Nanoparticle-based Paclitaxel vs Solvent-based Paclitaxel as Part of Neoadjuvant Chemotherapy for Early Breast Cancer (GeparSepto)

Inflammatory Breast Cancer Clinical Trial

— GeparSepto  

Official title:

A Randomized Phase III Trial Comparing Nanoparticle-based Paclitaxel With Solvent-based Paclitaxel as Part of Neoadjuvant Chemotherapy for Patients With Early Breast Cancer (GeparSepto)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01583426
• Other study ID #: GBG 69
• Secondary ID: 2011-004714-41
• Status: Completed
• Phase: Phase 3
• Start date: July 2012
• Est. completion date: December 2018

Study information

• Verified date: August 2020
• Source: German Breast Group
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Current guidelines as those from the AGO-Breast commission recommend for neoadjuvant breast cancer patients either a sequence of 4 cycles EC followed by 4 cycles of a taxane or 6 cycles of TAC based on previous large scale studies.

Treatment of patients with HER2-positive disease should include also simultaneous application of trastuzumab.

Solvent-based taxanes (paclitaxel, docetaxel) cause severe toxicities not only by the active agents itself but also by the solvents like cremophor. Nab-paclitaxel (Abraxane®) is a solvent-free formulation of paclitaxel encapsulated in albumin. It does not require premedication with corticosteroids or antihistamines to prevent the risk of solvent-mediated hypersensitivity reactions. This new formulation improves safety profile, allows higher dosing with shorter infusion duration, and produces higher tumor drug concentration.

As neoadjuvant treatment does not only allow to compare competing treatment approaches with a very high quality (homogenous treatment population, precise assessment of response by histological assessment), but also to identify predictive markers, this trial will compare weekly nab-paclitaxel with solvent-based paclitaxel at their currently optimal doses.

In case of HER2-positive tumor status patients receive Pertuzumab and Trastuzumab additionally.

Description:

Primary Objectives:

To compare the pathological complete response (pCR=ypT0 ypN0) rates of neoadjuvant treatment of nab-paclitaxel with solvent-based paclitaxel as part of neoadjuvant treatment of operable or locally advanced primary breast cancer

Secondary Objectives:

• To assess the pCR rates per arm separately for the stratified subpopulations.

• To determine the rates of ypT0/is ypN0; ypT0 ypN0/+; ypT0/is ypN0/+; ypT(any) ypN0; and regression grades.

• To determine the response rates of the breast tumor and axillary nodes based on physical examination and imaging tests (sonography, mammography, or MRI) after treatment in both arms.

• To assess clinical response rate after taxane in both groups

• To determine the breast conservation rate after each treatment.

• To assess the toxicity and compliance.

• To assess the time of onset of grade 3 neuropathy

• To assess the time of resolution of grade 3/4 neuropathy to at least grade 1

• To determine loco-regional invasive recurrence free survival (LRRFS), distant-disease-free survival (DDFS), invasive disease-free survival (IDFS), and overall survival (OS) in both arms and according to stratified subpopulations.

• To assess regional recurrence free survival (RRFS) in patients with initial node-positive axilla converted to negative at surgery and treated with sentinel node biopsy alone.

• To determine the pCR rate and local recurrence free survival (LRFS) in patients with a clinical complete response (cCR) and a negative core biopsy before surgery.

• To examine and compare pre-specified molecular markers such as SPARC, gp60, calveoline 1 and other markers potentially differentially predicting efficacy of nab-paclitaxel and solvent-based paclitaxel on core biopsies before, during and after chemotherapy.

Objectives of Substudies:

• To assess, characterize, and correlate circulating tumor cells and proteins with the effect of treatment (CTC Substudy).

• To correlate Single Nucleotide Polymorphisms (SNPs) of genes with the associated toxicity and histologically assessed treatment effect (Pharmacogenetic substudy)

• To assess ovarian function measured by amenorrhea rate in correlation with changes in E2, FSH, LH , Anti-Müller Hormone, ultrasound-follicle count in patients aged < 45 years.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1229
• Est. completion date: December 2018
• Est. primary completion date: December 2018
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Patients will be eligible for study participation only if they comply with the following criteria:

• Written informed consent for all study according to local regulatory requirements prior to beginning specific protocol procedures.

