Neo-CheckRay is a multicenter, open-label phase II study that randomizes luminal B breast cancer subjects candidate for neo-adjuvant chemotherapy in a 1:1:1 ratio in 3 arms: 1. the combination of weekly paclitaxel followed by dose-dense doxorubicin-cyclophosphamide (ddAC) and pre-operative radiation therapy (boost dose) on the primary tumour 2. arm 1 with the addition of the anti-PD-L1 antibody durvalumab 3. arm 2 with the addition of the anti-CD73 antibody oleclumab The primary tumour will be excised 2-6 weeks after completion of ddAC. A safety run-in is planned for the 6 first subjects before starting the randomized phase II trial. Those 6 subjects will receive the treatment given in Arm 3.
This trial consists of a safety run-in followed by a phase II randomised trial. The goal of the safety run-in is to assess the safety of adding SBRT to the neo-adjuvant systemic treatment. The doses of the IMPs will be identical in the safety run-in and the phase II randomised trial. Individual subject timelines are also identical in the safety run-in and the phase II randomised trial. The safety run-in is done as a precursor to the phase II randomised part of the Neo-CheckRay trial. Six subjects will be included in the safety run-in. These subjects are not part of the phase II total recruitment. Subjects in the safety run-in will receive the following treatments corresponding to arm 3 of the phase II randomised trial. This consists of: * q1w paclitaxel 80 mg/m² IV for 12 administration (12 weeks) followed by q2w dose-dense doxorubicin-cyclophosphamide IV (60 mg/m² and 600 mg/m² respectively) for 4 administrations (8 weeks) * Anti-PD-L1 antibody durvalumab 1500 mg IV q4w for 5 administration (20 weeks) * Anti-CD73 antibody oleclumab 3000 mg IV q2w for 4 administrations (8 weeks), followed by q4w for 3 administrations (12 weeks) * Pre-operative radiation therapy (boost dose) 3x8 Gy on the primary tumour at week 5 If all requirements are meet during the safety run-in, then the phase II part of the study will be opened. The phase II will consist of luminal B breast cancer subjects candidate for neo-adjuvant chemotherapy will be randomised in a 1:1:1 ratio between 3 arms: 1. Arm 1: the combination of weekly paclitaxel 80 mg/m² IV followed by q2w dose- dense doxorubicin-cyclophosphamide (ddAC) (60 mg/m² doxorubicin IV and 600 mg/m² cyclophosphamide IV) and pre-operative radiation therapy on the primary tumour (3x8 Gy). 2. Arm 2: drugs regimen of Arm 1 with the addition of the anti-PD-L1 antibody durvalumab IV 1500 mg q4w. 3. Arm 3: drugs regimen of Arm 2 with the addition of the anti-CD73 antibody oleclumab IV 3000 mg q2w for 4 administrations, followed by q4w for 3 administrations. The primary tumour will be excised 2-6 weeks after completion of ddAC. The study treatments end at surgery. All treatment after surgery, such as post-operative radiotherapy and hormonal therapy, will be performed according to standard of care and local site guidelines. The patient will then be followed for the next 5 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
147
an anti PD-L1 intravenous administration at 1500 mg every 4 weeks for 19 weeks.
Pre-operative radiation therapy (boost dose) 3x8 Gy on the primary tumour at week 5 given in 3 fractions. The 3 fractions will be spread at the minimum over 3 days and at the maximum over 6 days.
an anti-CD73 intravenous administration at 3000 mg every 2 weeks for the first 4 administrations then every 4 weeks for the last 3 administrations.
