Clinical trial NCT03150576: Platinum and Polyadenosine 5'Diphosphoribose Polymerisation Inhibitor for Neoadjuvant Treatment of Triple Negative Breast Cancer and/or Germline BRCA Positive Breast Cancer
Official title: Randomised, Phase II/III, 3 Stage Trial to Evaluate the Safety and Efficacy of the Addition of Olaparib to Platinum-based Neoadjuvant Chemotherapy in Breast Cancer Patients With TNBC and/or gBRCA.
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
PHASE3
Conditions: Breast Cancer
Keywords: Triple negative breast cancer
germline BRCA
platinum and PARP inhibitor
neoadjuvant chemotherapy
olaparib
Lead sponsor: Cambridge University Hospitals NHS Foundation Trust
Sponsor class: OTHER
Collaborators: name: AstraZeneca
name: Cancer Research UK
First posted: 2017-05-12
Enrollment: 780
Sex: ALL
Minimum age (years): 16
Maximum age (years): 70
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This neoadjuvant trial for patients with TNBC and/or gBRCA breast cancer, aims to investigate the safety and efficacy (improvement in pathological Complete Response at surgery) of concurrent platinum-based chemotherapy with olaparib an inhibitor of the PARP enzyme (PARPi).

Detailed description: Randomised, phase II/III 3 stage trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in breast cancer patients with TNBC and/or gBRCA.

Disease under investigation: Breast Cancer

Purpose of clinical trial: To establish if the addition of olaparib to neoadjuvant platinum-based chemotherapy for Triple Negative Breast Cancer (TNBC) and/or germline BRCA (gBRCA) breast cancer is safe and improves efficacy.

Trial Design: Open label, randomised, 3-stage Phase II/III

Sample Size: Minimum of 780 patients (including at least 220 gBRCA patients equally allocated to the control and the selected research arm).

Non Investigational Medicinal Products: Prophylactic granulocyte-colony stimulating factor (G-CSF) to be given as per local practice and 3 cycles of anthracyclines as per local practice.

Treatment period: A minimum of 21 weeks of chemotherapy followed by surgery.

Procedures: Screening \& enrolment

Eligible patients with early breast cancer will be registered and consented for screening:

BRCA mutation test Tumour Infiltrating Lymphocytes(TILs) score Cytokeratin 5/6 (CK5/6), Epidermal Growth Factor Receptor (EGFR) +/-, Androgen Receptor (AR) status by Immunohistochemistry (IHC).

Standard assessment prior to chemotherapy Standard staging to exclude metastatic disease. When eligibility is confirmed, patients will be randomised via a web-based central system which will allocate each patient a unique randomisation number associated with one of the treatment arms.

PARTNERing Pathway - For those patients who still have residual disease after receiving neoadjuvant chemotherapy +/- olaparib there is the opportunity to be screened to a sub-study to receive a further two cycles of chemotherapy consisting of Duralumab and AZD6738.

End of Trial: For patients, the end of trial is after the last follow-up visit or contact with the research team planned 10 years after surgery.

Procedures for safety monitoring during trial: Pharmacovigilance will be performed by the PARTNER Trial Office. Also, the Trial Management Group and the Independent Data and Safety Monitoring Committee will regularly review the patient safety data.

Criteria for discontinuation of trial treatment on safety grounds:

Severe toxicity or inter-current illness, requiring cessation in the judgement of patient's clinician.

Patient within 4 weeks has not recovered from toxicity to an extent that allows further treatment.

Patient unable to comply with trial procedures. Disease progression while on trial treatment. Patient becomes pregnant.

Eligibility criteria: Inclusion Criteria:

* Aged between 16 and 70.
* Written informed consent, willing and able to comply with the Protocol for the duration of the trial including undergoing treatment and scheduled visits and examinations.
* Histologically confirmed invasive breast cancer.
* ER-negative\*, and HER2-negative\*\* breast cancer (TNBC). Patients will be eligible with any PR status but PR expression must be scored.

OR

* Germline BRCA (gBRCA) mutation positive, HER2 negative, and PgR / ER of any status.
* T1, T2 or T3 tumours.
* T4 tumour of any size with direct extension to (a) chest wall or (b) skin. OR Inflammatory carcinoma with tumour of any size. OR

Other Locally Advanced Disease:

* Involvement of ipsilateral large or fixed axillary lymph nodes, or infra or supraclavicular nodes (\>10mm diameter or clinical N2 or N3) and primary breast tumour of any diameter.
* Involvement of ipsilateral large or fixed axillary lymph nodes, or infra or supraclavicular nodes (\>10mm diameter, or clinical N2 or N3), without a primary breast tumour identified, the presence of breast cancer in a Lymph Node (LN) must be histopathologically confirmed by LN biopsy.

