About 10-20% of all individuals with breast cancer have a so-called triple-negative tumor (TNBC). This type of breast cancer has a particularly unfavorable course and a higher mortality rate compared to other forms of breast cancer. Research studies show that it is important for individuals with TNBC to achieve a so-called pathologic complete response (pCR) to treatment. In the phase II study SAKK 66/22, it is being investigated whether the administration of the drug INT230-6 before surgery for breast cancer can increase the rate of pCR in the tumor and affected lymph nodes. The tolerability of INT230-6 as well as other factors such as response to treatment and the possibility of breast-conserving surgery are also being examined.
Triple-negative breast cancer (TNBC) poses significant challenges due to its aggressiveness, high relapse rates, and increased mortality. The Keynote-522 study revealed a 19.6% incidence of event-free survival (EFS) events in early-stage TNBC patients over 39 months. Achieving pathological complete response (pCR) and clearing positive lymph nodes are crucial prognostic factors. The IMP INT230-6 is a combination of the chemotherapeutic agents cisplatin and vinblastine, along with a molecule that facilitates their distribution in tumor tissue. INT230-6, currently in clinical trials, has demonstrated the ability to induce up to 95% necrosis in T2 breast cancer tumors and it has been observed to stimulate systemic immune activation during the period between diagnosis and surgery. Moreover, promising results have been seen in seven refractory breast cancer patients, resulting in decreased Ki67 levels and a median overall survival of 12 months. Completed and ongoing U.S. clinical trials including 91 patient a window-of-opportunity trial demonstrate the safety and early activity of INT230-6, both alone and with checkpoint inhibitors like pembrolizumab and ipilimumab, particularly in resistant cases. Based on the positive outcomes, it will be assessed within this clinical trial the safety and early clinical activity of INT230-6 in early TNBC patients, addressing the high unmet medical need in this challenging subtype.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
61
INT230-6 is a formulation consisting of an proprietary amphiphilic cell penetration enhancer molecule, 8-((2-hydroxybenzoyl)amino)octanoate, also referred to as SHAO, combined with cisplatin and vinblastine sulfate. The IMP is without marketing authorization in Switzerland and anywhere in the world.
Standard of care
Centre de lutte contre le cancer Léon Bérard
Lyon, France
RECRUITINGTumor Zentrum Aarau
Aarau, Switzerland
TERMINATEDSt. Claraspital
Basel, Switzerland
RECRUITINGEOC - IOSI Ospedale regionale Bellinzona e valli - San Giovanni
Bellinzona, Switzerland
RECRUITINGKantonsspital Graubünden
Chur, Switzerland
RECRUITINGKantonsspital Baselland
Liestal, Switzerland
RECRUITINGHOCH Health Ostschweiz
Sankt Gallen, Switzerland
RECRUITINGTBZO - Tumor- & Brustzentrum Ostschweiz
Sankt Gallen, Switzerland
TERMINATEDKantonsspital Winterthur
Winterthur, Switzerland
RECRUITINGUniversitätsspital Zürich - Klinik für Gynäkologie
Zurich, Switzerland
RECRUITINGPathological complete response (pCR) in the primary tumor (ypT0/Tis) and affected lymph nodes (ypN0).
The two following criteria need to be fulfilled for pCR: No invasive breast cancer in primary tumor (noninvasive breast residuals allowed) ypT0/Tis No invasive breast cancer in affected lymph nodes ypN0 The primary endpoint will be analyzed based on the resected patients set. The endpoint is evaluated according to the assessment of the local pathologist.
Time frame: At the date of tumor assessment after surgery, estimated at 29 to 32 weeks after treatment start for cohort A and at 27 to 30 weeks after treatment start for cohort B.
pCR (invasive and in-situ, only invasive, respectively) in the breast
No invasive and no in situ breast cancer in primary tumor ypT0 No invasive breast cancer in affected lymph nodes ypN0 The endpoint will be analyzed based on the resected patients set. The endpoint is evaluated according to the assessment of the local pathologist.
Time frame: At the date of tumor assessment after surgery, estimated at 29 to 32 weeks after treatment start for cohort A and at 27 to 30 weeks after treatment start for cohort B.
pCR in lymph nodes
No invasive and no in situ breast cancer in primary tumor ypT0 No invasive breast cancer in affected lymph nodes ypN0 The endpoint will be analyzed based on the resected patients set. The endpoint is evaluated according to the assessment of the local pathologist.
