Description:
Triple negative breast cancer (TNBC) is a difficult to treat molecular subtype with a poor
survival. TNBC can be divided into at least two molecular entities; BRCA-like and
non-BRCA-like. In this trial we would like to investigate whether a molecular subgroup exists
within TNBCs that derives a benefit from atezolizumab added to first line chemotherapy.
Title
- Brief Title: Triple-B Study;Carboplatin-cyclophosphamide Versus Paclitaxel With or Without Atezolizumab as First-line Treatment in Advanced Triple Negative Breast Cancer
- Official Title: Biomarker Discovery Randomized Phase IIb Trial With Carboplatin-cyclophosphamide Versus Paclitaxel With or Without Atezolizumab as First-line Treatment in Advanced Triple Negative Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
M13TNB
- SECONDARY ID:
2013-001484-23
- SECONDARY ID:
NL44403.031.13
- NCT ID:
NCT01898117
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Carbo/cyclo | Carboplatin, Cyclophosphamide | Carbo/cyclo |
Carbo/cyclo + atezolizumab | Carboplatin, Cyclophosphamide, Atezolizumab | Carbo/cyclo + Atezolizumab |
Paclitaxel | | Paclitaxel |
Paclitaxel + Atezolizumab | Paclitaxel, Atezolizumab | Paclitaxel + atezolizumab |
Purpose
Triple negative breast cancer (TNBC) is a difficult to treat molecular subtype with a poor
survival. TNBC can be divided into at least two molecular entities; BRCA-like and
non-BRCA-like. In this trial we would like to investigate whether a molecular subgroup exists
within TNBCs that derives a benefit from atezolizumab added to first line chemotherapy.
Detailed Description
Atezolizumab, a humanized monoclonal antibody that targets human programmed death-ligand 1
(PD-L1) has shown activity in TNBC. Early clinical trials with anti-PD-(L)1 monotherapy have
shown that the median duration to response in TNBC is remarkably long (18 weeks) compared to
cytotoxic chemotherapy. Since advanced TNBC is characterized by rapid disease progression,
most patients with TNBC may not have the opportunity to derive benefit from immunotherapy. We
hypothesize that by combining atezolizumab with paclitaxel or carboplatin-cyclophosphamide
the desired rapid tumor control will be obtained with chemotherapy and subsequently
atezolizumab can result in durable responses in a significant subset of patients. It is
unknown whether addition of atezolizumab to first line chemotherapy in TNBC is more
beneficial than adding this antibody to a second line treatment schedule. Because of this and
because of the poor outcome of patients with advanced TNBC experiencing disease progression
after first line palliative chemotherapy, patients who were randomized to a chemotherapy only
arm in this study will be offered the opportunity to cross over to the other chemotherapy
regimen plus atezolizumab at disease progression.
Trial Arms
Name | Type | Description | Interventions |
---|
Carbo/cyclo | Active Comparator | Carboplatin AUC=5 Cyclophosphamide 600 mg/m2 Q 4 weeks | |
Carbo/cyclo + Atezolizumab | Active Comparator | Carboplatin AUC=5 Cyclophosphamide 600 mg/m2 atezolizumab 840 mg d1,15 Q 4 weeks | - Carbo/cyclo + atezolizumab
|
Paclitaxel | Active Comparator | Paclitaxel 90 mg/m2 d1, 8, 15 Q 4 weeks | |
Paclitaxel + atezolizumab | Active Comparator | Paclitaxel 90 mg/m2 d1, 8, 15 atezolizumab 840 mg d1,15 Q 4 weeks | - Paclitaxel + Atezolizumab
|
Eligibility Criteria
Inclusion Criteria:
- Metastasized or locally advanced incurable triple negative breast cancer; patients
with stage IV at diagnosis are eligible as well. If the primary lesion is the only
measurable lesion according to RECIST criteria, every locoregional treatment must be
mentioned to the investigators.
- Histologically confirmed triple negative breast cancer (ER: < 10% nuclear staining of
tumor cells on IHC; HER2: either score 0 or 1 at immunohistochemistry or negative at
in situ hybridization [CISH or FISH] in case of score 2 or 3 on IHC)
- Histological confirmation of triple negative breast cancer of a metastatic lesion is
recommended
- Histological or cytological confirmation of metastatic breast cancer is required in
case of normal CA 15.3 levels
- Primary tumor or metastasis tissue (10 x10 μm blank slides FFPE tumor material) sent
to NKI-AVL for BRCA-like testing
- Pretreatment histological biopsy of a metastatic lesion for the translational research
questions (tumor tissue from bone metastases cannot be used).
- No previous cytotoxic therapy for metastatic disease
- Disease-free interval of at least 12 months after completion of adjuvant paclitaxel or
platinum compound therapy
- Disease-free interval of at least 6 months after completion of adjuvant docetaxel
- Measurable disease according to RECIST v1.1
- WHO performance status of 0 or 1
- Adequate bone marrow function: neutrophils ≥ 1.5 x 10E9 cells/l, platelets ≥100 x 10E9
cells/l, Hb ≥ 6.2 mmol/l.
