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SNF Platform Study of HR+/ HER2-advanced Breast Cancer

Primary Purpose

Breast Neoplasm, Breast Cancer, Hormone Receptor Positive Tumor

Status
Recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
PIK3CA inhibitor
AKT inhibitor
Carrelizumab
Famitinib
Fluzoparib
Dalpiciclib
SHR-A1811
TROP2 ADC
Everolimus
Aromatase Inhibitors or Fulvestrant
Goserelin
TPC
RTK Inhibitor
Sponsored by
Fudan University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Neoplasm

Eligibility Criteria

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

Inclusion Criteria:

  1. Female aged ≥18 years;
  2. HR+/HER2- invasive breast cancer confirmed by histology (specific definition: ER >10% positive tumor cells by immunohistochemistry is defined as ER positive, PR >10% positive tumor cells is defined as PR positive, ER and/or PR positive is defined as HR positive; HER2 0-1+ or HER2 + but negative by FISH without amplification was defined as HER2 negative);
  3. Locally advanced breast cancer (unable to undergo radical local treatment) or recurrent metastatic breast cancer;
  4. HR+/HER2- advanced breast cancer patients who had previously received CDK4/6 inhibitor therapy;
  5. At least one measurable lesion according to RECIST 1.1 (conventional CT scan ≥20 mm, spiral CT scan ≥10 mm, measurable lesion has not received radiotherapy);
  6. The functions of the main organs are basically normal and meet the following conditions:

    I. Blood routine examination criteria shall meet: HB ≥90 g/L (no blood transfusion within 14 days); The ANC acuity 1.5 x 109 / L; PLT acuity 75 x 109 / L; Ii. Biochemical tests should meet the following criteria: TBIL ≤1.5×ULN (upper limit of normal value); ALT and AST ≤3×ULN; If liver metastases were present, ALT and AST≤ 5×ULN; Serum Cr ≤1×ULN, endogenous creatinine clearance > 50 ml/min (Cockcroft-Gault formula);

  7. They have not received radiotherapy, molecular targeted therapy, or surgery within 3 weeks before the start of the study, and have recovered from the acute toxicity of previous treatment (if surgery was performed, the wound has healed completely); No peripheral neuropathy or grade I peripheral neurotoxicity;
  8. ECOG score ≤2, and life expectancy ≥3 months;
  9. Fertile female subjects were required to use a medically approved contraceptive method during the study treatment period and for at least 3 months after the last use of the study drug;
  10. Subjects volunteered to join the study, signed informed consent, had good compliance, and cooperated with follow-up.

Exclusion Criteria:

  1. Radiotherapy (except for palliative causes), chemotherapy, and immunotherapy were used in the first 3 weeks of treatment, except bisphosphonate (which can be used for bone metastasis);
  2. Uncontrolled central nervous system metastases (indicating symptomatic or symptomatic treatment with glucocorticoids or mannitol);
  3. A history of clinically important or uncontrolled heart disease, including congestive heart failure, angina pectoris, myocardial infarction, or ventricular arrhythmia within the last 6 months;
  4. Persistent grade 1 or higher adverse reactions caused by previous treatments. The exception to this is hair loss or something the researchers don't think should be ruled out. Such cases should be clearly documented in the investigator's notes;
  5. Underwent major surgery (except minor outpatient procedures, such as placement of vascular access) within 3 weeks of the first course of trial treatment;
  6. Pregnant or lactating patients; Malignancy (except basal cell carcinoma of the skin, which has been cured, and carcinoma in situ of the cervix) in the past 5 years.

Sites / Locations

  • Breast cancer institute of Fudan University Cancer HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Active Comparator

Arm Label

SNF1 1A: PIK3CA mutation

SNF1 1B: AKT pathway mutation

SNF1 1C: without above mutation

SNF2 2: Stratification of CD8 expression

SNF3 3: Stratification of BRCA/PALB2 expression

SNF4 4A: HER2 low

SNF4 4A: HER2 zero

The control arm

Arm Description

PIK3CA inhibitors +Aromatase inhibitors(Letrozole/Anastrozole/Exemestane, po, qd, specific dose (letrozole 2.5mg/ day; Anastrozole 1mg/ day, Exemestane 25mg/ day);Or fulvestrant, 500mg ,im, qm, followed by 500mg im 2 weeks after the first dose; Premenopausal: Goserelin 3.6mg IM every 4 weeks.

