Neoadjuvant Ontruzant (SB3) in Patients With HER2-positive Early Breast Cancer: An Open-Label (NeoON)

Breast Cancer Clinical Trial

— NeoON  

Official title:

Neoadjuvant Treatment of Ontruzant (SB3) in Patients With HER2-positive Early Breast Cancer: An Open-Label, Multicenter, Phase IV Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05036005
• Other study ID #: IFG-08-2019
• Status: Recruiting
• Phase: Phase 4
• Start date: July 11, 2021
• Est. completion date: July 2023

Study information

• Verified date: April 2023
• Source: Institut fuer Frauengesundheit
• Contact: NeoON Study Manager
• Phone: +49 9131 9279136
• Email: neo.on[@]ifg-erlangen.de
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The treatment of patients with HER2 positive early breast cancer has continuously improved over the last decades. Up to now both, trastuzumab and pertuzumab are approved in combination with chemotherapy (CTX) not only for the adjuvant but also for the neoadjuvant treatment of early breast cancer patients. A high pCR rate in the neoadjuvant setting was shown in several trials and observational studies with CTX+ trastuzumab and with CTX+ pertuzumab. The efficacy is dependent on a variety of mechanisms including the blocking of the important PI3K/Akt and MAPK pathways, and ADCC (antibody dependent cellular toxicity).

Recently the biosimilar Ontruzant® (SB3) has been introduced into the treatment of HER2 positive breast cancer as a biosimilar. Efficacy and toxicity have been shown to be equivalent to the first approved antibody, however, data from the real-world setting have not been published like it has for the originally approved antibody. Therefore, the aim of this study is to establish safety and efficacy for Ontruzant® in the real world setting. Patients can be included if they are treated with Ontruzant® in the neoadjuvant setting. Additionally, the study will be accompanied by a comprehensive immune monitoring program and biomarker program to explore immune oncology potential for the neoadjuvant treatment.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 108
• Est. completion date: July 2023
• Est. primary completion date: April 2023
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Written informed consent prior to beginning of trial specific procedures.

2. Subject must be female and aged = 18 years on day of signing informed consent.

3. ECOG 0-1.

4. Histologically confirmed, early HER2 positive breast cancer determined by core biopsy of breast tumor lesion.

5. Measurable tumor lesion with a size of = 1 cm assessed by sonography or magnetic resonance imaging (MRI) within = 28 days prior to entry. In case of inflammatory disease, the extent of inflammation will be measured.

6. Indication for chemotherapy.

7. Multicentric and/or multifocal disease as well as synchronous bilateral breast cancer is eligible as long as one measurable lesion meets all inclusion criteria. The investigator has to determine which lesion will be used for tumor evaluation before initiation of treatment.

8. Complete staging within 8 weeks prior to entry with no evidence of distant disease, including bilateral mammography, breast ultrasound, chest-X-ray (or chest CT-scan), liver ultrasound (or liver CT-scan or liver MRI) and bone scan.

9. Subjects must provide a core biopsy from tumor lesion before first chemotherapy, after 3 cycles of chemotherapy and after last neoadjuvant study treatment for biomarker analyses.

10. Adequate organ function defined as: Absolute neutrophile count =1500/µL, Platelets =100 000/µL, Hemoglobin =10.0 g/dL or =6.2 mmol/L, Creatinine =1.5 × ULN OR measured or calculated creatinine clearance =30 mL/min for participant with creatinine levels >1.5 × institutional ULN (GFR can also be used in place of creatinine or CrCl), Total bilirubin =1.5 ×ULN OR direct bilirubin =ULN for participants with total bilirubin levels >1.5 × ULN, AST (SGOT) and ALT (SGPT) =2.5 × ULN (=5 × ULN for participants with liver metastases), International normalized ratio (INR) OR prothrombin time (PT) =1.5 × ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants, LVEF > 50 %

11. Female subjects of childbearing potential must have a negative urine pregnancy test within 72 h prior to study entry and be willing to use an adequate method of contraception for course of the study through 7 months after the last dose of trial treatment.

Exclusion Criteria:

1. Concurrent participation in a study with an investigational agent/device or within 14 days of study entry.

2. Prior chemotherapy, radiation therapy or small molecule therapy for any reason.

3. Previous malignant disease being disease-free for less than 3 years (except in situ carcinoma of the cervix and basal cell carcinoma of the skin).

4. Pregnancy or lactation.

5. Prior neoadjuvant therapy.

6. Active infection requiring systemic therapy.

7. History of (non-infectious) pneumonitis that required steroids or current pneumonitis.

8. Active autoimmune disease or other diseases that requires systemic treatment with corticosteroids or immunosuppressive drugs (physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency is allowed).

9. History of primary or acquired immunodeficiency (including allogenic organ transplant).

10. Active or prior documented inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).

11. Known history of following infections: Human immunodeficiency virus (HIV), History of acute or chronic Hepatitis B or Hepatitis C, has received a live-virus vaccination within 30 days of planned treatment start. Seasonal flu vaccines that do not contain live virus are permitted.

12. Known congestive heart failure > NYHA I and/or coronary heart disease, angina pectoris, previous history of myocardial infarction, uncontrolled or poorly controlled arterial hypertension (e.g. blood pressure >160/90 mmHg under treatment with two or more antihypertensive drugs), rhythm disorders with clinically significant valvular heart disease.

