E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with HER2/ErbB2 positive primary breast cancer |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10006187 |
E.1.2 | Term | Breast cancer |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare disease-free survival (DFS) in patients with HER2 overexpressing and/or amplified breast cancer randomised to trastuzumab for one year versus lapatinib for one year versus trastuzumab (12 weeks) followed by a six-week treatment-free interval followed by lapatinib (34 weeks) versus trastuzumab in combination with lapatinib for one year. |
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E.2.2 | Secondary objectives of the trial |
To compare overall survival (OS) in patients randomised to trastuzumab for one year versus lapatinib for one year versus trastuzumab (12 weeks) followed by a six-week treatment-free interval followed by lapatinib (34 weeks) versus trastuzumab in combination with lapatinib for one year; To compare time to recurrence (TTR) in treatment groups; To compare time to distant recurrence (TTDR) in treatment groups; To evaluate the safety and tolerability of all four treatment groups; To compare the cumulative incidence of brain metastases as the first site of breast cancer recurrence in treatment groups; To conduct all analyses separately for cohorts defined by the presence or absence of cMyc gene amplification;To conduct all analyses separately for cohorts defined by the expression levels of PTEN; To conduct all analyses separately for cohorts defined by the presence or absence of p95 HER2 domain. |
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E.2.3 | Trial contains a sub-study | Information not present in EudraCT |
E.3 | Principal inclusion criteria |
1. Age > o equal 18 years 2. Eastern Cooperative Oncology Group (ECOG) performance status < o equal 1 3. Non-metastatic operable primary invasive adenocarcinoma of the breast fulfilling the following: a. Histologically confirmed; b. Adequately excised (exceptions: patients who have 'non-resectable' deep margin invasion are eligible provided they have had or will receive radiotherapyencompassing the region concerned; patients with histologically documented infiltration of the skin (pT4) are eligible provided they have undergone or will receive radiotherapy encompassing the tumour bed); c. Axilla dissected; sentinel node sampling is allowed provided that axillary dissection follows confirmation of a positive sentinel node; sentinel node sampling alone is NOT acceptable after neoadjuvant chemotherapy (in patients receiving neoadjuvant chemotherapy lymph node status will be considered unknown, regardless of the results of post-chemotherapy axillary dissection); d. Axillary node positive patient OR node negative patient with a tumour greater than or equal to 1.0 cm in greatest diameter (> o equal T1c) according to TNM. 4. Known hormone receptor status (ER/PgR or ER alone) 5. Must have received at least four cycles of an approved anthracycline-based (neo-) adjuvant chemotherapy regimen. For design 1: Randomisation must be performed no longer than 12 weeks from day 1 of the last chemotherapy cycle after obtaining a post-chemotherapy LVEF > o uguale 50. Study treatment should start no more than 14 days after randomisation. For design 2: Randomisation must be performed no longer than 6 weeks from day 1 of the last anthracycline-containing chemotherapy cycle after obtaining a postanthracycline chemotherapy LVEF > o equal 50. Study treatment should start no more than 14 days after randomization and must be concurrent with paclitaxel 6. Baseline LVEF > o equal 50% measured by echocardiography or MUGA scan after completion of all anthracycline-based (neo-) adjuvant chemotherapy and prior to the targeted therapy(ies). 7. Over expression and/or amplification of HER2 in the invasive component of the primary tumour (in case of neoadjuvant treatment, tissue sample used for HER2 testing should be collected before neoadjuvant treatment starts), according to one of the following definitions and confirmed by central laboratory prior to randomisation: 3+ over expression by IHC (> 30% of invasive tumour cells); 2+ or 3+ (in 30% or less neoplastic cells) over expression by IHC AND in situ hybridization (FISH/CISH) test demonstrating HER2 gene amplification; HER2 gene amplification by FISH/CISH ( > 6 HER2 gene copies per nucleus, or a FISH ratio [HER2 gene copies to chromosome 17 signals] of > than 2.2.) Patients with a negative or equivocal overall result (FISH test ratio of < 2.2, < 6.0 HER2 gene copies per nucleus) and staining scores of 0,1+, 2+ or 3+ (in 30% or less neoplastic cells) by IHC are not eligible for participation in the trial. Equivocal local results may be submitted for a final determination by the central laboratory 8. Completion of all necessary baseline laboratory and radiological investigations. 9. Signed written informed consent (approved by an Independent Ethics Committee and obtained prior to any study specific screening procedures). |