Time frame: At the date of tumor assessment after surgery, estimated at 29 to 32 weeks after treatment start for cohort A and at 27 to 30 weeks after treatment start for cohort B.
Pattern of non pCR
Pattern in the remaining tumor is for example visible circle or tumor border, moon shaped residual tumor, islands of tumor in sea of necrosis, tumor streaks radiating from the main tumor into the surrounding tissue, single tumor cells (e.g. in lobulary tumor). This endpoint will be analyzed based on the subset of patients in the resected patients set who did not achieve pCR in the primary tumor (any invasive cancer in primary tumor).
Time frame: At the date of tumor assessment after surgery, estimated at 29 to 32 weeks after treatment start for cohort A and at 27 to 30 weeks after treatment start for cohort B.
Overall response according to RECIST v1.1
Overall response (OR) is defined as complete response (CR) or partial response (PR) in the last pre-surgery tumor assessment compared with baseline MRI evaluated according to RECIST v1.1. In the subset of patients in cohort A additionally the change from baseline to the MRI between the 2nd injection and start of immunochemotherapy will be evaluated. The Criteria for RECIST v1.1. will be used with one modification: the injected lesion will still be measured/evaluated for this endpoint. Rationale: For a large proportion of the patients the injected lesion will be the only tumor lesion (cT2-4, cN0) or it will contain the majority of the tumor burden (in cN1 cases). Therefore, not evaluating this lesion would result in to many patients lost for this endpoint. This endpoint will be analyzed based on the FAS (Full Analysis Set).
Time frame: At 1 to 4 weeks after last SOC treatment and before surgery, estimated at 27 to 30 weeks after treatment start for cohort A and at 25 to 28 weeks after treatment start for cohort B.
Radiological tumor response using two perpendicular diameters
Bidimensional assessment is only done for the largest (injected) primary tumor in the breast (not of satellite lesions and not of lymph nodes): we use the largest diameter measured in MRI and its perpendicular second diameter in the same MRI image. The two diameters are multiplied. Radiological tumor response in the last pre-surgery MRI is defined as follows: * CR: disappearance of the whole lesion * PR: \> 50% decrease from baseline * PD: \> 25% increase from baseline or appearance of new lesions in the breast This endpoint will be analyzed based on the FAS (Full Analysis Set).
Time frame: At 1 to 4 weeks after last SOC treatment and before surgery, estimated at 27 to 30 weeks after treatment start for cohort A and 25 to 28 weeks after treatment start for cohort B.
Event free survival (EFS)
EFS is defined as the time from randomization to any of the following events, whichever comes first: * Progression of disease that precludes surgery * Local or distant recurrence * Second primary malignancy (breast or other cancers). The following events are excluded: basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix lobular carcinoma in situ of the breast (LCIS), ductal carcinoma in situ of the breast (DCIS) and myeloplastic syndrome * Death due to any cause Patients not experiencing an event will be censored at the date of the last available assessment before initiation of a subsequent treatment, if any. This endpoint will be analyzed based on the FAS.
Time frame: ): From the date of randomization until the date of the event of interest up to 3 years after surgery.
Rate of breast conserving surgery (BCS) at the time of definitive surgery
Proportion of patients with BCS at the time of definitive surgery. This endpoint will be analyzed based on the resected patients set.
Time frame: At the date of surgery, estimated at 29 to 32 weeks after treatment start for cohort A and at 27 to 30 weeks after treatment start for cohort B.
Conversion of intention for mastectomy to BSC and axillary lymph node dissection (ALND) to sentinel lymph node dissection (SLND) or tailored axillary surgery (TAS) after treatment
This endpoint is defined as the change from intended mastectomy at baseline to BCS at time point of definitive surgery or from ALND to SLND or TAS. It will be analyzed based on the subgroup of the patients in the resected patients set for which mastectomy or ALND was foreseen at registration.
Time frame: At the date of pre-operative interdisciplinary tumor board assessment, estimated at 26 to 32 weeks after treatment start for cohort A and at 24 to 30 weeks after treatment start for cohort B
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