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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03726879
Other study ID # BO40747
Secondary ID
Status Completed
Phase Phase 3
First received
Last updated
Start date January 11, 2019
Est. completion date August 24, 2023

Study information

Verified date January 2024
Source Hoffmann-La Roche
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study (also known as IMpassion050) will evaluate the efficacy and safety of atezolizumab compared with placebo when given in combination with neoadjuvant dose-dense anthracycline (doxorubicin) + cyclophosphamide followed by paclitaxel + trastuzumab + pertuzumab (ddAC-PacHP) in patients with early HER2-positive breast cancer (T2-4, N1-3, M0).


Recruitment information / eligibility

Status Completed
Enrollment 454
Est. completion date August 24, 2023
Est. primary completion date February 5, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Confirmed diagnosis of HER2-positive breast cancer, and hormonal and PD-L1 status, as documented through central testing of a representative tumor tissue specimen - Primary breast tumor size of > 2 cm by any radiographic measurement - Stage at presentation: T2-T4, N1-N3, M0 as determined by AJCC staging system, 8th edition - Pathologic confirmation of nodal involvement with malignancy must be determined by fine needle aspiration or core-needle biopsy. Surgical excision of lymph nodes is not permitted. - Patients with multifocal tumors are eligible provided at least one focus is sampled and centrally confirmed as HER2-positive. - Patients with multicentric tumors are eligible provided all discrete lesions are sampled and centrally confirmed as HER2-positive. - Eastern Cooperative Oncology Group Performance Status of 0 or 1 - Baseline LVEF >= 55% measured by echocardiogram (ECHO) or multiple-gated acquisition (MUGA) scans - Adequate hematologic and end-organ function obtained within 14 days prior to initiation of study treatment - For women of childbearing potential: agreement to remain abstinent or use contraceptive methods, and agreement to refrain from donating eggs - For men: agreement to remain abstinent or use contraceptive measures, and agreement to refrain from donating sperm Exclusion Criteria: - Prior history of invasive breast cancer - Stage IV (metastatic) breast cancer - Patients with synchronous bilateral invasive breast cancer - Prior systemic therapy for treatment of breast cancer - Previous therapy with anthracyclines or taxanes for any malignancy - Ulcerating or inflammatory breast cancer - Undergone incisional and/or excisional biopsy of primary tumor and/or axillary lymph nodes - Sentinel lymph node procedure or axillary lymph node dissection prior to initiation of neoadjuvant therapy - History of other malignancy within 5 years prior to screening, with the exception of those patients who have a negligible risk of metastasis or death - Cardiopulmonary dysfunction - Dyspnea at rest - Active or history of autoimmune disease or immune deficiency - Pregnancy or breastfeeding, or intention of becoming pregnant during study treatment or within 5 months after the final dose of atezolizumab/placebo, 6 months after the final dose of doxorubicin, 12 months after the final dose of cyclophosphamide, 6 months after the final dose of paclitaxel, or 7 months after the final dose of trastuzumab, pertuzumab, or trastuzumab emtansine whichever occurs last Exclusion Criteria Related to Trastuzumab Emtansine in the Adjuvant Setting: - Patients who achieved pCR - Evidence of clinically evident gross residual or recurrent disease following neoadjuvant therapy and surgery - Unable to complete surgery with curative intent after conclusion of neoadjuvant systemic therapy - Patient discontinued treatment with trastuzumab because of toxicity during the neoadjuvant phase of the study - Clinically significant history of liver disease, including cirrhosis, current alcohol abuse, autoimmune hepatic disorders, or sclerosis cholangitis - Patients with Grade >=2 peripheral neuropathy - Prior treatment with trastuzumab emtansine

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Atezolizumab
Atezolizumab will be administered as per the schedule specified in the respective arm.
Placebo
Placebo matched to atezolizumab will be administered as per the schedule specified in the respective arm.
Doxorubicin
Doxorubicin will be administered as per the schedule specified in the respective arm.
Cyclophosphamide
Cyclophosphamide will be administered as per the schedule specified in the respective arm.
Paclitaxel
Paclitaxel will be administered as per the schedule specified in the respective arm.
Trastuzumab
Trastuzumab will be administered as per the schedule specified in the respective arm.
Pertuzumab
Pertuzumab will be administered as per the schedule specified in the respective arm.
Trastuzumab Emtansine
Participants without pCR have the option of receiving adjuvant atezolizumab/placebo combined with Trastuzumab Emtansine 3.6 mg/kg IV Q3W.

Locations

Country Name City State
Brazil Hospital Araujo Jorge; Departamento de Ginecologia E Mama Goiania GO
Brazil Hospital Nossa Senhora da Conceicao Porto Alegre RS
Brazil Hospital Sao Lucas - PUCRS Porto Alegre RS
Brazil Hospital Sao Rafael - HSR Salvador BA
Brazil Hospital Perola Byington Sao Paulo SP
Canada Tom Baker Cancer Centre-Calgary Calgary Alberta
Canada Jewish General Hospital Montreal Quebec
Canada Hopital du Saint Sacrement Quebec City Quebec
Canada BCCA-Vancouver Cancer Centre Vancouver British Columbia
Czechia Masarykuv onkologicky ustav Brno
Czechia Fakultni nemocnice Olomouc; Onkologicka klinika Olomouc
Germany Klinikum Essen-Mitte Ev. Huyssens-Stiftung / Knappschafts GmbH; Klinik für Senologie / Brustzentrum Essen
Germany Praxis für Interdisziplinäre Onkologie und Hämatologie GbR Freiburg
Germany Kooperatives Mammazentrum Hamburg Krankenhaus Jerusalem Hamburg
Germany Sankt Elisabeth Krankenhaus; Gynaekology Leipzig
Germany Rotkreuzklinikum München; Frauenklinik Muenchen
Germany Universitätsklinikum Münster; Klinik für Frauenheilkunde und Geburtshilfe Münster
Germany St. Vincenz-Krankenhaus Paderborn; Haus 3 Frauenklinik Paderborn
Germany Universitätsfrauenklinik Ulm; Abteilung Gynäkologie Ulm
Italy Irccs Centro Di Riferimento Oncologico (CRO); Dipartimento Di Oncologia Medica Aviano Friuli-Venezia Giulia
Italy ASST DEGLI SPEDALI CIVILI DI BRESCIA; Oncologia Medica Brescia Lombardia
Italy Fondazione Del Piemonte Per L'oncologia Ircc Di Candiolo; Dipartimento Oncologico Candiolo Piemonte
Italy ASST DI MONZA; Oncologia Medica Monza Lombardia
Italy Istituto Nazionale Tumori Irccs Fondazione g. PASCALE;U.O.C. Oncologia Medica Senologica Napoli Campania
Italy Università degli Studi Federico II; Clinica di Oncologia Medica Napoli Campania
Italy IOV - Istituto Oncologico Veneto - IRCCS; Oncologia Medica II Padova Veneto
Italy Policlinico Universitario Agostino Gemelli Roma Lazio
Italy Istituto Clinico Humanitas;U.O. Oncologia Medica Ed Ematologia Rozzano Lombardia
Japan National Hospital Organization Shikoku Cancer Center Ehime
Japan Fukushima Medical University Hospital Fukushima
Japan Hiroshima City Hiroshima Citizens Hospital Hiroshima
Japan Hiroshima University Hospital Hiroshima
Japan National Hospital Organization Hokkaido Cancer Center Hokkaido
Japan Hyogo Cancer Center Hyogo
Japan Kanagawa Cancer Center Kanagawa
Japan Tokai University Hospital Kanagawa
Japan Kumamoto Shinto General Hospital Kumamoto
Japan Niigata Cancer Center Hospital Niigata
Japan Saitama Medical University International Medical Center Saitama
Japan Showa University Hospital Tokyo
Japan Toranomon Hospital Tokyo
Korea, Republic of Gachon University Gil Medical Center Incheon
Korea, Republic of Korea University Anam Hospital Seoul
