Clinical trial NCT06770296: The Dosing Regimen of Pyrotinib in HER2-positive Advanced First-line Breast Cancer: a Phase I Clinical Study
Official title: Pyrotinib at Different Doses in Combination With Trastuzumab and Paclitaxel Chemotherapy for First-Line Treatment of HER2-Positive Advanced Breast Cancer: A Multicenter, Randomized, Double-Cohort Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
Conditions: Breast Cancer
Keywords: HER2 positive
Pyrotinib
Lead sponsor: The First Affiliated Hospital with Nanjing Medical University
Sponsor class: OTHER
Collaborators: name: The First People's Hospital of Xuzhou
name: The Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu Province, China
name: The Second People's Hospital of Changshu
name: Shuyang County Traditional Chinese Medicine Hospital
name: Affiliated Hospital of Nantong University
name: Affiliated Hospital of Jiangsu University
name: The Affiliated Hospital of Xuzhou Medical University
First posted: 2025-01-13
Enrollment: 200
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: TREATMENT

Brief summary: Evaluate the safety and efficacy of Pyrotinib at different doses in combination with trastuzumab and paclitaxel chemotherapy for first-line treatment of HER2-positive advanced breast cancer.

Detailed description: This study is planned to include 200 patients with HER2-positive advanced breast cancer meeting the admission criteria between 2024-11-01 and 2026-11-01. Statistical software will be used by the randomization officers for 1:1 allocation to pyrotinib 320mg in combination with trastuzumab and paclitaxel chemotherapy group and pyrotinib 400mg in combination with trastuzumab and paclitaxel chemotherapy group.

Eligibility criteria: Inclusion Criteria:

* The subjects voluntarily joins the study and signs the informed consent;
* Subject is an adult female or male ≥ 18 years old and ≤ 75 years old at the time of informed consent;
* HER2-positive advanced breast cancer confirmed by pathology:HER2-positive was defined as \>10% of immunoreactive cells with an immunohistochemical (IHC) score of 3+ or HER2 gene amplification as a result of in situ hybridization (ISH). HER2 positivity should be verified by the pathology department of the research center;
* Recurrent or metastatic breast cancer; Patients with local recurrence had to be confirmed by the investigator as not amenable to curative resection;
* At least one measurable lesion or only bone metastases according to RECIST v1.1 criteria (including osteolytic lesions or mixed osteolytic/osteoblastic lesions);
* When randomized, Eastern Cooperative Oncology Group(ECGO) physical fitness status is 0 or 1 point;
* Vital organ function meets the following requirements (excluding the use of any blood components and cell growth factors during screening) : Absolute neutrophil (ANC) count ≥1.5×109/L; Platelet (PLT) ≥100×109/L; Hemoglobin (HB) ≥9g/dL; Total Bilirubin(TBIL) ≤ULN((Known patients with Gilbert's syndrome:Total Bilirubin(TBIL) ≤2×ULN);Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤1.5×ULN(Patients with liver metastasis:ALT and AST≤5×ULN); Alkaline phosphatase (AKP) ≤ 2.5 times ULN; Blood Urea Nitrogen and Serum creatinine (Cr) ≤1.5×ULN;Left Ventricular Ejection Fractions(LVEF)≥50%;Corrected QT Interval(QTcF)\<470msec.

Exclusion Criteria:

* The patient has received any systemic antitumor therapy at the stage of recurrence/metastasis, including any agents targeting EGFR or HER2, systemic chemotherapy, immunotherapy, and more than first-line endocrine therapy, as well as other antitumor therapies deemed by the investigators to be excluded;
* Tyrosine kinase inhibitor (TKI) preparations or macromolecular antibodies against HER have been used at any stage of breast cancer, except for trastuzumab in the (new) adjuvant stage;
* In the stage of breast cancer (new) adjuvant therapy, the time interval from the end of systemic therapy (except endocrine therapy) to the discovery of recurrence/metastasis is \<12 months;
* Patients with active brain metastases with pial metastases confirmed by MRI or lumbar puncture (brain metastases requiring mannitol treatment or with symptoms);
* Grade≥ 3 peripheral neuropathy according to CTCAE4.0.3 criteria;
* Patients judged by the investigators to be unsuitable for systematic chemotherapy;
* Use of endocrine therapy drugs within 7 days prior to randomization;
* Patients with other malignancies within the previous 5 years, excluding cured cervical carcinoma in situ, skin basal cell carcinoma, or squamous cell carcinoma (patients with other malignancies occurring more than 5 years after randomization, such as those cured only by surgery, are allowed to be included);
* Had a major surgical procedure or significant trauma within 4 weeks prior to randomization, or was expected to undergo major surgery;
* Serious heart disease or discomfort, including but not limited to the following:

Previous history of heart failure or systolic dysfunction (LVEF\<50%) High-risk or treatment-requiring angina pectoris or arrhythmias (e.g., second-degree type 2 atrioventricular block or third-degree atrioventricular block, ventricular tachycardia) Clinically significant valvular heart disease ECG showed transmural myocardial infarction Poor hypertension control (systolic blood pressure \>150mmHg and/or diastolic blood pressure \>100mmHg);

* Inability to swallow, chronic diarrhea, intestinal obstruction, or other factors affecting the administration and absorption of medications;
* Known allergic history of the drug components of this protocol;
* A history of immunodeficiency, including HIV infection, or other acquired, congenital immunodeficiency diseases, or a history of organ transplantation;
* Presence of third-space fluid accumulation that cannot be controlled by drainage or other methods (e.g., pleural fluid and ascites);
* Pregnant and lactating female subjects, or fertile subjects who were unwilling to use effective contraception throughout the trial period and within 3 months after the last study dose;
* Have a serious concomitant disease or other co-medical condition that interferes with planned treatment or any other condition that is not suitable for participation in this study, such as active hepatitis B, a lung infection requiring treatment.

Primary outcomes:
measure: Objective Response Rate
timeFrame: From the time of initiation of treatment in this study to the time of disease progression in the subjects,assessed up to 100 months.
Secondary outcomes:
Other outcomes:
measure: Progression Free Survival
timeFrame: From date of randomization until the date of first documented progression or death from any cause, whichever came first,assessed up to 100 months.
measure: Overall survival
timeFrame: From date of randomization until the date of first documented progression or death from any cause, whichever came first,assessed up to 100 months.
measure: Duration of Response
timeFrame: From the first evaluation of CR, PR (whichever occurs first) to disease progression or death,whichever came first,assessed up to 100 months.
measure: Patient report outcome
timeFrame: Through study completion, an average of 1 year(From the date of enrollment to the clinical outcome from patients' report)
measure: Incidence of Treatment-Emergent Adverse Events
timeFrame: From the beginning of the patient's use of pyrrotinib until the end of the safety follow-up period (28 days after the last dose).
Locations:
city: Nanjing
country: China
facility: Jiangsu Provincial People's Hospital
state: Jiangsu
Study officials:
affiliation: The First Affiliated Hospital with Nanjing Medical University
name: Yongmei Yin, Ph.D
role: STUDY_CHAIR
References: