Clinical trial NCT06459791: Efficacy of Personalized Tumorogram-based Therapy in Cancer Established From Patient-derived Organoid
Official title: Efficacy of Personalized Tumorogram-based Therapy in Cancer Established From Patient-derived Biological Avatar: Proof-of-concept Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Metastatic Breast Cancer
Keywords: tumorogram
metastatic breast cancer
avatar
Organoid
PDO
Lead sponsor: Institut Curie
Sponsor class: OTHER
First posted: 2024-06-14
Enrollment: 110
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Methodology: RIPH 1, Phase II, multi-center, single-arm, non-randomized study
Primary purpose: TREATMENT

Brief summary: A biopsy of a breast tumor lesion will be performed for processing to establish avatars (patient-derived organoids -PDO). A personalized tumorogram for each patient will be provided, based on the results of the drug screening (= tumor predicted as sensitive, intermediate, resistant or non-evaluable for each drug tested). Patients with an informative tumorogram will receive one of the recommended treatments (line N+1) in the event of tumor progression, administered according to standard procedures and validated at medical meetings specific to each center, and their fate will be monitored.

Detailed description: A biopsy of a breast tumor lesion will be performed and transferred to the LIP laboratory at the Institut Curie (Laboratoire d'Investigation Préclinique, Département de Recherche Translationnelle) for processing to establish avatars (patient-derived organoids -PDO).

Step 1: Establishment of avatar (PDO): follow-up of line N (standard care) when the tumorogram is established, then follow-up of standard line N+1.

* The patient will then be treated (line N) as part of standard care while awaiting the result of the tumorogram.
* A drug screening will be carried out on the PDO (\~5-10 drugs/patient), which will be progressive and adapted to the clinical context (including treatment history), including drugs used in standard care (cf. list in Table 1).
* A personalized tumorogram for each patient will be provided, based on the results of the drug screening (= tumor predicted as sensitive, intermediate, resistant or non-evaluable for each drug tested).
* A multidisciplinary committee will be set up for this study, which will meet regularly (\~1 time per week) to discuss patients included in the study, obtaining PDOs, drugs to be prioritized in the screening, results of the drug screening and personalized tumorograms. The committee will include at least one oncologist and one biologist from the laboratory.
* The multidisciplinary committee will make a therapeutic recommendation based on the personalized tumorogram, which may include several drugs considered sensitive to the tumour
* A tumorogram will be considered as informative if it proposes at least one chemotherapy molecule considered as sensitive in the PDO model.
* Patients whose PDO could not be obtained, or whose tumorogram was not informative, will receive standard treatment.

Step 2: informative tumorogram: follow-up of experimental line N+1 Patients with an informative tumorogram will receive one of the recommended treatments (line N+1) in the event of tumor progression, administered according to standard procedures and validated at medical meetings specific to each center, and their fate will be monitored.

Eligibility criteria: Inclusion Criteria:

1. Patient over 18 years of age
2. Advanced breast cancer
3. Triple-negative phenotype (HR-/HER2-) or HR+/HER2- after hormone resistance (progression after treatment with hormone therapy + CDK4/6 inhibitor)
4. Tumor measurable according to RECISTv1.1 criteria, accessible to biopsy
5. Performans Status 0-1

Exclusion Criteria:

1. More than 3 lines of chemotherapy in the advanced setting (excluding hormone therapy/CDK4/6 inhibitor)
2. Progressive brain metastases
3. Leptomeningeal metastasis

Primary outcomes:
measure: Tumor response rate
timeFrame: 6 months
Secondary outcomes:
measure: Comparison of response rate between both the arms
timeFrame: 6 months
measure: Organoid cultures achievement
timeFrame: 6 months
measure: Tumorograms performance
timeFrame: 6 months
measure: Overall survival
timeFrame: up to 18 months
Other outcomes:
Locations:
city: Paris
country: France
facility: Institut Curie
city: Paris
country: France
facility: Hôpital Saint-Louis - AP-HP Senopole
city: Saint-Cloud
country: France
facility: Institut Curie
Study officials:
affiliation: Institut Curie
name: Luc CABEL, MD
role: PRINCIPAL_INVESTIGATOR
References: