A Study for the Neoadjuvant Treatment of Breast Cancer
Primary Purpose
Breast Cancer
Status
Recruiting
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Docetaxel
Carboplatin
Trastuzumab
Pertuzumab
Nab paclitaxel
Epirubicin
Cyclophosphamide
Docetaxel
Epirubicin
Cyclophosphamide
Nab paclitaxel
Sponsored by
About this trial
This is an interventional treatment trial for Breast Cancer focused on measuring breast cancer, neoadjuvant therapy, Docetaxel, albumin-bound paclitaxel, TCbHP, nPCbHP, ddEC-wnP, EC-T
Eligibility Criteria
Inclusion Criteria:
- Female patients aged ≥18 years;
- unilateral primary invasive breast cancer that meets clinical diagnostic criteria and is histologically confirmed;
- The tumor is >2cm, and the clinical stage is consistent with cT stage 2-4; or lymph node metastasis with clear clinical/pathological evidence;
- known hormone receptor status (estrogen receptor [ER], progesterone receptor [PR]) and HER2 status with known Ki67 expression levels; (ER/PR positive defined as stained cells >1%, HER2 positive defined as IHC 3+ or IHC 2+ with a positive FISH test);
- Triple-negative breast cancer (TNBC): ER/PR negative, HER2 negative; tumor >2cm or lymph node metastasis with clear postoperative pathological evidence; Luminal breast cancer: ER>1%, HER2 negative, postoperative pathological evidence definite lymph node metastasis (different adjuvant chemotherapy regimens depending on whether the lymph nodes are N1 or N2-3); HER2-positive breast cancer: HER2-positive, regardless of ER/PR status; (the above classification determines enrollment and neoadjuvant therapy, and does not represent the corresponding molecular typing definition);
- patients who need neoadjuvant chemotherapy as judged by the investigator;
- ECOG physical fitness score of 0-1;
- The patient has not received any treatment for breast cancer before enrollment;
- Electrocardiogram (ECG) and echocardiography must confirm normal cardiac function within 3 months prior to randomization. Left ventricular ejection fraction (LVEF) must be ≥55%;
- Liver and kidney function: serum creatinine ≤1.5 times the upper limit of normal; AST and ALT ≤3 times the upper limit of normal; total bilirubin ≤1.5 times the upper limit of normal, or ≤2.5 times the upper limit of normal when the patient has Gilbert's syndrome ;
- Bone marrow function: neutrophils≥1.5×109/L, platelets≥100×109/L, hemoglobin≥90g/L;
- Able to comply with outpatient treatment, laboratory monitoring and necessary clinical visits during the study period;
- Subjects have the ability to understand, agree and sign the Informed Consent Form (ICF) for the study prior to initiating any protocol-related procedures; subjects have the ability to express consent (where applicable).
Exclusion Criteria:
- Advanced and/or inoperable patients with distant metastasis confirmed by imaging evidence or pathology;
- Patients with bilateral invasive breast cancer;
- Other malignant tumors have occurred in the past 5 years, except for skin cancers of cured cervical carcinoma in situ and non-melanoma;
- Pregnant or breastfeeding women; patients with childbearing potential who are unwilling or unable to take effective contraceptive measures;
- The molecular status of ER/PR and HER2 and Ki67 cannot be determined;
- Patients with CNS metastases or > grade 1 peripheral neuropathy;
- Surgical axillary staging within 6 months prior to study entry;
- Radiotherapy, chemotherapy, biotherapy and/or endocrine therapy for currently diagnosed breast cancer prior to study entry;
- Patients with severe myelosuppression at screening;
- Patients with severe liver dysfunction (Child's Class III) or renal dysfunction at screening ;
- Other concomitant diseases (e.g. untreated congenital heart disease, glomerulonephritis, etc.) which, in the opinion of the investigator, seriously endanger the safety of the patient or would prevent the implementation or completion of the programme treatment;
- Patients with hypersensitivity to any of the components of albumin paclitaxel, epirubicin, cyclophosphamide, docetaxel, trastuzumab, and pertuzumab;
- Patients with psychiatric disorders;
- Subjects who are participating in another clinical study or whose first dose was administered less than 4 weeks (or 5 half-lives of the study drug) from the end of the previous clinical study (last dose) ;
- The investigator judges other situations that may affect the clinical research and the judgment of the research results and are not suitable for inclusion in the research.
