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    Summary
    EudraCT Number:2020-002918-41
    Sponsor's Protocol Code Number:IJB-EBC-Decrescendo-2020
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2022-02-25
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2020-002918-41
    A.3Full title of the trial
    De-escalation of adjuvant chemotherapy in HER2-positive, estrogen receptor-negative, node-negative early breast cancer patients who achieved pathological complete response after neoadjuvant chemotherapy and dual HER2-blockade.
    Depotenziamento della chemioterapia adiuvante in pazienti affetti da carcinoma mammario precoce HER2 positivo, negativo al recettore dell’estrogeno, con linfonodi negativi che hanno raggiunto una risposta patologica completa con chemioterapia neoadiuvante e doppia inibizione di HER2.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Clinical study to test a new treatment regimen without chemotherapy after surgery for patients with early breast cancer that is ‘HER2-positive’ and ‘hormone receptor-negative’, who respond well to a simplified pre-surgery treatment.
    Studio clinico finalizzato a testare un nuovo regime di trattamento senza chemioterapia dopo l’intervento chirurgico per pazienti con un tumore al seno precoce “positivo a HER2” e “negativo ai recettori ormonali”, che rispondono bene a un trattamento pre-operatorio semplificato.
    A.3.2Name or abbreviated title of the trial where available
    DECRESCENDO
    DECRESCENDO
    A.4.1Sponsor's protocol code numberIJB-EBC-Decrescendo-2020
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorInstitut Jules Bordet
    B.1.3.4CountryBelgium
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportF. Hoffmann-La-Roche
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationInternational Breast Cancer Study Group IBCSG
    B.5.2Functional name of contact pointRegulatory Office
    B.5.3 Address:
    B.5.3.1Street AddressEffingerstrasse 40
    B.5.3.2Town/ cityBern
    B.5.3.3Post code3008
    B.5.3.4CountrySwitzerland
    B.5.4Telephone number+41315119400
    B.5.5Fax number+41315119401
    B.5.6E-mailregulatoryoffice@ibcsg.org
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name PHESGO
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameFDC pertuzumab and trastuzumab with recombinant human hyaluronidase (rHuPH20)
    D.3.2Product code [RO7198574]
    D.3.4Pharmaceutical form Solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPERTUZUMAB
    D.3.9.1CAS number 380610-27-5
    D.3.9.2Current sponsor codeRO4368451
    D.3.9.4EV Substance CodeSUB16455MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number80
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTRASTUZUMAB
    D.3.9.1CAS number 180288-69-1
    D.3.9.2Current sponsor codeRO0452317
    D.3.9.4EV Substance CodeSUB12612MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePaclitaxel
    D.3.2Product code [Paclitaxel]
    D.3.4Pharmaceutical form Concentrate for solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPACLITAXEL
    D.3.9.1CAS number 33069-62-4
    D.3.9.2Current sponsor codePaclitaxel
    D.3.9.4EV Substance CodeSUB09583MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameDocetaxel
    D.3.2Product code [Docetaxel]
    D.3.4Pharmaceutical form Concentrate and solvent for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNDOCETAXEL
    D.3.9.1CAS number 33069-62-4
    D.3.9.2Current sponsor codedocetaxel
    D.3.9.4EV Substance CodeSUB12492MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Kadcyla
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nametrastuzumab emtansine
    D.3.2Product code [RO5304020]
    D.3.4Pharmaceutical form Powder for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTRASTUZUMAB EMTANSINE
    D.3.9.1CAS number 1018448-65-1
    D.3.9.2Current sponsor codeRO5304020
    D.3.9.3Other descriptive nameTRASTUZUMAB EMTANSINE
    D.3.9.4EV Substance CodeSUB35467
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number160
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name PHESGO
    D.2.1.1.2Name of the Marketing Authorisation holderRoche Registration GmbH
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameFDC pertuzumab and trastuzumab with recombinant human hyaluronidase (rHuPH20)
    D.3.2Product code [RO7198574]
