TOUCH: A study to reduce the use of chemotherapy in postmenopausal patients with ER-positive and HER2-positive breast cancer
Zusammenfassung der Studie
A large proportion of patients with this type of breast cancer clearly respond to hormonal treatment (such as Letrozole) and to HER2 treatment (e.g., Herceptin®, also known as Trastuzumab). Due to the size of the tumor, a surgical procedure to remove the tumor, or in some cases, to remove the entire breast (mastectomy) is standardly performed. The drug treatment (neoadjuvant treatment) before the procedure aims to shrink (reduce) the cancer disease. The effectiveness of this treatment is directly measured by the reduction of the tumor. A smaller breast tumor allows for a less extensive surgical procedure and improved cosmetic (aesthetic) results. The combination of anti-HER2 treatment, hormone therapy, and chemotherapy given before surgery has proven effective for hormone-sensitive and HER2-positive breast cancers. Additionally, the combination of drugs that block the growth of cancer cells (so-called “cyclin inhibitors”) and hormone therapy may be effective for this type of tumors. The aim of this study is to investigate whether the treatment given to postmenopausal women with HER2-positive and hormone-positive breast cancer before the surgical procedure is more effective when combined with chemotherapy (Paclitaxel) (Arm A), or when combined with hormone therapy and Palbociclib (Arm B). Patients will be randomly assigned to one of the two treatment groups (Arm A/B). It is expected that a total of 144 patients will be enrolled in the study over a period of 30 months in European study centers. In Switzerland, it is planned that 30 patients will participate in the study. The study will last approximately 3.5 years until its completion.
(BASEC)
Untersuchte Intervention
Arm A:
Paclitaxel 80 mg/m2, administered by infusion on days 1, 8, and 15 every 28 days, for 4 cycles
Trastuzumab 600 mg, administered as a subcutaneous injection every 3 weeks, for 5 doses
Pertuzumab 840 mg, administered by infusion as a loading dose (first dose), followed by 420 mg every 3 weeks, for 5 doses
OR
Arm B:
Palbociclib capsules are taken orally (swallowed). The dosage is 125 mg per day, to be taken continuously for 3 weeks, followed by 1 week of treatment break; this is repeated in four cycles of 28 days.
Letrozole tablets are taken orally. The dosage is 2.5 mg per day over a period of 16 weeks.
Trastuzumab 600 mg, administered as a subcutaneous injection every 3 weeks, for 5 doses
Pertuzumab 840 mg, administered by infusion as a loading dose (first dose), followed by 420 mg every 3 weeks, for 5 doses.
(BASEC)
Untersuchte Krankheit(en)
Hormone-positive early-stage breast cancer with HER2 overexpression (also referred to as “HER2-positive”).
(BASEC)
Histologically confirmed invasive breast cancer with the following characteristics: - Early breast cancer with a tumor size > 1 cm - No clinical evidence of regional lymph node metastases (N0) or lymph node involvement - No evidence of metastases (M0) - Female aged 65 years or older - Primary tumor must have positive estrogen receptor (ER) ≥10% - Primary tumor must be HER2-positive (BASEC)
Ausschlusskriterien
- Tumor of any size with direct extension to the chest wall and/or skin - Inflammatory breast cancer - Bilateral invasive breast cancer - Previous treatment for a primary invasive breast cancer (BASEC)
Studienstandort
Basel, Bellinzona, Bern, Freiburg, Genf, St Gallen, Winterthur, Zürich, Andere
(BASEC)
Frauenfeld, Baden,
(BASEC)
Sponsor
ETOP IBCSG Partners Foundation
(BASEC)
Kontakt für weitere Auskünfte zur Studie
Kontaktperson Schweiz
Barbara Ruepp
+41 31 511 94 16
ibcsg-regulatory@clutteretop.ibcsg.orgETOP IBCSG Partners Foundation
(BASEC)
Allgemeine Auskünfte
USL4 Hospital of Prato, Italy,Institut Curie, Paris, France
(ICTRP)
Wissenschaftliche Auskünfte
USL4 Hospital of Prato, Italy,Institut Curie, Paris, France
(ICTRP)
Name der bewilligenden Ethikkommission (bei multizentrischen Studien nur die Leitkommission)
Ethikkommission Ostschweiz EKOS
(BASEC)
Datum der Bewilligung durch die Ethikkommission
04.12.2018
(BASEC)
ICTRP Studien-ID
NCT03644186 (ICTRP)
Offizieller Titel (Genehmigt von der Ethikkommission)
TOUCH: Phase II open-label, multicenter, randomized trial of neoadjuvant palbociclib in combination with hormonal therapy and HER2 blockade versus paclitaxel in combination with HER2 blockade for postmenopausal patients with hormone receptor positive/HER2 positive early breast cancer (BASEC)
Wissenschaftlicher Titel
Phase II Open-label, Multicentre, Randomized Trial of Neoadjuvant Palbociclib in Combination With Hormonal Therapy and HER2 Blockade Versus Paclitaxel in Combination With HER2 Blockade for Postmenopausal Patients With Hormone Receptor Positive/HER2 Positive Early Breast Cancer (ICTRP)
Öffentlicher Titel
To Reduce the Use of Chemotherapy in Postmenopausal Patients With ER-positive and HER2-positive Breast Cancer (TOUCH) (ICTRP)
Untersuchte Krankheit(en)
Breast Cancer;Estrogen Receptor Positive Tumor;HER2-positive Breast Cancer (ICTRP)
Untersuchte Intervention
Drug: Paclitaxel;Drug: Trastuzumab;Drug: Pertuzumab;Drug: Palbociclib;Drug: Letrozole;Drug: Trastuzumab;Drug: Pertuzumab (ICTRP)
Studientyp
Interventional (ICTRP)
Studiendesign
Allocation: Randomized. Intervention model: Parallel Assignment. Primary purpose: Treatment. Masking: None (Open Label). (ICTRP)
Ein-/Ausschlusskriterien
Gender: Female
Maximum age: N/A
Minimum age: 18 Years
Inclusion Criteria:
1. Histologically confirmed invasive breast cancer, with the following characteristics:
- Early breast cancer with tumor size >1 cm (as measured by at least one of the
required examination methods of clinical examination, mammography and
ultrasonography);
- No clinical evidence of regional lymph node metastasis (via physical and/or
radiological exam) (cN0) OR
- Clinical evidence of cN1 status, defined by nodal involvement limited to
clinically or radiologically detectable metastasis to movable ipsilateral level
I, II axillary lymph node(s)
- No evidence of metastasis (M0).