Korea, Republic of Samsung Medical Centre; Oncology Seoul
Korea, Republic of Seoul National University Hospital Seoul
Poland Instytut "Centrum Zdrowia Matki Polki"; Klinika Onkologii ?ód?
Poland Narodowy Inst.Onkol.im.Sklodowskiej-Curie Panstw.Inst.Bad Gliwice; Centr.Diagn.i Lecz.Chor.Piersi Gliwice
Poland Regionalny Szpital Specjalistyczny im. W. Bieganskiego; Oddzial Onkologii Klinicznej Grudzi?dz
Poland Szpital Uniwersytecki w Krakowie, Oddzia? Kliniczny Kliniki Onkologii Kraków
Poland Narodowy Inst.Onkologii im.Sklodowskiej-Curie Panstw.Inst.Bad; Klinika Nowtw.Piersi i Chir.Rekonstr Warszawa
Russian Federation Republican Clinical Oncology Dispensary of Ministry of Healthcare of Tatarstan Republic Kazan Tatarstan
Russian Federation City Clinical Oncology Hospital Moscow Moskovskaja Oblast
Russian Federation Blokhin Cancer Research Center; Combined Treatment Moskva Moskovskaja Oblast
Russian Federation SBIH "Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM" Moskva Moskovskaja Oblast
Russian Federation FSBI National Medical Research Radiological Center; A. TSYB MEDICAL RADIOLOGICAL RESEARCH CENTER Obninsk Kaluga
Russian Federation Petrov Research Inst. of Oncology Sankt Petersburg
Spain Hospital Universitari Germans Trias i Pujol; Servicio de Oncologia Badalona Barcelona
Spain Hospital Clínic i Provincial; Servicio de Hematología y Oncología Barcelona
Spain Complejo Asistencial Universitario De Burgos; Servicio de Oncologia Burgos
Spain Hospital Universitario Virgen de La Arrixaca; Servicio De Oncologia El Palmar Murcia
Spain Hospital Clinico de Granada; Servicio de Oncologia Granada
Spain Complejo Hospitalario de Jaen-Hospital Universitario Medico Quirurgico; Servicio de Oncologia Jaen
Spain Hospital Universitari Arnau de Vilanova de Lleida; Servicio de Oncologia Lerida
Spain Centro Integral Oncologico Clara Campal; Servicio de Oncología Madrid
Spain Clinica Universidad de Navarra Madrid; Servicio de Oncología Madrid
Spain Clinica Universitaria de Navarra; Servicio de Oncologia Pamplona Navarra
Spain Hospital Univ Vall d'Hebron; Servicio de Oncologia Sant Andreu de La Barca Barcelona
Spain Hospital Universitario Virgen del Rocio; Servicio de Oncologia Sevilla
Spain Hospital Universitario Virgen Macarena; Servicio de Oncologia Sevilla
Taiwan China Medical University Hospital; Surgery Taichung
Taiwan Mackay Memorial Hospital; Dept of Surgery Taipei
Taiwan Koo Foundation Sun Yat-Sen Cancer Center; Hemato-Oncology Taipei City
Taiwan Chang Gung Medical Foundation - Linkou; Dept of Surgery Taoyuan
United States HCA Midwest Division Kansas City Missouri
United States Tennessee Oncology Nashville Tennessee
United States New York University Medical Center PRIME; NYU Langone Medical Center New York New York

