This study is a prospective, open-label, multi-center, phase II clinical trial designed for HER2-negative breast cancer with pathogenic mutations in the germline gene (gBRCA1/2) that were indicated for neoadjuvant chemotherapy. The characteristics of this study are a precision treatment scheme without chemotherapy, the scheme of HRS-1167 combined with famitinib neoadjuvant therapy for patients with gBRCA mutations is explored, and the efficacy of combined immunotherapy is further explored according to the efficacy of the combination of the two drugs.
This study is a prospective, open-label, multi-center, phase II clinical trial designed for HER2-negative breast cancer with pathogenic mutations in the germline gene (gBRCA1/2) that were indicated for neoadjuvant chemotherapy. The characteristics of this study are a precision treatment scheme without chemotherapy, the scheme of HRS-1167 combined with famitinib neoadjuvant therapy for patients with gBRCA mutations is explored, and the efficacy of combined immunotherapy is further explored according to the efficacy of the combination of the two drugs. The study consists of a safety run-in period to explore the safety of HRS-1167 combined with famitinib, which is used to provide a recommended dose for the combination of HRS-1167 and famitinib. The latter phase II period is used to explore the efficacy of HRS-1167 plus famitinib /HRS-1167 plus famitinib plus camrelizumab as neoadjuvant therapy for gBRCA-mutated HER2-negative breast cancer. The primary endpoints in safety run-in period: the incidence of dose-limiting toxicity (DLT), the incidence and severity of adverse events (AE) and serious adverse events (SAE) ; in phase 2: the rate of pathological complete response (pCR) after surgery for each cohort as assessed by the investigator. Secondary endpoints included residual cancer burden (RCB) score, 3-year event-free survival (EFS), objective response rate (ORR), complete cell cycle arrest (CCCA) rate for HR+/HER2 - breast cancer, safety, and translational exploration study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
130
a highly selective PARP1 inhibitor
a tyrosine kinase inhibitor targeting VEGFR2, PDGFR, and c-kit
a humanised anti-programmed death-1 (anti PD-1) antibody
Breast cancer institute of Fudan University Cancer Hospital
Shanghai, Shanghai Municipality, China
RECRUITINGSafety run-in: Incidence rate of dose-limiting toxicities (DLTs)
Incidence rate of DLT will be evaluated in participants in the Safety Run-In, who will be followed for protocol-defined DLT events up to 28±3 days after the first dose of HRS-1167 and famitinib.
Time frame: 28±3 days
Safety run-in: adverse events (AEs)
Incidence rate of AEs of any cause will be evaluated in participants in the Safety Run-In according to CTCAE v5.0.
Time frame: 28±3 days
Safety run-in: Serious adverse events (SAEs)
Incidence rate of SAEs of any cause will be evaluated in participants in the Safety Run-In according to CTCAE v5.0.
Time frame: 28±3 days
Phase 2: Total Pathologic complete response (tpCR: ypT0/Tis ypN0) rate
Defined as no residual invasive cancer cells are found in the pathological examination of breast and axillary lymph node; if only residual in situ cancer cells are present in the surgical specimens, it can also be considered as achieving a pathological complete response.
Time frame: Immediately after the surgery
Phase 2: Residual Cancer Burden (RCB)
RCB will be estimated from routine pathological sections of the primary breast tumor site and the regional lymph nodes after the completion of neoadjuvant therapy. The pathological variables include bidimensional diameters of the primary tumor bed, the proportion of primary tumor area containing invasive carcinoma, the number of positive lymph nodes, and the diameter of the largest nodal metastasis
Time frame: Immediately after the surgery
Phase 2: Event-free survival (EFS)
Defined as the time from the date of the first study dose to any of the following events: progression of disease that precludes surgery, local or distant recurrence, second primary malignancy (breast or other cancers) or death due to any cause.
Time frame: Approximately 3 years
Phase 2: Objective response rate (ORR)
Defined as the proportion of patients with complete response (CR) and partial response (PR) by magnetic resonance imaging (MRI) according to RECIST v1.1.
Time frame: Immediately after the surgery
Phase 2: Rate of complete cell cycle arrest (CCCA) in HR+/HER2- breast cancer
Rate of CCCA determined by IHC Ki67 ( Ki67 ≤ 2.7%) between pre- and post-treatment.
Time frame: After 4 weeks of therapy
Phase 2: Adverse events (AEs)
Incidence rate of AEs of any cause will be evaluated in participants enrolled in the phase 2 period according to CTCAE v5.0.
Time frame: Up to 6 months
Phase 2: Serious adverse events (SAEs)
Incidence rate of SAEs of any cause will be evaluated in participants enrolled in the phase 2 period according to CTCAE v5.0.
Time frame: Up to 6 months
Biomarker analysis1
Gene mutations in the paired tumor and peripheral blood will be tested and analysed to predict therapy response.
Time frame: At baseline, at the end of first 2 cycles (each cycle is 28 days) and immediately after the surgery
Biomarker analysis 2
Gene expression signatures in the paired tumor and peripheral blood will be tested and analysed to predict therapy response.
Time frame: At baseline, at the end of first 2 cycles (each cycle is 28 days) and immediately after the surgery
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