Sites / Locations
- 2nd Affiliated Hospital, School of Medicine, Zhejiang UniversityRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm Type
Active Comparator
Experimental
Active Comparator
Experimental
Arm Label
TCbHP
nPCbHP
EC-T
ddEC-wnP
Arm Description
HER2-positive breast cancer
HER2-positive breast cancer
Luminal breast cancer (HER2-, LN+), and triple negative breast cancer
Luminal breast cancer (HER2-, LN+), and triple negative breast cancer
Outcomes
Primary Outcome Measures
pCR(pathological complete response)
defined as ypT0/is, ypN0 (defined as no invasive tumor in breast and axillary lymph nodes
Secondary Outcome Measures
OS
overall survival
DFS
disease-free survival
DMFS
distant metastasis-free survival
Secondary pCR
defined as ypT0, ypN0 (no invasive or residual carcinoma in situ lesions in breast and axillary lymph nodes
Full Information
NCT ID
NCT05420454
First Posted
June 12, 2022
Last Updated
June 28, 2022
Sponsor
Second Affiliated Hospital, School of Medicine, Zhejiang University
1. Study Identification
Unique Protocol Identification Number
NCT05420454
Brief Title
A Study for the Neoadjuvant Treatment of Breast Cancer
Official Title
A Prospective, Open-label Study to Evaluate Injectable Albumin-bound Paclitaxel Versus Docetaxel for the Neoadjuvant Treatment of Breast Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
June 2022
Overall Recruitment Status
Recruiting
Study Start Date
July 10, 2022 (Anticipated)
Primary Completion Date
June 10, 2027 (Anticipated)
Study Completion Date
December 20, 2027 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Second Affiliated Hospital, School of Medicine, Zhejiang University
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
Due to the unique advantages of albumin-bound paclitaxel, several studies in China and abroad have tried to use albumin-bound paclitaxel for neoadjuvant treatment of breast cancer up to now. However, comparative studies between paclitaxel and docetaxel are still rare, In this study, a prospective, randomized, open-label, multi-center clinical study was conducted to analyse the efficacy and safety of albumin-bound paclitaxel and docetaxel in the neoadjuvant treatment of breast cancer, and to further analyse the efficacy and safety of albumin paclitaxel in combination with chemotherapy for postoperative breast cancer in different subtypes of breast cancer patients, in order to obtain more realistic data and provide new treatment options for breast cancer patients.
Detailed Description
Neoadjuvant chemotherapy refers to systemic chemotherapy as the first step for treating breast cancer patients before planned local treatment like surgery for those without distant metastasis. It is reported that preoperative neoadjuvant chemotherapy can facilitate breast conservation, render inoperable tumors operable and provide important prognostic information at an individual patient level based on response to therapy.
Previous studies have confirmed that the efficacy of albumin-bound paclitaxel in neoadjuvant therapy and was well tolerated when combined with sequential chemotherapy with anthracyclines .
The GBG69 study was the first to compare the efficacy and safety of nab-paclitaxel (nab-P) and solvent-based paclitaxel in the neoadjuvant treatment of breast cancer. The results showed that the pCR rate in the nab-P group was significantly higher than that in the solvent paclitaxel group (38% vs 29% p<0.001). Long-term follow-up results showed that after 4 years, iDFS was also significantly improved in nab-P-treated patients compared with solvent paclitaxel (84.0% vs 76.3%; HR, 0.66; 95% CI, 0.51-0.86; P = 0.0023).
