Clinical trial NCT05159193: Neoadjuvant Treatment Pegylated Liposomal Doxorubicin Plus Cyclophosphamide Sequential Docetaxel Plus Trastuzumab and Pertuzumab Versus Docetaxel Plus Carboplatin Combined With Trastuzumab and Pertuzumab in HER-2 Positive Breast Cancer
Official title: A Multicentre, Open-label, Randomised Trial of Neoadjuvant Pegylated Liposomal Doxorubicin Plus Cyclophosphamide Sequential Docetaxel Plus Trastuzumab and Pertuzumab Versus Docetaxel Plus Carboplatin Combined With Trastuzumab and Pertuzumab in HER-2 Positive Breast Cancer
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Breast Cancer
Lead sponsor: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Sponsor class: OTHER
Collaborators: name: CSPC Ouyi Pharmaceutical Co., Ltd.
First posted: 2021-12-16
Enrollment: 372
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a multicenter, open label, non-inferiority, randomized controlled clinical study.

The aim of this study is to evaluate the efficacy and safety of a pegylated liposomal doxorubicin + cyclophosphamide followed by docetaxel plus trastuzumab and pertuzumab (PLD + C + HP followed by THP) regimen compared with a docetaxel + carboplatin plus trastuzumab and pertuzumab (TCbHP) regimen in the neoadjuvant treatment of HER-2-positive breast cancer.


Eligibility criteria: Inclusion Criteria:

1. Female patients aged from 18 to 70 years old;
2. Histologically confirmed as invasive breast cancer and without previous treatment.;
3. HER-2 Positive (defined by IHC 3+ or ISH positive);
4. Tumor \> 2cm;
5. Biopsy pathology (FNAB or CNB) diagnosed regional lymph node metastasis within 28 days prior to randomization;
6. Participants must have at least one measurable disease according to RECIST 1.1.
7. Participants with multifocal tumors (more than one tumor confined to the same quadrant as the primary tumor) are eligible provided all discrete lesions are sampled and centrally confirmed as HER2 positive.
8. Operable breast cancer with cT2-cT4/cN1-cN3/cM0, according to the AJCC tumor staging manual (8th Edition).
9. The HR(ER and PR) status of the primary tumor and the expression level of Ki-67 are clear.
10. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1;
11. LVEF ≥ 55%;
12. Brain natriuretic peptide (BNP) (or N-terminal pro brain natriuretic peptide (NT proBNP)) and cardiac troponin assays were within normal values.
13. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and serum total bilirubin are all ≤2 ULN. Serum creatinine ≤ 1.5 ULN.
14. Bone marrow function: white blood cell counts ≥ 3.0x10\^9/L, absolute neutrophil counts (ANC) ≥ 1.5x10\^9/L, platelets ≥ 100x10\^9/L, hemoglobin ≥ 90g/L;
15. Participants had good compliance with the planned treatment and follow-up, understood the study procedures of this study, and signed informed consent form.

Exclusion Criteria:

1. Breast cancer with distant metastasis;
2. Participants with multiple lesions (in different quadrants) or bilateral breast cancer;
3. Participants who have received prior anti-cancer therapy for breast cancer except those participants with a history of breast lobular carcinoma in situ (LCIS) that was surgically managed or ductal carcinoma in situ (DCIS) treated exclusively with mastectomy. In case of prior history of LCIS/DCIS, \>5 years must have passed from surgery until diagnosis of current breast cancer;
4. In the past and present, participants with severe cardiac disease or discomfort , including but not limited: 1)High-risk uncontrolled arrhythmia, atrial tachycardia (heart rate \> 100/min in resting state), significant ventricular arrhythmia (ventricular arrhythmia) or higher atrioventricular block (second-degree type 2 \[Mobitz 2\] atrioventricular block or third-degree atrioventricular block); 2)Angina pectoris requiring anti-angina medication; 3)Clinically significant valvular heart disease; 4)ECG showing transmural myocardial infarction; 5)Uncontrolled hypertension (eg systolic blood pressure \> 180mm Hg or diastolic blood pressure \> 100mmHg); 6)Myocardial infarction; 7)Congestive heart failure;
5. Participants have the following serious illnesses or medical conditions, including but not limited: 1)History of serious neurological or psychiatric disorders, including psychosis, dementia, or epilepsy, that prevent understanding and informed consent; 2)Active uncontrolled infection; 3)Active peptic ulcer, unstable diabetes;
6. A history of other malignancies within the previous 5 years, except for adequately treated carcinoma in situ of the cervix or basal cell carcinoma of the skin;
7. Treatment with any investigational drug within 28 days prior to randomization;
8. Participants who are known to be allergic to the active or other components of the study treatment or have contraindications for surgery;
9. Participants who are pregnant, breastfeeding, or refuse to use adequate contraception prior to study entry and for the duration of study participation;
10. Participants who were judged by the investigator to be unsuitable for this study.

Primary outcomes:
measure: Pathological complete response (pCR) rate
timeFrame: Within 2 to 5 weeks after completion of neoadjuvant therapy
Secondary outcomes:
measure: Objective response rate (ORR) at the end of neoadjuvant chemotherapy
timeFrame: After the last dose to before surgery or within 21 days
measure: 5-year disease-free survival (DFS) rate
timeFrame: 5 years
measure: Breast conservation rate at surgery
timeFrame: Within 2 to 5 weeks after completion of neoadjuvant therapy
measure: Number of participants with treatment-related adverse events as assessed by NCI-CTCAE V5.0, including overall and Grade 3/4 adverse events.
timeFrame: 5 years
measure: Percentage of Participants with dose reductions of chemotherapy due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
timeFrame: 1 year
measure: Percentage of Participants with chemotherapy delay due to Grade 3/4 adverse events as assessed by NCI-CTCAE V5.0
timeFrame: 1 year
measure: Relative dose intensity (RDI)
timeFrame: 1 year
Other outcomes:
measure: Subgroup analysis of pathological complete response (pCR) rates based on clinically relevant baseline characteristics
timeFrame: Within 2 to 5 weeks after completion of neoadjuvant therapy
measure: Biomarkers
timeFrame: From before neoadjuvant therapy to surgery
Locations:
city: Guandong
country: China
facility: Sunyat-sen Memorial Hospital
state: Guangdong
Study officials:
References: