Description:
Approximately 3.5% to 6% of newly diagnosed breast cancer patients are stage IV metastatic.
De novo metastatic breast cancer accounts for 20% to 25% of these cases. Despite a decrease
in mortality in Europe and North America due to early detection and access to treatment,
breast cancer remains the 2ⁿᵈ leading cause of cancer deaths in developed countries after
lung cancer and the world's leading cause.
In the ESME French national retrospective cohort (NCT03275311), the newly diagnosed estrogen
receptor (ER)-positive and HER2-negative (luminal) metastatic patients had a 59.1 months
overall survival (OS) for pre-menopausal women and 44.7 months for postmenopausal women. In
the same cohort, the median OS was 47.4 months for de novo metastatic patients with hormone
receptor (HR)-positive / HER2-negative breast cancer.
The most important current treatment for metastatic breast cancer remains systemic therapy.
Surgery and radiation are mainly used to treat symptoms. However, more than 15 retrospective
studies have assessed the impact of locoregional treatment on relapse and OS. These studies
suggested an improvement of the OS in patients with de novo metastatic breast cancer thanks
to the addition of locoregional treatment to systemic therapy. Recent data from the ESME
cohort suggest that patients with de novo luminal or HER2-positive metastatic breast cancer
may benefit from local treatment of the primary tumor.
Several prospective trials have attempted to demonstrate the benefit of locoregional
treatment with mixed results. This can be explained by a limited power of statistical
analysis, on the recruitment of patients with breast cancer of all types, and on a limited
access to effective systemic therapies in some cases and all before the area of anti CD4/6
which is the current standard treatment in patients with HR-positive / HER2-negative luminal
metastatic disease.
However, guidelines indicate that a "multimodal approach, including curative locoregional
treatments, should be considered". As a result, many clinicians offer locoregional treatment
of the primary tumor, especially if there is a good response to the first line of systematic
treatment.
Taken together, these data underscore the need for an evaluation of the value of combined
therapy - endocrine therapy - CDK4/6 inhibitor and locoregional treatment - in this
population of patients with newly diagnosed HR-positive / HER2-negative breast cancer.
Title
- Brief Title: Locoregional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients
- Official Title: PALbociclib in Advanced Breast Cancer: Therapy INtegrating locorEgional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients
Clinical Trial IDs
- ORG STUDY ID:
UC-0140/1814
- SECONDARY ID:
2019-A00570-57
- NCT ID:
NCT03870919
Conditions
- Breast Cancer Stage IV
- Radiotherapy
- Surgery
Interventions
Drug | Synonyms | Arms |
---|
Palbociclib | | Palbociclib + locoregional treatment |
Purpose
Approximately 3.5% to 6% of newly diagnosed breast cancer patients are stage IV metastatic.
De novo metastatic breast cancer accounts for 20% to 25% of these cases. Despite a decrease
in mortality in Europe and North America due to early detection and access to treatment,
breast cancer remains the 2ⁿᵈ leading cause of cancer deaths in developed countries after
lung cancer and the world's leading cause.
In the ESME French national retrospective cohort (NCT03275311), the newly diagnosed estrogen
receptor (ER)-positive and HER2-negative (luminal) metastatic patients had a 59.1 months
overall survival (OS) for pre-menopausal women and 44.7 months for postmenopausal women. In
the same cohort, the median OS was 47.4 months for de novo metastatic patients with hormone
receptor (HR)-positive / HER2-negative breast cancer.
The most important current treatment for metastatic breast cancer remains systemic therapy.
Surgery and radiation are mainly used to treat symptoms. However, more than 15 retrospective
studies have assessed the impact of locoregional treatment on relapse and OS. These studies
suggested an improvement of the OS in patients with de novo metastatic breast cancer thanks
to the addition of locoregional treatment to systemic therapy. Recent data from the ESME
cohort suggest that patients with de novo luminal or HER2-positive metastatic breast cancer
may benefit from local treatment of the primary tumor.
Several prospective trials have attempted to demonstrate the benefit of locoregional
treatment with mixed results. This can be explained by a limited power of statistical
analysis, on the recruitment of patients with breast cancer of all types, and on a limited
access to effective systemic therapies in some cases and all before the area of anti CD4/6
which is the current standard treatment in patients with HR-positive / HER2-negative luminal
metastatic disease.
However, guidelines indicate that a "multimodal approach, including curative locoregional
treatments, should be considered". As a result, many clinicians offer locoregional treatment
of the primary tumor, especially if there is a good response to the first line of systematic
treatment.
Taken together, these data underscore the need for an evaluation of the value of combined
therapy - endocrine therapy - CDK4/6 inhibitor and locoregional treatment - in this
population of patients with newly diagnosed HR-positive / HER2-negative breast cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
Palbociclib + locoregional treatment | Other | All patients will receive the standard of care treatment ie Palbociclib + letrozole for 24-26 weeks. After this period, patient will have the most adapted locoregional treatment ie surgery (conservative or mastectomy) with or without radiotherapy, or radiotherapy. The palbociclib will be continued until progression | |
Eligibility Criteria
Inclusion Criteria:
1. Women with newly diagnosed and histologically proven de novo adenocarcinoma of the
breast, Any T, any N, with at least one metastatic site measurable and/or
non-measurable according to Response Evaluation Criteria In Solid Tumours (RECIST)
v1.1 and/or PET Response Criteria in Solid Tumours (PERCIST) v1.0 and/or MD Anderson
bone response criteria (MDA criteria). For patients with only bone metastases, at
least one lytic and non-irradiated lesion must be present NB: Bilateral breast cancer
is allowed only if tumours present similar histological criteria (morphological
subtype, ER and HER2 status).