Sponsors (2)

Lead Sponsor Collaborator
Hoffmann-La Roche Chugai Pharmaceutical

Countries where clinical trial is conducted

United States,  Brazil,  Canada,  Czechia,  Germany,  Italy,  Japan,  Korea, Republic of,  Poland,  Russian Federation,  Spain,  Taiwan, 

Outcome

Type Measure Description Time frame Safety issue
Primary Percentage of Participants With Pathological Complete Response (pCR) in the PD-L1-Positive Population (IC 1/2/3) pCR is defined as the absence of residual invasive cancer on hematoxylin and eosin evaluation of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy (NAST) (i.e., ypT0/is ypN0 in the current American Joint Committee on Cancer [AJCC] staging system, 8th edition). Treatment comparison was made using Cochran-Mantel-Haenszel test stratified by disease stage (T2 vs. T3-4) and hormone receptor status (estrogen receptor (ER) positive and/or progesterone receptor (PgR) positive vs. ER negative and PgR negative). From randomization to approximately 6 months
Primary pCR in the ITT Population pCR is defined as the absence of residual invasive cancer on hematoxylin and eosin evaluation of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy (NAST) (i.e., ypT0/is ypN0 in the current American Joint Committee on Cancer [AJCC] staging system, 8th edition). Treatment comparison was made using Cochran-Mantel-Haenszel test stratified by disease stage (T2 vs. T3-4) and hormone receptor status (ER positive and/or PgR positive vs. ER negative and PgR negative). From randomization to approximately 6 months
Secondary Percentage of Participants With pCR Based on Hormone Receptor Status pCR (ypT0/is ypN0) based upon hormone receptor status (estrogen receptor [ER]/progesterone receptor [PgR] positive or ER/PgR negative). From randomization to approximately 24 months
Secondary Percentage of Participants With pCR in the PD-L1-Negative Population pCR (ypT0/is ypN0) in the IC 0 Population From randomization to approximately 24 months
Secondary Event-Free Survival (EFS) EFS defined as the time from randomization to the first documented disease recurrence, unequivocal tumor progression determined by the treating investigator, or death from any cause, whichever occurs first, in all patients and based upon hormone receptor status (ER/PgR positive or ER/PgR negative) and PD-L1 status (IC 0; IC 1/2/3). From randomization to first documented disease recurrence, unequivocal tumor progression determined by the treating investigator, or death from any cause (up to approximately 54 months)
Secondary Disease-Free Survival (DFS) DFS defined as the time from surgery to the first documented disease recurrence or death from any cause, whichever occurs first, in all patients who undergo surgery and based upon hormone receptor status (ER/PgR positive or ER/PgR negative) and PD-L1 status (IC 0; IC 1/2/3). Time from surgery to first documented disease recurrence or death from any cause (up to approximately 54 months)
Secondary Overall Survival (OS) OS defined as the time from randomization to death from any cause in all patients and based upon hormone receptor status (ER/PgR positive or ER/PgR negative) and PD-L1 status (IC 0; IC 1/2/3). From randomization to date of death from any cause (up to approximately 54 months)
Secondary Mean Changes From Baseline in Function (Role, Physical) EORTC QLQ-C30 is a self-reported questionnaire that included functional scales (physical, role, cognitive, emotional, social), symptom scales (fatigue, pain, nausea/vomiting), global health scale/quality of life (GHS/QOL) and single items (dyspnea, appetite loss, insomnia, constipation, diarrhea, financial difficulties). Questions 1-28 on the QLQ-C30 were on a 4-point scale (1=Not at All to 4=Very Much). Questions 29-30 (GHS scale) were on a 7-point scale (1=Very Poor to 7=Excellent). For this instrument, GHS/QOL and functional scales were linearly transformed so each score ranged 0-100, where lower scores indicate poorer functioning (e.g., worsening) and higher scores indicate better functioning (e.g., improvement). Baseline; Day 1 of Cycle 1-9, on Day 1 of every other cycle thereafter until Cycle 22; at the treatment discontinuation or early termination visit and follow up visit. Cycle 1-4, each cycle is 14 days. Cycle 5-22, each cycle is 21 days.
Secondary Mean Changes From Baseline in Global Health Status EORTC QLQ-C30 is a self-reported questionnaire that included functional scales (physical, role, cognitive, emotional, social), symptom scales (fatigue, pain, nausea/vomiting), GHS/QOL and single items (dyspnea, appetite loss, insomnia, constipation, diarrhea, financial difficulties). Questions 1-28 on the QLQ-C30 were on a 4-point scale (1=Not at All to 4=Very Much). Questions 29-30 (GHS scale) were on a 7-point scale (1=Very Poor to 7=Excellent). For this instrument, GHS/QOL and functional scales were linearly transformed so each score ranged 0-100, where lower scores indicate poorer functioning (e.g., worsening) and higher scores indicate better functioning (e.g., improvement). Baseline; Day 1 of Cycle 1-9, on Day 1 of every other cycle thereafter until Cycle 22; at the treatment discontinuation or early termination visit and follow up visit. Cycle 1-4, each cycle is 14 days. Cycle 5-22, each cycle is 21 days.
Secondary Percentage of Participants With Adverse Events From randomization up until clinical cut-off date (approximately 24 months)
Secondary Maximum Serum Concentration (Cmax) of Atezolizumab Cmax is the maximum (or peak) concentration that a study drug achieves in the body. 30 minutes post infusion on Day 1 Cycle (C) 1.
Secondary Minimum Serum Concentration (Cmin) of Atezolizumab Cmin is the minimum (or trough) concentration that a study drug achieves in the body. Pre-dose on Day 1 Cycle (C) 2, 3, 4, 8, 12, 16, ATDV (an average of 1 year). C 2-4, each C is 14 days. C 8-16, each C is 21 days. With protocol version 5, collection is only required ATDV/completion (an average of 1 year).
