| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
| Triple-negative breast cancer (TNBC) |
|
| E.1.1.1 | Medical condition in easily understood language |
| TNBC refers to a type of breast cancer that does not express the genes for estrogen receptor (ER), progesterone receptor (PgR) or HER2/neu |
|
| 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 | 20.0 |
| 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 |
| • To evaluate the efficacy of adjuvant atezolizumab + paclitaxel, dose-dense doxorubicin/epirubicin, and cyclophosphamide (T-AC/EC) compared with T-AC/EC alone in patients with TNBC based on invasive disease-free survival (iDFS) |
|
| E.2.2 | Secondary objectives of the trial |
• To evaluate the efficacy of adjuvant atezolizumab + T-AC/EC compared with T-AC/EC alone based on iDFS in the PD-L1 selected and in the node-positive disease subpopulations, overall survival (OS), recurrence-free interval (RFI), Distant RFI and disease-free survival (DFS)
• To evaluate patient-reported outcomes (PROs) of function and health-related quality of life (HRQoL) associated with atezolizumab + T-AC/EC compared with T-AC/EC alone, as measured by the validated patient reported outcome tools
• To evaluate the safety and tolerability of atezolizumab + T-AC/EC compared with T-AC/EC alone
• To characterize the serum pharmacokinetics of atezolizumab when administered in combination with T-AC/ EC chemotherapy
• To evaluate the immune response to atezolizumab
|
|
| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
- Age >= 18 years
- Eastern Cooperative Oncology Group Performance Status of 0 or 1
- Non-metastatic operable Stage II-III breast cancer; patients with node-negative disease must have a pathologic tumor size > 2cm
- Histologically documented TNBC that is centrally confirmed
- Confirmed tumor Programmed death-ligand 1 (PD-L1) evaluation (centrally conducted)
- Adequately excised: Patients must have undergone either breast-conserving surgery or mastectomy/nipple- or skin-sparing mastectomy
- Pathological tumor-node-metastasis staging: Patient must have had sentinel lymph node biopsy and/or axillary lymph node dissection for evaluation of pathologic nodal status
- Patients with synchronous bilateral invasive disease are eligible only if all bilateral invasive lesions are histologically confirmed as triple negative by central lab and have completed adequate pathological tumor-node metastasis staging bilaterally as described
- No more than 8 weeks (56 days) may elapse between definitive breast surgery and randomization
- Baseline left ventricular ejection fraction >= 53% measured by echocardiogram or multiple-gated acquisition scans
- Adequate hematologic and end-organ function
- Negative HIV test at screening
- Negative hepatitis B surface antigen (HBsAg) test at screening
- Negative total hepatitis B core antibody (HBcAb) test at screening, or positive total HBcAb test followed by a negative hepatitis B virus (HBV) DNA test at screening. The HBV DNA test will be performed only for patients who have a positive total HBcAb test.
- Negative hepatitis C virus (HCV) antibody test at screening, or positive HCV antibody test followed by a negative HCV RNA test at screening
- The HCV RNA test will be performed only for patients who have a positive HCV antibody test.
- Representative formalin-fixed, paraffin embedded tumor specimen from surgical resection in paraffin blocks or at least 25 unstained slides, with an associated pathology report documenting locally assessed ER, PgR, and HER2 negativity
Patients with 20 to 25 unstained slides available at baseline may be eligible upon discussion with the Medical Monitor.