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E.4 | Principal exclusion criteria |
1. History of any prior (ipsi- and/or contralateral) invasive breast carcinoma; 2. Past or current history of malignant neoplasms, except for curatively treated: Basal and squamous cell carcinoma of the skin; Carcinoma in situ of the cervix 3. Any clinically staged T4 tumour, including inflammatory breast cancer; 4. Bilateral tumours; 5. Multifocal tumours; 6. Maximum cumulative dose of doxorubicin >360mg/m2 or maximum cumulative dose of epirubicin >720mg/m2 or any prior anthracyclines unrelated to the present breast cancer; 7. (Neo-) or adjuvant chemotherapy using peripheral stem cell or bone marrow stem cell support; 8. Any prior mediastinal irradiation except internal mammary node irradiation for the present breast cancer; 9. Patients with positive or suspicious internal mammary nodes identified by sentinel node technique which have not been irradiated or will not be irradiated, or patients with supraclavicular lymph node involvement (confirmed by fine needle aspirate or biopsy); 10. Prior use of anti-HER2 therapy for any reason or other prior biologic or immunotherapy for breast cancer; 11. Concurrent anti-cancer treatment, except hormonal therapy; 12. Concurrent anti-cancer treatment in another investigational trial with hormone therapy or immunotherapy: 13. Serious cardiac illness or medical conditions including but not confined to: History of documented congestive heart failure (CHF) or systolic dysfunction (LVEF <50%); High-risk uncontrolled arrhythmias (ventricular tachycardia, high-grade AV-block, supraventricular arrhythmias which are not adequately rate-controlled); Angina pectoris requiring antianginal medication; Clinically significant valvular heart disease; Evidence of transmural infarction on ECG;Poorly controlled hypertension (e.g. systolic >180mm Hg or diastolic >100mm Hg); 14. Other concurrent serious diseases that may interfere with planned treatment including severe pulmonary conditions/illness; 15. Any of the following abnormal laboratory tests immediately prior to randomisation: serum total bilirubin >2.0 x upper limit of normal (ULN); alanine amino transferase (ALAT) or aspartate amino transferase (ASAT) >2.5 x ULN; alkaline phosphatase (ALP) > 2.5 x ULN; serum creatinine >2.0 x ULN; total white blood cell count (WBC) <2.5 x 109/L; absolute neutrophil count <1.5 x 109/L; platelets <100 x 109/L. 16. Unresolved or unstable serious adverse events from prior adjuvant chemotherapy or radiotherapy; 17. Malabsorption syndrome, any disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, or persons unable to swallow oral medication. Subjects with ulcerative colitis are also excluded; 18. Pregnant or lactating women (women of childbearing potential must have a negative pregnancy test - urine or serum - within 7 days prior to randomisation); 19. Women of childbearing potential and male participants with partners of child bearing potential, including women whose last menstrual period was <1 year ago (unless surgically sterile) who are unable or unwilling to use adequate contraceptive measures during study treatment (adequate contraceptive measures: intra-uterine device, barrier method - condoms, diaphragm - also in conjunction with spermicidal jelly, or total abstinence. Oral, injectable, or implant hormonal contraceptives are not indicated in this patient population); 20. Concomitant use of CYP3A4 inhibitors or inducers. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint for analysis is disease-free survival (DFS) which will be defined as the time from randomisation until the first occurrence of: 1. Breast cancer recurrence at any site; 2. A second primary cancer (invasive contralateral breast or non-breast malignancy); 3. Death from any cause as first event. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Information not present in EudraCT |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Information not present in EudraCT |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 15 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 15 |
E.8.9.2 | In all countries concerned by the trial months | 0 |