AKT pathway inhibitors +Aromatase inhibitors(Letrozole/Anastrozole/Exemestane, po, qd, specific dose (letrozole 2.5mg/ day; Anastrozole 1mg/ day, Exemestane 25mg/ day);Or fulvestrant, 500mg ,im, qm, followed by 500mg im 2 weeks after the first dose; Premenopausal: Goserelin 3.6mg IM every 4 weeks.

Everolimus 10mg po qd+Aromatase inhibitors(Letrozole/Anastrozole/Exemestane, po, qd, specific dose (letrozole 2.5mg/ day; Anastrozole 1mg/ day, Exemestane 25mg/ day);Or fulvestrant, 500mg ,im, qm, followed by 500mg im 2 weeks after the first dose; Premenopausal: Goserelin 3.6mg IM every 4 weeks.

Treatment of physician' choice+Pd-1 mab (Carrelizumab 200mg Q2W)+Famitinib 15mg po qd for 4 weeks as a cycle

Fluzoparib SHR3162 100mg po qd+Dalpiciclib 125mg po qd for 4 weeks as a cycle

Treatment of Physicians' Choice (albumin-paclitaxel, capecitabine, vinorelbine, and irbribulin)

Outcomes

Primary Outcome Measures

Overall response rate (ORR)
The proportion of participants whose best outcome is complete remission or partial remission (according to RECIST1.1)

Secondary Outcome Measures

Clinical Benefit Rate (CBR)
the percentage of subjects with CR+PR+SD and last more than 24 weeks in all of the subjects
Progression Free Survival (PFS)
time to progressive disease (according to RECIST1.1)
Overall Survival (OS)
time to death due to any cause
CTCAE scale (V5.0)
To evaluate the rate of adverse effects of patient by the standard CTCAE scale (V5.0)

Full Information

First Posted
October 13, 2022
Last Updated
May 7, 2023
Sponsor
Fudan University
Collaborators
Peking University Cancer Hospital & Institute, First Hospital of China Medical University, Sun Yat-sen University, First Affiliated Hospital Xi'an Jiaotong University, Chongqing University Cancer Hospital, Northern Jiangsu Province People's Hospital, Fujian Medical University Union Hospital, Ningbo Medical Center Lihuili Hospital, Shanghai First Maternity and Infant Hospital, Shanghai 6th People's Hospital, Affiliated Hospital of Nantong University
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1. Study Identification

Unique Protocol Identification Number
NCT05594095
Brief Title
SNF Platform Study of HR+/ HER2-advanced Breast Cancer
Official Title
Precision Platform Study of HR+/ HER2-advanced Breast Cancer Based on SNF Typing (A Prospective, Open-label, Multi-center, Phase II Platform Study)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Recruiting
Study Start Date
December 30, 2022 (Actual)
Primary Completion Date
December 1, 2025 (Anticipated)
Study Completion Date
December 1, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Fudan University
Collaborators
Peking University Cancer Hospital & Institute, First Hospital of China Medical University, Sun Yat-sen University, First Affiliated Hospital Xi'an Jiaotong University, Chongqing University Cancer Hospital, Northern Jiangsu Province People's Hospital, Fujian Medical University Union Hospital, Ningbo Medical Center Lihuili Hospital, Shanghai First Maternity and Infant Hospital, Shanghai 6th People's Hospital, Affiliated Hospital of Nantong University

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to establish a prospective, single-center platform research based on clinical subtypes to explore precision therapy in patients hormone-receptor-positive HER2-negative advanced breast cancer who had previously used CDK4/6 inhibitors.
Detailed Description
Participants in this study were hormone-receptor-positive HER2-negative patients with advanced breast cancer who had previously used CDK4/6 inhibitors. Hormone receptor positive HER2 negative was defined as ER positive (IHC ER positive percentage > 10% or PR positive (IHC PR positive percentage > 10%) and HER2 negative (IHC-/+; Or IHC++ but FISH/CISH-). The Department of Pathology and the Key Laboratory of Breast Cancer of Fudan University Shanghai Cancer Center conducted digital pathological typing of the biopsy pathology of metastatic lesions of all participants . If the pathology of metastatic lesions could not be obtained, the digital pathological typing was performed according to the pathology of primary lesions. According to the digital pathological types of biopsy tissue and peripheral blood ctDNA, the patients were divided into four precise subtypes: SNF1, SNF2, SNF3, and SNF4. At the same time, the negative control group was randomly set by subtype stratification at 2:1. In different SNF types, patients were divided into 7 subcohorts according to the genetic PANEL results.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Neoplasm, Breast Cancer, Hormone Receptor Positive Tumor, HER2-negative Breast Cancer, Advanced Breast Cancer

