The purpose of this study is to evaluate whether trastuzumab and letrozole are effective and safe in the preoperative treatment for postmenopausal patients with hormone receptor-positive and HER2-positive breast cancer.
Eligibility criteria * Ages Eligible for Study: ≥ 20 years * Invasive cancer (clinical stage IB-IIIB) * Measurable tumor larger than 1cm * ECOG status 0 or 1 * Postmenopausal women * Age ≥55 years and amenorrhea * Age \<55 years and amenorrhea for ≥12 months with FSH \>30 mIU/ml * HER2 positive tumor * 3 positive on IHC * 2 positive on IHC with HER2 gene amplification on FISH or SISH using a single-probe or dual-probe * Estrogen receptor positive tumor * Positive ER expression with Allred score more than PS3/TS8 or modified Allred score more than PS4/TS7 * Eligible cardiac function * Normal heard evaluated by ECG * Consider clinically non-significant arrythmia and ischemic change as normal * LVEF ≥ 55% measured by ECHO or MUGA scan Outcome measures * Primary End-point * The rate of pathologic complete response (pCR) * No residual invasive cancer in breast * Secondary End-point * Clinical Response Rate * Safety profiles for the preoperative use of concurrent trastuzumab and letrozole * The rate of breast conservative surgery * Total pathologic complete response (tpCR) * No residual invasive cancer in breast and ipsilateral axilla * Analysis of biomarkers based on baseline specimen and residual tumor * Ki67 expression * cDNA microarray: gene expression profiling * Association between clinical response rate and circulating tumor cells (CTCs) * CTCs are measured by CytoGen (SEOUL, KOREA)"
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
132
\- Eight times IV administration of trastuzumab per 3 weeks * Trastuzumab 8mg/kg on Day 1 of Cycle 1 * Trastuzumab 6mg/kg from Day 1 of Cycle 2 to Day 1 of Cycle 8
\- Daily letrozole 2.5 mg/day for 24 weeks
Hallym University Sacred Heart Hospital
Anyang, South Korea
RECRUITINGInje University Pusan Paik Hospital
Busan, South Korea
The rate of pathologic complete response
No residual invasive cancer in breast regardless of axilla
Time frame: At time of surgery
Clinical Response Rate
Clinical response includes complete response, partial response and stable disease.
Time frame: At time of surgery
Safety profiles for the preoperative use of concurrent trastuzumab and letrozole
Toxicity according to CTCAE protocol from the initiated day to 3 months after surgery
Time frame: Up to 3 months after surgery
The rate of breast conservative surgery
The rate of breast conservative surgery among the patients receiving surgery
Time frame: Up to 3 weeks after surgery
Total pathologic complete response (tpCR)
No residual invasive cancer in breast and ipsilateral axilla
Time frame: At time of surgery
Analysis of biomarkers based on baseline specimen and residual tumor
* Ki67 expression * cDNA microarray: gene expression profiling
Time frame: Baseline and at time of surgery
Association between clinical response rate and circulating tumor cells (CTCs)
Association between clinical response rate and circulating tumor cells (CTCs) : CTCs are measured by CytoGen (SEOUL, KOREA)"
Time frame: Baseline and at time of surgery
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