13. Pre-existing motor or sensory neuropathy of a severity grade =2 by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

14. Any other condition in opinion of the investigator that would interfere with applied systemic treatment or other trial procedures.

Related Conditions & MeSH terms

• Breast Cancer
• Breast Cancer Female
• Breast Neoplasms
• HER2-positive Breast Cancer

Intervention

Drug:
• Ontruzant
All patients will receive an initial dose of Ontruzant® i.v. 8 mg/kg b.w in combination with standard chemotherapy with or without pertuzumab i.v. 480 mg followed by 5 cycles of Ontruzant® i.v. 6 mg/kg b.w. q21d in combination with standard chemotherapy with or without pertuzumab i.v. 420 mg. Addition of pertuzumab is at the discretion of investigator's decision.
• Chemotherapy
All patients will receive an initial dose of Ontruzant® i.v. 8 mg/kg b.w in combination with standard chemotherapy with or without pertuzumab i.v. 480 mg followed by 5 cycles of Ontruzant® i.v. 6 mg/kg b.w. q21d in combination with standard chemotherapy with or without pertuzumab i.v. 420 mg. Choice of chemotherapy is at the discretion of the investigator
• Pertuzumab
All patients will receive an initial dose of Ontruzant® i.v. 8 mg/kg b.w in combination with standard chemotherapy with or without pertuzumab i.v. 480 mg followed by 5 cycles of Ontruzant® i.v. 6 mg/kg b.w. q21d in combination with standard chemotherapy with or without pertuzumab i.v. 420 mg. Addition of pertuzumab is at the discretion of investigator's decision.

Locations

Country	Name	City	State
Germany	Hämato-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg	Aschaffenburg	Bavaria
Germany	Department for Hematology, Oncology and Tumor Immunology Charité Campus Benjamin Franklin	Berlin
Germany	Department of Gynecology and Obstetrics, HELIOS Hospital Berlin Buch GmbH	Berlin
Germany	Department for Gynecology and Obstetrics, Marienhospital Bottrop gGmbH	Bottrop	North Rhine-Westphalia
Germany	Department of Gynecology and Obstetrics, Dresden University Hospital Carl-Gustav Carus	Dresden	Saxony
Germany	Department of Gynecology and Obstetrics, Erlangen University Hospital	Erlangen	Bavaria
Germany	Center for Hematology and Oncology Bethanien	Frankfurt	Hesse
Germany	Department of Gynecology, University Hospital Hamburg-Eppendorf	Hamburg	Haburg
Germany	Division Gynecologic Oncology, Heidelberg University Hospital (UKHD)	Heidelberg	Baden-Wuerttemberg
Germany	Department of Gynecology and Obstetrics, University Medicine Mainz	Mainz	Hesse
Germany	Department of Gynecology, Tübingen University Hospital	Tübingen	Baden-Wuerttemberg

Sponsors (2)

Lead Sponsor	Collaborator
Institut fuer Frauengesundheit	Samsung Bioepis Co., Ltd.

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	To assess the antibody-dependent cell mediated cytotoxicity (ADCC)	ADCC will be quantified and immune phenotyping will be performed from peripheral blood mononuclear cells (PBMCs).	Measured from biomaterial collected at baseline, 12 weeks after treatment initiation and at surgery
Other	Fc?R genotypes	Germline DNA will be genotyped in order to specify Fc?R polymorphisms and impact of Fc?R genotypes on ADCC and pCR will be assessed.	Measured from biomaterial collected at baseline, 12 weeks after treatment initiation and at surgery
Primary	Pathological complete response (pCR) rate	Pathological complete response (pCR) rate, defined as the complete absence of tumor cells (ypT0; ypN0) after neoadjuvant study treatment of HER2-positive early breast cancer patients treated with Ontruzant® (SB3) in combination with pertuzumab (optional) and a standard chemotherapy.	Pathological complete response will be assessed at final surgery.
Secondary	Pathological complete response (pCR) rate in patients without pertuzumab	Pathological complete response (pCR) rate, defined as the complete absence of tumor cells (ypT0; ypN0) after neoadjuvant study treatment of HER2-positive early breast cancer patients treated with Ontruzant® (SB3) and a standard chemotherapy who were not treated with pertuzumab.	Pathological complete response will be assessed at final surgery.
Secondary	Number of participants wuth treatment-related adverse events as assessed by CTCAE v5.0	The safety endpoints for the study will include rate of AE/SAEs and fatal SAEs, causality and outcome of AE/SAEs, rate of treatment discontinuations and reasons, Changes in vital signs, laboratory values etc. Grading of AE/SAEs will be based on NCI CTCAE v5.0.	Adverse ebents will be assessed from first administration of trial treatment until 30 days after last administration of trial treatment.
Secondary	EORTC-QLQ-C30	To evaluate changes in health related quality of life (QoL) assessments from baseline in all subjects using Quality of Life Questionnaire Core 30 (EORTC QLQ-C30).	Every nine weeks from first administration of trial medication through study completion, up to 30 days after administration of last medication.
Secondary	EORTC-QLQ-BR23	To evaluate changes in health related quality of life (QoL) assessments from baseline in all subjects using Quality of Life Questionnaire Breast Cancer-Specific Quality of Life (EORTC QLQ-BR23).	Every nine weeks from first administration of trial medication through study completion, up to 30 days after administration of last medication.