Description:
This study is being done to see if it is possible to use blood samples to predict response to
treatment in breast cancer patients receiving preoperative (or neoadjuvant) therapy. Research
has shown that most breast cancers release tumor-specific DNA into the blood (that is, DNA
that is specific to the tumor cells or cancer). This DNA can be detected in blood testing
known as plasma tumor-DNA or "ptDNA." This DNA is separate from that found in the blood and
tissue samples which serve as the "instruction book" or "genetic code" for the cells that
make-up the human body. The changes in ptDNA before and after treatment, as well as after
surgery, may also help investigators to understand more about a patient's risk of cancer
returning and long-term outcomes.
Title
- Brief Title: Monitoring Plasma Tumor DNA in Early-Stage Breast Cancer
- Official Title: Plasma Tumor DNA and Pathologic Complete Response in Early-Stage, High-Risk Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
TBCRC040
- SECONDARY ID:
TBCRC 040
- SECONDARY ID:
IRB00093688
- NCT ID:
NCT02743910
Conditions
Purpose
This study is being done to see if it is possible to use blood samples to predict response to
treatment in breast cancer patients receiving preoperative (or neoadjuvant) therapy. Research
has shown that most breast cancers release tumor-specific DNA into the blood (that is, DNA
that is specific to the tumor cells or cancer). This DNA can be detected in blood testing
known as plasma tumor-DNA or "ptDNA." This DNA is separate from that found in the blood and
tissue samples which serve as the "instruction book" or "genetic code" for the cells that
make-up the human body. The changes in ptDNA before and after treatment, as well as after
surgery, may also help investigators to understand more about a patient's risk of cancer
returning and long-term outcomes.
Detailed Description
This is a prospectively designed study. Up to 229 newly diagnosed invasive HER2-positive or
triple-negative breast cancer patients planning neoadjuvant therapy (NAT) will be enrolled.
Blood samples will be collected pre-operatively at the time of diagnosis/prior to NAT,
post-cycle 1/pre-cycle 2 of NAT, after all NAT/immediately before surgery, and
post-operatively at 6, 12, 24, and 36 months, and annually thereafter if funding allows.
Researchers will also collect representative tissue samples from the diagnostic biopsy (in
all participants) and definitive surgery (if available). Additionally, to look at feasibility
of tumor DNA analyses in urine samples, urine samples will be collected along with blood
samples (urine tumor DNA or utDNA).
Next generation sequencing will be performed on core biopsies of all enrolled patients for
tumor-specific mutations (TSM) discovery. Based on those findings, droplet digital PCR
(ddPCR) on plasma DNA samples will also be performed to confirm the presence of the TSM in
the plasma on diagnosis, and one TSM will be chosen to track as the plasma tumor DNA (ptDNA)
mutation of interest. Investigators will perform ddPCR on pre-operative plasma DNA samples
and will assess for the presence of ptDNA. Pathologists will assess surgical specimens for
pathologic response (such as complete response/pCR and residual cancer burden/RCB). As
primary endpoint, investigators will assess the number of patients with and without
preoperative ptDNA who have pCR versus residual disease. As exploratory endpoints, the
following will also be performed: (a) quantitative multiplex methylation-specific PCR
(QM-MSP) in diagnostic biopsy and definitive residual surgery specimen; and, (b) the
circulating methylated tumor DNA (cMethDNA) assay in plasma specimens (baseline and after
NAT), and evaluate associations with pathologic response.
Additional endpoints include the association between plasma and tissue markers at baseline,
after NAT, and (if available) during surveillance with long-term prognosis (invasive
disease-free survival/IDFS and distant disease-free survival/DDFS).
Trial Arms
Name | Type | Description | Interventions |
---|
Stage II-III breast cancer | | Up to 229 newly diagnosed stage II-III invasive HER2-positive or triple-negative breast cancer patients planning neoadjuvant therapy (NAT) will be enrolled. ptDNA blood samples as well as a representative tumor tissue sample from both the diagnostic and surgical procedure (if available) will be collected. | |
Eligibility Criteria
Inclusion Criteria:
- Newly diagnosed, histologically confirmed invasive breast cancer that is triple
negative (estrogen receptor [ER], progesterone receptor [PR], and HER2-neu negative)
or HER2-positive (any ER/PR status)
- Unresected, untreated breast cancer that is T2, T3, or T4a-c; any N (nodal status);
and M0 (not metastatic)
- ECOG Performance Status of 0 or 1
- Planning to receive a neoadjuvant chemotherapy regimen containing a taxane ± an
anthracycline for at least 4 cycles. Patients with HER2-positive disease must also be
planning to receive HER2-targeted therapy.
- Diagnostic tumor material must be available for correlative analyses
- Patients must have the ability to understand and the willingness to sign a written
informed consent document
Exclusion Criteria:
- No prior treatment for the current breast cancer, though prior use of selective
estrogen receptor modulators (SERMs) or aromatase inhibitors (AIs) for the prevention
of breast cancer is acceptable.
- Women who are pregnant or nursing are excluded.
- No history of another primary malignancy in the last 5 years prior to registration.
Patients with prior history of in situ cancer or basal or localized squamous cell skin
cancer are eligible.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Correlation of absence of plasma tumor DNA (ptDNA) with pathologic complete response (pCR) |
Time Frame: | 6 months |
Safety Issue: | |
Description: | To estimate the negative predictive value (NPV) of the absence of plasma tumor DNA (ptDNA) Tumor Specific Mutations (TSMs) after neoadjuvant therapy (NAT) for the absence of residual disease as defined by pathologic complete response (pCR) in stage II-III HER2-positive or triple negative breast cancer (TNBC)
NPV = True Negative/True Negative + False Negative (probability that the disease is not present when the test is negative) |
Secondary Outcome Measures
Measure: | Prognostic value of ptDNA for invasive disease-free survival and distant disease-free survival |
Time Frame: | 5 years |
Safety Issue: | |
Description: | To estimate the prognostic value of ptDNA for 5-year invasive disease-free survival (IDFS) and distant disease-free survival (DDFS) in TNBC patients following completion of loco-regional and systemic therapy |
Measure: | Correlation of absence of ptDNA with residual cancer burden (RCB) |
Time Frame: | 6 months |
Safety Issue: | |
Description: | To estimate the NPV of the absence of ptDNA TSMs after NAT for the absence of residual disease as defined by residual cancer burden (RCB) 0 or 1 |
Details
Phase: | |
Primary Purpose: | Observational |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins |
Trial Keywords
- preoperative
- neoadjuvant
- plasma tumor DNA
- ptDNA
Last Updated
January 12, 2021