Secondary Trough Concentration (Ctrough) for Pertuzumab and Trastuzumab in Serum Pre-dose on Day 1 Cycle (C) 8, 12, and at treatment discontinuation visit (ATDV) (an average of 1 year). C 1-4, each C is 14 days. C 8-12, each C is 21 days. With protocol version 5, collection is only required ATDV/completion (an average of 1 year).
Secondary Cmax of Trastuzumab Emtansine in Serum Cmax is the maximum (or peak) concentration that a study drug achieves in the body. Day 1 of Cycle 9 and Cycle 12, at treatment disontinuation visit (an average of 1 year). Cycle 9 and 12 are each 21 days. With protocol version 5, collection is only required at the time of treatment discontinuation/completion (an average of 1 year).
Secondary Cmin of Trastuzumab Emtansine in Serum Cmin is the minimum (or trough) concentration that a study drug achieves in the body. Day 1 of Cycle 9 and Cycle 12, at treatment disontinuation visit (an average of 1 year). Cycle 9 and 12 are each 21 days. With protocol version 5, collection is only required at the time of treatment discontinuation/completion (an average of 1 year).
Secondary Number of Participants With Treatment-Emergent Anti-Drug Antibodies (ADAs) to Atezolizumab Participants were considered to be treatment-emergent ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following study drug exposure (treatment-induced ADA response), or if they were ADA-positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants were considered to be treatment-emergent ADA-negative if they were ADA-negative or were missing data at baseline and all post-baseline samples were negative, or if they were ADA-positive at baseline but did not have any post-baseline samples with a titer that was at least 0.60 titer units greater than the titer of the baseline sample (treatment unaffected). Day 1 Cycle (C) 1, 2, 3, 4, 8, 12, 16, at treatment discontinuation visit (ATDV) (an average of 1 year). C 1-4, each C is 14 days. C 8-16, each C is 21 days. With protocol version 5, collection is only required ATDV/completion (an average of 1 year).
Secondary Number of Participants With Treatment-Emergent ADAs to Trastuzumab Participants were considered to be treatment-emergent ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following study drug exposure (treatment-induced ADA response), or if they were ADA-positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants were considered to be treatment-emergent ADA-negative if they were ADA-negative or were missing data at baseline and all post-baseline samples were negative, or if they were ADA-positive at baseline but did not have any post-baseline samples with a titer that was at least 0.60 titer units greater than the titer of the baseline sample (treatment unaffected). Day 1 Cycle (C) 1, 8, 12 and at treatment discontinuation visit (ATDV) (an average of 1 year). C 1-4, each C is 14 days. C 8-12, each C is 21 days. With protocol version 5, collection is only required ATDV/completion (an average of 1 year).
Secondary Number of Participants With Treatment-Emergent ADAs to Pertuzumab Participants were considered to be treatment-emergent ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following study drug exposure (treatment-induced ADA response), or if they were ADA-positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants were considered to be treatment-emergent ADA-negative if they were ADA-negative or were missing data at baseline and all post-baseline samples were negative, or if they were ADA-positive at baseline but did not have any post-baseline samples with a titer that was at least 0.60 titer units greater than the titer of the baseline sample (treatment unaffected). Day 1 of Cycle (C) 1, 8, 12, and at treatment discontinuation visit (ATDV) (an average of 1 year). C 1-4, each C is 14 days. C 8-12, each C is 21 days. With protocol version 5, collection is only required ATDV/completion (an average of 1 year).
Secondary Number of Participants With Treatment-Emergent ADAs to Trastuzumab Emtansine Participants were considered to be treatment-emergent ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following study drug exposure (treatment-induced ADA response), or if they were ADA-positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants were considered to be treatment-emergent ADA-negative if they were ADA-negative or were missing data at baseline and all post-baseline samples were negative, or if they were ADA-positive at baseline but did not have any post-baseline samples with a titer that was at least 0.60 titer units greater than the titer of the baseline sample (treatment unaffected). Day 1 of Cycle 9 and Cycle 12, at treatment disontinuation visit (an average of 1 year). Cycle 9 and 12 are each 21 days. With protocol version 5, collection is only required at the time of treatment discontinuation/completion (an average of 1 year).
Secondary Percentage of Participants With pCR Based on PIK3CA Mutation Status pCR is defined as the absence of residual invasive cancer on hematoxylin and eosin evaluation of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy (NAST) (i.e., ypT0/is ypN0 in the current American Joint Committee on Cancer [AJCC] staging system, 8th edition). From randomization to approximately 24 months
Secondary EFS Based on PIK3CA Mutation Status From randomization to first documented disease recurrence, unequivocal tumor progression determined by the treating investigator, or death from any cause (up to approximately 54 months)
Secondary DFS Based on PIK3CA Mutation Status Time from surgery to first documented disease recurrence or death from any cause (up to approximately 54 months)
Secondary OS Based on PIK3CA Mutation Status From randomization to date of death from any cause (up to approximately 54 months)
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