• Complete baseline documentation must be sent to GBG Forschungs GmbH.

• Unilateral or bilateral primary carcinoma of the breast, confirmed histologically by core biopsy. Fine-needle aspiration alone is not sufficient. Incisional biopsy is not allowed. In case of bilateral cancer, the investigator has to decide prospectively which side will be evaluated for the primary endpoint.

• Tumor lesion in the breast with a palpable size of >= 2 cm or a sonographical size of >= 1 cm in maximum diameter. The lesion has to be measurable in two dimensions, preferably by sonography. In case of inflammatory disease, the extent of inflammation can be used as measurable lesion.

• Patients must be in the following stages of disease:

• - cT2 - cT4a-d or

• cT1c and cN+ or

• - cT1c and pNSLN+ or

• - cT1c and ER-neg and PR-neg or

• - cT1c and Ki67 > 20%

• - cT1c and HER2-pos

• In patients with multifocal or multicentric breast cancer, the largest lesion should be measured.

• Centrally confirmed ER/PR/HER-2, Ki-67 and SPARC status detected on core biopsy. ER/PR positive is defined as >1% stained cells and HER2-positive is defined as IHC 3+ or in-situ hybridisation (ISH) ratio >2.0. Formalin-fixed, paraffin-embedded (FFPE) breast tissue from core biopsy has therefore to be sent to the Dept. of Pathology at the Charité, Berlin prior to randomization.

• Age >= 18 years.

• Karnofsky Performance status index >= 80%.

• Normal cardiac function must be confirmed by ECG and cardiac ultrasound (LVEF or shortening fraction) within 3 months prior to randomization. Results must be above the normal limit of the institution. For patients with HER2-positive tumors LVEF must be >= 55%.

• Laboratory requirements:

• Hematology

• - Absolute neutrophil count (ANC) >= 2.0 x 109 / L and

• Platelets >= 100 x 109 / L and

• Hemoglobin >= 10 g/dL (>= 6.2 mmol/L)

• Hepatic function

• - Total bilirubin < 1.5x UNL and

• ASAT (SGOT) and ALAT (SGPT) <= 1.5x UNL and

• Alkaline phosphatase <= 2.5x UNL.

• Negative pregnancy test (urine or serum) within 14 days prior to randomization for all women of childbearing potential.

• Complete staging work-up within 3 months prior to randomization. All patients must have bilateral mammography, breast ultrasound (<= 21 days), breast MRI (optional), chest X-ray (PA and lateral), abdominal ultrasound or CT scan or MRI, and bone scan done. In case of positive bone scan, bone X-ray is mandatory. Other tests may be performed as clinically indicated.

• Patients must be available and compliant for central diagnostics, treatment and follow-up.

Exclusion Criteria:

• Prior chemotherapy for any malignancy.

• Prior radiation therapy for breast cancer.

• Pregnant or lactating patients. Patients of childbearing potential must implement adequate non-hormonal contraceptive measures (barrier methods, intrauterine contraceptive devices, sterilization) during study treatment.

• Inadequate general condition (not fit for anthracycline-taxane-targeted agents-based chemotherapy).

• Previous malignant disease without being disease-free for less than 5 years (except CIS of the cervix and non-melanomatous skin cancer).

• Known or suspected congestive heart failure (>NYHA I) and / or coronary heart disease, angina pectoris requiring antianginal medication, previous history of myocardial infarction, evidence of transmural infarction on ECG, uncontrolled or poorly controlled arterial hypertension (i.e. BP >160 / 90 mm Hg under treatment with two antihypertensive drugs), rhythm abnormalities requiring permanent treatment, clinically significant valvular heart disease.

• History of significant neurological or psychiatric disorders including psychotic disorders, dementia or seizures that would prohibit the understanding and giving of informed consent.

• Persons who have been admitted to an institution by order of jurisdictional or governmental grounds.

• Pre-existing motor or sensory neuropathy of grade 2 or more by NCI-CTC criteria v 4.0.

• Currently active infection.