OR

Multifocal tumour:

- with at least one tumour with a size\>10mm.

* Patients with bilateral disease are eligible to enter the trial provided that both breast disease meets the above criteria.
* Be fit to receive the trial chemotherapy regimen in the opinion of the responsible clinician:

Adequate bone marrow, hepatic, and renal function. ECOG performance status of 0, or 1.

* Treatment should be commenced within 6 weeks of the diagnostic biopsy. In uncommon circumstances, where medically acceptable, treatment is permitted to start within a maximum of 9 weeks of the diagnostic biopsy.
* Availability of the Tumour Infiltrating Lymphocytes score is required.
* Availability of CK 5/6 and EGFR +/- Androgen Receptor IHC score.
* Availability of slides and paraffin embedded tissue blocks from pre-chemotherapy core biopsy and from primary surgical resection is required.
* Women of child-bearing potential (WCBP), defined as not surgically sterilized or not post-menopausal for at least 24 consecutive months if age ≤55 year or 12 months if age \>55 years, must have a negative serum or urine pregnancy test within 14 days prior to randomisation.
* All WCBP and all sexually active male patients as well as their partners must be aware that they should not conceive during the treatment period and therefore should routinely use effective forms of contraception, throughout their participation in the trial and for at least 6 months after the last dose of trial treatment. Please follow the olaparib contraception guidelines.

Exclusion Criteria:

* T0 tumour in absence of axillary node \>10mm.
* TNBC with a non-basal phenotype which strongly expresses Androgen Receptor.
* Previous or concomitant chemotherapy or biological agents used for the treatment of cancer in the last 5 years.
* Malignancy within the last 5 years except: adequately treated non-melanoma skin cancer; curatively treated in situ cancer of the cervix; ductal carcinoma in situ (DCIS); Stage 1, grade 1 endometrial carcinoma; or other solid tumours including lymphomas (without bone marrow involvement) curatively treated with no evidence of disease for ≥5 years.
* Patients with myelodysplastic syndrome/acute myeloid leukaemia.
* Evidence of distant metastasis apparent prior to randomisation.
* Patients with uncontrolled seizures.
* Pre-existing sensory or motor neuropathy of CTCAE v4.03, grade ≥2.
* Concomitant use of known potent CYP3A4 inhibitors and inducers. Consider wash-out periods.
* Pregnant or breast feeding women.
* Not suitable for neoadjuvant chemotherapy in the opinion of the responsible clinician.
* Major surgery within 14 days of starting trial treatment and patients must have recovered from any effects of any major surgery.
* Any evidence of other disease or any concomitant medical or psychiatric problems which in the opinion of the Investigator would prevent completion of treatment or follow-up. For example:

Evidence of severe or uncontrolled cardiac disease Uncontrolled ventricular arrhythmia Recent myocardial infarction (within 12 months) Active infection including Hepatitis B, Hepatitis C and Human Immunodeficiency virus (HIV). Screening for chronic conditions is not required.

* ECG with mean resting QTc \>470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome.
* Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the trial medication
* Known hypersensitivity to olaparib, carboplatin, paclitaxel or their excipients (including cremophor).
* Whole blood transfusions in the last 120 days prior to blood sampling for BRCA test as it may interfere with the results (packed red blood cells and platelet transfusions are acceptable).

