Choice Of the Most Active Strategies for Short term recurring Triple Negative Breast Cancer: A phase Ib/II, open-label, modular, dose-finding and dose-expansion study to explore safety, tolerability, pharmacokinetics, and anti-tumor activity of novel therapeutics in patients with early relapsed metastatic triple-negative breast cancer
Every year, approximately 170.000 women are diagnosed with triple negative breast cancer (TNBC) and about 80-85% present with a stage II or III tumor making them eligible to neoadjuvant chemotherapy (NACT). Despite the substantial outcome improvements achieved with neoadjuvant chemotherapy-based strategies, at least 50-60% of patients with TNBC do not achieve pCR and are at higher risk of presenting with early disease recurrences. About 40% of patients with no-pCR experience distant recurrences within 12 months from the end of (neo)adjuvant treatments. Overall, 20-25% of patients with TNBC develop an early recurrence at ≤ 12 months from the end of (neo)adjuvant chemotherapy. Neither standard chemotherapy options nor approved targeted therapies exist for 35.000-40.000 women/year with TNBC (≈1200 women/year in France) that progress during (neo)adjuvant treatment or within 1 year from its termination. These patients present a "hard-to-treat" disease and a disproportionately high rate of morbidity and mortality. Notwithstanding, they are excluded from most current clinical trials that evaluate the efficacy of innovative strategies, with immunotherapy or targeting therapies in combination with chemotherapy. The treatment algorithm in 1st line is often based on the use of platine-containing regimens that provide very low response rates (less than 15%), no more than 2-3 months of 1st-line PFS and a median OS of about 9 months. Yet, comprehensive genomic analyses performed over the past years on patients with residual disease after neoadjuvant chemotherapy have not introduced concrete findings for guiding drug development in this setting. Comparisons of initial biopsies with post-NACT tumor tissues revealed a wide range of profound tumor changes acquired under the selective pressure of NACT that encompass the development of dominant subclones, tumor immune depletion and stem-cell phenotype enrichment that cannot be addressed with a single treatment strategy. Therefore, it is necessary to explore a broad range of treatment approaches to cover the different patterns involved. The idea is to set a rapidly recruiting phase I-II trials allowing to explore new treatment-strategies in patients with early recurrent and highly refractory TNBC have the potential to fulfil this utmost and urgent medical need.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Patients in module 1 \& 2 will receive Datopotamab Deruxtecan (Dato-DXd) 6mg/kg every 21 days
Patients in module 2 only will receive Durvalumab 1120mg every 21 days
Gustave Roussy
Villejuif, France
RECRUITINGPart 2_Efficacy of study therapies in each module_objective response rate (ORR) at 6 months.
ORR is defined as the proportion of patients who achieved a confirmed CR or PR within the 6 months of treatment initiation assessed by investigators.
Time frame: Within the 6 months of treatment initiation
Part 1_Safety and to determine the recommended phase II dose (RP2D) of study therapies in each module
measured by the DLTs, frequency and severity of any AEs, TEAEs, SAEs, AESIs graded according to NCI-CTCAE v5.0, proportion of treatment discontinuations, interruptions, and dose reductions due to any AEs; frequency and severity of laboratory abnormalities defined by NCI-CTCAE v5.0
Time frame: During treatment_to be determined according to modules added later on
Part 1&2_Progression free survival (PFS)
Defined as the time from the date of first dose until the date of the first objective documentation of disease progression or death from any cause, whichever occurs first. For patients without documented radiological progression, PFS will be censored at the date of last adequate radiological assessment without progression, unless death occurs within ≤ 2 missing assessments following the date of last known progression-free, in which case the death will be counted as a PFS event.
Time frame: From the time date of the first dose until progression or death from any cause, whichever occurs first
Part 1&2_Duration of response (DOR)
Defined as the time from the date of the first documentation of objective response (CR or PR) to the date of the first documentation of progression (PD) or death due to any cause, whichever occurs first. Duration of response will be measured for responding patients (CR or PR) only.
Time frame: From cycle 3 (Week 6; each cycle is 28 days) up to 2 years after the EoT, an average of 33 months
Part 1&2_Clinical benefit rate (CBR)
Defined as the proportion of patients with a complete (CR) or partial response (PR) or with stable disease (SD) \> 6 months.
Time frame: During treatment period, a median of 6 months
Part 1&2_Overall survival (OS)
Defined as the time from the date of first dose until death. Patients alive at last follow-up will be censored at this date.
Time frame: From the date of the first dose until 24 months after EoT
Part 2_Frequency of all adverse events
Time frame: From enrollment to 30 days after EoT for module 1 and for 90 days for module 2
Part 2_Severity of all adverse events
As defined by the NCI-CTCAE v5.0.
Time frame: From enrollment to 30 days after Eo for module 1 and for 90 days for module 2
Part 2_Frequency of laboratory abnormalities
Time frame: From enrollment until progression, median of 6 months
Severity of laboratory abnormalities
Defined by NCI-CTCAE v5.0
Time frame: From enrollment until progression, median of 6 months
Proportion of treatment discontinuation due to any AEs.
Time frame: Treatment Period, median of 6 months
Proportion of treatment interruptions due to any AEs.
Time frame: Treatment Period, median of 6 months
Proportion of dose reductions due to any AEs.
Time frame: Treatment Period, median of 6 months
Part 1_efficacy of study therapies in each module_objective response rate (ORR)
ORR is defined as the proportion of patients who achieved a complete response (CR) or partial response (PR) assessed by investigators. The objective response will be radiologically assessed every 6 weeks using RECIST v1.1.
Time frame: Within the 6 months of treatment initiation
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