Description:
c-TRAK TN is a multi-centre phase II study, consisting of a circulating tumour DNA (ctDNA)
screening component and a therapeutic component. c-TRAK TN aims to assess whether ctDNA
screening can be used to detect residual disease following patients standard primary
treatment for triple negative breast cancer, and will assess the safety and activity of the
investigational medicinal product pembrolizumab.
Title
- Brief Title: A Trial Using ctDNA Blood Tests to Detect Cancer Cells After Standard Treatment to Trigger Additional Treatment in Early Stage Triple Negative Breast Cancer Patients
- Official Title: c-TRAK TN: A Randomised Trial Utilising ctDNA Mutation Tracking to Detect Minimal Residual Disease and Trigger Intervention in Patients With Moderate and High Risk Early Stage Triple Negative Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
ICR-CTSU/2016/10058
- SECONDARY ID:
2017-000508-92
- NCT ID:
NCT03145961
Conditions
- Triple Negative Breast Cancer
Interventions
Drug | Synonyms | Arms |
---|
Pembrolizumab | Keytruda | Pembrolizumab Treatment |
Purpose
c-TRAK TN is a multi-centre phase II study, consisting of a circulating tumour DNA (ctDNA)
screening component and a therapeutic component. c-TRAK TN aims to assess whether ctDNA
screening can be used to detect residual disease following patients standard primary
treatment for triple negative breast cancer, and will assess the safety and activity of the
investigational medicinal product pembrolizumab.
Detailed Description
Patients will undergo blinded serial ctDNA screening every 3 months from the point of
registration and completion of primary treatment for their triple negative breast cancer. If
a ctDNA positive result occurs on or before their 12 month ctDNA screening assessment they
will be randomised by the Institute of Cancer Research Clinical Trials and Statistics Unit
(ICR-CTSU) in a 2:1 ratio to the pembrolizumab treatment arm or observation arm. The patient
and their treating team will only be informed of the randomisation if they are allocated
treatment.
Patients without a positive ctDNA result within 12 months of starting ctDNA screening, will
not be randomised but will continue to have blinded ctDNA screening every 3 months up to 2
years from starting ctDNA screening.
All patients will be followed up every 6 months until recurrence, specific withdrawal of
consent for follow up, or until sponsor advises no further follow up is required.
Trial Arms
Name | Type | Description | Interventions |
---|
Observation | No Intervention | Patient will have blood samples collected for ctDNA analysis every 3 months for up to 2 years from starting ctDNA screening. | |
Pembrolizumab Treatment | Experimental | Patients will be given pembrolizumab every 3 weeks for up to a maximum of 12 months, with blood samples collected prior to each cycle for continued ctDNA analysis. Following treatment discontinuation, blood samples will be collected for ctDNA analysis every 3 months for a further 12 months. | |
Eligibility Criteria
Inclusion Criteria:
1. Signed Informed Consent Form for Registration
2. Male or female patients ages 16 years or older
3. Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
4. Histologically proven primary triple negative breast cancer as defined as oestrogen
receptor (ER) negative, progesterone receptor (PgR) negative (if available, otherwise
PgR unknown), (as defined by Allred score 0/8 or 2/8 or stain in <1% of cancer cells)
and human epidermal growth factor receptor 2 (HER2) negative (immunohistochemistry
0/1+ or negative by in situ hybridization) as determined by local laboratory.
5. Availability of tissue from two archival tumour tissue samples (either from diagnostic
biopsy, and/or primary surgery. If only one tumour sample is available, the site
should inform the ICR-CTSU who will discuss eligibility with the Chief Investigator or
the designated Trial Management Group (TMG) member. Patients who have tumours
previously sequenced outside the c-TRAK TN trial must provide one archival tumour
tissue sample and the report that confirms the mutations detected.
6. Patients with moderate or high risk early stage triple negative breast cancer
according to the following risk of relapse criteria:
Neoadjuvant chemotherapy (no adjuvant chemotherapy planned):
High risk criteria - Residual microscopic or macroscopic invasive cancer in the
axillary nodes after chemotherapy Moderate risk criteria - Residual invasive cancer in
the breast, and axillary lymph node negative after chemotherapy
Adjuvant chemotherapy:
High risk criteria - Tumour size >50mm and node positive OR ≥4 nodes positive
regardless of primary tumour size.
Moderate risk criteria - Tumour size >20mm AND/OR involved axillary macroscopic lymph
node.
Both neoadjuvant and adjuvant chemotherapy:
Patients who have received both neoadjuvant chemotherapy and further adjuvant
chemotherapy must fulfil only the adjuvant chemotherapy risk criteria to be eligible.
They can fulfil the criteria on either clinical staging prior to neoadjuvant
chemotherapy or pathological staging at surgery.
7. Patients must be registered according to the following criteria for timing of
registration:
Neoadjuvant chemotherapy (no adjuvant chemotherapy planned):
Patients must be registered within 6 weeks of surgery. Patients may be registered
before or during radiotherapy and should be registered as early as possible.
Adjuvant chemotherapy (no neoadjuvant chemotherapy received):
Patients must be registered before, or on the day of, the 3rd cycle of adjuvant
chemotherapy and should be registered as early as possible.
Both neoadjuvant and adjuvant chemotherapy Patients must be registered within 6 weeks
of surgery. Patients may be registered before or during radiotherapy. Patients must
register before starting capecitabine.
