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A Randomized, Controlled, Open-label Clinical Trial of Adjuvant Intensive Therapy for HR+/ HER2-SNF4 Early Breast Cancer

Primary Purpose

HR+/HER2-breast Cancer

Status
Not yet recruiting
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Standard endocrine therapy plus Apatinib
Sponsored by
Fudan University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HR+/HER2-breast Cancer

Eligibility Criteria

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

Inclusion Criteria: Women aged ≥18 years and ≤70 years; Histologically confirmed HR+/HER2- invasive breast cancer (defined by immunohistochemical detection of ER > 10% positive tumor cells were defined as ER positive, PR > 10% positive tumor cells were defined as positive PR, and ER and/or PR were defined as positive HR. HER2 0-1+ or HER2 ++ but negative by FISH test, no amplification, defined as HER2 negative); Definition of SNF4 subtype: SNF4 subtype confirmed by digital pathology of H&E sections; High-risk early breast cancer, which was pathologically confirmed as HR+/HER2- and SNF4 subtypes; pT2-4N0-3M0; Complete the adjuvant chemotherapy selected by the doctor; No more than 16 months from surgery to randomization, and no more than 12 weeks after non-endocrine therapy; The functions of major organs are basically normal, meeting the following conditions: The standard of blood routine examination shall meet: HB ≥90 g/L (no blood transfusion within 14 days); ANC ≥1.5×109 /L; PLT ≥75×109 /L; Biochemical examination shall meet the following standards: TBIL ≤1.5×ULN (upper limit of normal value); ALT and AST ≤3 x ULN; In case of liver metastasis, ALT and AST≤ 5×ULN; Serum Cr ≤1×ULN, endogenous creatinine clearance > 50 ml/min (Cockcroft-Gault formula); ECOG score 0 or 1; Fertile female subjects are required to use a medically approved contraceptive for the duration of the study treatment and for at least 3 months after the last use of the study drug; The subjects voluntarily joined the study, signed the informed consent, had good compliance, and cooperated with follow-up. Exclusion Criteria: bilateral breast cancer; A history of other malignancies, except cured basal cell carcinoma of the skin and carcinoma in situ of the cervix; transfer of any part; Pregnant or lactating women, women of childbearing age can not effectively contraceptive; Patients participating in other clinical trials; Severe organ dysfunction (heart, lung, liver and kidney); 50% (cardiac hypertrophy); Severe cardiovascular and cerebrovascular disease (e.g., unstable angina, chronic heart failure, myocardial infarction, or cerebrovascular accident) within 6 months before randomization; Diabetics with poor blood sugar control; Patients with a history of gastrointestinal bleeding or a definite tendency to gastrointestinal bleeding within the past 6 months, such as esophageal varicose veins with bleeding risk, locally active ulcer lesions, stool occult blood ≥ (++), shall not be included in the group; If fecal occult blood (+), gastroscopy is required; Abdominal fistula, gastrointestinal perforation, or abdominal abscess in the 28 days before the study; Urine routine showed urine protein ≥++ or confirmed 24 hours urine protein quantity > 1.0g; Patients with hypertension who cannot be reduced to the normal range after antihypertensive medication (systolic blood pressure > 140mmHg, diastolic blood pressure > 90mmHg). Allergic constitution, or known allergic history of the drug components of the program; Previous thyroid dysfunction; Severe or uncontrolled infection; Those who have a history of psychotropic drug abuse and cannot abstain or have a history of mental disorders; The researchers determined that the patients were not suitable for the study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Standard endocrine therapy plus Apatinib

    Standard endocrine therapy

    Arm Description

    5 to 10 years of endocrine therapy (e.g., aromatase inhibitors, tamoxifen, LHRH agonists, etc.) and 2 years of CDK4/6 inhibitors, depending on clinical indications. plus Apatinib, 250mg orally once a day;

    5 to 10 years of endocrine therapy (e.g., aromatase inhibitors, tamoxifen, LHRH agonists, etc.) and 2 years of CDK4/6 inhibitors, depending on clinical indications.

    Outcomes

    Primary Outcome Measures

    3-year survival without invasive disease (iDFS)
    3-year survival without invasive disease (iDFS)

    Secondary Outcome Measures

    3-year distant disease free survival (DDFS)
    3-year distant disease free survival (DDFS)
    5-year overall survival (OS)
    5-year overall survival (OS)
    security
    Incidence of treatment-emergent adverse events adverse events according to CTCAE 5.0
    PRO (patient reported outcome)
    Registration of differences in quality of life between the two groups in the study. EORTC QLQ-C30(scale range 0-100, a higher score indicating better quality of life) will be used for as quality of life measurement. The scores will be presented graphically in separate figures. Differences between the groups will be tested using t-test and analysis of covariance.

    Full Information

    First Posted
    May 23, 2023
    Last Updated
    June 2, 2023
    Sponsor
    Fudan University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05889871
    Brief Title
    A Randomized, Controlled, Open-label Clinical Trial of Adjuvant Intensive Therapy for HR+/ HER2-SNF4 Early Breast Cancer
    Official Title
    A Randomized, Controlled, Open-label, Phase III Clinical Trial of Adjuvant Intensive Therapy for HR+/ HER2-SNF4 Early Breast Cancer Based on SNF Molecular Classification
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    June 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    June 1, 2023 (Anticipated)
    Primary Completion Date
    June 1, 2026 (Anticipated)
    Study Completion Date
    June 1, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Fudan 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
    This is a randomized, controlled, open, phase III trial of adjuvant intensive therapy for early breast cancer with HR+/ HER2-SNF4 based on SNF molecular typing. A randomized, controlled, open Phase III study to explore the efficacy and safety of Apatinib combined with standard endocrine therapy in adjuvant intensive therapy for HR+/ HER2-SNF4 type early high-risk breast cancer.
    Detailed Description
    584 patients with lumofacial breast cancer (ER and PR positive, HER2 negative) who received surgery in the Breast Surgery Department of the Affiliated Cancer Hospital of Fudan University were previously collected. The main work was genome sequencing (514 cases of whole exon sequencing, 527 cases of OncoScan microarray), 573 cases of transcriptome sequencing, 228 cases of proteomics (TMT mass spectrometry), 384 cases of metabolomics (liquid chromatography), 439 cases of digital pathology, and partial paired single cell transcriptome sequencing. This group ranks as the largest Asian coelfacial breast cancer multiomics cohort to date. All patients could be divided into four categories by SNF algorithm fusion clustering, namely SNF1 (classical coelateral type), SNF2 (immune-mediated type), SNF3 (proliferative type) and SNF4 (receptor tyrosine kinase-driven type). Different types had unique multiomics and clinicopathological characteristics, which fully analyzed the molecular heterogeneity of coelateral type breast cancer. This is a randomized, controlled, open, phase III trial of adjuvant intensive therapy for early breast cancer with HR+/ HER2-SNF4 based on SNF molecular typing. A randomized, controlled, open Phase III study to explore the efficacy and safety of Apatinib combined with standard endocrine therapy in adjuvant intensive therapy for HR+/ HER2-SNF4 type early high-risk breast cancer.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    HR+/HER2-breast Cancer

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Standard endocrine therapy plus Apatinib
    Arm Type
    Experimental
    Arm Description
    5 to 10 years of endocrine therapy (e.g., aromatase inhibitors, tamoxifen, LHRH agonists, etc.) and 2 years of CDK4/6 inhibitors, depending on clinical indications. plus Apatinib, 250mg orally once a day;
    Arm Title
    Standard endocrine therapy
    Arm Type
    Active Comparator
    Arm Description
    5 to 10 years of endocrine therapy (e.g., aromatase inhibitors, tamoxifen, LHRH agonists, etc.) and 2 years of CDK4/6 inhibitors, depending on clinical indications.
    Intervention Type
    Drug
    Intervention Name(s)
    Standard endocrine therapy plus Apatinib
    Intervention Description
    Standard endocrine therapy plus Apatinib
    Primary Outcome Measure Information:
    Title
    3-year survival without invasive disease (iDFS)
    Description
    3-year survival without invasive disease (iDFS)
    Time Frame
    3 years
    Secondary Outcome Measure Information:
    Title
    3-year distant disease free survival (DDFS)
    Description
    3-year distant disease free survival (DDFS)
    Time Frame
    3 years
    Title
    5-year overall survival (OS)
    Description
    5-year overall survival (OS)
    Time Frame
    5 years
    Title
    security
    Description
    Incidence of treatment-emergent adverse events adverse events according to CTCAE 5.0
    Time Frame
    through study completion, an average of 1 year
    Title
    PRO (patient reported outcome)
    Description
    Registration of differences in quality of life between the two groups in the study. EORTC QLQ-C30(scale range 0-100, a higher score indicating better quality of life) will be used for as quality of life measurement. The scores will be presented graphically in separate figures. Differences between the groups will be tested using t-test and analysis of covariance.
    Time Frame
    5 years

