A Study to Measure the Expression of the HER2-HER3 Dimer in Tumour and Blood (Exosomes) Samples From Patients With HER2 Positive Breast Cancer Receiving HER2 Targeted Therapies — HERdi PREDICT  

HER2-positive Breast Cancer Clinical Trial

Official title: HERdi PREDICT: A Pilot Study to Measure the Expression of the HER2-HER3 Dimer in Samples From Patients With HER2 Positive Breast Cancer Receiving HER2 Targeted Therapies

Status Recruiting

Clinical Trial Summary

The treatment of breast cancer is determined by its 'receptor (or signal) status'. Receptors are signals present on all cells and if abnormal can drive cancer growth. One of the signals that can drive breast cancer growth is the HER2 receptor/signal. One quarter of all breast cancers are found to have too many HER2 signals i.e. HER2-positive breast cancer.

HER2 is a member of the HER-family which constitutes HER1,HER2,HER3,and HER4 signals. Currently, tests can identify breast cancers with too much HER2, from a biopsy, so a cancer doctor can prescribe anti-HER2 treatment to block these signals. These drugs have improved survival rates in HER2-positive breast cancer. Members of the HER family can also 'pair' with each other to activate signals that encourage cancer growth. For example, HER3 naturally 'pairs' with HER2. Though anti-cancer drugs have been developed to target this pairing, the current method of patient selection is not developed to detect pairing of signals in tissue biopsies. A specialist imaging technique called FLIM-FRET (FLIM- Fluorescence Lifetime Imaging Microscopy; FRET- Forster resonance energy transfer) can identify signal pairing on cancer cells from tissue, and potentially, from blood samples.

This study involves having blood tests while participants receive anti-HER2 treatment. The investigators will also seek permission to take samples of cancer tissue from the biopsies that were already carried out, e.g. at diagnosis. Some participants may need an additional biopsy, which will be discussed with participants prior to consent. This study will use the specialist FLIM-FRET technique to measure the signal pairing in tumour samples and blood samples. Investigators will measure if the levels of signal pairing from blood are the same as that from tissue, which could lead to bloods tests being used to select patients for anti-HER2 treatments, instead of invasive tissue biopsies. Changes in signal pairing may also help to predict if a cancer is becoming resistant to treatment.

Clinical Trial Description

The study will recruit 40 participants to two groups as outlined below:

Group 1: Early HER2 positive breast cancer (20 patients) Group 2: Metastatic HER2 positive breast cancer (20 patients)

The two groups represent the natural spectrum of breast cancer in its clinical presentation.

GROUP 1: EARLY BREAST CANCER

Group 1 will include patients with early HER2 positive breast cancer recommended to receive neo-adjuvant chemotherapy inclusive of HER2 directed therapy (trastuzumab + pertuzumab), prior to proceeding to curative surgery. All participants are expected to have had a diagnostic core biopsy and definitive breast surgery on completion of neoadjuvant chemotherapy as standard of care. Blood samples will be obtained for biomarker analysis in exosomes. Participants in Group 1 A will be requested to have a biopsy on completion of anthracycline based chemotherapy and prior to commencing on HER2-directed therapy.

Group 1 A: Participants in Group 1 commencing treatment with anthracycline based chemotherapy for up to 4 cycles followed by a switch in treatment to taxane based chemotherapy in combination with HER2 directed therapy (trastuzumab + pertuzumab) for up to 4 cycles

Group 1 B: Participants in Group 1 commencing treatment with taxane based systemic therapy in combination with HER2 directed therapy (trastuzumab + pertuzumab) for up to 6 cycles:

GROUP 2: METASTATIC BREAST CANCER:

Group 2 will include patients will include participants recommended commencing any line of palliative systemic therapy inclusive of a HER2 directed therapy by their treating oncologist. All participants are expected to have had a diagnostic core biopsy. Blood samples will be obtained for biomarker analysis in exosomes. ;

Related Conditions & MeSH terms

• Breast Neoplasms
• HER2-positive Breast Cancer

• NCT number: NCT04288141
• Study type: Observational
• Source: King's College London
• Contact: Louisa McDonald
• Phone: 0207 188 2007
• Email: Louisa.McDonald@gstt.nhs.uk
• Status: Recruiting
• Start date: December 20, 2019
• Completion date: June 2023