E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
HER2-POSITIVE, LOCALLY ADVANCED, INFLAMMATORY, OR EARLY-STAGE BREAST CANCER |
CÁNCER DE MAMA HER2 POSITIVO LOCALMENTE AVANZADO, INFLAMATORIO O PRECOZ |
|
E.1.1.1 | Medical condition in easily understood language |
early breast cancer |
Cáncer de mama precoz |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10006187 |
E.1.2 | Term | Breast cancer |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
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 |
The primary objective of this study is to evaluate the cardiac safety of neoadjuvant treatment with the following regimens: - ddAC-->T+ PH: Dose-dense doxorubicin and cyclophosphamide (ddAC) given every 2 weeks for four cycles with granulocyte colony-stimulating factor (G-CSF) support as needed according to local guidelines, followed by weekly paclitaxel (T) for 12 weeks, with pertuzumab and trastuzumab (PH) given every 3 weeks from the start of paclitaxel (Cohort A). - FEC-->D+ PH: 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) given every 3 weeks for four cycles, followed by docetaxel (D) given every 3 weeks for four cycles, with pertuzumab and trastuzumab (PH) given every 3 weeks from the start of docetaxel (Cohort B). |
El objetivo principal de este estudio es evaluar la seguridad cardiaca del tratamiento neoadyuvante con los siguientes regímenes: - ACdd-->T + PH: doxorubicina y ciclofosfamida a dosis densas (ACdd) administradas cada 2 semanas durante cuatro ciclos con tratamiento de soporte con factor estimulante de colonias de granulocitos (G-CSF) según se requiera de acuerdo con las directrices locales, seguidas de paclitaxel (T) semanal durante 12 semanas, con pertuzumab y trastuzumab (PH) administrados cada 3 semanas desde el comienzo del paclitaxel (cohorte A). - FEC -->D + PH: 5-fluorouracilo, epirubicina y ciclofosfamida (FEC) administrados cada 3 semanas durante cuatro ciclos, seguidos de docetaxel (D) administrado cada 3 semanas durante cuatro ciclos, con pertuzumab y trastuzumab (PH) administrados cada 3 semanas desde el comienzo del docetaxel (cohorte B). |
|
E.2.2 | Secondary objectives of the trial |
- Secondary safety objectives are to evaluate the safety profiles of the two treatment regimens during the pre-operative (neoadjuvant) and adjuvant treatment periods, including adverse events (graded according to NCI CTCAE Version 4.0), serious adverse events, laboratory abnormalities (graded according to NCI CTCAE Version 4.0), and serum levels of anti-therapeutic antibodies (ATAs) against pertuzumab. - The efficacy objectives for this study are as follows: - To make an assessment of the antitumor activity associated with each regimen, as indicated by the pCR rate (defined as eradication of invasive disease in the breast and axilla; i.e., ypT0/is ypN0, or tpCR rate) - To investigate the clinical response, event-free survival (EFS), invasive disease-free survival (iDFS), and overall survival (OS) for each treatment regimen |
Los objetivos de seguridad secundarios comprenden la evaluación de los perfiles de seguridad de los dos regímenes de tratamiento durante los periodos de tratamiento preoperatorio (neoadyuvante) y adyuvante, incluyendo acontecimientos adversos (clasificados de acuerdo a los CTCAE-NCI versión 4.0), acontecimientos adversos graves, alteraciones analíticas (clasificadas de acuerdo a los CTCAE-NCI versión 4.0) y concentraciones séricas de anticuerpos antiterapéuticos (AAT) frente a pertuzumab. Los objetivos de eficacia de este estudio son los siguientes: - Evaluar la actividad antitumoral asociada a cada régimen de acuerdo a la tasa de RCp (definida como la erradicación de la enfermedad invasiva en mama y axila; es decir, ypT0/is ypN0, o tasa de RCpt) - Estudiar la respuesta clínica, supervivencia sin acontecimientos (SSA), supervivencia sin enfermedad invasiva (SSEi) y supervivencia global (SG) para cada régimen de tratamiento |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Adult patients, > o = 18 years of age - HER2-positive breast cancer confirmed by a central laboratory - Primary tumor > 2 cm in diameter, or > 5 mm in diameter and node-positive - Eastern Cooperative Oncology Group (ECOG) performance status < o = 1 - Baseline LVEF > o = 55% (measured by ECHO or MUGA) |
- Edad > o = 18 años - Cáncer de mama HER2 positivo confirmado las en un laboratorio central - Tumor primario con diámetro > 2 cm o, diámetro > 5 mm y ganglios positivos - Estado funcional del Eastern Cooperative Oncology Group (ECOG) < o = 1 - FEVI basal > o = 55% (determinada mediante ECO o MUGA) |
|
E.4 | Principal exclusion criteria |
- Any previous systemic therapy (including chemotherapy, immunotherapy, HER2-targeted agents, and antitumor vaccines) for cancer, or radiation therapy for cancer - Metastatic disease (Stage IV) or bilateral breast cancer - Previous exposure to any investigational treatment within 4 weeks before the first dose of study treatment - History of non-breast malignancies within 5 years prior to study entry, except for carcinoma in situ of the cervix, carcinoma in situ of the colon, melanoma in situ, and basal cell and squamous cell carcinoma of the skin. - Inadequate hematologic, renal or liver function - Pregnant or lactating women - History of congestive heart failure of any New York Heart Association (NYHA) criteria - angina requiring anti-anginal medication - history of myocardial infarction within 6 months of enrollment - serious or uncontrolled cardiac arrhythmia requiring treatment - History or evidence of poorly controlled hypertension - Severe, uncontrolled systemic disease - Positive for hepatitis B, hepatitis C or HIV infection |