Another phase II study compared docetaxel and albumin paclitaxel in neoadjuvant chemotherapy for HER2-negative early-stage breast cancer. The results showed a slightly higher pCR rate in the nab-P group (docetaxel: 12%; nab-P: 17%). In the Ki67>20% subgroup, the pCR rates were 16% (docetaxel) vs 24% (nab-P) respectively. demonstrating that albumin-bound paclitaxel (nab-P) appears to demonstrate greater efficacy in breast cancer compared to docetaxel.
However, comparative studies between paclitaxel and docetaxel are still rare, In this study, a prospective, randomized, open-label, multi-center clinical study was conducted to analyse the efficacy and safety of albumin-bound paclitaxel and docetaxel in the neoadjuvant treatment of breast cancer, and to further analyse the efficacy and safety of albumin paclitaxel in combination with chemotherapy for postoperative breast cancer in different subtypes of breast cancer patients, in order to obtain more realistic data and provide new treatment options for breast cancer patients.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
breast cancer, neoadjuvant therapy, Docetaxel, albumin-bound paclitaxel, TCbHP, nPCbHP, ddEC-wnP, EC-T
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
1576 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
TCbHP
Arm Type
Active Comparator
Arm Description
HER2-positive breast cancer
Arm Title
nPCbHP
Arm Type
Experimental
Arm Description
HER2-positive breast cancer
Arm Title
EC-T
Arm Type
Active Comparator
Arm Description
Luminal breast cancer (HER2-, LN+), and triple negative breast cancer
Arm Title
ddEC-wnP
Arm Type
Experimental
Arm Description
Luminal breast cancer (HER2-, LN+), and triple negative breast cancer
Intervention Type
Drug
Intervention Name(s)
Docetaxel
Intervention Description
75 mg/m2, d1, q3w,6 cycles
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
AUC 6, d1, q3w ,6 cycles
Intervention Type
Drug
Intervention Name(s)
Trastuzumab
Intervention Description
starting dose 8 mg/kg, maintenance dose 6 mg/kg, d1, q3w ,6 cycles
Intervention Type
Drug
Intervention Name(s)
Pertuzumab
Intervention Description
starting dose of 840 mg, maintenance dose of 420 mg, d1, q3w,6 cycles
Intervention Type
Drug
Intervention Name(s)
Nab paclitaxel
Intervention Description
220 mg/m2, d1, q3w,6 cycles
Intervention Type
Drug
Intervention Name(s)
Epirubicin
Intervention Description
90 mg/m2,d1, q3w × 4 cycles,followed by docetaxel
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
600 mg/m2, d1, q3w ,4 cycles,followed by docetaxel
Intervention Type
Drug
Intervention Name(s)
Docetaxel
Intervention Description
100 mg/m2, d1, q3w × 4 cycles
Intervention Type
Drug
Intervention Name(s)
Epirubicin
Intervention Description
90 mg/m2,d1, q2w × 4 cycles,followed by nab-paclitaxel
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
600 mg/m2, d1, q2w × 4 cycles followed by nab-paclitaxel
Intervention Type
Drug
Intervention Name(s)
Nab paclitaxel
Intervention Description
125 mg/m2, d1,8,15, q3w× 4 cycles
Primary Outcome Measure Information:
Title
pCR(pathological complete response)
Description
defined as ypT0/is, ypN0 (defined as no invasive tumor in breast and axillary lymph nodes
Time Frame
1year
Secondary Outcome Measure Information:
Title
OS
Description
overall survival
Time Frame
10 years
Title
DFS
Description
disease-free survival
Time Frame
2 years
Title
DMFS
Description
distant metastasis-free survival
Time Frame
2 years
Title
Secondary pCR
Description
defined as ypT0, ypN0 (no invasive or residual carcinoma in situ lesions in breast and axillary lymph nodes
Time Frame
1 year
Other Pre-specified Outcome Measures:
Title
ORR
Description
tumor response rate based on imaging assessment in the neoadjuvant therapy (preoperative) stage