- For women of childbearing potential: agreement to remain abstinent or use contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 5 months after the last dose of atezolizumab, or 6 months after the last dose of paclitaxel or doxorubicin, or 12 months after the last dose of cyclophosphamide
- For men: agreement to remain abstinent or use contraceptive measures and agreement to refrain from donating sperm during the treatment period and 6 months after the last dose of paclitaxel, cyclophosphamide, or doxorubicin/epirubicin
- Women who are not postmenopausal or have not undergone a sterilization procedure must have a negative serum pregnancy test result within 14 days prior to initiation of study drug
|
|
| E.4 | Principal exclusion criteria |
- Prior history of invasive breast cancer
- Any T4 clinical tumor
- For the currently diagnosed breast cancer, any previous systemic anti-cancer treatment planned in the context of this study
- Previous therapy with anthracyclines or taxanes for any malignancy
- History of ductal carcinoma in situ and/or lobular carcinoma in situ that was treated with any form of systemic, hormonal therapy, or radiotherapy (RT) to the ipsilateral breast where invasive cancer subsequently developed
- Contraindication to RT when adjuvant RT is clinically indicated
- Cardiopulmonary dysfunction
- Prior malignancies within 5 years prior to randomization
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells
- Known allergy or hypersensitivity to any component of the atezolizumab, paclitaxel, cyclophosphamide, or doxorubicin/epirubicin formulations and filgrastim or pegfilgrastim or granulocyte-macrophage colony-stimulating factor formulations
- Active or history of autoimmune disease or immune deficiency
- History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography scan
- Current treatment with anti-viral therapy for HBV
- Urinary outflow obstruction
- Severe infections within 4 weeks prior to initiation of study treatment
- Treatment with therapeutic oral or IV antibiotics within 2 weeks prior to initiation of study treatment
- Major surgical procedure other than for diagnosis within 4 weeks prior to initiation of study treatment or anticipation of need for a major surgical procedure during the study treatment
- Prior allogeneic stem cell or solid organ transplant
- Administration of a live attenuated vaccine within 4 weeks prior to initiation of study treatment or anticipation of need for such a vaccine during the study or within 5 months after the last dose of atezolizumab
- Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the patient at high risk from treatment complications
- Prior treatment with CD137 agonists or immune checkpoint-blockade therapies
- Treatment with systemic immunosuppressive medications within 2 weeks prior to initiation of study treatment or anticipation of need for systemic immunosuppressive medication during the study
- Pregnant or lactating, or intending to become pregnant during the study
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|
| E.5 End points |
| E.5.1 | Primary end point(s) |
|
| E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
| E.5.2 | Secondary end point(s) |
1. iDFS in the subpopulation with PD-L1-selected tumor status (IC1/2/3) and node-positive disease
2. OS
3. iDFS including second primary non-breast invasive cancer as an event
4. RFI
5. Distant RFI
6. DFS
7. Occurrence and severity of adverse events as defined by National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
8. Mean and mean changes from baseline score in function (role, physical) and global health status (GHS)/HRQoL by assessment timepoint, and between treatment arms as assessed by the functional and GHS/HRQoL scales of the EORTC QLQ-C30
9. Serum concentration of atezolizumab at specified timepoints
10. Incidence of anti-drug antibodies (ADAs) during the study relative to the prevalence of ADAs at baseline
|
|
| E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-8. Up to 7 years
9-10. Day 1 of Cycle 1-4, 6, 10, and 15 and at treatment discontinuation visit (<= 30 days after last dose) and at 120 days after last dose of atezolizumab
|
|
| 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 | No |
| 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) | 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) | No |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | Yes |
| E.8.2.3.1 | Comparator description |
| Paclitaxel, Doxorubicin/Epirubicin, Cyclophosphamide |
|
| 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 | 2 |
| E.8.5 | The trial involves multiple Member States | Yes |
| E.8.5.1 | Number of sites anticipated in the EEA | 130 |
| 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 |
| Australia |
| Austria |
| Belgium |
| Brazil |
| China |
| Costa Rica |
| Czech Republic |
| Denmark |
| France |
| Germany |
| Guatemala |
| Hong Kong |
| Hungary |
| Ireland |
| Israel |
| Italy |
| Japan |
| Korea, Republic of |
| Mexico |
| Poland |
| Romania |
| Russian Federation |
| Singapore |
| Spain |
| Switzerland |
| Taiwan |
| Thailand |
| Ukraine |
| United Kingdom |
| United States |
|
| E.8.7 | Trial has a data monitoring committee | Yes |
| 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 study is planned to end when approximately 289 deaths have been observed for the analysis of OS. |
|
| E.8.9 Initial estimate of the duration of the trial |
| E.8.9.1 | In the Member State concerned years | 7 |
| 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 | 7 |
| E.8.9.2 | In all countries concerned by the trial months | 0 |
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