Non-randomized, open label, translational research study in women with early HER2-positive invasive breast carcinoma eligible for neoadjuvant treatment. The aim of BIONHER is to assess the impact of short-term neoadjuvant dual HER2-blockade on HER2-positive breast cancer transcriptomic profile and to evaluate whether early on treatment tumor biopsy can improve the accuracy of predicting response over the pre-treatment alone.
This is a prospective study of paired tumor samples from patients with newly diagnosed HER2-positive breast cancer eligible for neoadjuvant treatment to evaluate whether early on-treatment biomarkers can improve the accuracy of predicting response over pre-treatment samples alone. Sequential tumor biopsies will be obtained at two time points: before initiation of neoadjuvant dual HER2-blockade (pre-treatment, day 1) and 1 week later (day 8), before introduction of paclitaxel to the neoadjuvant treatment. Following the completion of neoadjuvant paclitaxel, trastuzumab and pertuzumab (THP) for 16 weeks, patients will proceed to surgery. After surgery, adjuvant treatment (including need for Anthracyclines) will be followed as per clinical practice. The study will comprise two phases: a discovery phase (n=60) where sequential paired tumor biopsies will be used for RNA-Seq analysis and assessment of tumor infiltrating lymphocytes (TILs) and CelTIL score. Radiomic characteristics of MRI, HER2Dx® and spatial transcriptomics (using GeoMx®) will be also evaluated. This phase will be followed by a validation phase (n=20) in which prediction accuracy observed in the discovery phase will be validated by Nanostring gene expression analysis using a new cohort of patients with HER2-positive breast cancer eligible for neoadjuvant therapy.
Study Type
OBSERVATIONAL
Enrollment
80
Trastuzumab loading dose at 8mg/kg at day 1 followed by Trastuzumab at 6mg/kg in a 21-day cycle for six cycles
Pertuzumab loading dose at 840mg at day 1 followed by Pertuzumab at 420mg in a 21-day cycle for six cycles
Paclitaxel starting at day 8 at 80mg/m2, days 1, 8, and 15 of a 21-day cycle for up to fifteen weeks
Institut Català d'Oncologia l'Hospitalet
L'Hospitalet de Llobregat, Barcelona, Spain
RECRUITINGChanges in gene expression (by RNA-seq technology) induced by a single dose of dual HER2-blockade with pertuzumab and trastuzumab.
Time frame: Between day 1 and day 8
Gene expression patterns (by RNA-seq technology) induced by a single dose of dual HER2-blockade with pertuzumab and trastuzumab to better predict pathological complete response (pCR) in HER2-positive breast cancer
Time frame: Between day 1 and day 8
Characterize the immune component of the tumor microenvironment (TME) using Spatial transcriptomics.
Time frame: Between day 1 and day 8
Changes in the immune component of TME induced early by treatment after the first dose of dual anti-HER2 blockade that are associated with pCR.
Time frame: Between day 1 and day 8
Clinical and radiomic characteristics of MRI together with machine learning for a better prediction of which patients will achieve a pCR and which will not
Time frame: Between MRI at diagnosis and pre-surgery
Machine learning for a construction and validation of (by Nanostring technology) an early predictor of response to the neoadjuvant treatment to distinguish between responders and nonresponders.
Time frame: Between day 1 and day 8
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