    D.3.4Pharmaceutical form Solution for injection/infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPERTUZUMAB
    D.3.9.1CAS number 380610-27-5
    D.3.9.2Current sponsor codeRO4368451
    D.3.9.4EV Substance CodeSUB16455MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTRASTUZUMAB
    D.3.9.1CAS number 180288-69-1
    D.3.9.2Current sponsor codeRO0452317
    D.3.9.4EV Substance CodeSUB12612MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number60
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    HER2-positive, estrogen receptor (ER)-negative/progesterone receptor (PR)-negative, node-negative early breast cancer
    HER2-positivo, recettore degli estrogeni (ER)-negativo/recettore del progesterone (PR)-negativo, tumore al seno precoce nodale negativo
    E.1.1.1Medical condition in easily understood language
    Early breast cancer
    Cancro al seno precoce
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate 3-year RFS in subjects with HER2-enriched, ER-negative/PR-negative, clinically node-negative breast cancers who achieve a pCR after neoadjuvant treatment with weekly paclitaxel (or docetaxel every 3 weeks) and dual HER2 blockade with pertuzumab and trastuzumab FDC SC
    Per valutare la RFS a 3 anni in soggetti con tumori al seno arricchiti di HER2, ER-negativi/PR-negativi, clinicamente nodosi, che ottengono una pCR dopo un trattamento neoadiuvante con paclitaxel settimanale (o docetaxel ogni 3 settimane) e un doppio blocco HER2 con pertuzumab e trastuzumab FDC SC
    E.2.2Secondary objectives of the trial
    To evaluate 3-year RFS in all subjects with ER-negative/PR-negative, clinically node-negative breast cancers who achieve a pCR after neoadjuvant treatment with weekly paclitaxel (or docetaxel every 3 weeks) and dual HER2 blockade with pertuzumab and trastuzumab FDC SC.
    Valutare la RFS a 3 anni in tutti i soggetti con tumori al seno ER-negativi/PR-negativi, clinicamente nodosi, che ottengono una pCR dopo un trattamento neoadiuvante con paclitaxel settimanale (o docetaxel ogni 3 settimane) e il doppio blocco HER2 con pertuzumab e trastuzumab FDC SC.
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: FLEXIBLE CARE SUB-STUDY (version 1.0)
    • To compare subjects' preference for administration of pertuzumab and trastuzumab FDC SC outside the hospital versus in the hospital.
    • To assess and compare the proportion of subjects deciding to receive treatment outside the hospital setting versus in the hospital after the treatment cross-over period.
    • To compare QoL between subjects who choose administration in the hospital versus those who choose administration outside the hospital of pertuzumab and trastuzumab FDC SC.
    • To evaluate QoL at different time points in subjects who choose administration in the hospital versus those who choose administration outside the hospital.
    • To evaluate the safety and feasibility of the administration of pertuzumab and trastuzumab FDC SC outside the hospital, and to compare it with the administration of pertuzumab and trastuzumab FDC SC in the hospital.
    • To evaluate subject assessed satisfaction with in the hospital versus outside the hospital administration of pertuzumab and trastuzumab FDC SC.
    • To evaluate HCP's satisfaction with SC administration of pertuzumab and trastuzumab FDC in the hospital versus outside the hospital.
    • To assess cross-over rate of subjects that chose administration in the hospital versus those who chose outside the hospital during the treatment continuation period.
    • To evaluate the productivity and economic impact of the administration in the hospital versus outside the hospital from the subject's perspective
    • To evaluate the productivity and economic impact of the administration in the hospital versus outside the hospital from the HCP's perspective.

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: SOTTOSTUDIO CURA FLESSIBILE (versione 1.0)
    - Confrontare la preferenza dei soggetti per la somministrazione di pertuzumab e trastuzumab FDC SC fuori dall'ospedale rispetto a quella in ospedale.
    - Valutare e confrontare la proporzione di soggetti che decidono di ricevere il trattamento fuori dall'ambiente ospedaliero rispetto a quello in ospedale dopo il periodo di cross-over del trattamento.