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
SNF1 1A: PIK3CA mutation
Arm Type
Experimental
Arm Description
PIK3CA inhibitors +Aromatase inhibitors(Letrozole/Anastrozole/Exemestane, po, qd, specific dose (letrozole 2.5mg/ day; Anastrozole 1mg/ day, Exemestane 25mg/ day);Or fulvestrant, 500mg ,im, qm, followed by 500mg im 2 weeks after the first dose; Premenopausal: Goserelin 3.6mg IM every 4 weeks.
Arm Title
SNF1 1B: AKT pathway mutation
Arm Type
Experimental
Arm Description
AKT pathway inhibitors +Aromatase inhibitors(Letrozole/Anastrozole/Exemestane, po, qd, specific dose (letrozole 2.5mg/ day; Anastrozole 1mg/ day, Exemestane 25mg/ day);Or fulvestrant, 500mg ,im, qm, followed by 500mg im 2 weeks after the first dose; Premenopausal: Goserelin 3.6mg IM every 4 weeks.
Arm Title
SNF1 1C: without above mutation
Arm Type
Experimental
Arm Description
Everolimus 10mg po qd+Aromatase inhibitors(Letrozole/Anastrozole/Exemestane, po, qd, specific dose (letrozole 2.5mg/ day; Anastrozole 1mg/ day, Exemestane 25mg/ day);Or fulvestrant, 500mg ,im, qm, followed by 500mg im 2 weeks after the first dose; Premenopausal: Goserelin 3.6mg IM every 4 weeks.
Arm Title
SNF2 2: Stratification of CD8 expression
Arm Type
Experimental
Arm Description
Treatment of physician' choice+Pd-1 mab (Carrelizumab 200mg Q2W)+Famitinib 15mg po qd for 4 weeks as a cycle
Arm Title
SNF3 3: Stratification of BRCA/PALB2 expression
Arm Type
Experimental
Arm Description
Fluzoparib SHR3162 100mg po qd+Dalpiciclib 125mg po qd for 4 weeks as a cycle
Arm Title
SNF4 4A: HER2 low
Arm Type
Experimental
Arm Title
SNF4 4A: HER2 zero
Arm Type
Experimental
Arm Title
The control arm
Arm Type
Active Comparator
Arm Description
Treatment of Physicians' Choice (albumin-paclitaxel, capecitabine, vinorelbine, and irbribulin)
Intervention Type
Drug
Intervention Name(s)
PIK3CA inhibitor
Intervention Description
PIK3CA inhibitor
Intervention Type
Drug
Intervention Name(s)
AKT inhibitor
Intervention Description
AKT inhibitor
Intervention Type
Drug
Intervention Name(s)
Carrelizumab
Other Intervention Name(s)
SHR1210
Intervention Description
Pd-1 mab
Intervention Type
Drug
Intervention Name(s)
Famitinib
Intervention Description
VEGFR inhibitor
Intervention Type
Drug
Intervention Name(s)
Fluzoparib
Other Intervention Name(s)
SHR3162
Intervention Description
PARP inhibitor
Intervention Type
Drug
Intervention Name(s)
Dalpiciclib
Other Intervention Name(s)
SHR6390
Intervention Description
CDK4/6 inhibitor
Intervention Type
Drug
Intervention Name(s)
SHR-A1811
Intervention Description
HER2 ADC
Intervention Type
Drug
Intervention Name(s)
TROP2 ADC
Intervention Description
TROP2 ADC
Intervention Type
Drug
Intervention Name(s)
Everolimus
Intervention Description
mTOR inhibior
Intervention Type
Drug
Intervention Name(s)
Aromatase Inhibitors or Fulvestrant
Intervention Description
Letrozole/Anastrozole/Exemestane or Fulvestrant
Intervention Type
Drug
Intervention Name(s)
Goserelin
Intervention Description
For premenopause
Intervention Type
Drug
Intervention Name(s)
TPC
Intervention Description
Treatment of Physicians' Choice (albumin-paclitaxel, capecitabine, vinorelbine, and irbribulin)
Intervention Type
Drug
Intervention Name(s)
RTK Inhibitor
Intervention Description
Sorafenib, Apatinib, Famitinib
Primary Outcome Measure Information:
Title
Overall response rate (ORR)
Description
The proportion of participants whose best outcome is complete remission or partial remission (according to RECIST1.1)
Time Frame
Randomization until the first occurrence of disease progression or death from any cause, which ever occurs first, through the end of study (approximately 3 years)
Secondary Outcome Measure Information:
Title
Clinical Benefit Rate (CBR)
Description
the percentage of subjects with CR+PR+SD and last more than 24 weeks in all of the subjects
Time Frame
Randomization until the first occurrence of disease progression or death from any cause, which ever occurs first, through the end of study (approximately 3 years
Title
Progression Free Survival (PFS)
Description
time to progressive disease (according to RECIST1.1)
Time Frame
Randomization until the first occurrence of disease progression or death from any cause, which ever occurs first, through the end of study (approximately 3 years)]
Title
Overall Survival (OS)
Description
time to death due to any cause
Time Frame
Randomization to death from any cause, through the end of study (approximately 3 years)
Title
CTCAE scale (V5.0)
Description
To evaluate the rate of adverse effects of patient by the standard CTCAE scale (V5.0)
Time Frame
up to One Year during follow-up