2. Postmenopausal, defined by women with:
- Prior bilateral surgical oophorectomy; OR
- Amenorrhea and age =60 years; OR
- Age <60 years and amenorrhea for 12 or more consecutive months in the absence
of alternative pathological or physiological cause (including chemotherapy,
tamoxifen, toremifene, ovarian suppression, or hormonally-based contraception)
plus FSH and serum estradiol levels within the laboratory's reference ranges
for postmenopausal women
3. Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
4. Primary tumor must have positive estrogen receptor (ER) =10%
5. Primary tumor must be HER2-positive (by IHC and/or ISH)
6. Baseline LVEF =55% measured by Echocardiography (preferred) or MUGA scan
7. Normal hematologic status:
- Absolute neutrophil count =1500/mm3 (1.5 ? 109/L);
- Platelets =100 ? 109/L;
- Hemoglobin =9 g/dL (=90 g/L).
8. Normal renal function: serum creatinine =1.5 ULN
9. Normal liver function:
- Serum total bilirubin =1.5 ? upper limit of normal (ULN). In the case of known
Gilbert's syndrome, a higher serum total bilirubin (<2 ? ULN) is allowed;
- AST or ALT =2.5 ? ULN;
- Alkaline phosphatase =2.5 ? ULN.
10. Written Informed Consent (IC) must be signed and dated by the patient and the
Investigator prior to randomization.
11. The patient has been informed of and agrees to data transfer and handling, in
accordance with national data protection guidelines.
12. The patient agrees in writing to make tumor (mandatory diagnostic core biopsy and
surgical specimen) available for submission for central pathology review and to
conduct translational studies as part of this protocol.
Exclusion Criteria:
1. Tumor of any size with direct extension to the chest wall and/or to the skin
(ulceration or skin nodules) (T4 according to AJCC 8th edition cancer staging TNM)
2. Inflammatory breast cancer
3. Bilateral invasive breast cancer
4. Received any prior treatment for primary invasive breast cancer
5. Any active tumor of non-breast-cancer histology
6. Any of the following in the previous 6 months: myocardial infarction,
severe/unstable angina pectoris, ongoing cardiac dysrhythmias of NCI CTCAE grade =2,
atrial fibrillation of any grade, coronary/peripheral artery bypass graft,
symptomatic congestive heart failure (NYHA functional classification =II),
cerebrovascular accident including transient ischemic attack, or symptomatic
pulmonary embolism.
7. Concurrent disease or condition that would make the subject inappropriate for study
participation or any serious medical disorder that would interfere with the
subject's safety
8. Contraindications or known hypersensitivity to any of the trial medications or
excipients
9. Treatment with any investigational agents within 30 days prior to expected start of
trial treatment
10. Any GI disorder that may affect absorption of oral medications, such as
malabsorption syndrome or status post major bowel resection
11. Evidence via physical and/or radiological exam of cN2 or cN3 nodal involvement
defined by: metastasis to ipsilateral level I, II axillary lymph nodes that are
clinically fixed or matted, OR involvement of ipsilateral infraclavicular, internal
mammary and/or supraclavicular lymph node(s)
12. History of extensive disseminated/bilateral or known presence of interstitial
fibrosis or interstitial lung disease, including a history of pneumonitis,
hypersensitivity pneumonitis, interstitial pneumonia, obliterative bronchiolitis,
and pulmonary fibrosis. A history of prior radiation pneumonitis is not considered
an exclusion criterion. (ICTRP)
nicht verfügbar
Primäre und sekundäre Endpunkte
Pathological Complete Response (pCR) (ICTRP)
Pathological Complete Response (pCR) in the Breast;Objective Response;Rate of Breast Conserving Surgery (BCS) (ICTRP)
Registrierungsdatum
nicht verfügbar
Einschluss des ersten Teilnehmers
nicht verfügbar
Sekundäre Sponsoren
Pfizer;Hoffmann-La Roche (ICTRP)
Weitere Kontakte
Laura Biganzoli, MD;Etienne Brain, MD, USL4 Hospital of Prato, Italy,Institut Curie, Paris, France (ICTRP)
Sekundäre IDs
2017-005067-40, IBCSG 55-17 (ICTRP)
Angaben zur Verfügbarkeit von individuellen Teilnehmerdaten
nicht verfügbar
Weitere Informationen zur Studie
https://clinicaltrials.gov/ct2/show/NCT03644186 (ICTRP)
Ergebnisse der Studie
Zusammenfassung der Ergebnisse
nicht verfügbar
Link zu den Ergebnissen im Primärregister
nicht verfügbar