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Neoadjuvant Treatment Pegylated Liposomal Doxorubicin Plus Cyclophosphamide Sequential Docetaxel Plus Trastuzumab and Pertuzumab Versus Docetaxel Plus Carboplatin Combined With Trastuzumab and Pertuzumab in HER-2 Positive Breast Cancer

Primary Purpose

Breast Cancer

Status
Recruiting
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
pegylated liposomal doxorubicin (PLD)
cyclophosphamide (C)
trastuzumab (H)
pertuzumab (P)
docetaxel (T)
docetaxel (T)
carboplatin (Cb)
trastuzumab (H)
pertuzumab (P)
Sponsored by
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Female patients aged from 18 to 70 years old;
  2. Histologically confirmed as invasive breast cancer and without previous treatment.;
  3. HER-2 Positive (defined by IHC 3+ or ISH positive);
  4. Tumor > 2cm;
  5. Biopsy pathology (FNAB or CNB) diagnosed regional lymph node metastasis within 28 days prior to randomization;
  6. Participants must have at least one measurable disease according to RECIST 1.1.
  7. Participants with multifocal tumors (more than one tumor confined to the same quadrant as the primary tumor) are eligible provided all discrete lesions are sampled and centrally confirmed as HER2 positive.
  8. Operable breast cancer with cT2-cT4/cN1-cN3/cM0, according to the AJCC tumor staging manual (8th Edition).
  9. The HR(ER and PR) status of the primary tumor and the expression level of Ki-67 are clear.
  10. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1;
  11. LVEF ≥ 55%;
  12. Brain natriuretic peptide (BNP) (or N-terminal pro brain natriuretic peptide (NT proBNP)) and cardiac troponin assays were within normal values.
  13. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and serum total bilirubin are all ≤2 ULN. Serum creatinine ≤ 1.5 ULN.
  14. Bone marrow function: white blood cell counts ≥ 3.0x10^9/L, absolute neutrophil counts (ANC) ≥ 1.5x10^9/L, platelets ≥ 100x10^9/L, hemoglobin ≥ 90g/L;
  15. Participants had good compliance with the planned treatment and follow-up, understood the study procedures of this study, and signed informed consent form.

Exclusion Criteria:

  1. Breast cancer with distant metastasis;
  2. Participants with multiple lesions (in different quadrants) or bilateral breast cancer;
  3. Participants who have received prior anti-cancer therapy for breast cancer except those participants with a history of breast lobular carcinoma in situ (LCIS) that was surgically managed or ductal carcinoma in situ (DCIS) treated exclusively with mastectomy. In case of prior history of LCIS/DCIS, >5 years must have passed from surgery until diagnosis of current breast cancer;
  4. In the past and present, participants with severe cardiac disease or discomfort , including but not limited: 1)High-risk uncontrolled arrhythmia, atrial tachycardia (heart rate > 100/min in resting state), significant ventricular arrhythmia (ventricular arrhythmia) or higher atrioventricular block (second-degree type 2 [Mobitz 2] atrioventricular block or third-degree atrioventricular block); 2)Angina pectoris requiring anti-angina medication; 3)Clinically significant valvular heart disease; 4)ECG showing transmural myocardial infarction; 5)Uncontrolled hypertension (eg systolic blood pressure > 180mm Hg or diastolic blood pressure > 100mmHg); 6)Myocardial infarction; 7)Congestive heart failure;
  5. Participants have the following serious illnesses or medical conditions, including but not limited: 1)History of serious neurological or psychiatric disorders, including psychosis, dementia, or epilepsy, that prevent understanding and informed consent; 2)Active uncontrolled infection; 3)Active peptic ulcer, unstable diabetes;
  6. A history of other malignancies within the previous 5 years, except for adequately treated carcinoma in situ of the cervix or basal cell carcinoma of the skin;
  7. Treatment with any investigational drug within 28 days prior to randomization;
  8. Participants who are known to be allergic to the active or other components of the study treatment or have contraindications for surgery;
  9. Participants who are pregnant, breastfeeding, or refuse to use adequate contraception prior to study entry and for the duration of study participation;
  10. Participants who were judged by the investigator to be unsuitable for this study.