• Definite contraindications for the use of corticosteroids.

• Known hypersensitivity reaction to one of the compounds or incorporated substances used in this protocol.

• Concurrent treatment with:

• - chronic corticosteroids unless initiated > 6 months prior to study entry and at low dose (10 mg or less methylprednisolone or equivalent).

• - sex hormones. Prior treatment must be stopped before study entry.

• - other experimental drugs or any other anti-cancer therapy.

• Participation in another clinical trial with any investigational, not marketed drug within 30 days prior to study entry.

• Male patients.

Related Conditions & MeSH terms

• Breast Cancer Female NOS
• Breast Neoplasms
• Carcinoma, Ductal, Breast
• HER-2 Positive Breast Cancer
• Inflammatory Breast Cancer
• Inflammatory Breast Cancer Stage IV
• Invasive Ductal Breast Cancer
• Mucinous Breast Cancer Stage II
• Tubular Breast Cancer Stage II
• Tubular Breast Cancer Stage III

Intervention

Drug:
• nab-Paclitaxel
nab-Paclitaxel 125 mg/m² weekly for 12 weeks
• Paclitaxel
Paclitaxel 80 mg/m² weekly for 12 weeks

Locations

Country	Name	City	State
Germany	Helios-Klinikum Berlin-Buch	Berlin

Sponsors (3)

Lead Sponsor	Collaborator
German Breast Group	Celgene Corporation, Roche Pharma AG

Country where clinical trial is conducted

Germany, 

References & Publications (4)

Gradishar WJ, Krasnojon D, Cheporov S, Makhson AN, Manikhas GM, Clawson A, Bhar P. Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. J Clin Oncol. 2009 Aug 1;27(22):3611-9. doi: 10.1200/JCO.2008.18.5397. Epub 2009 May 26. Erratum in: J Clin Oncol. 2011 Jul 1;29(19):2739. — View Citation

Huober J, von Minckwitz G, Denkert C, Tesch H, Weiss E, Zahm DM, Belau A, Khandan F, Hauschild M, Thomssen C, Högel B, Darb-Esfahani S, Mehta K, Loibl S. Effect of neoadjuvant anthracycline-taxane-based chemotherapy in different biological breast cancer phenotypes: overall results from the GeparTrio study. Breast Cancer Res Treat. 2010 Nov;124(1):133-40. doi: 10.1007/s10549-010-1103-9. Epub 2010 Aug 10. — View Citation

Loibl S, von Minckwitz G, Schneeweiss A, Paepke S, Lehmann A, Rezai M, Zahm DM, Sinn P, Khandan F, Eidtmann H, Dohnal K, Heinrichs C, Huober J, Pfitzner B, Fasching PA, Andre F, Lindner JL, Sotiriou C, Dykgers A, Guo S, Gade S, Nekljudova V, Loi S, Untch M, Denkert C. PIK3CA mutations are associated with lower rates of pathologic complete response to anti-human epidermal growth factor receptor 2 (her2) therapy in primary HER2-overexpressing breast cancer. J Clin Oncol. 2014 Oct 10;32(29):3212-20. doi: 10.1200/JCO.2014.55.7876. Epub 2014 Sep 8. — View Citation