8. Consent to provide research blood samples.
9. Patients with bilateral tumours can be included if both are triple negative and if two
archival tissues samples can be provided per tumour.
10. Patients must have had surgery achieving clear margins (as per local guidelines).
11. Female and male patients of reproductive potential must be willing to use an adequate
method of contraception, for the first year of the trial and if randomised to
pembrolizumab, for the duration of treatment through to 120 days after the last dose
of pembrolizumab. Note: Abstinence is acceptable if this is the usual lifestyle and
preferred contraception for the patient.
12. Patients must be willing to have frequent blood tests (every 3 months for 2 years in
ctDNA screening and 3 weekly if subsequently allocated pembrolizumab) and receive a 12
month course of pembrolizumab if randomised to pembrolizumab treatment on ctDNA
detection.
13. No evidence of distant metastatic disease on staging scans conducted at any time since
initial diagnosis
NB: Additional eligibility criteria apply to confirm eligibility to commence pembrolizumab
treatment following randomisation.
Exclusion Criteria:
1. Any concurrent or planned treatment for the current diagnosis of breast cancer other
than surgery, locoregional adjuvant radiotherapy, standard neoadjuvant or adjuvant
chemotherapy, or a bisphosphonate/denosumab.
2. Prior treatment with a programmed death ligand 1(PDL1), programmed cell death protein
1 (PD1), or other immunomodulatory therapy.
3. Prior diagnosis of cancer including prior diagnosis of breast cancer in the previous 5
years, other than for basal cell carcinoma of the skin or cervical carcinoma in situ
4. Patients previously entered into a therapeutic trial during or after neoadjuvant
chemotherapy where experimental therapy is continued post-surgery.
5. Treatment with an unlicensed or investigational product within 4 weeks of trial entry.
6. Active autoimmune disease requiring systemic therapy in the last two years (i.e. with
use of disease modifying agents, corticosteroids or immunosuppressive drugs).
Replacement therapy (e.g. thyroxine, insulin or physiologic corticosteroid replacement
therapy for adrenal or pituitary insufficiency) is not considered a form of such
systemic treatment.
7. Diagnosis of immunodeficiency or receiving systemic steroid therapy or any other form
of immunosuppressive therapy within 7 days prior to the first dose of pembrolizumab.
8. Known history of active Tuberculosis Bacillus (TB).
9. Known history of Human Immunodeficiency Virus (HIV).
10. Known active Hepatitis B or Hepatitis C.
11. Known history of, or any evidence of active, non-infectious pneumonitis.
12. Active infection requiring systemic therapy.
13. Previous solid organ or allogenic stem cell transplantation
14. Females who are pregnant or breastfeeding.
15. Presence of any systemic illness incompatible with participation in the clinical trial
or inability to provide written informed consent.
NB. Additional exclusion criteria apply to confirm eligibility to commence pembrolizumab
treatment following randomisation.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 16 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Positive ctDNA detection by 12 months |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The proportion of patients with ctDNA positivity by 12 months as assessed by the blood sample taken at that timepoint |
Secondary Outcome Measures
Measure: | Time to ctDNA detection |
Time Frame: | Baseline to first ctDNA positivity (up to a maximum of 12 months after starting ctDNA surveillance) |
Safety Issue: | |
Description: | The time from entry into ctDNA surveillance to first positive ctDNA detection |
Measure: | Detection of overt metastatic disease at time of first ctDNA detection in patients allocated to pembrolizumab |
Time Frame: | Baseline to first ctDNA positivity (up to a maximum of 12 months after starting ctDNA surveillance) |
Safety Issue: | |
Description: | Proportion of patients with metastatic disease at the same time point as first positive ctDNA detection |
Measure: | Lead time between ctDNA detection and disease recurrence in the pembrolizumab treatment and observation groups |
Time Frame: | From date of randomisation to recurrence detection, expected to occur up to 5 years |
Safety Issue: | |
Description: | The time between randomisation to the therapeutic aspect of the trial (either to pembrolizumab treatment or observation group) and first confirmed detection of recurrent disease. |
Measure: | Absence of detectable ctDNA or disease recurrence after 6 months in the observation group |
Time Frame: | 6 months after randomisation |
Safety Issue: | |
Description: | Proportion of patients without detectable ctDNA or disease recurrence 6 months after randomisation to observation group |
Measure: | Safety and tolerability of pembrolizumab assessed using NCI CTCAE v4.0, and the proportion of patients reporting dose reductions or delays. |
Time Frame: | Throughout pembrolizumab treatment, up to 12 months of treatment |
Safety Issue: | |
Description: | Adverse events assessed throughout treatment period, using the NCI CTCAE v4.0. Proportion of patients reporting a dose reduction or delay will be presented. |
Measure: | Commencement of treatment in patients randomised to receive pembrolizumab |
Time Frame: | At point of commencement or non-commencement of treatment, up to 8 weeks following randomisation |
Safety Issue: | |
Description: | Proportion of patients randomised to receive pembrolizumab who start the therapy. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Institute of Cancer Research, United Kingdom |
Trial Keywords
- Breast cancer early stage
- circulating tumour DNA
- pembrolizumab
- targeted therapy
- randomised clinical trial
- phase II
- mutation screening
- intermediate endpoint
Last Updated
January 9, 2020