    - Confrontare la QoL tra i soggetti che scelgono la somministrazione in ospedale rispetto a quelli che scelgono la somministrazione fuori dall'ospedale di pertuzumab e trastuzumab FDC SC.
    - Valutare la QoL in diversi punti temporali nei soggetti che scelgono la somministrazione in ospedale rispetto a quelli che scelgono la somministrazione fuori dall'ospedale.
    - Valutare la sicurezza e la fattibilità della somministrazione di pertuzumab e trastuzumab FDC SC fuori dall'ospedale, e confrontarla con la somministrazione di pertuzumab e trastuzumab FDC SC in ospedale.
    - Valutare la soddisfazione dei soggetti rispetto alla somministrazione di pertuzumab e trastuzumab FDC SC in ospedale rispetto alla somministrazione di pertuzumab e trastuzumab FDC SC fuori dall'ospedale.
    - Valutare la soddisfazione del personale sanitario con la somministrazione SC di pertuzumab e trastuzumab FDC in ospedale rispetto a quella fuori dall'ospedale.
    - Valutare il tasso di cross-over dei soggetti che hanno scelto la somministrazione in ospedale rispetto a quelli che hanno scelto fuori dall'ospedale durante il periodo di continuazione del trattamento.
    - Valutare la produttività e l'impatto economico della somministrazione in ospedale rispetto a quella fuori dall'ospedale dal punto di vista del soggetto
    - Valutare la produttività e l'impatto economico della somministrazione in ospedale rispetto a quella fuori dall'ospedale dal punto di vista dell'operatore sanitario.
    E.3Principal inclusion criteria
    1. Male or female.
    2. Age =18 years old.
    3. Eastern Cooperative Oncology Group (ECOG) performance status =1. (Appendix 1).
    4. Subjects whose tumour measures =15 mm and =50 mm, according to clinical staging performed with imaging exams (either mammography, ultrasound or breast magnetic resonance imaging [MRI]).
    5. Must have histologically confirmed diagnosis of HER2-positive and ER-negative/PR-negative breast cancer (analysis performed by the local laboratory).
    a. HER2-positive defined as a score of 3+ in IHC or a positive ISH (ratio of HER2 copy number/chromosome 17 =2 or average HER2 copy number =6 signals per cell).
    b. ER-negative/PR-negative defined as estrogen receptor and progesterone receptor nuclear staining <1% by IHC.
    6. Subjects with multifocal or multicentric invasive disease are eligible as long as all the lesions can be characterised and are confirmed to be HER2-positive and ER and PR negative.
    7. Node-negative disease (N0): no axillary lymph nodes identifiable at ultrasound, or in case of suspect axillary lymph nodes are identified, fine-needle aspiration or core biopsy must be carried out to confirm that axillary status is negative. Axillary micrometastases (i.e., if the greatest diameter of the nodal metastasis in a sentinel node is 0.2 mm or less) are not allowed.
    8. Serum pregnancy test (for women of childbearing potential) negative within 7 days prior to treatment start.
    9. Women of childbearing potential must agree to use 1 highly effective non-hormonal contraceptive method with a failure rate of less than 1% per year (see protocol section 5.14.1) from the signing of the ICF until at least 7 months after last dose of study drugs; or they must totally abstain from any form of sexual intercourse. Men with a partner of childbearing potential must agree to use condom in combination with a spermicidal foam, gel, film, cream, or suppository, and agreement to refrain from donating sperm, during the course of this study and for at least 7 months after the last administration of study treatment.
    10. Adequate bone marrow and coagulation functions as defined below:
    • Absolute neutrophil count =1500 /µL or 1.5x109/L
    • Haemoglobin =9 g/dL (blood transfusions to reach these levels of haemoglobin are allowed)
    • Platelets =100,000/µL or 100x109/L
    • International normalized ratio (INR) and activated partial thromboplastin time (aPTT) = 1.5 ×ULN
    11. Adequate liver function as defined below:
    • Serum total bilirubin =1.5 x ULN. In case of known Gilbert’s syndrome =3xUNL is allowed
    • AST (SGOT) and ALT (SGPT) =2.5 x ULN
    • Alkaline phosphatase =2.5 x ULN
    12. Adequate renal function as defined below:
    • Creatinine =1.5 x UNL or creatinine clearance >60 mL/min/1.73 m2
    13. Completion of all necessary screening procedures within 28 days prior to enrolment.
    14. Adequate cardiac function, defined as a left ventricular ejection fraction =55% estimated by echocardiogram (ECHO) or multiple-gated acquisition scintigraphy (MUGA).