Time Frame
1year
Title
Remission rate of neurotoxicity
Time Frame
5 years
Title
The incidence of other AEs
Time Frame
5 years
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Female patients aged ≥18 years;
unilateral primary invasive breast cancer that meets clinical diagnostic criteria and is histologically confirmed;
The tumor is >2cm, and the clinical stage is consistent with cT stage 2-4; or lymph node metastasis with clear clinical/pathological evidence;
known hormone receptor status (estrogen receptor [ER], progesterone receptor [PR]) and HER2 status with known Ki67 expression levels; (ER/PR positive defined as stained cells >1%, HER2 positive defined as IHC 3+ or IHC 2+ with a positive FISH test);
Triple-negative breast cancer (TNBC): ER/PR negative, HER2 negative; tumor >2cm or lymph node metastasis with clear postoperative pathological evidence; Luminal breast cancer: ER>1%, HER2 negative, postoperative pathological evidence definite lymph node metastasis (different adjuvant chemotherapy regimens depending on whether the lymph nodes are N1 or N2-3); HER2-positive breast cancer: HER2-positive, regardless of ER/PR status; (the above classification determines enrollment and neoadjuvant therapy, and does not represent the corresponding molecular typing definition);
patients who need neoadjuvant chemotherapy as judged by the investigator;
ECOG physical fitness score of 0-1;
The patient has not received any treatment for breast cancer before enrollment;
Electrocardiogram (ECG) and echocardiography must confirm normal cardiac function within 3 months prior to randomization. Left ventricular ejection fraction (LVEF) must be ≥55%;
Liver and kidney function: serum creatinine ≤1.5 times the upper limit of normal; AST and ALT ≤3 times the upper limit of normal; total bilirubin ≤1.5 times the upper limit of normal, or ≤2.5 times the upper limit of normal when the patient has Gilbert's syndrome ;
Bone marrow function: neutrophils≥1.5×109/L, platelets≥100×109/L, hemoglobin≥90g/L;
Able to comply with outpatient treatment, laboratory monitoring and necessary clinical visits during the study period;
Subjects have the ability to understand, agree and sign the Informed Consent Form (ICF) for the study prior to initiating any protocol-related procedures; subjects have the ability to express consent (where applicable).
Exclusion Criteria:
Advanced and/or inoperable patients with distant metastasis confirmed by imaging evidence or pathology;
Patients with bilateral invasive breast cancer;
Other malignant tumors have occurred in the past 5 years, except for skin cancers of cured cervical carcinoma in situ and non-melanoma;
Pregnant or breastfeeding women; patients with childbearing potential who are unwilling or unable to take effective contraceptive measures;
The molecular status of ER/PR and HER2 and Ki67 cannot be determined;
Patients with CNS metastases or > grade 1 peripheral neuropathy;
Surgical axillary staging within 6 months prior to study entry;
Radiotherapy, chemotherapy, biotherapy and/or endocrine therapy for currently diagnosed breast cancer prior to study entry;
Patients with severe myelosuppression at screening;
Patients with severe liver dysfunction (Child's Class III) or renal dysfunction at screening ;
Other concomitant diseases (e.g. untreated congenital heart disease, glomerulonephritis, etc.) which, in the opinion of the investigator, seriously endanger the safety of the patient or would prevent the implementation or completion of the programme treatment;
Patients with hypersensitivity to any of the components of albumin paclitaxel, epirubicin, cyclophosphamide, docetaxel, trastuzumab, and pertuzumab;
Patients with psychiatric disorders;
