Angina pectoris within the last 6 months requiring anti-anginal medication,
- Clinically significant valvular heart disease,
- Evidence of myocardial infarction on electrocardiogram (ECG),
- Poorly controlled hypertension (e.g., systolic > 180 mm Hg or diastolic > 100 mm Hg).
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Inadequate organ function including but not confined to:
- hepatic impairment (Child Pugh Class C)
- pulmonary disease (severe dyspnea at rest requiring oxygen therapy)
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Abnormal blood values:
- Thrombocytopenia > CTCAE grade 1
- Increases in ALT/AST > CTCAE grade 1
- Hypokalaemia > CTCAE grade 1
- Neutropenia > CTCAE grade 1
- Anaemia > CTCAE grade 1
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Paclitaxel+Trastuzumab+Pertuzumab Perjeta Injectable Product Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Herceptin Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Surgery Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Herceptin Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Biopsy Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Anastrozole Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Biopsy Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Perjeta Injectable Product Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Surgery Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Leuporelin acetate Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Paclitaxel Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Tamoxifen Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Epirubicin Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Letrozole Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Cyclophosphamide Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Exemestane Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Leuprorelin acetate Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Paclitaxel+Trastuzumab+Pertuzumab Goserelin Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with standard Taxane chemotherapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Epirubicin Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Anastrozole Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Cyclophosphamide Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Letrozole Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Exemestane Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Paclitaxel Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Tamoxifen Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care Endocrine+Trastuzumab+Pertuzumab Goserelin Neoadjuvant therapy: Trastuzumab and Pertuzumab in a 3-weekly schedule in combination with endocrine therapy. Adjuvant Therapy: Standard of care
- Primary Outcome Measures
Name Time Method Pathological complete response (pCR) 14 weeks after start of therapy treatment 14 weeks after start of therapy treatment, tumor and lymph node biopsy is performed to reach the primary endpoint of pathological complete response (pCR) which is defined as the absence of residual invasive cancer of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy (ypT0/is ypN0 in the current AJCC staging system). As secondary endpoint, also other response states will be taken into account: no invasive tumor in the complete resected breast specimen irrespective of the lymph node state following completion of neoadjuvant systemic therapy (ypT0/is, any ypN).
- Secondary Outcome Measures
Name Time Method Health-related quality of life using EORTC QBL-BR-23 scale During the neoadjuvant treatment phase at baseline (week 1) and at week 13. In the adjuvant therapy phase, every 3 month, up to 12 months (from date of randomization) or date of drop out, whatever comes first Assessment of quality of life questions during the past week or during the past 4 weeks (depending on the questions) are measured on a 4 level-scale: 1 (not at all); 2 (a little); 3 (quite a bit); 4 (very much)
Health-related quality of life using EQ5D-5L scale During the neoadjuvant treatment phase at baseline (week 1) and at week 13. In the adjuvant therapy phase, every 3 month, up to 12 months (from date of randomization) or date of drop out, whatever comes first * questions about "self care", "usual activities", "pain /discomfort", anxiety/depression" are assessed on a 5 level-scale using tick boxes : "I have no problem"; "I have slight problems"; "I have moderate problems"; "I have severe problems" "I am unable"
* assessment of the patient health (good or bad) is measured on a scale numbered from 0 to 100 (100 means the best heath and 0 means the worst)Health-related quality of life using EORTC QLQ-C30 scale During the neoadjuvant treatment phase at baseline (week 1) and at week 13. In the adjuvant therapy phase, every 3 month, up to 12 months (from date of randomization) or date of drop out, whatever comes first * Assessment of quality of life questions (activities, breath, pain, sleep, appetite, vomiting, constipation, others..) are measured on a 4 level-scale: 1 (not at all); 2 (a little); 3 (quite a bit); 4 (very much)
* Assessment of Overall health and overall quality of life during the past week is measured on a 7 level-scale going from 1 (very poor) to 7 (excellent)Tumor size reduction by mammography at screening visit and 12 weeks after start of therapy treatment The diameters of the tumors in the breast will be measured in millimeter by mammography as part of clinical response measure. The tumor size measurement 13 weeks after start of therapy is also used to reach a secondary endpoint: near pCR, defined as tumor sized ypT1a/is, any ypN with tumor size.
Overall survival From date of randomization until the date of death from any cause, assessed up to 60 months The overall survival is defined as time (days) between study treatment allocation and death of patient due to any cause.
Tumor size reduction by palpation and ultrasound at screening visit and 4, 7 and 13 weeks after start of therapy treatment The diameters of the tumors in the breast will be measured in millimeter by palpation and ultrasound as part of clinical response measure. The tumor size measurement 13 weeks after start of therapy is also used to reach a secondary endpoint: near pCR, defined as tumor sized ypT1a/is, any ypN with tumor size.
Number of mastectomies 14 weeks after start of therapy treatment The number of mastectomies will be determined at time of surgery (week 14 and week 18)
Ki67 level 4 weeks after start of therapy treatment The level of Ki67 in biopsie material will be measured at week 4 of neoadjuvant therapy
Duration of invasive disease-free survival From date of treatment allocation until the date of first documented progression or secondary tumor or date of death from any cause, whichever came first, assessed up to 60 months (study duration including follow up) Duration of invasive disease-free survival is defined as time (days) between study treatment allocation and relapse, secondary tumor event or death.
cDNA composition at baseline, 3 weeks, 4 weeks and 6, 18, 24, 36 48 and 60 months after start of therapy treatment The composition of cDNA in blood samples will be measured
Trial Locations
- Locations (1)
Evangelisches Krankenhaus Bethesda Mönchengladbach
🇩🇪Mönchengladbach, Germany