Sites / Locations

  • Sunyat-sen Memorial HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

PLD + C + HP followed by THP

TCbHP

Arm Description

pegylated liposomal doxorubicin (PLD) 30 mg/m^2, i.v., d1 + cyclophosphamide (C) 600 mg/m^2, i.v., d1 + trastuzumab (H) 8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., d1 + pertuzumab (P) 840 mg loading dose, 420 mg maintenance doses, i.v., d1 followed by docetaxel (T) 90~100 mg/m^2, i.v., d1 + trastuzumab (H) 6 mg/kg, i.v., d1 + pertuzumab (P) 420 mg, i.v., d1 q3w, for 4 cycles. After neoadjuvant therapy, patients are required to receive a total of 1 year of treatment with trastuzumab (6mg/kg) combined with pertuzumab (420mg), i.v., d1, q3w, regardless of surgery.

docetaxel (T) 75 mg/m^2, i.v., d1 + carboplatin (Cb) AUC 6, i.v., d1 + trastuzumab (H) 8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., d1 + pertuzumab (P) 840 mg loading dose, 420 mg maintenance doses, i.v., d1 q3w, for 6 cycles. After neoadjuvant therapy, patients are required to receive a total of 1 year of treatment with trastuzumab (6mg/kg) combined with pertuzumab (420mg), i.v., d1, q3w, regardless of surgery.

Outcomes

Primary Outcome Measures

Pathological complete response (pCR) rate
The percentage of participants without residual invasive cancer (ypT0/Tis ypN0 in the current AJCC staging system) when the complete resected breast specimen and all sampled regional lymph nodes were evaluated with hematoxylin and eosin staining after completion of systemic neoadjuvant therapy.

Secondary Outcome Measures

Objective response rate (ORR) at the end of neoadjuvant chemotherapy
The number of participants who achieved complete response and partial response at the end of neoadjuvant chemotherapy as a percentage of the overall evaluable participants.
5-year disease-free survival (DFS) rate
DFS is defined as the time from randomization to tumor recurrence or death from any cause. 5-year DFS rate is the percentage of participants with DFS from enrollment through 5 years.
Breast conservation rate at surgery
Percentage of participants receiving breast-conserving surgery after neoadjuvant therapy.
Number of participants with treatment-related adverse events as assessed by NCI-CTCAE V5.0, including overall and Grade 3/4 adverse events.
Number of participants with treatment-related adverse events as assessed by NCI-CTCAE V5.0, including overall and Grade 3/4 adverse events.
Percentage of Participants with dose reductions of chemotherapy due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Percentage of Participants with dose reductions of chemotherapy due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Percentage of Participants with chemotherapy delay due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Percentage of Participants with chemotherapy delay due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Relative dose intensity (RDI)
RDI=actual dose intensity* / standard dose intensity# actual dose intensity* = drug standard dose (mg/m^2) / weeks of administration per cycle (week) standard dose intensity# = actual standard dose (mg/m^2) / actual dosing weeks (week)

