In the TROIKA study, the proposed biosimilar HD201 will be compared to its reference product Herceptin®. The aim of the study is to demonstrate equivalence of HD201 and Herceptin® in terms of efficacy, safety and pharmacokinetics.
This is a randomised, double-blind, parallel group, equivalence, multicentre Phase III study. 500 patients with HER2+ early breast cancer (EBC) will be randomised (1:1) to receive either HD201 in combination with chemotherapy (n=250) or Herceptin® in combination with chemotherapy (n=250). HD201 or Herceptin® will be administered every 3 weeks for 8 cycles(24 weeks). After administration of the final neoadjuvant study drug dose, surgery will be done within 3-8 weeks followed by an adjuvant treatment period for 10 cycles. Patients completing the 18 cycles of treatment and those discontinuing the study will attend an End of Treatment (EOT) visit 4 weeks (+/- 2 days), after last administration of study medication, followed by a follow-up period of 2 years. Patients will attend study visits every 3 weeks. At each visit, patients will undergo a complete physical examination, vital signs, weight, performance status, clinical laboratory tests and adverse events (AEs), concomitant medication will be recorded. After the EOT visit patients will be followed every 6 months for an additional 24 months or until death, whichever occurs first, to collect data on cardiac safety and disease status. Cardiac safety will be assessed by echocardiography or multigated acquisition (MUGA) scan to evaluate the left ventricular ejection fraction (LVEF) (at screening, before cycle 5, before surgery, before cycles 12 and 16, EOT visit, and at 6 and 12 months after the completion of trastuzumab (more frequent if necessary)) and by means of a 12-lead ECG (at screening, before cycle 5, before surgery, before cycles 12 and 16, EOT visit, and at 6 and 12 months after the completion of trastuzumab). The primary efficacy endpoint, total pathological complete response (tpCR) will be assessed at the time of surgery after neoadjuvant treatment completion after 24 weeks. tpCR will be assessed both by local and by central reading. Sampling for pharmacokinetics (PK) analysis (determination of Ctrough values) will be performed in all patients before cycle 5 and cycle 8. An Independent Data Monitoring Committee will be implemented that reviews accumulating data of the clinical trial with respect to any potential safety issues, study progress and critical efficacy endpoints. The members will be selected on the basis of relevant experience and understanding of clinical research and the issues specific to the therapeutic area, as well as previous data monitoring committee experience.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
503
Minsk Clinical Oncological Dispensary
Minsk, Belarus
Complex Oncology Center
Plovdiv, Bulgaria
East Tallinn Central Hospital
Tallinn, Estonia
total pathological complete response rate (tpCR)
To compare the total pathological complete response rate (tpCR) in patients treated with HD201 plus chemotherapy to that in patients treated with Herceptin® plus chemotherapy.
Time frame: After 24 weeks (end of cycle 8)
total breast pathological complete response rate (bpCR)
To compare total breast pathological complete response rate (bpCR) between the two arms at the time of surgery.
Time frame: After 24 weeks (end of cycle 8)
Overall response rate (ORR)
ORR defined as proportion of patients whose best overall response is either complete response (CR) or partial response (PR) at the time of surgery.
Time frame: After 24 weeks (end of cycle 8)
Overall Survival (OS)
OS defined as the time from Day 1 of therapy until death from any cause
Time frame: From date of randomisation until death from any cause or two years after End of Treatment, whichever comes first
Event-free Survival (EFS)
EFS defined as the time from Day 1 of therapy (day of first infusion of medication on study) until progression of disease or death from any cause.
Time frame: From date of randomisation until death from any cause or two years after End of Treatment, whichever comes first
Incidence of Treatment-Emergent Adverse Events (Safety and tolerability)
Safety and tolerability will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events and CTC v4.03
Time frame: From baseline through study completion until 18 months or until death, whichever came first
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75 mg/m2 via i.v. infusion during cycles 5-8.
500 mg/m2 via i.v. infusion during cycles 5-8.
Centre René Huguenin (Institut Curie)
Saint-Cloud, France
S. Khechinashvili University Hospital
Tbilisi, Georgia
National Institute of Oncology
Budapest, Hungary
University of Debrecen
Debrecen, Hungary
Modena Hospital
Modena, Italy
Beacon International Specialist Centre
Kuala Lumpur, Malaysia
Hospital Kuala Lumpur
Kuala Lumpur, Malaysia
...and 5 more locations
Cardiac dysfunction
Cardiac dysfunction will be monitored by 12-Lead ECG and measurement of the LVEF by echocardiography or MUGA scan
Time frame: Within 28 days before start of treatment, before cycle 5,12 and 16 (1 cycle is 3 weeks), before surgery (after 24 weeks), at end of treatment (4 weeks from last administration of drug medication) and one year after completion of trastuzumab therapy.
Immunogenecity
Incidence of human trastuzumab antibodies
Time frame: At baseline (within 28 days before start of treatment), before surgery (after 24 weeks), at end of treatment (4 weeks from last administration of drug medication) and one year after completion of trastuzumab therapy.
Clearance (Pharmacokinetic)
Sampling will be performed in all patients to compare the PK through values of HD201 and Herceptin.
Time frame: Before administration of treatment at Cycles 5 and 8 (1 cycle is 3 weeks)
Area under the curve (AUC, Pharmacokinetic)
Sampling will be performed in all patients to compare the PK through values of HD201 and Herceptin.
Time frame: Before administration of treatment at Cycles 5 and 8 (1 cycle is 3 weeks)
Plasma half life (Pharmacokinetic)
Sampling will be performed in all patients to compare the PK through values of HD201 and Herceptin.
Time frame: Before administration of treatment at Cycles 5 and 8 (1 cycle is 3 weeks)