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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03595592
Other study ID # FM-17-B01
Secondary ID 2017-000981-31
Status Active, not recruiting
Phase Phase 3
First received
Last updated
Start date September 7, 2018
Est. completion date March 15, 2027

Study information

Verified date March 2024
Source Fondazione Michelangelo
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

n the present study the neoadjuvant approach with the anti-HER2 trastuzumab and pertuzumab combined with carboplatin and paclitaxel will be used to compare the Event-Free Survival (EFS) in regimens with and without atezolizumab. Following the neoadjuvant part of the study, after surgery all patients will continue to receive trastuzumab and pertuzumab to complete one year of anti-HER2 therapy. Similarly, patients allocated to receive atezolizumab will continue atezolizumab to complete one year In addition, several IHC and molecular assays will be performed before and during the period of chemotherapy administration and at surgery with the goal of defining a marker of efficacy to be later validated in a larger adjuvant setting.


Description:

Dual targeting of HER2 with trastuzumab and pertuzumab in HER2-positive breast cancer is linked to clinical evidence of reversal of initial resistance to trastuzumab (Baselga J et al, J Clin Oncol 2010) in cases progressing on trastuzumab therapy, and in dramatic improvement in progression free and overall survival when the two monoclonal antibodies are used in combination with docetaxel (THP regimen) as first line therapy of metastatic disease as shown in the CLEOPATRA study (Swain S et al, ESMO abstract 2014). The randomized NeoSphere study showed that the same THP regimen given for 4 cycles as neoadjuvant treatment increased the rate of pathologic complete response (pCR) over that with conventional docetaxel and trastuzumab or docetaxel and pertuzumab (Gianni L et al, Lancet Oncol 2012). Encouraging clinical data emerging in the field of tumor immunotherapy have demonstrated that therapies focused on enhancing T cell responses against cancer can result in a significant survival benefit in patients with advanced malignancies (Hodi FS and Dranoff G, J Cutan Pathol 2010; Kantoff PW et al, New Engl J Med 2010; Chen DS et al, Clin Cancer Res 2012). Many human tumors have been found to overexpress PD L1, which acts to suppress anti tumor immunity. PD 1 is an inhibitory receptor expressed on T cells following T cell activation, which is sustained in states of chronic stimulation, such as in chronic infection or canc Atezolizumab is a human monoclonal antibody containing an engineered Fc-domain to optimize efficacy and safety that targets PD-L1 and blocks binding of its receptors, including PD-1 and B7.1. In addition to being involved in the natural progression of cancer, immunity can affect the activity of various anticancer agents. Accordingly, recent evidence suggests that some chemotherapeutic drugs, such as anthracyclines and oxaliplatin, rely on the induction of anticancer immune responses. Immune responses also play a major role in the efficacy of targeted therapies with monoclonal antibodies (Stagg J et al, Breast Care 2012). Studies have shown monoclonal antibodies such as trastuzumab and rituximab rely in part on immunemediated killing through antibody-dependent cellular cytotoxicity (ADCC). While innate immune responses appear to be important for tumor antigen-targeted monoclonal antibody therapies, recent studies in mice and correlative clinical evidence suggest that trastuzumab may also stimulate adaptive antitumor immunity. These studies raise the possibility that combination strategies may be used to capitalize on the adaptive tumor-specific immunity generated by anti-HER2 monoclonal antibodies. Based on these considerations, we plan to conduct a randomized neoadjuvant study of the combination of trastuzumab, pertuzumab, carboplatin and paclitaxel with or without atezolizumab in women with early high-risk and locally advanced HER2-positive suitable for neoadjuvant therapy. One study arm will also include anthracycline and cyclophosphamide.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 650
Est. completion date March 15, 2027
Est. primary completion date December 15, 2026
Accepts healthy volunteers No