Full Information

First Posted
November 25, 2021
Last Updated
February 17, 2022
Sponsor
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Collaborators
CSPC Ouyi Pharmaceutical Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT05159193
Brief Title
Neoadjuvant Treatment Pegylated Liposomal Doxorubicin Plus Cyclophosphamide Sequential Docetaxel Plus Trastuzumab and Pertuzumab Versus Docetaxel Plus Carboplatin Combined With Trastuzumab and Pertuzumab in HER-2 Positive Breast Cancer
Official Title
A Multicentre, Open-label, Randomised Trial of Neoadjuvant Pegylated Liposomal Doxorubicin Plus Cyclophosphamide Sequential Docetaxel Plus Trastuzumab and Pertuzumab Versus Docetaxel Plus Carboplatin Combined With Trastuzumab and Pertuzumab in HER-2 Positive Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Recruiting
Study Start Date
December 20, 2021 (Actual)
Primary Completion Date
October 30, 2024 (Anticipated)
Study Completion Date
January 31, 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Collaborators
CSPC Ouyi Pharmaceutical Co., Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This is a multicenter, open label, non-inferiority, randomized controlled clinical study. The aim of this study is to evaluate the efficacy and safety of a pegylated liposomal doxorubicin + cyclophosphamide followed by docetaxel plus trastuzumab and pertuzumab (PLD + C + HP followed by THP) regimen compared with a docetaxel + carboplatin plus trastuzumab and pertuzumab (TCbHP) regimen in the neoadjuvant treatment of HER-2-positive breast cancer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
372 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
PLD + C + HP followed by THP
Arm Type
Experimental
Arm Description
pegylated liposomal doxorubicin (PLD) 30 mg/m^2, i.v., d1 + cyclophosphamide (C) 600 mg/m^2, i.v., d1 + trastuzumab (H) 8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., d1 + pertuzumab (P) 840 mg loading dose, 420 mg maintenance doses, i.v., d1 followed by docetaxel (T) 90~100 mg/m^2, i.v., d1 + trastuzumab (H) 6 mg/kg, i.v., d1 + pertuzumab (P) 420 mg, i.v., d1 q3w, for 4 cycles. After neoadjuvant therapy, patients are required to receive a total of 1 year of treatment with trastuzumab (6mg/kg) combined with pertuzumab (420mg), i.v., d1, q3w, regardless of surgery.
Arm Title
TCbHP
Arm Type
Active Comparator
Arm Description
docetaxel (T) 75 mg/m^2, i.v., d1 + carboplatin (Cb) AUC 6, i.v., d1 + trastuzumab (H) 8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., d1 + pertuzumab (P) 840 mg loading dose, 420 mg maintenance doses, i.v., d1 q3w, for 6 cycles. After neoadjuvant therapy, patients are required to receive a total of 1 year of treatment with trastuzumab (6mg/kg) combined with pertuzumab (420mg), i.v., d1, q3w, regardless of surgery.
Intervention Type
Drug
Intervention Name(s)
pegylated liposomal doxorubicin (PLD)
Other Intervention Name(s)
duomeisu, Doxorubicin Hydrochloride Liposome Injection
Intervention Description
pegylated liposomal doxorubicin (PLD) 30 mg/m^2, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide (C)
Other Intervention Name(s)
huanlinxianan
Intervention Description
cyclophosphamide (C) 600 mg/m^2, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
trastuzumab (H)
Other Intervention Name(s)
qutuozhudankang
Intervention Description
trastuzumab (H) 8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
pertuzumab (P)
Other Intervention Name(s)
patuozhudankang
Intervention Description
pertuzumab (P) 840 mg loading dose, 420 mg maintenance doses, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
docetaxel (T)
Other Intervention Name(s)
duoxitasai
Intervention Description
docetaxel (T) 90~100 mg/m^2, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
docetaxel (T)
Other Intervention Name(s)
duoxitasai
Intervention Description
docetaxel (T) 75 mg/m^2, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
carboplatin (Cb)
Other Intervention Name(s)
kabo
Intervention Description
carboplatin (Cb) AUC 6, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
trastuzumab (H)
Other Intervention Name(s)
qutuozhudankang
Intervention Description
trastuzumab (H) 8 mg/kg loading dose, 6 mg/kg maintenance doses, i.v., d1, q3w
Intervention Type
Drug
Intervention Name(s)
pertuzumab (P)
Other Intervention Name(s)
patuozhudankang
Intervention Description
pertuzumab (P) 840 mg loading dose, 420 mg maintenance doses, i.v., d1, q3w
Primary Outcome Measure Information:
Title
Pathological complete response (pCR) rate
Description
The percentage of participants without residual invasive cancer (ypT0/Tis ypN0 in the current AJCC staging system) when the complete resected breast specimen and all sampled regional lymph nodes were evaluated with hematoxylin and eosin staining after completion of systemic neoadjuvant therapy.
Time Frame
Within 2 to 5 weeks after completion of neoadjuvant therapy
Secondary Outcome Measure Information:
Title
Objective response rate (ORR) at the end of neoadjuvant chemotherapy
Description
The number of participants who achieved complete response and partial response at the end of neoadjuvant chemotherapy as a percentage of the overall evaluable participants.
Time Frame
After the last dose to before surgery or within 21 days
Title
5-year disease-free survival (DFS) rate
Description
DFS is defined as the time from randomization to tumor recurrence or death from any cause. 5-year DFS rate is the percentage of participants with DFS from enrollment through 5 years.
Time Frame
5 years
Title
Breast conservation rate at surgery
Description
Percentage of participants receiving breast-conserving surgery after neoadjuvant therapy.
Time Frame
Within 2 to 5 weeks after completion of neoadjuvant therapy
Title
Number of participants with treatment-related adverse events as assessed by NCI-CTCAE V5.0, including overall and Grade 3/4 adverse events.
Description
Number of participants with treatment-related adverse events as assessed by NCI-CTCAE V5.0, including overall and Grade 3/4 adverse events.
Time Frame
5 years
Title
Percentage of Participants with dose reductions of chemotherapy due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Description
Percentage of Participants with dose reductions of chemotherapy due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Time Frame
1 year
Title
Percentage of Participants with chemotherapy delay due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Description
Percentage of Participants with chemotherapy delay due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
Time Frame
1 year
Title
Relative dose intensity (RDI)
Description
RDI=actual dose intensity* / standard dose intensity# actual dose intensity* = drug standard dose (mg/m^2) / weeks of administration per cycle (week) standard dose intensity# = actual standard dose (mg/m^2) / actual dosing weeks (week)
Time Frame
1 year
Other Pre-specified Outcome Measures:
Title
Subgroup analysis of pathological complete response (pCR) rates based on clinically relevant baseline characteristics
Description
Subgroup analysis of pathological complete response (pCR) rates based on clinically relevant baseline characteristics
Time Frame
Within 2 to 5 weeks after completion of neoadjuvant therapy