    15. Availability of a pre-treatment tumour biopsy sample as specified below:
    • At least one FFPE tumour block must be available for central evaluation. Whenever possible, two FFPE tumour blocks should be available (preferred).
    • If a block cannot be provided, 6 unstained FFPE slides of 10 µm thickness and 20 unstained FFPE slides of 4 µm thickness from the pre-treatment tumour biopsy must be provided as an alternative. These slides must be freshly cut prior the shipment to the sponsor
    • In either case, the local pathologist must evaluate an H&E stained slide to ensure that the tumour surface is at least 4 mm² and that tumour cellularity is =10%.
    Note: Tumour biopsy should be sent the central research laboratory when the patient is confirmed to be eligible for the study.
    16. Signed Informed Consent form (ICF) obtained prior to any study related procedure.
    17. Subject is willing and able to comply with the protocol for the duration of the study including treatment and scheduled visits and examinations.
    1. Maschio o femmina
    2. Età =18 anni
    3. ECOG performance status =1
    4. dimensioni del tumore =15 mm e =50 mm, secondo la stadiazione clinica eseguita con esami di imaging (mammografia, ecografia o MRI)
    5. Deve avere una diagnosi istologicamente confermata di cancro al seno HER2-positivo e ER-negativo/PR-negativo (analisi eseguita dal laboratorio locale)
    a. HER2-positivo definito come un punteggio di 3+ in IHC o un ISH positivo (rapporto numero di copie HER2/cromosoma 17 =2 o numero medio di copie HER2 =6 segnali per cellula)
    b. ER-negativo/PR-negativo definito come colorazione nucleare del recettore degli estrogeni e del recettore del progesterone <1% da IHC
    6. I soggetti con malattia invasiva multifocale o multicentrica sono ammissibili a condizione che tutte le lesioni possano essere caratterizzate e siano confermate essere HER2-positive e ER e PR negative
    7. Malattia nodosa negativa (N0): nessun linfonodo ascellare identificabile all'ecografia, o nel caso in cui vengano identificati linfonodi ascellari sospetti, deve essere effettuata un'aspirazione con ago sottile o una core biopsy per confermare che lo stato ascellare è negativo. Le micrometastasi ascellari (cioè, se il diametro maggiore della metastasi linfonodale in un linfonodo sentinella è di 0,2 mm o meno) non sono ammesse
    8. Test di gravidanza negativo nei 7 giorni precedenti l'inizio del trattamento
    9. Le donne in età fertile devono accettare di utilizzare 1 metodo contraccettivo non ormonale altamente efficace con un tasso di fallimento inferiore all'1% all'anno dalla firma dell'ICF fino ad almeno 7 mesi dopo l'ultima dose dei farmaci dello studio; oppure devono astenersi completamente da qualsiasi forma di rapporto sessuale. Gli uomini con una partner potenzialmente fertile devono accettare di usare il preservativo in combinazione con una schiuma spermicida, un gel, una pellicola, una crema o una supposta, e accettare di astenersi dal donare lo sperma, durante il corso di questo studio e per almeno 7 mesi dopo l'ultima somministrazione del trattamento dello studio
    10. Adeguate funzioni del midollo osseo e della coagulazione:
    - Conta assoluta dei neutrofili =1500 /µL o 1,5x109/L
    - Emoglobina =9 g/dl (sono consentite trasfusioni di sangue per raggiungere questi livelli di emoglobina)
    - Piastrine =100.000/µL o 100x109/L
    - Rapporto internazionale normalizzato (INR) e tempo di tromboplastina parziale attivato (aPTT) = 1,5 ×ULN
    11. Funzione epatica adeguata:
    - Bilirubina totale del siero = 1,5 x ULN. In caso di sindrome di Gilbert nota =3xUNL è consentito
    - AST (SGOT) e ALT (SGPT) =2.5 x ULN
    - Fosfatasi alcalina =2.5 x ULN
    12. Funzione renale adeguata:
    - Creatinina =1.5 x UNL o clearance della creatinina >60 mL/min/1.73 m2
    13. Completamento di tutte le procedure di screening necessarie entro 28 giorni prima dell'arruolamento
