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Efficacy and Safety Study of Trastuzumab and Paclitaxel Based Regimens to Treat HER2-positive Breast Cancer

Primary Purpose

HER-2 Positive Breast Cancer

Status
Unknown status
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Trastuzumab
Paclitaxel
Epirubicin
Carboplatin
Sponsored by
Zhimin Shao
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HER-2 Positive Breast Cancer focused on measuring HER2, Breast cancer, neoadjuvant chemotherapy, efficacy, safety

Eligibility Criteria

18 Years - 69 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Female patients, presenting for the first time with invasive breast cancer, who have not received any previous treatment for an invasive malignancy
  2. Aged ≥18 years and < 70 years with life expectancy > 12 months
  3. Histologically confirmed invasive breast cancer (excluding inflammatory breast cancer) by core needle biopsy, staged II-III according to TNM Classification System, with no evidence of metastasis and tumor size ≥3 cm
  4. HER2 positive confirmed by IHC 2+ and FISH positivity or IHC 3+
  5. At least one measurable lesion according to RECIST criteria 1.1
  6. Patients with a left ventricular ejection fraction(LVEF)≥55% by MUGA scan or echocardiography
  7. ECOG PS 0-1
  8. Willing to take biopsy before surgery and during chemotherapy and willing to take pre-operative chemotherapy and related treatment
  9. Signed written informed consent; Able to comply with the protocol

Exclusion Criteria:

  1. Patient is pregnant or lactating.
  2. Women of child-bearing potential must have a negative pregnancy test (urine or serum) within 7 days of drug administration and agree to take an adequate contraceptive measure
  3. Previous treatment with chemotherapy or hormonal therapy or any prior therapy with an anti-HER2 therapy for any malignancy.
  4. History of congestive heart failure, uncontrolled or symptomatic angina pectoris, arrhythmia or myocardial infarction
  5. Other invasive malignancy (including second primary breast cancer) which could affect compliance with the protocol or interpretation of results. Patients who have been curatively treated and free of malignant disease for greater than 5 years are generally eligible
  6. Inadequate bone marrow, hepatic and renal functions as evidenced by the following:

    • Neutrophil count of <1500/uL,
    • Platelet count of <100,000/uL.
    • Haemoglobin <10 g/dL.
    • Serum total bilirubin > 1.5*ULN (upper limit of normal),
    • ALT or AST > 2.5*ULN,
    • Alkaline phosphatase > 2.5*ULN,
    • Serum creatinine > 1.5*ULN.
  7. Other serious illness or medical condition including:

    • Congestive heart failure (NYHA class II, III, IV) or history of documented congestive heart failure, unstable angina pectoris, myocardial infarction in the last 6 months, clinically significant valvular heart disease, or high-risk uncontrolled arrhythmias.
    • Patients with dyspnoea at rest due to malignant or other disease (e.g. pulmonary metastases with lymphangitis) or who require supportive oxygen therapy.
    • Active serious uncontrolled infections.
    • Poorly controlled diabetes mellitus.
  8. Not willing to take pre-operative biopsy or neo-adjuvant therapy
  9. Patients with psychiatric disorder or other disease leading to incompliance to the therapy
  10. Known hypersensitivity to any ingredient of the regimen
  11. Treatment with any investigational drug within 30 days before the beginning of treatment with study drug.

Sites / Locations

  • Breast cancer institute of Fudan University Cancer Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Trastuzumab+ Carboplatin+Paclitaxel

Trastuzumab+Epirubicin+Paclitaxel

Arm Description

Neoadjuvant treatment regimen:Trastuzumab,Carboplatin,Paclitaxel

Neoadjuvant treatment regimen:Trastuzumab,Epirubicin,Paclitaxel

Outcomes

Primary Outcome Measures

pathologic complete response rate
Percentage of complete pathological response, e.g. no microscopic evidence of residual invasive tumor cells in any resected specimens of the breast and/or axillary nodes.

Secondary Outcome Measures

Disease free survival
Percentage of recurrence-free survival using Kaplan-Meier method, including subgroup analysis of DFS who complete 1-year trastuzumab treatment
Overall response rate
Percentage of clinical objective response using the RECIST scale
Percentage of conserving breast surgery
Percentage of conserving breast surgery
Safety
Incidence and severity of adverse events using the NCI-CTC scale 4.0

Full Information

First Posted
August 28, 2011
Last Updated
August 21, 2012
Sponsor
Zhimin Shao
Collaborators
Roche Pharma AG
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1. Study Identification

Unique Protocol Identification Number
NCT01428414
Brief Title
Efficacy and Safety Study of Trastuzumab and Paclitaxel Based Regimens to Treat HER2-positive Breast Cancer
Official Title
Multicenter, Randomized, Open-label Phase II Study to Compare the Efficacy and Safety of Trastuzumab and Paclitaxel Based Regimen Plus Carboplatin or Epirubicin as Neoadjuvant Therapy in HER2-positive Breast Cancer Patients
Study Type
Interventional