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female patients aged from 18 to 70 years old; Histologically confirmed as invasive breast cancer and without previous treatment.; HER-2 Positive (defined by IHC 3+ or ISH positive); Tumor > 2cm; Biopsy pathology (FNAB or CNB) diagnosed regional lymph node metastasis within 28 days prior to randomization; Participants must have at least one measurable disease according to RECIST 1.1. Participants with multifocal tumors (more than one tumor confined to the same quadrant as the primary tumor) are eligible provided all discrete lesions are sampled and centrally confirmed as HER2 positive. Operable breast cancer with cT2-cT4/cN1-cN3/cM0, according to the AJCC tumor staging manual (8th Edition). The HR(ER and PR) status of the primary tumor and the expression level of Ki-67 are clear. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; LVEF ≥ 55%; Brain natriuretic peptide (BNP) (or N-terminal pro brain natriuretic peptide (NT proBNP)) and cardiac troponin assays were within normal values. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and serum total bilirubin are all ≤2 ULN. Serum creatinine ≤ 1.5 ULN. Bone marrow function: white blood cell counts ≥ 3.0x10^9/L, absolute neutrophil counts (ANC) ≥ 1.5x10^9/L, platelets ≥ 100x10^9/L, hemoglobin ≥ 90g/L; Participants had good compliance with the planned treatment and follow-up, understood the study procedures of this study, and signed informed consent form. Exclusion Criteria: Breast cancer with distant metastasis; Participants with multiple lesions (in different quadrants) or bilateral breast cancer; Participants who have received prior anti-cancer therapy for breast cancer except those participants with a history of breast lobular carcinoma in situ (LCIS) that was surgically managed or ductal carcinoma in situ (DCIS) treated exclusively with mastectomy. In case of prior history of LCIS/DCIS, >5 years must have passed from surgery until diagnosis of current breast cancer; In the past and present, participants with severe cardiac disease or discomfort , including but not limited: 1)High-risk uncontrolled arrhythmia, atrial tachycardia (heart rate > 100/min in resting state), significant ventricular arrhythmia (ventricular arrhythmia) or higher atrioventricular block (second-degree type 2 [Mobitz 2] atrioventricular block or third-degree atrioventricular block); 2)Angina pectoris requiring anti-angina medication; 3)Clinically significant valvular heart disease; 4)ECG showing transmural myocardial infarction; 5)Uncontrolled hypertension (eg systolic blood pressure > 180mm Hg or diastolic blood pressure > 100mmHg); 6)Myocardial infarction; 7)Congestive heart failure; Participants have the following serious illnesses or medical conditions, including but not limited: 1)History of serious neurological or psychiatric disorders, including psychosis, dementia, or epilepsy, that prevent understanding and informed consent; 2)Active uncontrolled infection; 3)Active peptic ulcer, unstable diabetes; A history of other malignancies within the previous 5 years, except for adequately treated carcinoma in situ of the cervix or basal cell carcinoma of the skin; Treatment with any investigational drug within 28 days prior to randomization; Participants who are known to be allergic to the active or other components of the study treatment or have contraindications for surgery; Participants who are pregnant, breastfeeding, or refuse to use adequate contraception prior to study entry and for the duration of study participation; Participants who were judged by the investigator to be unsuitable for this study.
Facility Information:
Facility Name
Sunyat-sen Memorial Hospital
City
Guandong
State/Province
Guangdong
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Qiang Liu, PhD
Phone
86-020-34071157
Email
victorlq@hotmail.com
First Name & Middle Initial & Last Name & Degree
Qiang Liu, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Neoadjuvant Treatment Pegylated Liposomal Doxorubicin Plus Cyclophosphamide Sequential Docetaxel Plus Trastuzumab and Pertuzumab Versus Docetaxel Plus Carboplatin Combined With Trastuzumab and Pertuzumab in HER-2 Positive Breast Cancer

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