Untch M, Jackisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Wiebringhaus H, Kümmel S, Hilfrich J, Warm M, Paepke S, Just M, Hanusch C, Hackmann J, Blohmer JU, Clemens M, Darb-Esfahani S, Schmitt WD, Dan Costa S, Gerber B, Engels K, Neklj — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Pathological complete response (pCR=ypT0 ypN0) rates of neoadjuvant treatment of nab-paclitaxel with solvent-based paclitaxel as part of neoadjuvant treatment of operable or locally advanced primary breast cancer.	No microscopic evidence of residual invasive or non-invasive viable tumor cells in all resected specimens of the breast and axilla.; Pathological response will be assessed considering all removed breast and lymphatic tissues from all surgeries.; The primary endpoint will be summarized as pathological complete remission rate for each treatment group.	24 weeks (time window + 3 weeks)
Secondary	Rates of ypT0/is ypN0; ypT0 ypN0/+; ypT0/is ypN0/+; ypT(any) ypN0, and regression grade	Response (by physical examination, imaging response, breast conservation) will also be summarized as rates in each treatment group.	24 weeks (time window + 3 weeks)
Secondary	Clinical and imaging response	To determine the response rates of the breast tumor and axillary nodes based on physical examination and imaging tests (sonography, mammography, or MRI) after treatment in both arms.	24 weeks (time window + 3 weeks)
Secondary	Tolerability and safety	Descriptive statistics for the 4 treatments (each taxane +/- anti-HER2-treatment) will be given on the number of patients whose treatment had to be reduced, delayed or permanently stopped.	during treatment (24 weeks)
Secondary	pCR rates per arm	To assess clinical response rate after taxane in both groups.	24 weeks (time window + 3 weeks)
Secondary	Breast conservation rate	To determine the breast conservation rate after each treatment.	24 weeks (time window + 3 weeks)
Secondary	Onset of grade 3 neuropathy	To assess the time of onset of grade 3 neuropathy.	24 weeks (time window + 3 weeks)
Secondary	Resolution of grade 3/4 neuropathy	To assess the time of resolution of grade 3/4 neuropathy to at least grade 1.	24 weeks (time window + 3 weeks)
Secondary	Regional recurrence free survival (RRFS) in patients with initial node-positive axilla	To assess regional recurrence free survival (RRFS) in patients with initial node-positive axilla converted to negative at surgery and treated with sentinel node biopsy alone.	until event occurs - no event for cured patients
Secondary	pCR rate and local recurrence free survival (LRFS) in patients with a clinical complete response (cCR) and a negative core biopsy	To determine the pCR rate and local recurrence free survival (LRFS) in patients with a clinical complete response (cCR) and a negative core biopsy before surgery.	24 weeks (time frame + 3 weeks)
Secondary	Examination and comparison of molecular markers	To examine and compare pre-specified molecular markers such as SPARC, gp60, calveoline 1 and other markers potentially differentially predicting efficacy of nab-paclitaxel and solvent-based paclitaxel on core biopsies before, during and after chemotherapy.; The aim is to identify potential predictive short and long term parameters.	Baseline, 12 weeks and 24 weeks (time frame + 3 weeks)
Secondary	CTC Substudy	To assess, characterize, and correlate circulating tumor cells and proteins with the effect of treatment.	Baseline, 12 weeks and 24 weeks (time frame + 3 weeks)
Secondary	Pharmacogenetic substudy	To correlate Single Nucleotide Polymorphisms (SNPs) of genes with the associated toxicity and histologically assessed treatment effect.	Baseline
Secondary	Ovarian substudy	To assess ovarian function measured by amenorrhea rate in correlation with changes in E2, FSH, LH , Anti-Müller Hormone, ultrasound-follicle count in patients aged <45 years.	Baseline, 6 months, 12 months, 18 months, 24 months 30 months
Secondary	Loco-regional invasive recurrence free survival (LRRFS) in both arms and according to stratified subpopulations.	LRRFS is defined as the time period between registration and first event and will be analyzed after the end of the study by referring to data from GBG patient's registry.	5 years
Secondary	Distant-disease-free survival (DDFS) in both arms and according to stratified subpopulations.	DDFS is defined as the time period between registration and first event and will be analyzed after the end of the study by referring to data from GBG patient's registry.	5 years
Secondary	Invasive disease-free survival (IDFS) in both arms and according to stratified subpopulations.	IDFS is defined as the time period between registration and first event and will be analyzed after the end of the study by referring to data from GBG patient's registry.	5 years
Secondary	Overall survival (OS) in both arms and according to stratified subpopulations.	OS is defined as the time period between registration and first event and will be analyzed after the end of the study by referring to data from GBG patient's registry.	5 years
Secondary	Surgical substudy in patients with high probability for pCR	If it can be shown at an interim analysis that the positive predictive value for a pCR of a negative (>=3) core biopsies before surgery in patients with complete clinical response is >90%, these patients might opt for having no further breast surgery.	Baseline, after 4 cycles and before surgery (time frame + 3 weeks)

External Links

•   Sponsor study homepage