This phase II randomized trial is for patients with clinical stage II-III, ER and PR \<10%, HER2-negative invasive breast carcinoma (triple negative breast cancer) for whom adjuvant RT is planned and pre-operative RT is deemed feasible by the treating radiation oncologist. Subjects will be randomized into arm A or B and treatment will last for 16 weeks. Both groups will receive Durvalumab 750mg IV Q2 weeks x 2 then a biopsy prior to durvalumab 1500mg IV Q4 weeks x 3 with paclitaxel and carboplatin IV weekly x 12. Arm B will receive radiation (24 Gy total) starting with the second durvalumab dose every other day (8Gy per fraction) for one week. Following treatment, subjects will receive SOC breast surgery and continue on to physician's choices SOC treatment during the 3 year follow up period. This study hopes to explore the impact of checkpoint blockade administration with a non- anthracycline chemotherapy regimen plus RT on post-surgery pathologic complete response (pCR) rate in the breast and axilla (ypT0/Tis ypN0) following 12 weeks of treatment and surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
IV administration of 5 treatments;every 2 weeks for 2 treatments and then every 4 weeks for 3 treatments
The second dose of durvalumab will be given in conjunction with an RT boost, consisting of 8 Gy in 3 fractions for a total of 24 Gy.
IV administration weekly for 12 weeks
IV administration every week for 12 weeks
Cedars Sinai Medical Center
Los Angeles, California, United States
Pathological complete response rate in the breast and axilla
Proportion of subjects without residual invasive cancer in the breast and axilla from randomization to definitive surgery. Measured as the lack of residual invasive cancer on hematoxylin and eosin evaluation of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy at the time of definitive surgery.
Time frame: 20 weeks from randomization
Pathological complete invasive and in situ response rate (breast and axilla)
Proportion of subjects without residual invasive and in situ cancer in the breast and axilla disease from randomization to definitive surgery. \- Residual invasive cancer and in situ disease defined based on hematoxylin and eosin evaluation of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy by pathological assessment.
Time frame: 20 weeks from randomization
Proportion of subjects with pathological invasive complete response in the breast only
Proportion of subjects without residual invasive cancer in the breast from randomization to definitive surgery. \- Residual invasive breast cancer defined based on hematoxylin and eosin evaluation of the complete resected breast specimen following completion of neoadjuvant systemic therapy by pathological assessment.
Time frame: 20 weeks from randomization
Residual Cancer Burden (RCB)
Proportion of subjects with RCB 0-I, II or III from randomization to definitive surgery. -Residual Cancer Burden defined based on the RCB index, a component of four pathological parameters: bi-dimensional diameter of primary tumor bed, percent of cellularity in the tumor bed, number of involved lymph nodes and size of the largest nodal metastasis. The RCB possible scores are: RCB 0 (pCR), RCB I, RCB II, RCB III.
Time frame: 20 weeks from randomization
Event Free Survival
Mean difference in time (in months) from randomization to any of the following events progression of disease that precludes surgery, local or distant recurrence, or death due to any cause.
Time frame: 36 months from randomization
Invasive disease-free survival (IDFS)
Mean difference in time (in months) from date of surgery (date of no disease) to the first documentation of invasive progressive disease or death.
Time frame: 33 months from surgery
Overall survival
Mean difference in time (in months) from randomization to death.
Time frame: 36 months from randomization
Adverse Events (AEs) and Serious Adverse Events (SAEs)
Incidence and severity of adverse events (AE) and serious adverse events (SAE) from cycle 1 day 1 until 30 days post-surgery. -AEs and SAEs based on CTCAE 5.0
Time frame: 24 weeks from treatment initiation
Frequency of adjuvant treatment after surgery
Average number of subjects receiving adjuvant treatment after surgery.
Time frame: 36 months from randomization
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