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria: 1. Female patients aged 18 years or older with early high-risk ((T1cN1; T2N1; T3N0) or locally advanced and inflammatory breast cancers (stage III A-C according to AJCC) suitable for neoadjuvant treatment 2. Histologically confirmed unilateral invasive breast cancer 3. HER2 positive disease according to ASCO/CAP guidelines 2013 [defined as IHC 3+ or ISH positive (by gene copy number or HER2 gene/CEP17 ratio of 2 or greater)] 4. Known estrogen (ER) and progesterone receptor (PgR) 5. Availability of a representative paraffin-embedded (FFPE) tumor block taken at diagnostic biopsy for central confirmation of HER2 eligibility, for assessment of ER, PgR, Ki67 and PD-L1 expression and for biomarker evaluation is mandatory. Note: the diagnostic biopsy of the breast lesion may have been taken before the required screening procedures. If diagnostic sentinel node biopsy if performed, an FFPE block must be available. An FFPE tumor block is also mandatory after the first cycle of therapy. Surgery tissue (residual tumor or tumor bed in case of pCR and axillary node material) is also mandatory. 6. Consent to the collection of blood samples mandatorily before starting neoadjuvant treatment, after the first cycle of therapy, at the end of neoadjuvant treatment (before surgery), 6 months after surgery and at the end of all treatments. 7. ECOG performance status 0 or 1 8. For women who are not postmenopausal (= 12 months of non-therapy-induced amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to remain abstinent or use single or combined contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 6 months after the last dose of study drugs. Abstinence is only acceptable if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception. Examples of contraceptive methods with a failure rate of < 1% per year include tubal ligation, male sterilization, hormonal implants, established, proper use of combined oral or injected hormonal contraceptives, and certain intrauterine devices. Alternatively, two methods (e.g., two barrier methods such as a condom and a cervical cap) may be combined to achieve a failure rate of < 1% per year. Barrier methods must always be supplemented with the use of a spermicide 9. Written informed consent to participate in the trial (approved by the Institutional Review Board [IRB]/ Independent Ethics Committee [IEC]) obtained prior to any study specific screening procedures 10. Willing and able to comply with the protocol Exclusion Criteria: 1. Evidence of bilateral breast cancer or metastatic disease (M1) 2. Patients with HER2-negative defined as 0-1+ by immunohistochemistry or 2+ by immunohistochemistry without HER2 amplification by either In Situ Hybridization (ISH) or other amplification tests done locally are considered not eligible for the study 3. Pregnant or lactating women. Documentation of a negative pregnancy test must be available for premenopausal women with intact reproductive organs and for women less than one year after the last menstrual cycle 4. Women with childbearing potential unless (1) surgically sterile or (2) using adequate measures of contraception, for example abstinence, an intra-uterine device, or double barrier method of contraception 5. Previous treatment with chemotherapy, hormonal therapy or an investigational drug for any type of malignancy 6. Previous investigational treatment for any condition other than malignancy within 4 weeks of randomization date 7. Administration of a live, attenuated vaccine within 4 weeks before Day 1 or anticipation that such a live attenuated vaccine will be required during the study 8. Previous or concomitant malignancy of any other type that could affect compliance with the protocol or interpretation of results. Patients with curatively treated basal cell carcinoma of the skin or in situ cervix cancer are generally eligible 9. Pre-existing motor or sensory neuropathy of grade > 1 for any reason 10. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins 11. Known hypersensitivity or allergy to biopharmaceuticals produced in Chinese hamster ovary cells or any component of the atezolizumab formulation 12. Patients with prior allogeneic stem cell or solid organ transplantation 13. History of autoimmune disease including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Bell's palsy, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis 14. History of idiopathic pulmonary fibrosis (including bronchiolitis obliterans with organizing pneumonia) or evidence of active pneumonitis on screening chest computed tomography scan 15. Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis, cirrhosis, fatty liver, and inherited liver disease 16. History of HIV infection, active hepatitis B (chronic or acute), or hepatitis C infection. Patients with past or resolved hepatitis B infection (defined as having a negative HBsAg test and a positive hepatitis B core antigen [anti-HBc] test) are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction assay (PCR) is negative for HCV RNA 17. Active tuberculosis 18. Severe infections within 4 weeks prior to Day 1, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia. Signs or symptoms of significant infection within 2 weeks prior to Day 1 19. Received oral or IV antibiotics within 2 weeks prior to Cycle 1 Day 1 20. Other serious illness or medical condition including: history of documented congestive cardiac failure; New York Heart Association (NYHA) Class II or greater CHF; angina pectoris requiring anti-anginal medication or unstable angina within 6 months prior to Day 1; evidence of transmural infarction on ECG; myocardial infarction stroke or transient ischemic attack (TIA) within 6 months prior to Day 1; poorly controlled hypertension (e.g. systolic >180 mm Hg or diastolic >100 mm Hg; however, patients with hypertension which is well controlled on medication are eligible); clinically significant valvular heart disease; high-risk uncontrolled arrhythmias 21. Patients with a history of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the investigator to be clinically significant and precluding informed consent or adversely affecting compliance with study drugs 22. Serious uncontrolled infections (bacterial or viral) or poorly controlled diabetes mellitus 23. Any of the following abnormal baseline hematological values: 1. White blood count (WBC) < 2.5 x 109/L 2. Absolute Neutrophil Count (ANC) < 1.5 x 109/L 3. Lymphocyte count < 0.5 x 109/L 4. Platelet count < 100 x 109/L 5. Hemoglobin (Hb) < 10 g/dL 24. Any of the following abnormal baseline laboratory tests 1. Serum total bilirubin > 1.5 x ULN (upper limit of normal) (except for patients with clearly documented Gilbert's syndrome) 2. Alanine transaminase (ALT) or aspartate transaminase (AST) > 1.25 x ULN 3. Alkaline phosphatase > 2.5xx ULN 4. Serum creatinine > 1.5 x ULN 5. INR and aPTT > 1.5 × ULN within 2 weeks prior to enrollment. This applies only to patients who are not receiving therapeutic anticoagulation; patients receiving therapeutic anticoagulation should be on a stable dose. 25. Baseline left ventricular ejection fraction (LVEF) < 50% by echocardiography or multi-gated scintigraphic scan (MUGA) 26. Major surgical procedure within 28 days prior to Day 1 or anticipation of need for a major surgical procedure during the course of the study 27. Influenza vaccination should be given during influenza season only (approximately October to March). Patients must not receive live, attenuated influenza vaccine (e.g., FluMist®) within 4 weeks prior to Day 1 or at any time during the study.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Trastuzumab
Trastuzumab will be given i.v. on day 1 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
Pertuzumab
Pertuzumab will be given i.v. on day 1 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
Carboplatin
Carboplatin will be given i.v. on day 1 and day 8 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
Paclitaxel
Paclitaxel will be given i.v. on day 1 and day 8 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
Doxorubicin
Adriamycin will be delivered i.v. on day 1 every 3 weeks in arm ACy followed by HPCT for the first 3 cycles
Cyclophosphamide
Cyclophosphamide will be given i.v. on day 1 every 3 weeks in arm ACy followed by HPCT and atezolizumab for the first 3 cycles
Atezolizumab
Atezolizumab will be given i.v. on day 1 every 3 weeks in arm ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
Procedure:
Surgery
Breast cancer surgery (breast and axilla) either conservative or radical not later than 4 weeks from the last dose of neoadjuvant therapy in all study arms

Locations

Country Name City State
Austria Klinikum Klagenfurt am Wörthersee Abteilung für Innede Medizin und Hämatologie und internistische Onkologie Klagenfurt am Wörthersee
Austria Krankenhaus der Barmherzigen Schwestern Linz
Austria Universitätsklinikum St. Pölten Klinische Abteilung für Innere Medizin St. Poelten
Austria Klinische Abteilung für Allgemeine Gynäkologie und Gynäkologische Onkologie - Universitätsklinik für Frauenheilkunde Medizinische Universität Wien / AKH " Wien
Germany Klinik für Gynäkologie am Campus Charité Mitte (CCM) Berlin
Germany Department of Gynecology and Obstetrics, Marienhospital Bottrop
Germany Klinikum Coburg, Frauenklinik Coburg
Germany St Johannes Hospital Dortmund
Germany Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Universitätsklinikum Carl Gustav Carus Dresden
Germany Markus Krankenhaus - Klinik für Gynäkologie und Geburtshilfe Frankfurt
Germany SRH Waldklinikum Gera
Germany Universitätsklinikum Greifswald, Frauenklinik Greifswald
Germany Klinik und Poliklinik für Gynäkologie am Universitätsklinikum (Saale) Halle (saale)
Germany Gynäkologisch-Onkologische Praxis Hannover
Germany NCT Nationales Zentrum für Tumorerkrankungen Gynäkologische Onkologie, Frauenklinik Heidelberg
Germany St. Marien-Klinik GmbH Frauenklinik der St. Vincentius-Kliniken gAG - Gynäkologisches Krebszentrum Karlsruhe - Brustzentrum Karlsruhe Karlsruhe
Germany Städtisches Klinikum Magdeburg - Klinik für Allgemein - und Viszeralchirurgie Magdeburg
Germany Am Schillerhain 1-8 Marktredwitz
Germany Klinikum Nürnberg Nord Nürnberg
Germany Onkologische Praxis Velbert Velbert
Germany Marien Hospital Witten Witten
Italy Ospedale Papa Giovanni XXIII Bergamo
Italy Presidio Ospedaliero Di Summa-Perrino Brindisi
Italy Dipartimento di Oncologia Medica AUSL della Romagna Faenza
Italy IST San Martino Genova
Italy Istituto Scientifico Romagnolo per lo studio e la cura dei tumori Meldola
Italy Fondazione IRCCS Istituto Nazionale dei Tumori Milano
Italy Istituto Europeo di Oncologia Milano
Italy Ospedale Luigi Sacco Milano
Italy Ospedale San Raffaele Milano
Italy AO Universitaria Policlinico di Modena Modena
Italy Ospedale Sacro Cuore - Don Calabria Negrar
Italy Fondazione Salvatore Maugeri Pavia
Italy Azienda Ospedaliero Universitaria Pisana Ospedale S. Chiara Pisa
Italy Arcispedale Santa Maria Nuova - A.O. Reggio Emilia Reggio Emilia
Italy Ospedale Infermi AUSL della Romagna Rimini
Italy Istituto Nazionale Tumori - Regina Elena Roma
Italy Ospedale Santa Maria della Misericordia Udine
Spain Centro Oncologico de Galicia A Coruña
Spain Hospital Virgen de Los Lirios Alcoy
Spain Hospital General Unv. Alicante Alicante
Spain "Hospital Infanta Cristina de Badajoz (CICAB - Centro de Investigación Clínica del Área de Salud de Badajoz)" Badajoz
Spain Hospital Clinic Provincial Barcelona
Spain Hospital de la Santa Creu i Sant Pau Barcelona
Spain Hospital del Mar - IMAS Barcelona
Spain Hospital de Basurto Bilbao
Spain Hospital San Pedro de Alcantara Cáceres
Spain Hospital Virgen de la Nieves Granada
Spain Hospital Juan Ramón Jimenez Huelva
Spain Hospital Clinico San Carlos Madrid
Spain Hospital de Fuenlabrada Madrid
Spain Hospital Gregorio Marañon Madrid
Spain Hospital Unv. Fundación Jimenez Diaz Madrid
Spain MD Anderson Cancer Center Madrid
Spain Complejo Hospitalario de Especialidades Virgen de la Victoria Málaga
Spain Hospital General Universitario Morales Meseguer Murcia
Spain Clinica Universitaria de Navarra Pamplona
Spain Complejo Hospitalario de Salamanca Salamanca
Spain Hospital de Donostia San Sebastián
Spain Hospital Onkologikoa San Sebastián
Spain Hospital Clinico Unv. de Santiago Santiago De Compostela
Spain Hospital Virgen de la Salud de Toledo Toledo
Spain Hospital Clínico Universitario de Valencia Valencia
Spain Hospital Lozano Blesa Zaragoza
Spain Hospital Miguel Servet Zaragoza

Sponsors (2)

Lead Sponsor Collaborator
Fondazione Michelangelo Hoffmann-La Roche

Countries where clinical trial is conducted

Austria,  Germany,  Italy,  Spain, 

Outcome

Type Measure Description Time frame Safety issue
Primary Event Free Survival (EFS) Assess EFS (disease progression while on neoadjuvant therapy or disease recurrence after surgery) in the study arms 5 years after the randomization of the last patient
Secondary Pathological complete response (pCR) Assess the rate of pCR defined as absence of invasive cancer in both breast and axillary nodes (ypT0Tis ypN0) At surgery, an expected average of 26 weeks after the randomization of the last patients
Secondary Clinical objective response Assess the rate of clinical response rate after neoadjuvant therapy Participants will be followed for the duration of neoadjuvant therapy, an expected average of 22 weeks
Secondary Distant Event Free Survival (DEFS) Assess DEFS (defined as the occurrence of distant disease progression while on neoadjuvant therapy or distant disease recurrence after surgery) in the study arms 5 years after the randomization of the last patients
Secondary Overall Survival (OS) Assess OS in all arms 5 years after the randomization of the last patient
Secondary Number of participants with adverse events as a measure of safety and tolerability Number of participants with adverse events and related grades in all arms Participants will be followed for up to 5 years from the last randomized patient
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