    14. Funzione cardiaca adeguata, definita come una frazione di eiezione ventricolare sinistra =55% stimata tramite ECHO o MUGA
    15. Disponibilità di un campione di biopsia tumorale pre-trattamento:
    - Almeno un blocco di tumore FFPE deve essere disponibile per la valutazione centrale. Quando possibile, devono essere disponibili due
    - Se non è possibile fornire un blocco, si devono fornire in alternativa 6 vetrini FFPE non colorati di 10 µm di spessore e 20 vetrini FFPE non colorati di 4 µm di spessore dalla biopsia tumorale pre-trattamento.
    - In entrambi i casi, il patologo locale deve valutare un vetrino colorato H&E per garantire che la superficie del tumore sia di almeno 4 mm² e che la cellularità del tumore sia =10%
    Nota: La biopsia del tumore deve essere inviata al laboratorio di ricerca centrale quando è confermato che il paziente è eleggibile per lo studio
    16. Modulo di consenso informato firmato (ICF) ottenuto prima di qualsiasi procedura relativa allo studio
    17. Il soggetto è disposto e in grado di rispettare il protocollo per tutta la durata dello studio, compreso il trattamento e le visite ed esami programmati
    E.4Principal exclusion criteria
    1. Pregnant and/or lactating women.
    2. Bilateral invasive breast cancer.
    3. Evidence of metastatic breast cancer: all subjects must have had a CT/MRI scan of the thorax/abdomen/pelvis to rule out metastatic breast cancer prior to enrolment. FDG/PET-CT can be used as an alternative to replace all the exams above. A screening bone scan must have been done if ALP and/or corrected calcium levels were above the institutional upper limits at screening (if PET/CT was used as an alternative imaging exam, a bone scan and/or CT/MRI is not required).
    4. Subject with a significant medical, neuro-psychiatric, or surgical condition, currently uncontrolled by treatment, which, in the investigator’s opinion, may interfere with completion of the study.
    5. Previous exposure to any anti-HER2 treatment.
    6. Concomitant exposure to any investigational products as part of a clinical trial within 30 days prior to enrolment.
    7. Subject with second primary malignancies diagnosed = 5 years before enrolment in the study. Exceptions are: adequately treated non-melanoma skin cancer, in situ cancer of the cervix, ductal carcinoma in situ of the breast, and any other solid or haematological tumour diagnosed > 5 years before enrolment and for which no chemotherapy and no systemic treatment were necessary, with no evidence of disease recurrence.
    8. Resting electrocardiogram (ECG) with QTc >470 msec detected on at 2 or more time points within a 24-hour period, or family history of long QT syndrome.
    9. Serious cardiac illness or medical conditions including, but not confined to, the following:
    • History of NCI CTCAE (v4) Grade ¿3 symptomatic congestive heart failure (CHF) or New York Heart Association (NYHA) Class ¿ II
    • High-risk uncontrolled arrhythmias (i.e., atrial tachycardia with a heart rate ¿ 100/min at rest, significant ventricular arrhythmia [ventricular tachycardia], or higher-grade atrioventricular [AV]-block, such as second degree AV-block Type 2 [Mobitz 2] or third-degree AV-block) – Serious cardiac arrhythmia not controlled by adequate medication, severe conduction abnormality
    • Angina pectoris requiring anti-anginal medication
    • Clinically significant valvular heart disease
    • Evidence of transmural infarction on ECG
    • Evidence of myocardial infarction within 12 months prior to randomization
    • Poorly controlled hypertension (i.e., systolic ¿ 180 mm Hg or diastolic ¿ 100 mmHg)
    10. History of ventricular dysrhythmias or risk factors for ventricular dysrhythmias, such as structural heart disease (e.g., severe LVSD, left ventricular hypertrophy), coronary heart disease (symptomatic or with ischemia demonstrated by diagnostic testing), clinically significant electrolyte abnormalities (e.g., hypokalemia, hypomagnesemia, hypocalcemia), or family history of sudden unexplained death or long QT syndrome.
