Clinical Trials /

Pertuzumab and Trastuzumab as Neoadjuvant Treatment in Patients With HER2-Positive Breast Cancer

NCT01937117

Description:

This research is being done to determine if early changes on a type of imaging procedure called PET (Positron Emission Tomography) can predict which patients are most likely to respond to the combination of trastuzumab and pertuzumab when given prior to surgery.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title:Pertuzumab and Trastuzumab as Neoadjuvant Treatment in Patients With HER2-Positive Breast Cancer
  • Official Title:A Phase 2 Clinical Trial Assessing the Correlation of Early Changes in Standardized Uptake Value (SUV) on Positron Emission Tomography (PET) With Pathological Complete Response (pCR) to Pertuzumab and Trastuzumab in Patients With Primary Operable HER2-Positive Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: TBCRC 026
  • SECONDARY ID: TBCRC026
  • SECONDARY ID: NA_00080994
  • NCT ID: NCT01937117

Trial Conditions

  • Breast Cancer

Trial Interventions

DrugSynonymsArms
TrastuzumabHerceptinTrastuzumab and Pertuzumab
PertuzumabPerjetaTrastuzumab and Pertuzumab

Trial Purpose

This research is being done to determine if early changes on a type of imaging procedure called PET (Positron Emission Tomography) can predict which patients are most likely to respond to the combination of trastuzumab and pertuzumab when given prior to surgery.

Detailed Description

This study will evaluate for the first time the correlation between early changes in SUV and pCR in men and women with ER-negative, HER2-positive breast cancer receiving trastuzumab and pertuzumab (PT) pre-operatively. This has not previously been evaluated in patients receiving antiHER2 therapy alone and as such is novel and potentially practice changing. The results from this phase 2 biomarker study will be used to plan a randomized study using a predefined cut point for SUV decline such that the investigators can further attempt to identify a group of individuals with HER2-positive early breast cancer who do not require cytotoxic chemotherapy in addition to anti-HER2 agents. This non-invasive biomarker approach will be of great interest to breast cancer oncologists and patients by facilitating a personalized approach to managing patients with HER2-positive disease that will undoubtedly spare toxicity and reduce the costs associated with anti-cancer strategies, without compromising efficacy.

Trial Arms

NameTypeDescriptionInterventions
Trastuzumab and PertuzumabExperimentalResponse to preoperative treatment with trastuzumab (8 mg/kg loading dose, then 6 mg/kg every 3 weeks, IV) and pertuzumab (840 mg as a loading dose, then 420 mg every 3 weeks, IV) every 3 weeks for 4 doses (total 12 weeks or 3 months of treatment) as assessed by Positron Emission Tomography (PET)
    • Trastuzumab
    • Pertuzumab

Eligibility Criteria

Inclusion Criteria:

- Female and male patients, 18 years old or older

- Histologically proven infiltrating carcinoma of the breast on core needle biopsy that is: ER/PR ≤10% staining by IHC and HER2 positive - IHC 3+, ISH ≥2.0, or average HER2 copy number ≥6.0 signals per cell or per current ASCO-CAP (American Society of Clinical Oncology - College of American Pathologists) or NCCN (National Comprehensive Cancer Network) guidelines. Note: All histological diagnostic material should be reviewed at enrolling institution as required per local standards.

- Unresected, untreated breast cancer that meets one of the following clinical stages (see Appendix A): T2, T3, or T4a-c lesion, any N, M0. Note: Patients with inflammatory breast cancer (T4d) are not eligible. Bilateral cancers are permitted with approval of the Protocol Chair.

- ECOG performance status 0-1 (Appendix B)

- Adequate organ function as follows:

1. Absolute neutrophil count (ANC) ≥ 1,500/mm3

2. Platelet count ≥ 100,000/mm3

3. Hemoglobin ≥ 10 g/dL

4. Creatinine ≤ 1.5 times the upper limit of normal with creatinine clearance ≥ 50 mL/min using the Modified Cockcroft-Gault method

5. Bilirubin (total) ≤ 1.5 times upper limit normal (with exception of Gilberts syndrome)

6. AST(SGOT), ALT(SGPT), and alkaline phosphatase ≤ 2 times the upper limit of normal

- Adequate cardiac function as defined by LVEF ≥ 50% on echocardiogram or multi-gated acquisition scan (MUGA)

- Able and amenable to baseline and follow-up PET/CT imaging and study-specific biopsy procedures. Note: If there are any imaging concerns that the patient may not be suitable for quantitative PET/CT (e.g., a metallic device directly overlies the breast), discussion with the local and central radiologists is required to confirm eligibility for the trial. Also, it is expected that subjects have all PET/CT imaging done on pre-qualified machines for the study; if baseline imaging done on another machine, please contact the Protocol Chair/designee for guidance prior to confirming eligibility.

- The patient, if of childbearing potential, is willing to use effective, non-hormonal contraception while on treatment and for at least 6 months following the last dose of therapy.

- Patient understands the study regimen, its requirements, risks, and discomforts, and is able and willing to sign an informed consent form.

Exclusion Criteria:

- Received prior or ongoing local (e.g radiation) or systemic treatment (chemotherapy or endocrine therapy) for the current breast cancer. Patients who received tamoxifen or raloxifene or another agent for prevention of breast cancer may be included as long as the patient has discontinued the treatment at least one month prior to baseline study biopsy.

- Systemic treatment for prior cancer within the last 5 years, with the exception of adequately treated cone-biopsied in situ carcinoma of the cervix uteri and basal or squamous cell carcinoma of the skin.

- Women who are pregnant or nursing

- Current use of any investigational agents

- Known hypersensitivity to trastuzumab or pertuzumab

- Any medical condition that in the opinion of the investigator puts the patient at risk of potentially serious complications while on this therapy. Specifically, uncontrolled hypertension (systolic >150 and/or diastolic >100), unstable angina, congestive heart failure of any New York Heart Association (NYHA) classification, serious cardiac arrhythmia requiring treatment (exception: atrial fibrillation, paroxysmal supraventricular tachycardia), history of myocardial infarction within 6 months of enrollment.

Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Both
Healthy Volunteers:No

Primary Outcome Measures

Measure:Change in SUV on FDG PET
Time Frame:3 months
Safety Issue:No
Description:To correlate baseline and change (day 15) in SUV on FDG PET with pathological complete response (pCR) in patients treated with preoperative pertuzumab/trastuzumab

Secondary Outcome Measures

Measure:Change in ptDNA with response
Time Frame:3 months
Safety Issue:No
Description:To correlate PIK3CA mutation status and other genomic alterations (mutations/somatic rearrangements) qualitatively and quantitatively in plasma tumor DNA (ptDNA) with pCR
Measure:Change in PI3K pathway activation with response
Time Frame:3 months
Safety Issue:No
Description:To correlate PI3K pathway activation (e.g. PTEN low and/or PIK3CA mutation, HER 1-4 expression and/or phosphorylation) in tumor samples and pCR
Measure:Changes in Ki67 with response
Time Frame:3 months
Safety Issue:No
Description:To correlate baseline and change (day 15) in Ki67 with pCR

Trial Keywords

  • Breast cancer
  • Preoperative treatment
  • Neoadjuvant treatment