2. Estrogen Receptor (ER)-positive and HER2-negative breast cancer. To be considered as
ER-positive, the biopsy of the primary tumour must display at least 10% of cancer
cells with positive ER staining. HER2-positive is defined as IHC3+ or FISH/CISH
amplified according to 2018 criteria
3. Age ≥18 years
4. Eastern Cooperative Oncology Group (ECOG) ≤2
5. Indication for treatment with palbociclib and letrozole (with or without ovarian
suppression)
6. Diagnostic FFPE tumour sample and/or frozen primary breast tumour sample available
7. Women of childbearing potential must have a negative serum or urine pregnancy test
done within 14 days before inclusion
8. Patients must agree to use adequate contraception methods for the duration of the
study and for within 21 days after completing treatment
9. Willingness and ability to comply with scheduled visits, treatment plan, laboratory
tests, and any protocol-related procedures including absence of co-morbidities
preventing surgery and or radiotherapy and any psychological, familial, sociological
or geographical condition potentially hampering compliance with the study protocol and
follow-up schedule. Those conditions should be discussed with the patient before
registration in the trial
10. Patient affiliated to a social security system
11. Written informed consent obtained prior to performing any protocol-related procedures
including screening evaluations
Exclusion Criteria:
1. Patients with advanced, symptomatic, visceral spread at a risk for short-term,
life-threatening complications according to investigator judgement and at risk for
visceral crisis as defined by ABC4*
2. Women with previously diagnosed and treated ipsilateral adenocarcinoma of the breast
3. Women with previously treated or concomitant contralateral breast cancer except for
Ductal carcinoma in situ (DCIS) treated with curative intent
4. Patients with another concomitant cancer
5. Concurrent enrolment in another clinical trial in which investigational therapies are
administered or administration of an investigational drug within 30 days before
inclusion
6. Pregnant women or women who are breast-feeding
7. Inability or willingness to swallow oral medication
8. HIV, hepatitis (B and C)
9. Active infection
10. Prior therapy for metastatic breast cancer (systemic or local)
11. Persons deprived of their freedom or under guardianship or incapable of giving consent
- Visceral crisis is defined as severe organ dysfunction as assessed by signs and
symptoms, laboratory studies and rapid progression of disease. Visceral crisis is
not the mere presence of visceral metastases but implies important visceral
compromise leading to a clinical indication for a more rapidly efficacious
therapy, particularly since another treatment option at progression will probably
not be possible.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall survival rate in patients receiving the letrozole plus palbociclib combination plus locoregional treatment |
Time Frame: | 24 months |
Safety Issue: | |
Description: | Overall survival |
Secondary Outcome Measures
Measure: | Clinical response rate on both primary tumour and metastasis disease |
Time Frame: | 24 months |
Safety Issue: | |
Description: | Follow-up of the disease status by imaging exams until surgery |
Measure: | Pathological response rate in primary tumour |
Time Frame: | 26 weeks |
Safety Issue: | |
Description: | Pathological response (tumour size, cellularity... ) evaluated at the surgery or at the biopsy |
Measure: | Conversion rate of breast surgery (conservative-radical) |
Time Frame: | 26 weeks |
Safety Issue: | |
Description: | Rate of modification of indication of mastectomy |
Measure: | Locoregional control rate |
Time Frame: | 60 months |
Safety Issue: | |
Description: | Rate of locoregional recurrence after surgery and/or radiotherapy |
Measure: | Progression-free survival (PFS) |
Time Frame: | 60 months |
Safety Issue: | |
Description: | Follow-up of the disease status by imaging exams |
Measure: | Overall survival |
Time Frame: | 60 months |
Safety Issue: | |
Description: | |
Measure: | Incidence of combined therapies in terms of adverse events |
Time Frame: | 60 months |
Safety Issue: | |
Description: | Will be evaluated using the National Cancer Institute - common terminology criteria for adverse events (NCI-CTCAE) v5.0 |
Measure: | Registration of post letrozole-CDKi therapies |
Time Frame: | 60 months |
Safety Issue: | |
Description: | Records of cancer treatments prescribed to patients after disease progression |
Measure: | Evolution of quality of life during treatment |
Time Frame: | 60 months |
Safety Issue: | |
Description: | self-administered questionnaire of quality of life EORTC QLQ-C30 taking into account the patient's activity and his/her physical and psychological state |
Measure: | Evolution of quality of life during treatment |
Time Frame: | 60 months |
Safety Issue: | |
Description: | self-administered questionnaire of quality of life EORTC QLQ-BR23, complementary module to QLQ C30 questionnaire, is more specifically interested in patients with se cancer and the impact of treatment on their lives |
Measure: | Evolution of quality of life during treatment |
Time Frame: | 60 months |
Safety Issue: | |
Description: | self-administered questionnaire of quality of life Euroquol EQ-5D-5L consists of a descriptive system and a visual scale |
Details
Phase: | N/A |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | UNICANCER |
Trial Keywords
Last Updated
March 10, 2021