Subjects who are participating in another clinical study or whose first dose was administered less than 4 weeks (or 5 half-lives of the study drug) from the end of the previous clinical study (last dose) ;
The investigator judges other situations that may affect the clinical research and the judgment of the research results and are not suitable for inclusion in the research.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yiding CHEN
Phone
13605719519
Email
ydchen@zju.edu.cn
First Name & Middle Initial & Last Name or Official Title & Degree
Huihui CHEN
Phone
571-87784527
Email
huihuicyj@zju.edu.cn
Facility Information:
Facility Name
2nd Affiliated Hospital, School of Medicine, Zhejiang University
City
Hangzhou
State/Province
Zhejiang
ZIP/Postal Code
310000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yiding Chen
Phone
571-87784527
Email
ydchen@zju.edu.cn
12. IPD Sharing Statement
Citations:
PubMed Identifier
20133263
Citation
Robidoux A, Buzdar AU, Quinaux E, Jacobs S, Rastogi P, Fourchotte V, Younan RJ, Pajon ER, Shalaby IA, Desai AM, Fehrenbacher L, Geyer CE Jr, Mamounas EP, Wolmark N. A phase II neoadjuvant trial of sequential nanoparticle albumin-bound paclitaxel followed by 5-fluorouracil/epirubicin/cyclophosphamide in locally advanced breast cancer. Clin Breast Cancer. 2010 Feb;10(1):81-6. doi: 10.3816/CBC.2010.n.011.
Results Reference
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PubMed Identifier
25989989
Citation
Shimada H, Ueda S, Saeki T, Shigekawa T, Takeuchi H, Hirokawa E, Sugitani I, Sugiyama M, Takahashi T, Matsuura K, Yamane T, Kuji I, Hasebe T, Osaki A. Neoadjuvant triweekly nanoparticle albumin-bound paclitaxel followed by epirubicin and cyclophosphamide for Stage II/III HER2-negative breast cancer: evaluation of efficacy and safety. Jpn J Clin Oncol. 2015 Jul;45(7):642-9. doi: 10.1093/jjco/hyv055. Epub 2015 May 19.
Results Reference
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PubMed Identifier
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Citation
Untch M, Jackisch C, Schneeweiss A, Conrad B, Aktas B, Denkert C, Eidtmann H, Wiebringhaus H, Kummel 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, Nekljudova V, Loibl S, von Minckwitz G; German Breast Group (GBG); Arbeitsgemeinschaft Gynakologische Onkologie-Breast (AGO-B) Investigators. Nab-paclitaxel versus solvent-based paclitaxel in neoadjuvant chemotherapy for early breast cancer (GeparSepto-GBG 69): a randomised, phase 3 trial. Lancet Oncol. 2016 Mar;17(3):345-356. doi: 10.1016/S1470-2045(15)00542-2. Epub 2016 Feb 8. Erratum In: Lancet Oncol. 2016 Jul;17 (7):e270.
Results Reference
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PubMed Identifier
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Citation
Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kummel S, Warm M, Fasching PA, Just M, Hanusch C, Hackmann J, Blohmer JU, Rhiem K, Schmitt WD, Furlanetto J, Gerber B, Huober J, Nekljudova V, von Minckwitz G, Loibl S. NAB-Paclitaxel Improves Disease-Free Survival in Early Breast Cancer: GBG 69-GeparSepto. J Clin Oncol. 2019 Sep 1;37(25):2226-2234. doi: 10.1200/JCO.18.01842. Epub 2019 May 13.
Results Reference
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Citation
Kuwayama T, Nakamura S, Hayashi N, Takano T, Tsugawa K, Sato T, Kitani A, Okuyama H, Yamauchi H. Randomized Multicenter Phase II Trial of Neoadjuvant Therapy Comparing Weekly Nab-paclitaxel Followed by FEC With Docetaxel Followed by FEC in HER2- Early-stage Breast Cancer. Clin Breast Cancer. 2018 Dec;18(6):474-480. doi: 10.1016/j.clbc.2018.06.012. Epub 2018 Jun 27.
Results Reference
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A Study for the Neoadjuvant Treatment of Breast Cancer
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