Primary outcomes:
measure: Stage 1 - Number of participants with treatment-related adverse events as assessed by NCI CTCAE v4.03.
timeFrame: 1 year - when first 25 patients in each research arm who had received at least one dose of Olaparib protocol treatment have completed their protocol treatment.
measure: Stage 2 - pCR rate and completion rate of Olaparib treatment as per protocol.
timeFrame: 15 months - when pathological complete response (pCR) is available for 53 patients in each of two research arms.
measure: Stage 3 - Efficacy analysis based on pCR at surgery. To be assessed by central review of pathology reports.
timeFrame: 5.5 years - October 2021 approx.
Secondary outcomes:
measure: pCR at surgery - assessed by review of histopathology slides
timeFrame: Up to 2 years after last patient randomised
measure: PARTNERing Pathway
timeFrame: 2 cycles (each lasting 28 days)
measure: Relapse-Free Survival (RFS)
timeFrame: Up to 10 years after last patient is randomised
measure: Breast cancer specific survival (BCSS)
timeFrame: Up to 10 years after last patient is randomised
measure: Distant disease-free survival
timeFrame: Up to 10 years after last patient is randomised
measure: Local recurrence-free survival
timeFrame: Up to 10 years after last patient is randomised
measure: Overall survival (OS)
timeFrame: Up to 10 years after last patient is randomised
measure: Time to second cancer (TTSC)
timeFrame: Up to 10 years after last patient is randomised
measure: pCR in breast alone
timeFrame: Up to 2 years after last patient is randomised
measure: Residual Cancer Burden (RCB)
timeFrame: Up to 10 years after last patient is randomised
measure: Radiological response - as assessed by radiological response criteria as per RECIST v1.1
timeFrame: Up to 2 years after last patient is randomised
measure: Treatment related toxicities - as assessed by CTCAE v4.03
timeFrame: Up to 10 years after last patient is randomised
measure: Quality of Life Questionnaire
timeFrame: Up to 10 years after last patient is randomised
Other outcomes:
measure: Discovery and validation of markers that can be correlated with outcomes (pCR and RFS).
timeFrame: Up to 15 years after last patient is randomised
Locations:
city: Cambridge
country: United Kingdom
facility: Cambridge University Hospitals NHS Foundation Trust & the University of Cambridge
state: Cambridgeshire
city: Burton Upon Trent
country: United Kingdom
facility: Queen's Hospital
state: Derby
city: Manchester
country: United Kingdom
facility: The Christie
state: Lancs
city: Wakefield
country: United Kingdom
facility: Pinderfields General Hospital
state: Yorkshire
city: Ayr
country: United Kingdom
facility: University Hospital Ayr
city: Basingstoke
country: United Kingdom
facility: Basingstoke and North Hampshire Hospital
city: Bedford
country: United Kingdom
facility: Bedford General Hospital
city: Bournemouth
country: United Kingdom
facility: Royal Bournemouth Hospital
city: Bristol
country: United Kingdom
facility: Bristol Haematology & Cancer Centre
city: Bury Saint Edmunds
country: United Kingdom
facility: West Suffolk Hospital
city: Cardiff
country: United Kingdom
facility: Velindre Cancer Centre
city: Colchester
country: United Kingdom
facility: Colchester General Hospital
city: Dudley
country: United Kingdom
facility: Russells Hall Hospital
city: Huntingdon
country: United Kingdom
facility: Hinchingbrooke Hospital
city: Ipswich
country: United Kingdom
facility: Ipswich Hospital
city: Kidderminster
country: United Kingdom
facility: Kidderminster General Hospital
city: Kilmarnock
country: United Kingdom
facility: University Hospital Crosshouse
city: London
country: United Kingdom
facility: University College London Hospital
city: London
country: United Kingdom
facility: Royal Free Hospital
city: Northwood
country: United Kingdom
facility: Mount Vernon Cancer Centre
city: Nottingham
country: United Kingdom
facility: Nottingham City Hospital
city: Oxford
country: United Kingdom
facility: Churchill Hospital
city: Peterborough
country: United Kingdom
facility: Peterborough City Hospital
city: Poole
country: United Kingdom
facility: Poole Hospital
city: Redditch
country: United Kingdom
facility: The Alexandra Hopsital
city: Romford
country: United Kingdom
facility: Queen's Hospital
city: Southampton
country: United Kingdom
facility: Southampton General Hospital
city: Swansea
country: United Kingdom
facility: Singleton Hospital
city: Winchester
country: United Kingdom
facility: Royal Hampshire County Hospital
city: Worcester
country: United Kingdom
facility: Worcestershire Royal Hospital
Study officials:
affiliation: The University of Cambridge, Department of Oncology
name: Jean Abraham
role: PRINCIPAL_INVESTIGATOR
References:
citation: Woitek R, McLean MA, Ursprung S, Rueda OM, Manzano Garcia R, Locke MJ, Beer L, Baxter G, Rundo L, Provenzano E, Kaggie J, Patterson A, Frary A, Field-Rayner J, Papalouka V, Kane J, Benjamin AJV, Gill AB, Priest AN, Lewis DY, Russell R, Grimmer A, White B, Latimer-Bowman B, Patterson I, Schiller A, Carmo B, Slough R, Lanz T, Wason J, Schulte RF, Chin SF, Graves MJ, Gilbert FJ, Abraham JE, Caldas C, Brindle KM, Sala E, Gallagher FA. Hyperpolarized Carbon-13 MRI for Early Response Assessment of Neoadjuvant Chemotherapy in Breast Cancer Patients. Cancer Res. 2021 Dec 1;81(23):6004-6017. doi: 10.1158/0008-5472.CAN-21-1499. Epub 2021 Oct 8.