Institut Jules Bordet
Brussels, Belgium
Cliniques Universitaires Saint-Luc
Brussels, Belgium
Universitaire Ziekenhuizen
Leuven, Belgium
CHU UCL Namur Sainte-Elisabeth
Namur, Belgium
GZA - Ziekenhuizen (Campus St. Augustinus)
Wilrijk, Belgium
Centre Georges François Leclerc
Dijon, France
Institut Curie
Paris, France
Safety Run-in: Evaluation of the immune related or radiation therapy related toxicity of special interest
Immune related or radiation therapy related toxicity of special interest are identifitied as: * Any Grade 4 immune-related AE * Any ≥ Grade 3 colitis * Any ≥ Grade 3 renal failure/nephritis * Any ≥ Grade 3 non-infectious pneumonitis irrespective of duration * Any Grade 3 immune-related AE, excluding colitis, renal failure/nephritis and pneumonitis, that does not downgrade to ≤ Grade 2 within 3 days after onset of the event despite maximal medical supportive care including systemic corticosteroids or does not downgrade to ≤ Grade 1 or baseline within 14 days * Liver transaminase elevation ≥ 5 ULN or total bilirubin \> 3 × ULN will be considered a DLT regardless of duration or reversibility * Any increase in AST or ALT \> 3 × ULN and concurrent increase in total bilirubin \> 2 × ULN
Time frame: 7 months
Safety Run-in: Evaluation of the feasibility of the primary surgery
Feasibility of performing surgery within 6 weeks after the last neo-adjuvant treatment. This would indicate that there were no significant delays or toxicities that would results in surgery being delayed.
Time frame: 7 months
Phase II: Demonstration of the tumour response in arms 2 or 3 versus arm 1
To demonstrate improved tumour response of the primary tumour and nodal metastases in arms 2 or 3 versus arm 1 using residual cancer burden (RCB 0-1 vs. RCB 2-3) at time of surgery.
Time frame: 24 months
Phase II: Evaluation of the rthe complete pathological response rate defined as ypT0/Tis ypN0
Absence of residual invasive disease, residual in situ carcinoma is accepted.
Time frame: 24 months
Phase II: Evaluation of the complete pathological response rate defined as ypT0 ypN0
absence of residual invasive disease and in situ carcinoma.
Time frame: 24 months
Phase II: Evaluation of the response to the primary tumour irrespective of the response to the pathological lymph nodes
Complete pathologic response rate (pCR) of the primary tumour (ypT0/ Tis), irrespective of the response rate of the resected nodal metastases
Time frame: 24 months
Phase II: Evaluation of the response to the pathological lymph nodes irrespective of the response to the primary tumour
Complete pathologic response rate (pCR) of the resected nodal metastases (ypN0), irrespective of the response rate of the primary tumour.
Time frame: 24 months
Phase II: Evaluation of the the feasibility to perform breast-sparing surgery of the arms 2 and 3 versus arm 1
% of breast conservation surgery in arms 2 and 3 versus arm 1
Time frame: 24 months
Phase II: Demonstration of the an increase in TIL levels of the primary breast cancer between baseline and the week 6 biopsy
Change in TIL levels between baseline and the week 6 biopsy.
Time frame: 24 months
Phase II: Evaluation of the ability to control invasive disease and survival in arms 2 and 3 versus arm 1 at year 3 and 5 years after surgery
Efficacy endpoints at 3 years and 5 years after surgery will be measured, as defined by the Standardized Definitions for Efficacy End Points in Neoadjuvant Breast Cancer Clinical Trials (NeoSTEEP) (88). The following endpoints will be assessed: event-free survival (EFS), breast cancer event-free survival (BC-EFS), overall survival (OS) and distant recurrence-free survival (DRFS). Furthermore, the occurrence of ipsilateral locoregional recurrence (breast, chestwall or locoregional nodal recurrence), ipsilateral local recurrence (breast or chest wall) (laterality of the index lesion), and ipsilateral locoregional nodal recurrence (laterality of the index lesion) will be assessed. The endpoints will be measured using regular follow-up investigations: lab work, clinical examination and annual breast ultrasound and mammography. Radiologic imaging will not be routinely performed, unless directed by abnormal blood results or clinical examination.
Time frame: 5 years
Phase II: Evaluation of the severity and duration of AEs of the arms 2 and 3 versus arm 1
Duration and severity of AEs based on CTCAE 5.0
Time frame: 5 years
Phase II: Evaluation of the the cosmetic changes to the breast of the arms 2 and 3 versus arm 1
Changes in breast appearance: breast fibrosis in whole breast, breast fibrosis in boost area, breast size, breast shape, nipple position, shape of the areola and nipple, skin color, appearance of surgical scar, evaluation of teleangiectasia and global cosmetic result. Information on cosmetic and plastic surgical procedures will be collected (for example: oncoloplastic surgery, breast implants, and other procedures).
Time frame: 5 years
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