2. Study Status

Record Verification Date
August 2012
Overall Recruitment Status
Unknown status
Study Start Date
August 2011 (undefined)
Primary Completion Date
August 2014 (Anticipated)
Study Completion Date
February 2015 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Zhimin Shao
Collaborators
Roche Pharma AG

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of the investigators study is to compare the efficacy and safety of combining trastuzumab and paclitaxel based regimen plus carboplatin or epirubicin as neoadjuvant therapy in Chinese HER2-positive breast cancer patients. 100 patients from multicenter would be randomly assigned into two treatment arms and receive neoadjuvant chemotherapy followed by operation and adjuvant treatment. The main end point of this study would be the efficacy and safety of the two treatment arms, and the trend of the two curves is anticipated.
Detailed Description
With the increased awareness and development of the diagnosis of breast cancer, more and more breast cancer is diagnosed at early. Amplification or overexpression, or both, of human epidermal growth factor receptor-2 (HER2, also known as ERBB2), a transmembrane receptor tyrosine kinase, is present in around 22% of early breast cancers, 35% of locally advanced and metastatic tumors, and 40% of inflammatory breast cancers, and is associated with aggressive disease and poor prognosis. The significant efficacy and good safety profile of Trastuzumab targeting HER 2 combination with chemotherapy as adjuvant treatment on EBC are accepted. Currently Trastuzumab has moved to Neoadjuvant treatment combined with chemotherapy based on many publications, among them pCR is accepted as primary endpoint to evaluate the efficacy of neoadjuvant therapy. In the investigators study, Trastuzumab was concomitantly administered with different chemotherapies after randomization to determine the effect of this approach on the pathologic CR rates. 100 patients from multicenter would be randomly assigned into two treatment arms and receive neoadjuvant chemotherapy followed by operation and adjuvant treatment. Pathological complete response rate (pCR), disease free survival (DFS), response rates (RR), percentage of conserving breast surgery and adverse events including Serious AEs and non-serious AEs would be compared. The follow up time for each patients would be 3 years at most.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HER-2 Positive Breast Cancer
Keywords
HER2, Breast cancer, neoadjuvant chemotherapy, efficacy, safety

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Trastuzumab+ Carboplatin+Paclitaxel
Arm Type
Active Comparator
Arm Description
Neoadjuvant treatment regimen:Trastuzumab,Carboplatin,Paclitaxel
Arm Title
Trastuzumab+Epirubicin+Paclitaxel
Arm Type
Active Comparator
Arm Description
Neoadjuvant treatment regimen:Trastuzumab,Epirubicin,Paclitaxel
Intervention Type
Drug
Intervention Name(s)
Trastuzumab
Other Intervention Name(s)
Herceptin
Intervention Description
2 mg/kg, iv, d1,8,15(loading dose 4mg/kg wk1), qw
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Other Intervention Name(s)
Taxol
Intervention Description
75mg/m2, iv d1, 8,15. qw; 4-6 cycles
Intervention Type
Drug
Intervention Name(s)
Epirubicin
Other Intervention Name(s)
Epirubicin Hydrochloride for Injection
Intervention Description
75mg/m2, iv d1, q3w, 4-6 cycles
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Other Intervention Name(s)
CARBOPLATIN FOR INJECTION
Intervention Description
AUC 2, qw, iv d1, 8,15. 4-6 cycles
Primary Outcome Measure Information:
Title
pathologic complete response rate
Description
Percentage of complete pathological response, e.g. no microscopic evidence of residual invasive tumor cells in any resected specimens of the breast and/or axillary nodes.
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Disease free survival
Description
Percentage of recurrence-free survival using Kaplan-Meier method, including subgroup analysis of DFS who complete 1-year trastuzumab treatment
Time Frame
3 years at most
Title
Overall response rate
Description
Percentage of clinical objective response using the RECIST scale
Time Frame
3 years
Title
Percentage of conserving breast surgery
Description
Percentage of conserving breast surgery
Time Frame
3 years
Title
Safety
Description
Incidence and severity of adverse events using the NCI-CTC scale 4.0
Time Frame
3 years