    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: Women aged ≥18 years and ≤70 years; Histologically confirmed HR+/HER2- invasive breast cancer (defined by immunohistochemical detection of ER > 10% positive tumor cells were defined as ER positive, PR > 10% positive tumor cells were defined as positive PR, and ER and/or PR were defined as positive HR. HER2 0-1+ or HER2 ++ but negative by FISH test, no amplification, defined as HER2 negative); Definition of SNF4 subtype: SNF4 subtype confirmed by digital pathology of H&E sections; High-risk early breast cancer, which was pathologically confirmed as HR+/HER2- and SNF4 subtypes; pT2-4N0-3M0; Complete the adjuvant chemotherapy selected by the doctor; No more than 16 months from surgery to randomization, and no more than 12 weeks after non-endocrine therapy; The functions of major organs are basically normal, meeting the following conditions: The standard of blood routine examination shall meet: HB ≥90 g/L (no blood transfusion within 14 days); ANC ≥1.5×109 /L; PLT ≥75×109 /L; Biochemical examination shall meet the following standards: TBIL ≤1.5×ULN (upper limit of normal value); ALT and AST ≤3 x ULN; In case of liver metastasis, ALT and AST≤ 5×ULN; Serum Cr ≤1×ULN, endogenous creatinine clearance > 50 ml/min (Cockcroft-Gault formula); ECOG score 0 or 1; Fertile female subjects are required to use a medically approved contraceptive for the duration of the study treatment and for at least 3 months after the last use of the study drug; The subjects voluntarily joined the study, signed the informed consent, had good compliance, and cooperated with follow-up. Exclusion Criteria: bilateral breast cancer; A history of other malignancies, except cured basal cell carcinoma of the skin and carcinoma in situ of the cervix; transfer of any part; Pregnant or lactating women, women of childbearing age can not effectively contraceptive; Patients participating in other clinical trials; Severe organ dysfunction (heart, lung, liver and kidney); 50% (cardiac hypertrophy); Severe cardiovascular and cerebrovascular disease (e.g., unstable angina, chronic heart failure, myocardial infarction, or cerebrovascular accident) within 6 months before randomization; Diabetics with poor blood sugar control; Patients with a history of gastrointestinal bleeding or a definite tendency to gastrointestinal bleeding within the past 6 months, such as esophageal varicose veins with bleeding risk, locally active ulcer lesions, stool occult blood ≥ (++), shall not be included in the group; If fecal occult blood (+), gastroscopy is required; Abdominal fistula, gastrointestinal perforation, or abdominal abscess in the 28 days before the study; Urine routine showed urine protein ≥++ or confirmed 24 hours urine protein quantity > 1.0g; Patients with hypertension who cannot be reduced to the normal range after antihypertensive medication (systolic blood pressure > 140mmHg, diastolic blood pressure > 90mmHg). Allergic constitution, or known allergic history of the drug components of the program; Previous thyroid dysfunction; Severe or uncontrolled infection; Those who have a history of psychotropic drug abuse and cannot abstain or have a history of mental disorders; The researchers determined that the patients were not suitable for the study.

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    A Randomized, Controlled, Open-label Clinical Trial of Adjuvant Intensive Therapy for HR+/ HER2-SNF4 Early Breast Cancer

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