Multicenter, open label, non-randomized phase 2 trial to evaluate the efficacy and safety of nab-paclitaxel in the neoadjuvant treatment of ER positive human epidermal growth factor receptor 2 (HER2) negative patients amenable to receive neoadjuvant chemotherapy.
The primary objective of the trial is to determine the percentage of patients with poor response \[residual cancer burden III (RCB-III) rate\] in contrast to good response \[residual cancer burden 0/I RCB-0/1\] measured by the Symmans criteria \[20\] at surgery, in patients with stage II-III luminal breast cancer treated with neoadjuvant nab-paclitaxel. The primary endpoint of the study is to determine the residual cancer burden grade III (RCB-III) after surgery. The total number of patients to be included in this study is 78 patients. The duration of the study, from first patient visit to last patient visit will be approximately 90 months (Including follow-ups)
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
83
Corporación Sanitaria Parc Taulí
Sabadell, Barcelona, Spain
Instituto Oncológico de Guipúzcoa
Donostia / San Sebastian, Guipúzcoa, Spain
Hospital Universitario de Canarias
San Cristóbal de La Laguna, Santa Cruz De Tenerife, Spain
The Residual Cancer Burden Grade III (RCB-III).
The RCB-III was reported, including a 95% confidence interval. The estimate of the RCB-III was calculated as follows: Overall Response Rate = Number of patients with RCB-III / Intent to treat (ITT) population
Time frame: After surgery, up to 4 months
Pathologic Complete Response (pCR) Rate
Objective Response was measured following the Response Evaluation Criteria In Solid Tumors (RECIST 1.1) criteria. For the purpose of this study a response is defined as the achievement of a complete or partial response measured by breast MRI. Pathological complete response (pCR) was evaluated following the Symmans method at the time of the definitive surgery. For the purpose of this study RCB-0 was considered a pCR. The pCR (RCB-0) rate (pCRR) was reported including a 95% confidence interval. The estimate of the pCR rate was calculated as follows by central laboratory: pCR Rate = Number of patients with pCR / ITT population.
Time frame: After surgery, up to 4 months
Objective Response Rate (ORR) by Magnetic Resonance Imaging (MRI)
The ORR was reported including a 95% confidence interval. The estimate of the ORR was determined according to RECIST 1.1 and measured by MRI and mammogram in patients treated with this regimen. ORR was calculated as follows: Overall Response Rate = Number of Complete Responses (CRs), Partial Responses (PRs) / ITT population
Time frame: After surgery, up to 4 months
Objective Response Rate (ORR) by Mammogram
The ORR was reported including a 95% confidence interval. The estimate of the ORR was determined according to RECIST 1.1 and measured by MRI and mammogram in patients treated with this regimen. ORR was calculated as follows: Overall Response Rate = Number of CRs, PRs / ITT population
Time frame: After surgery, up to 4 months
Invasive Disease Free Survival (IDFS)
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Complejo Hospitalario Universitario A Coruña
A Coruña, Spain
Hospital Clinic i Provincial
Barcelona, Spain
Hospital de la Santa Creu i Sant Pau
Barcelona, Spain
Complejo Hospitalario de Jaén
Jaén, Spain
Hospital General Universitario Gregorio Marañón
Madrid, Spain
Hospital La Paz
Madrid, Spain
Hospital Universitario Morales Meseguer
Murcia, Spain
...and 3 more locations
IDFS was defined as the time (days) from the date of randomization until the date of objective recurrent disease (local, regional or distant), second primary invasive malignancy (breast or non-breast) or death from any cause. For patients not known to have died as of the data cut-off date and who do not have recurrent disease or second primary tumor, invasive disease-free survival will be censored at the last contact date. Ductal carcinoma in-situ (DCIS) will not be considered an event for the purpose of this analysis.
Time frame: Up to 6 years
Rate of Conversion to Breast Conserving Surgery (BCS)
The conversion from the initially planned mastectomy to BCS was reported including a 95% confidence interval. The estimate of the rate of conversion to BCS was calculated as follows: BCS rate = Number of patients with BCS / Number of patients with initially planned mastectomy.
Time frame: After surgery, up to 4 months
The Number of Participants Who Experienced Adverse Events (AE)
Incidence of adverse events by maximum CTCAE grade (v4.03; NCI 2010) that occur during the study treatment period or within 30 days of the last dose of study treatment, regardless of causality and according to the relationship to study drug as assessed by the investigator, were collected and evaluated.
Time frame: During treatment and until 30 days after the last dose of each patient study treatment
Ki67 in Pre-treatment Tumor Samples as Tumor Predictive Marker of Nab-paclitaxel Response
Ki67 was analysed by immunohistochemistry following the American Society of Clinical Oncology and the College of American Pathologists guidelines. The cut-off considered for Ki67 expression was 20% of positively stained tumor cells.
Time frame: Baseline visit
Caveolin-1 in Pre-treatment Tumor Samples as Tumor Predictive Marker of Nab-paclitaxel Response
Caveolin (Cav)-1 was evaluated in the stroma and its expression was categorized in low, moderate, or high (tertile). The high expression of Cav-1 was considered as positive.
Time frame: Baseline visit
Secreted Protein, Acidic, Cysteine-rich (SPARC) in Pre-treatment Tumor Samples as Tumor Predictive Marker of Nab-paclitaxel Response
SPARC was evaluated for both tumor and stroma. Its expression was categorized as negative when the intensity was absent-to-weak (1), or moderate (11)-to-strong (111) with a proportion of stained cells \<10%. Immunolabeling was positive if the intensity was moderate (11)-to-strong (111) and the extent of staining was 10%.
Time frame: Baseline visit
Molecular Tumor Subtypes According to St. Gallen Criteria 2013 in Pre-treatment Tumor Samples as Predictive Marker of Nab-paclitaxel Response
Molecular subtypes were classified according to St. Gallen criteria 2013 and Prat et al. into Luminal A (ER+, Progesterone Receptor (PgR) \>20%, Human Epidermal growth factor Receptor 2 - (HER2), Ki67 \<14%), Luminal B1 (ER+, HER2-, PgR \>20% and/or Ki67 \<14%), Luminal B2 (ER+, HER2+, any PgR, any Ki67), TN (ER-, PgR-, HER2-), and HER2-enriched (ER-, PgR-, HER2+) subtypes.
Time frame: Baseline