Phase II, randomized, Active-controlled open label trial for treatment of high risk, HR-/HER2- (triple negative) breast cancer, with two sequences of neoadjuvant chemotherapy on a background of pembrolizumab
This is a randomized, open-label, pilot study to evaluate the existence of a differential tumor immunomodulatory profile of neoadjuvant pembrolizumab in combination with paclitaxel and carboplatin vs pembrolizumab in combination with EC/AC in patients with triple negative, tumor infiltrating lymphocytes (TILs) enriched, early breast cancer to allow the optimization of future de-escalation strategies. There will be crossover between treatment arms when moving from the neoadjuvant to adjuvant treatment period for completion of standard chemotherapy plus pembrolizumab. The chemotherapy regimen included in this study is built upon previous studies of pembrolizumab plus chemotherapy. The synergistic effect of different chemotherapy backbone and pembrolizumab will be studied as part of a 2-arm study: Arm 1: (KXCb - PA\[E\]C): Pembrolizumab (K) every 3 weeks (Q3W) + paclitaxel (X) + carboplatin (Cb) once weekly (QW) for 4 cycles in the neoadjuvant setting followed by pembrolizumab + doxorubicin or epirubicin (A or E) + cyclophosphamide (C) for 4 cycles followed by pembrolizumab every 6 weeks for 5 cycles (total of 1 year of pembrolizumab) in the adjuvant setting. Arm 2: (KPA\[E\]C - KXCb): Pembrolizumab + doxorubicin or epirubicin (A or E) + cyclophosphamide (C) for 4 cycles in the neoadjuvant setting followed by pembrolizumab (K) every 3 weeks (Q3W) + paclitaxel (X) + carboplatin (Cb) once weekly (QW) for 4 cycles followed by pembrolizumab every 6 weeks for 5 cycles (total of 1 year of pembrolizumab) in the adjuvant setting. In case of clinical evidence of non-pCR, i.e., biopsy proven residual disease after the neoadjuvant phase, patients can proceed to the crossover part of the adjuvant phase before surgery (i.e., 4 cycles of chemotherapy plus pembrolizumab) receiving the remaining administrations of pembrolizumab after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
(KXCb - PA\[E\]C) vs (KPA\[E\]C - KXCb) Pembrolizumab (K) + paclitaxel (X) + carboplatin (Cb) followed by pembrolizumab + doxorubicin or epirubicin (A or E) + cyclophosphamide (C) followed by pembrolizumab in the adjuvant setting vs Pembrolizumab + doxorubicin or epirubicin (A or E) + cyclophosphamide (C) followed by pembrolizumab (K) + paclitaxel (X) + carboplatin (Cb) followed by pembrolizumab in the adjuvant setting
Fundaçao Champalimaud, Avenida Brasilia,
Lisbon, Portugal
Centro Hospitalar Universitário Lisboa Norte E.P.E
Lisbon, Portugal
Instituto Português de Oncologia Francisco Gentil, E.P.E
Porto, Portugal
Detect immunologic activation signal and the immunologically defined most suitable patient population for the synergistic interaction between pembrolizumab and chemotherapy backbone
Compare signals of immunological activation or a more favorable immunological context beetween T cell subpopulations and transcriptional changes of T cell populations infiltrating tumors at baseline and C2D1
Time frame: At the end of cycle 1 (each cycle is 28 days)
Rate of pCR
Compare the rate of pCR in subjects with locally advanced TNBC with TILs ≥ 10% in arm A and arm B at cycle 4
Time frame: 6 months to one year after subject inclusion
Primary translational endpoint
Quantification of number of T cells per mm2 with different phenotypes using fate bifurcation as defined as the proportion of TILs with the phenotype T-bet(hi) PD1(mid) CD8+.
Time frame: 6 months to one year after subject inclusion
Changes in the immunogenic phenotype
Determine changes in the immunogenic phenotype by longitudinally evaluating RNA-based gene expression signatures (e.g., tumor inflammation signature expression of granzyme A \[GZMA\] and perforin 1 at baseline and at C2D1.
Time frame: 6 months to one year after subject inclusion
Incidence of treatment relatred Adverse events
Describe the safety and tolerability of the combinations of pembrolizumab plus chemotherapy (either EC/AC or paclitaxel + carboplatin) in the Neoadjuvant and Adjuvant setting throught the CTCAE version 5.0 adverse event evaluation
Time frame: 6 months to one year after subject inclusion
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.