- Cualquier terapia sistémica previa para el cáncer (incluida quimioterapia, inmunoterapia, agentes dirigidos a HER2 y vacunas antitumorales) o radioterapia para el cáncer - Enfermedad metastásica (estadio IV) o cáncer de mama bilateral - Pacientes que hayan recibido algún tratamiento en investigación en las 4 semanas previas a la primera dosis del estudio - Antecedentes de neoplasias malignas que no sean de mama en los 5 años previos a la incorporación en el estudio, excepto carcinoma in situ de cuello uterino, carcinoma in situ de colon, melanoma in situ y carcinoma cutáneo basocelular y de células escamosas. - Deterioro de la función hematológica, renal o hepática - Mujeres embarazadas o en periodo de lactancia - Antecedentes de Insuficiencia Cardiaca Congestiva de cualquier grado en la clasificación NYHA (New York Heart Association) - Angina que requiere medicación antianginosa - Antecedentes de infarto de miocardio en los 6 meses previos a inclusión - Arritmia cardiaca grave o no controlada que requiere tratamiento - Antecedentes de evidencia de hipertensión mal controlada - Enfermedad sistémica grave, no controlada - Pacientes con infección conocida por VIH, virus de la hepatitis B o virus de la hepatitis C |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Cardiac safety: Incidence of left ventricular systolic dysfunction (symptomatic or asymptomatic). |
Seguridad cardiaca: Incidencia de disfunción sistólica ventricular izquierda (sintomática o asintomática) |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary cardiac safety evaluation will occur after all patients have completed neoadjuvant therapy (or have withdrawn from the study or are lost to follow up). Cardiac safety will continue to be assessed in all patients throughout the adjuvant and post-treatment period. Additional analyses of these parameters (and other safety and efficacy data) will be conducted after the primary analysis at the following timepoints: - After all patients have completed adjuvant anti-HER2 therapy (or have withdrawn from the study or are lost to follow up) - At the end of the study (5 years after the last patient was enrolled) |
La evaluación principal de la seguridad cardiaca tendrá lugar cuando todos los pacientes hayan completado el tratamiento neoadyuvante (o se hayan retirado del estudio o se haya perdido su seguimiento). La seguridad cardiaca seguirá evaluándose en todos los pacientes en el transcurso del periodo de tratamiento adyuvante y del periodo posterior al tratamiento. Se realizarán análisis adicionales de estos parámetros (y de otros datos de seguridad y eficacia) después del análisis principal, en los momentos siguientes: - Después de que todos los pacientes hayan completado el tratamiento adyuvante anti-HER2 (o se hayan retirado del estudio o se haya perdido su seguimiento) - Al final del estudio (5 años después de la inclusión del último paciente) |
|
E.5.2 | Secondary end point(s) |
- To make an assessment of the antitumor activity associated with each regimen, as indicated by the pCR rate - To investigate the clinical response, event-free survival (EFS), invasive disease-free survival (iDFS), and overall survival (OS) for each treatment regimen - Safety: Incidence of adverse events |
- Evaluar la actividad antitumoral asociada a cada régimen de acuerdo a la tasa de RCp - Estudiar la respuesta clínica, supervivencia sin acontecimientos (SSA), supervivencia sin enfermedad invasiva (SSEi) y supervivencia global (SG) para cada régimen de tratamiento - Seguridad: Incidencia de los acontecimientos adversos |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Efficacy will be assessed at the time of the primary analysis and at other key timepoints: - After all patients have completed adjuvant anti-HER2 therapy (or have withdrawn from the study or are lost to follow up) - At the end of the study (5 years after the last patient was enrolled) |
La eficacia se evaluará en el momento del análisis principal y en otros momentos clave: - Después de que todos los pacientes hayan completado el tratamiento adyuvante anti-HER2 (o se hayan retirado del estudio o se haya perdido su seguimiento) - Al final del estudio (5 años después de la inclusión del último paciente) |
|
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 | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
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) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 7 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 59 |
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 | No |
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 |
Canada |
Denmark |
France |
Italy |
Norway |
Portugal |
Brazil |
Germany |
Spain |
Poland |
United Kingdom |
United States |
|
E.8.7 | Trial has a data monitoring committee | No |
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
|
The end of the study will be 5 years after enrollment of the last patient in the study (or when all patients have died or the trial is terminated by the Sponsor, whichever is earliest). This data point will be considered last patient, last visit (LPLV). |
El final del estudio tendrá lugar 5 años después de la inclusión del último paciente en el estudio (o cuando todos los pacientes hayan fallecido o el promotor dé por terminado el estudio, lo que ocurra primero). Este momento se considerará la última visita del último paciente (UVUP). |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 6 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |