This is a single-center, open-label, randomized phase II clinical trial designed to evaluate the efficacy and safety of neoadjuvant Culmerciclib combined with aromatase inhibitor versus aromatase-inhibitor monotherapy in patients with Hormone Receptor-positive, Human Epidermal Growth Factor Receptor 2-negative early-stage breast cancer.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
24 weeks of continuous oral Culmerciclib 180 mg once daily ,continuously
Anastrozole 1 mg, letrozole 2.5 mg, or exemestane 25 mg, administered orally once daily continuously
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Guangzhou, Guangdong, China
RECRUITINGRate of participants achieving Residual Cancer Burden (RCB) grade 0 or 1
Proportion of subjects achieving RCB-0 or RCB-1 scores for tumor in the breast tumor bed and regional lymph nodes following neoadjuvant therapy, calculated using the online calculator available on the MD Anderson official website, as assessed by pathologists blinded to treatment assignment. Subjects who discontinued study treatment and received other non-protocol-specified neoadjuvant therapy prior to definitive surgery, subjects who did not undergo surgery, and subjects with missing efficacy information will be categorized as not achieving RCB-0/I (non-responders).
Time frame: Within 4 weeks after surgery
Pathological complete response rate
The proportion of patients with no residual invasive tumor cells in the breast and axillary nodes, regardless of ductal carcinoma in situ
Time frame: Within 4 weeks after surgery
Objective response rate
The proportion of participants achieving complete response and partial response from the initiation of treatment until disease progression or completion of preoperative neoadjuvant therapy. According to RECIST Version 1.1, intra-breast lesions are evaluated by breast MRI at the end of Week 8 and end of week 24, and after discontinuation of study treatment (if applicable).
Time frame: Within 2 weeks of breast MR examination
Endocrine Prognostic Index score 0 rate
The proportion of participants achieving a score of 0 according to the standard Pre-operative Endocrine Prognostic Index (PEPI) after neoadjuvant therapy
Time frame: Within 4 weeks after surgery
Complete Cell Cycle Arrest (CCCA) rate
Proportion of subjects with Ki67 \< 2.7% after neoadjuvant therapy
Time frame: Within 4 weeks after surgery
Breast conservation surgery rate
The proportion of patients who had successful breast conservation surgery after neoadjuvant therapy
Time frame: Within 4 weeks after surgery
Health-related Quality of Life 1
Scores on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30, version 3.0) are linearly transformed to a 0-100 scale for all subscales and single items. The instrument comprises functional scales (physical, role, cognitive, emotional, social), a global health status/quality-of-life scale, and symptom scales/items (fatigue, pain, nausea/vomiting, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). For functional and global health status scales, higher scores indicate better functioning and higher quality of life; for symptom scales, higher scores indicate worse symptoms or greater problems.
Time frame: Within 7 days before the first treatment and the end of each cycle (each cycle is 28 days)
Health-related Quality of Life 2
The EORTC Quality of Life Questionnaire Breast Cancer Module (QLQ-BR42) has all subscale and item scores also linearly transformed to a 0-100 scale. The module includes functional subscales (e.g., body image, sexual functioning) and symptom subscales (e.g., systemic therapy side effects, breast symptoms, arm symptoms). Higher scores on functional subscales indicate better functioning, while higher scores on symptom subscales indicate more severe symptoms or side effects.
Time frame: Within 7 days before the first treatment and the end of each cycle (each cycle is 28 days)
5-year event-free survival
the time from random assignment until any relapse, unequivocal tumor progression, or any-cause death
Time frame: During the 5 years after random assignment
5-year overall survival
the time from random assignment until any-cause death
Time frame: During the 5 years after random assignment
Safety (AEs+SAEs)
General safety will be assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). Ovarian toxicity will be evaluated by menstrual status and FSH and E2
Time frame: from signing the informed consent form until 2 years after completion of neoadjuvant treatment
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