This phase II multicentre randomized open-label study will assess the safety and efficacy of Pembrolizumab in combination with standard chemotherapy in inflammatory breast cancer. Pembrolizumab will be administered every 3 weeks during the neoadjuvant chemotherapy. Tissue and blood samples will be collected pre- and post-treatment for translational research.
Inflammatory breast cancer (IBC) is a rare and highly aggressive subtype of locally advanced breast cancer representing approximately 5% of all breast cancers that requires immediate aggressive treatment. Significant progress has been made in recent years using a combination of treatments, including neoadjuvant chemotherapy, surgery and radiation therapy. Accumulating data indicate a prognostic and/or predictive impact for immune-response variables in BC. Recent data, suggest that PD-L1 is overexpressed in a significant number of BC, notably in IBC and may have significant prognostic or predictive value. Furthermore it may be targeted to restore or boost functional antitumor immunity. Pembrolizumab, a PD-1-directed monoclonal antibody is already registered and has an out-standing activity in advanced melanoma and NSCLC patients, with promising results in several other tumor types, including triple-negative BC, and a favorable profile of tolerance. Thus, potential benefits of pembrolizumab in combination with a conventional cytotoxic backbone may be considered as high in HER2-negative IBC. The aim of the study is to assess the pathological complete response rate following neoadjuvant EC-paclitaxel chemotherapy plus pembrolizumab and to assess if neoadjuvant chemotherapy with anthracycline-based induction in combination with pembrolizumab exposes IBC patients to significant toxicity. rates.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
52
Patients will receive intravenously 1 dose of Pembrolizumab every 3 weeks
The cytotoxic regimen is a combination of dose-dense EC, followed by weekly paclitaxel
Clinique de L'Europe
Amiens, France
Institut Sainte Catherine
Avignon, France
Institut BERGONIE
Bordeaux, France
CENTRE Francois Baclesse
Central evaluation of pathological complete response rate
absence of any residual invasive cancer on hematoxylin and eosin evaluation of the resected breast specimen and all sampled ipsilateral lymph nodes following completion of NAST (i.e., ypT0/is, ypN0 in the current AJCC staging system)
Time frame: Following completion of neoadjuvant systemic treatment, an average of 24 weeks
Dose Limiting Toxicity (DLT) rates
incidence of DLT during the 21 days following the first administration of pembrolizumab in combination with EC, will be assessed separately in the first 3 patients of each stratum (HR+ and HR-). DLTs will be defined according to CTCAE.
Time frame: during 21 days following the first administration of pembrolizumab
occurrence of serious adverse events and adverse events starting grade 2 or grade 1 (run-in period)
according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) V5.0
Time frame: during 21 days following the first administration of pembrolizumab
Local evaluation of pathological complete response rate
defined as absence of any residual invasive cancer on hematoxylin and eosin evaluation of the resected breast specimen and all sampled ipsilateral lymph nodes following completion of NAST (i.e., ypT0/is, ypN0 in the current AJCC staging system)
Time frame: Following completion of neoadjuvant systemic treatment, an average of 24 weeks
Invasive disease-free survival (IDFS)
time from surgery to the first documented occurrence of an event, defined as: Ipsilateral invasive breast tumor recurrence, Ipsilateral local-regional invasive breast cancer recurrence, Distant recurrence, Contralateral invasive breast cancer, Death from any cause
Time frame: 3 years
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Caen, France
Centre Georges Francois Leclerc
Dijon, France
Centre Leon Berard
Lyon, France
Institut Curie
Paris, France
Centre Henri Becquerel
Rouen, France
Institut Curie hopital rene huguenin
Saint-Cloud, France
Institut de cancérologie de la loire
Saint-Priest-en-Jarez, France
...and 2 more locations
Invasive disease-free survival (IDFS)
time from surgery to the first documented occurrence of an event, defined as: Ipsilateral invasive breast tumor recurrence, Ipsilateral local-regional invasive breast cancer recurrence, Distant recurrence, Contralateral invasive breast cancer, Death from any cause
Time frame: 5 years
Event free survival (EFS)
time from randomization to disease progression, disease recurrence (local, regional, distant, or contralateral \[invasive or non invasive\]), or death from any cause)
Time frame: 3 years
Event free survival (EFS)
time from randomization to disease progression, disease recurrence (local, regional, distant, or contralateral \[invasive or non invasive\]), or death from any cause)
Time frame: 5 years
Overall survival (OS)
time from randomization to death from any cause
Time frame: 3 years
Overall survival (OS)
time from randomization to death from any cause
Time frame: 5 years