Neoadjuvant treatment is an important part of the treatment strategy for locally advanced TNBC having established a positive and significant correlation of pathologic Complete Response (pCR) with long-term clinical benefit such as Event-Free Survival (EFS) and Overall Survival (OS) as shown via large meta-analysis. Much effort has been made to identify novel agents and new drug combinations that can improve pCR rates in this specific clinical setting, which is the leading rationale to evaluate RP1 oncolytic immunotherapy in combination with Atezolizumab.
The combination of RP1 plus Atezolizumab, while being expected to result in increased efficacy, is not expected to result in significant additional toxicity, as compared to either agent alone. Capitalizing on the strong prognostic and predictive value of the TIL infiltrate in early-stage TNBC and the capacity of circulating tumor DeoxyriboNucleic Acid (ctDNA) detection to predict response to immunotherapy and NeoAdjuvant Chemotherapy (NAC), neoBREASTIM - a single-arm phase 2 study - will evaluate a novel, biomarker-driven combination of Atezolizumab plus RP1 oncolytic immunotherapy in the neo-adjuvant setting of patients diagnosed with early-stage, TIL-high TNBC.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
2
Patients will be treated in a window period (ie 3 treatment cycles). After evaluation, patients that had no increase in ctDNA after 3 cycles (see Definition of ctDNA status) will continue on the same treatment (intratumoral injections of RP1 in combination with Atezolizumab) for a total of 10 treatment cycles prior to surgery.
Institut Curie
Paris, France
Safety of the combination Atezolizumab plus RP1 oncolytic during the safety run-in phase
Incidence of combination Atezolizumab plus RP1 adverse events (AEs) graded according to NCI CTCAE v5.0 and nature and severity
Time frame: 9 months
Toxicity of the combination Atezolizumab plus RP1 oncolytic immunotherapy during the safety run-in phase.
Dose Limiting Toxicity (DLT) during the first cycle of treatment of the combination Atezolizumab plus RP1 oncolytic immunotherapy
Time frame: 9 months
Residual Cancer Burden (RCB) 0-1 during the phase II part
Rate of RCB 0-1 at time of surgery (in patients with no increase in ctDNA after cycle 3)
Time frame: 30 months
Response rate of RCB Score <= 1 at three cycles
Rate of RCB 0-1 after cycle 3 (in patients with no increase in ctDNA after cycle 3)
Time frame: 26 months
Safety and toxicity of the combination Atezolizumab plus RP1 oncolytic immunotherapy
Incidence, nature and severity of adverse events (AEs) graded according to NCI CTCAE v5.0 from the treatment start to the surgery
Time frame: 60 months
Invasive disease-free survival (iDFS)
iDFS will be measured using regular follow-up visits
Time frame: 60 months
Percentage of TILs
The percentage of TILs will be estimated and compared between RCB rates 0-1 versus 2-3
Time frame: 30 months
Pre-treatment expression of Programmed Death-Ligand 1 (PD-L1)
Expression of PD-L1 will be estimated and compared between RCB rates 0-1 versus 2-3
Time frame: 30 months
Correlation between RCB rates and response by Positron Emission Tomography-Scan (PET-CT) or breast MRI
To correlate the response by RCB rates with response by PET-CT or breast MRI will be studied
Time frame: 60 months
RCB rates and response
To correlate the response by breast MRI with RCB 0-1 rates,
Time frame: 60 months
Breast Conservation Surgery (BCS)
The rate of Breast Conservation Surgery (BCS) will be presented
Time frame: 30 months
Correlation between RCB rates and radiomics analyses
To correlate the RCB rates with response by radiomics analyses.
Time frame: 30 months
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