- Normal liver function: bilirubin < 1.5 x upper limit of the normal range (ULN);
alkaline phosphatase < 2.5 x ULN (< 5 x ULN in case of liver metastases, and < 7 x ULN
in case of bone metastases); transaminases (ASAT/ALAT) < 2.5 x ULN (and < 5 x ULN in
case of liver metastases).
- Normal renal function:
> calculated (Cockcroft-Gault) or measured creatinine clearance > 50 mL/min
- INR < 1.5 and APTT normal, unless patient is on stable anti-coagulant treatment for at
least two weeks with a low molecular weight heparin or coumarin, then an INR within
the target range (usually between 2 and 3) is allowed.
- Written informed consent
Exclusion Criteria:
- Receptor conversion to hormone receptor positive (defined as >= 10% positive ER or PgR
tumor cells) or HER2 positive
- Another cancer except basal-cell carcinoma of the skin or in situ cervical cancer
within the previous 5 years
- Other antitumor therapy within the previous 21 days
- Radiotherapy with palliative intent within the previous 7 days before randomization.
- Known CNS disease except for treated brain metastases.
- Uncontrolled serious medical or psychiatric illness
- Pre-existing peripheral neuropathy > grade 1 (NCI-CTC AE (version 4.03)) at inclusion
- Severe infection within 4 weeks prior to randomization
- received antibiotocs within 2 weeks prior to cycle 1, day 1
- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to randomization or anticipation of need for major surgical procedure during the
course of the study
- New York Heart Association Class II or greater congestive heart failure. LVEF by MUGA,
ultrasound or MRI must be ≥ 50% and should be performed within 4 weeks prior to
randomization if cardiac failure is suspected.
- History of myocardial infarction or unstable angina within 6 months prior to
randomization
- History of myocardial infarction or unstable angina or unstable arrhytmias within 3
months prior to randomization
futher criteria, see protocol
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Validate the BRCA-like test |
Time Frame: | assessed up to 120 months |
Safety Issue: | |
Description: | Validate the BRCA-like test in predicting differential PFS with first line alkylating and platinum agents when compared to paclitaxel in TNBC |
Secondary Outcome Measures
Measure: | Improvement of objective response by adding atezolizumab |
Time Frame: | assessed up to 120 months |
Safety Issue: | |
Description: | Determine whether atezolizumab added to first line palliative chemotherapy improves objective response in TNBC |
Measure: | Define predictive biomarkers for objective response gain |
Time Frame: | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 120 months |
Safety Issue: | |
Description: | Define predictive biomarkers for objective response gain of the addition of atezolizumab to first line chemotherapy; e.g PD-L1, intratumoral CD8, TILs and pre-treatment LDH |
Measure: | Define predictive biomarkers for PFS gain |
Time Frame: | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 120 months |
Safety Issue: | |
Description: | Define predictive biomarkers for PFS gain of carboplatin-cyclophosphamide or paclitaxel chemotherapy |
Measure: | Determine PFS in BRCA like TNBC |
Time Frame: | From date of randomization until date of first documented progression or date of death, which ever comes first, assessed up to 120 months |
Safety Issue: | |
Description: | Determine whether an alkylating platinum regimen is more effective then paclitaxel regarding PFS in BRCA like TNBC |
Measure: | Determine PFS in non BRCA like TNBC |
Time Frame: | From date of randomization until date of first documented progression or date of death, which ever comes first, assessed up to 120 months |
Safety Issue: | |
Description: | Determine whether paclitaxel is more effective then an alkylating platinum regimen regarding PFS in non BRCA like TNBC |
Measure: | Overall survival (OS) |
Time Frame: | assessed up to 120 months |
Safety Issue: | |
Description: | Evaluation of overall survival (OS) for all (sub)group comparisons as pre-specified for PFS |
Measure: | Toxicity of all study regimens |
Time Frame: | Assessed at 1 year |
Safety Issue: | |
Description: | Adverse events will be graded according to NCI Common Toxicity Criteria version 4.03 |
Measure: | Determine PFS in cross over |
Time Frame: | At 6 and 12 months and up to 120 months |
Safety Issue: | |
Description: | Determine the PFS and objective response after cross over to the other chemotherapy regimen with atezolizumab |
Measure: | Determine PFS in TNBC molecular subtypes |
Time Frame: | Assessed up to 120 months |
Safety Issue: | |
Description: | Determine whether TNBC molecular subtypes as defined by gene expression are predictive for differential PFS benefit of atezolizumab added to first line chemotherapy |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | The Netherlands Cancer Institute |
Trial Keywords
- Triple negative
- Metastatic
Last Updated
June 15, 2021