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
69 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female patients, presenting for the first time with invasive breast cancer, who have not received any previous treatment for an invasive malignancy Aged ≥18 years and < 70 years with life expectancy > 12 months Histologically confirmed invasive breast cancer (excluding inflammatory breast cancer) by core needle biopsy, staged II-III according to TNM Classification System, with no evidence of metastasis and tumor size ≥3 cm HER2 positive confirmed by IHC 2+ and FISH positivity or IHC 3+ At least one measurable lesion according to RECIST criteria 1.1 Patients with a left ventricular ejection fraction(LVEF)≥55% by MUGA scan or echocardiography ECOG PS 0-1 Willing to take biopsy before surgery and during chemotherapy and willing to take pre-operative chemotherapy and related treatment Signed written informed consent; Able to comply with the protocol Exclusion Criteria: Patient is pregnant or lactating. Women of child-bearing potential must have a negative pregnancy test (urine or serum) within 7 days of drug administration and agree to take an adequate contraceptive measure Previous treatment with chemotherapy or hormonal therapy or any prior therapy with an anti-HER2 therapy for any malignancy. History of congestive heart failure, uncontrolled or symptomatic angina pectoris, arrhythmia or myocardial infarction Other invasive malignancy (including second primary breast cancer) which could affect compliance with the protocol or interpretation of results. Patients who have been curatively treated and free of malignant disease for greater than 5 years are generally eligible Inadequate bone marrow, hepatic and renal functions as evidenced by the following: Neutrophil count of <1500/uL, Platelet count of <100,000/uL. Haemoglobin <10 g/dL. Serum total bilirubin > 1.5*ULN (upper limit of normal), ALT or AST > 2.5*ULN, Alkaline phosphatase > 2.5*ULN, Serum creatinine > 1.5*ULN. Other serious illness or medical condition including: Congestive heart failure (NYHA class II, III, IV) or history of documented congestive heart failure, unstable angina pectoris, myocardial infarction in the last 6 months, clinically significant valvular heart disease, or high-risk uncontrolled arrhythmias. Patients with dyspnoea at rest due to malignant or other disease (e.g. pulmonary metastases with lymphangitis) or who require supportive oxygen therapy. Active serious uncontrolled infections. Poorly controlled diabetes mellitus. Not willing to take pre-operative biopsy or neo-adjuvant therapy Patients with psychiatric disorder or other disease leading to incompliance to the therapy Known hypersensitivity to any ingredient of the regimen Treatment with any investigational drug within 30 days before the beginning of treatment with study drug.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Zhi-Ming Shao, MD
Organizational Affiliation
Fudan University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Breast cancer institute of Fudan University Cancer Hospital
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200032
Country
China

12. IPD Sharing Statement

Citations:
PubMed Identifier
19720916
Citation
Sikov WM, Dizon DS, Strenger R, Legare RD, Theall KP, Graves TA, Gass JS, Kennedy TA, Fenton MA. Frequent pathologic complete responses in aggressive stages II to III breast cancers with every-4-week carboplatin and weekly paclitaxel with or without trastuzumab: a Brown University Oncology Group Study. J Clin Oncol. 2009 Oct 1;27(28):4693-700. doi: 10.1200/JCO.2008.21.4163. Epub 2009 Aug 31.
Results Reference
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PubMed Identifier
20564392
Citation
Chang HR. Trastuzumab-based neoadjuvant therapy in patients with HER2-positive breast cancer. Cancer. 2010 Jun 15;116(12):2856-67. doi: 10.1002/cncr.25120.
Results Reference
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PubMed Identifier
18421049
Citation
Piccart-Gebhart MJ, Burzykowski T, Buyse M, Sledge G, Carmichael J, Luck HJ, Mackey JR, Nabholtz JM, Paridaens R, Biganzoli L, Jassem J, Bontenbal M, Bonneterre J, Chan S, Basaran GA, Therasse P. Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer. J Clin Oncol. 2008 Apr 20;26(12):1980-6. doi: 10.1200/JCO.2007.10.8399.
Results Reference
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PubMed Identifier
17762397
Citation
Nistico C, Bria E, Cuppone F, Fornier M, Sperduti I, Carpino A, Pace A, Cognetti F, Terzoli E. Weekly epirubicin and paclitaxel with granulocyte colony-stimulating factor support in previously untreated metastatic breast cancer patients: a phase II study. Anticancer Drugs. 2007 Jul;18(6):687-92. doi: 10.1097/CAD.0b013e328035f863.
Results Reference
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PubMed Identifier
20113825
Citation
Gianni L, Eiermann W, Semiglazov V, Manikhas A, Lluch A, Tjulandin S, Zambetti M, Vazquez F, Byakhow M, Lichinitser M, Climent MA, Ciruelos E, Ojeda B, Mansutti M, Bozhok A, Baronio R, Feyereislova A, Barton C, Valagussa P, Baselga J. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010 Jan 30;375(9712):377-84. doi: 10.1016/S0140-6736(09)61964-4.
Results Reference
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PubMed Identifier
19195817
Citation
Han S, Kim J, Lee J, Chang E, Gwak G, Cho H, Yang KH, Park S, Park K. Comparison of 6 cycles versus 4 cycles of neoadjuvant epirubicin plus docetaxel chemotherapy in stages II and III breast cancer. Eur J Surg Oncol. 2009 Jun;35(6):583-7. doi: 10.1016/j.ejso.2009.01.002. Epub 2009 Feb 5.
Results Reference
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Efficacy and Safety Study of Trastuzumab and Paclitaxel Based Regimens to Treat HER2-positive Breast Cancer

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