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female aged ≥18 years; HR+/HER2- invasive breast cancer confirmed by histology (specific definition: ER >10% positive tumor cells by immunohistochemistry is defined as ER positive, PR >10% positive tumor cells is defined as PR positive, ER and/or PR positive is defined as HR positive; HER2 0-1+ or HER2 + but negative by FISH without amplification was defined as HER2 negative); Locally advanced breast cancer (unable to undergo radical local treatment) or recurrent metastatic breast cancer; HR+/HER2- advanced breast cancer patients who had previously received CDK4/6 inhibitor therapy; At least one measurable lesion according to RECIST 1.1 (conventional CT scan ≥20 mm, spiral CT scan ≥10 mm, measurable lesion has not received radiotherapy); The functions of the main organs are basically normal and meet the following conditions: I. Blood routine examination criteria shall meet: HB ≥90 g/L (no blood transfusion within 14 days); The ANC acuity 1.5 x 109 / L; PLT acuity 75 x 109 / L; Ii. Biochemical tests should meet the following criteria: TBIL ≤1.5×ULN (upper limit of normal value); ALT and AST ≤3×ULN; If liver metastases were present, ALT and AST≤ 5×ULN; Serum Cr ≤1×ULN, endogenous creatinine clearance > 50 ml/min (Cockcroft-Gault formula); They have not received radiotherapy, molecular targeted therapy, or surgery within 3 weeks before the start of the study, and have recovered from the acute toxicity of previous treatment (if surgery was performed, the wound has healed completely); No peripheral neuropathy or grade I peripheral neurotoxicity; ECOG score ≤2, and life expectancy ≥3 months; Fertile female subjects were required to use a medically approved contraceptive method during the study treatment period and for at least 3 months after the last use of the study drug; Subjects volunteered to join the study, signed informed consent, had good compliance, and cooperated with follow-up. Exclusion Criteria: Radiotherapy (except for palliative causes), chemotherapy, and immunotherapy were used in the first 3 weeks of treatment, except bisphosphonate (which can be used for bone metastasis); Uncontrolled central nervous system metastases (indicating symptomatic or symptomatic treatment with glucocorticoids or mannitol); A history of clinically important or uncontrolled heart disease, including congestive heart failure, angina pectoris, myocardial infarction, or ventricular arrhythmia within the last 6 months; Persistent grade 1 or higher adverse reactions caused by previous treatments. The exception to this is hair loss or something the researchers don't think should be ruled out. Such cases should be clearly documented in the investigator's notes; Underwent major surgery (except minor outpatient procedures, such as placement of vascular access) within 3 weeks of the first course of trial treatment; Pregnant or lactating patients; Malignancy (except basal cell carcinoma of the skin, which has been cured, and carcinoma in situ of the cervix) in the past 5 years.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Zhimin Shao, M.D
Phone
+86-021-64175590
Ext
88807
Email
zhimingshao@yahoo.com
Facility Information:
Facility Name
Breast cancer institute of Fudan University Cancer Hospital
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200032
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Zhi-Ming Shao, MD
Phone
86-21-641755901105
Email
zhimingshao@yahoo.com
First Name & Middle Initial & Last Name & Degree
Lei Fan, MD
Phone
86-21-641755901105
Email
cmchen@medmail.com.cn
First Name & Middle Initial & Last Name & Degree
Zhi-Ming Shao, MD
First Name & Middle Initial & Last Name & Degree
Lei Fan, MD
First Name & Middle Initial & Last Name & Degree
Wenjuan Zhang, MD
First Name & Middle Initial & Last Name & Degree
Ying Zhou

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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SNF Platform Study of HR+/ HER2-advanced Breast Cancer

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