NordicTrip, a Translational Study of Preoperative Chemotherapy in TNBC
Breast Cancer, Triple Negative Breast Neoplasms
About this trial
This is an interventional treatment trial for Breast Cancer focused on measuring Breast neoplasms, Triple negative breast neoplasms, Neoadjuvant treatment, Translational research, Pathologic response, Pathologic complete response, epirubicin, cyclophosphamide, paclitaxel, carboplatin, capecitabine, Survival outcomes, Homologous repair deficiency, pembrolizumab
Eligibility Criteria
Inclusion Criteria:
- Signed written informed consent approved by the Ethical Review Board (IRB).
- Age 18 to 75 years.
- Histologically confirmed unilateral adenocarcinoma of the breast where neoadjuvant chemotherapy followed by definitive surgery is planned.
- Node positive disease (N1-3) or if clinically N0 Tumor size >20 mm.
ER negative tumor defined by at least one the following:
- ER < 1% cells positive by immuno-histochemistry (IHC)
- ER < 10% cells positive by IHC and progesterone receptor) progesterone receptor (PgR) < 10% cells positive by IHC
Human Epidermal Growth Factor Receptor2 (HER2)-normal tumor defined by at least one of the following:
- HER2 0 or 1+ by immunohistochemistry
- HER2 2+ by IHC and HER2 to centromere 17 ratio < 2.0 and/or less than 6 copies by in situ hybridization [ISH]).
Comment: Patients with 3+ IHC for HER2 will not be included irrespective of the outcome of in situ hybridization (ISH)-analysis.
- Consent for germline mutation screening for BRCA1, BRCA2 and other inherited breast cancer associated genes.
- World Health Organization (WHO) performance status 0 or 1.
- Negative pregnancy test in women of childbearing potential (premenopausal or <12 months of amenorrhea post-menopause and who have not undergone surgical sterilization).
- Willingness by the patient to undergo treatment according to the protocol and study related procedures.
Exclusion Criteria:
- Clinical or radiological signs of metastatic disease.
- Clinically inflammatory breast cancer
- History of other malignancy within the last 5 years, except for carcinoma in situ of the cervix or non-melanoma skin cancer.
- Previous chemotherapy for cancer or other malignant disease.
- Charlson comorbidity index, excluding score for malignancy: (CCI) > 2, Comment: In patients 70-75 a CCI = 3 is allowed, see appendix B.
Inadequate organ function, suggested by the following laboratory results:
a. Absolute neutrophil count < 1,5 x 109/l b Platelet count < 100 x 109/l c Haemoglobin < 90 g/L d Total bilirubin greater than the upper limit of normal (ULN) unless the patient has documented Gilbert´s syndrome e Aspartate Aminotransferase (AST), (SGOT) and/or Alanine Aminotransferase (ALT), (SGPT) > 2,5 x ULN f AST (SGOT) and/or ALT (SGPT) > 1,5 x ULN with concurrent serum alkaline phosphatase (ALP) > 2,5 x ULN g Serum creatinine clearance < 50 mL/min
- Concurrent peripheral neuropathy of grade 3 or greater (NCI-CTCAE, Version 5.0)
- Patient who is actively breast feeding.
- Assessed by the Investigator to be unable or unwilling to comply with the requirements of the protocol.
Sites / Locations
- Odense University HospitalRecruiting
- Vejle Hospital
- Aalborg UniversitetshospitaRecruiting
- RigshospitaletRecruiting
- Sydvestjysk SygehusRecruiting
- Nordsjællands HospitalRecruiting
- Regionsjælland Næstved SygehusRecruiting
- Sønderborg sygehusRecruiting
- Vejle syghusRecruiting
- Centralsjukhuset i Kristianstad
- Södra Älvsborgs HospitalRecruiting
- Gävle hospital, Department of OncologyRecruiting
- Sahlgrenska University Hospital, Department of OncologyRecruiting
- Halmstad Hospital, Department of Surgery
- Ryhov HospitalRecruiting
- Karlstad HospitalRecruiting
- Skåne University Hospital, Department of OncologyRecruiting
- Capio S:t Göran Hospital, Department of OncologyRecruiting
- Södersjukhuset, Department of OncologyRecruiting
- Sundsvall hospitalRecruiting
- Norrland University Hospital, Department of OncologyRecruiting
- Academical Hospital, Department of OncologyRecruiting
- Västmanlands Hopsital VästeråsRecruiting
- Växjö Hospital, Department of OncologyRecruiting
- Örebro University Hospital, Department of OncologyRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Arm A (Platinum-based dose dense EC):
Arm B (Platinum-based with capecitabine):
ddEC x 4 + pembrolizumab→ PK x 4 + pembrolizumab, Two-weekly epirubicin/cyclophosphamide (EC) x 4 (epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2), followed after a three-week interval by three-weekly carboplatin x 4 (AUC = 5) together with weekly paclitaxel x 12 (80 mg/m2). Pembrolizumab is given as a 400 mg iv dosis every 6 weeks for the duration of preoperative chemotherapy.*
CEX x 4→ PK x 4, Three-weekly cyclophosphamide/epirubicin/capecitabine (CEX) (epirubicin 75 mg/m2, cyclophosphamide 600 mg/m2 and capecitabine 900 mg/m2) x 4, followed after a three-week interval by three-weekly carboplatin x 4 (AUC = 5) together with weekly paclitaxel x 12 (80 mg/m2).Pembrolizumab is given as a 400 mg iv dosis every 6 weeks for the duration of preoperative chemotherapy.* *The addition of pembrolizumab is strongly recommended to all participating patients. However, patients with a documented contraindication, or unwilling to receive immunotherapy may be included in the study without the administration of pembrolizumab.