The purpose of this study is to determine if ribociclib in combination with letrozole for 24 weeks as neoadjuvant endocrine therapy increases the proportion of women with Pre-operative Endocrine Prognostic Index (PEPI) score of 0 at surgery compared to patients treated with letrozole alone therefore allowing more patients excellent outcomes without chemotherapy.
Subjects will be randomized (1:1:1) to either letrozole plus placebo vs. letrozole plus continuous dosing of ribociclib vs. letrozole plus intermittent dosing (3-weeks-on/1-week-off) of ribociclib. The difference in clinical, pathologic and radiologic response as well as Pre-operative Endocrine Prognostic Index (PEPI) scores across the three treatments arms will be examined. Subjects will also be followed for 5 years post-treatment to determine if ribociclib in combination with letrozole for 24 weeks results in improved 5 year Relapse Free Survival (RFS) compared to letrozole alone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
121
Nonsteroidal aromatase inhibitor
Oral cyclin-dependent kinase (CDK) inhibitor
Placebo for ribociclib
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
City of Hope National Medical Center
Duarte, California, United States
Rate of PEPI Score 0 at Surgery Between Ribociclib Containing Arms (Combined) vs. Letrozole Alone Arm.
The Preoperative Endocrine Prognostic Index (PEPI) score 0 is defined as: pT stage 0, 1, or 2 at surgery after 24 weeks of neoadjuvant therapy; negative axillary lymph nodes at surgey; Ki67 of ≤ 2.7 % at surgery; and tumor is ER+ at surgery. A PEPI score of 0 predicts a good outcome compare to PEPI score \>0.
Time frame: 24 weeks
Rate of Complete Cell Cycle Arrest at 2 Weeks Between Ribociclib Containing Arms (Combined) vs Letrozole Alone Arm.
Complete cell cycle arrest is defined as Ki67 at day 14 of \< 2.7.
Time frame: Day 14 of Cycle 1
Pathologic Complete Response Rate (pCR Rate): pCR Rate is Defined as the Proportion of Patients With no Histologic Evidence of Invasive Tumor Cells in the Surgical Breast Specimen and the Axillary Lymph Nodes
pCR is assciated with better outcomes in breast cancer
Time frame: At Surgery (Days 8-15 of Cycle 6)
Clinical Complete Response Rate (cCR Rate): cCR Rate is Defined as the Proportion of Patients With no Residual Tumor by Clinical Exam
Time frame: Post-surgery (Once in the first 4 weeks of post-op, then once every 6 months for 5 years post-op)
5 Year Relapse Free Survival (RFS)
Time frame: 5 years post-treatment
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Cancer Research Collaboration
Santa Ana, California, United States
University of Miami Sylvester Comprehensive Cancer Center
Deerfield Beach, Florida, United States
University of Kansas Cancer Center - West
Kansas City, Kansas, United States
University of Kansas Cancer Center - Overland Park
Overland Park, Kansas, United States
University of Kansas Cancer Center - Westwood
Westwood, Kansas, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
University of Kansas Cancer Center - South
Kansas City, Missouri, United States
University of Kansas Cancer Center - North
Kansas City, Missouri, United States
...and 3 more locations