    11. Peripheral neuropathy (CTCAE version 5) grade =2.
    12. Major surgery within 14 days prior to enrolment.
    13. Subject with HIV, Hepatitis B or Hepatitis C infection documented by serology, except for those subjects with a previous exposure to Hepatitis B who developed an effective immune response (HBSAg-negative and anti-HBS-positive).
    14. Previous allogeneic bone marrow transplant.
    15. Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (CTCAE grade =3).
    16. Subjects who received live attenuated vaccines within 14 days before enrolment.
    1. Donne incinte e/o in allattamento.
    2. Carcinoma mammario invasivo bilaterale.
    3. Evidenza di cancro al seno metastatico: tutti i soggetti devono essere stati sottoposti a una scansione CT/MRI del torace/addome/pelvi per escludere un cancro al seno metastatico prima dell'arruolamento. FDG/PET-CT può essere usato come alternativa per sostituire tutti gli esami di cui sopra. Una scansione ossea di screening deve essere stata fatta se i livelli di ALP e/o di calcio corretto erano superiori ai limiti superiori istituzionali allo screening (se la PET/CT è stata usata come esame di imaging alternativo, una scansione ossea e/o CT/MRI non è richiesta).
    4. Soggetto con una condizione medica, neuro-psichiatrica o chirurgica significativa, attualmente non controllata dal trattamento, che, a giudizio dello sperimentatore, può interferire con il completamento dello studio.
    5. Precedente esposizione a qualsiasi trattamento anti-HER2.
    6. Esposizione concomitante a qualsiasi prodotto in sperimentazione come parte di uno studio clinico entro 30 giorni prima dell'arruolamento.
    7. Soggetto con secondi tumori maligni primari diagnosticati = 5 anni prima dell'arruolamento nello studio. Le eccezioni sono: cancro della pelle non melanoma adeguatamente trattato, cancro in situ della cervice, carcinoma duttale in situ del seno, e qualsiasi altro tumore solido o ematologico diagnosticato > 5 anni prima dell'arruolamento e per il quale non è stata necessaria alcuna chemioterapia e nessun trattamento sistemico, senza evidenza di recidiva della malattia.
    8. 8. Elettrocardiogramma a riposo (ECG) con QTc >470 msec rilevato in 2 o più punti temporali in un periodo di 24 ore, o storia familiare di sindrome del QT lungo.
    9. 9. Gravi malattie cardiache o condizioni mediche che includono, ma non si limitano a quanto segue:
    - Storia di insufficienza cardiaca congestizia (CHF) sintomatica di grado ¿3 dell'NCI CTCAE (v4) o classe ¿ II della New York Heart Association (NYHA)
    - Aritmie incontrollate ad alto rischio (cioè tachicardia atriale con una frequenza cardiaca ¿ 100/min a riposo, aritmia ventricolare significativa [tachicardia ventricolare] o blocco atrioventricolare [AV] di grado superiore, come blocco AV di secondo grado di tipo 2 [Mobitz 2] o blocco AV di terzo grado) - Aritmia cardiaca grave non controllata da farmaci adeguati, grave anomalia della conduzione
    - Angina pectoris che richiede farmaci antianginosi
    - Malattia cardiaca valvolare clinicamente significativa
    - Evidenza di infarto transmurale su ECG
    - Evidenza di infarto miocardico nei 12 mesi precedenti la randomizzazione
    - 9. Ipertensione mal controllata (cioè, sistolica ¿ 180 mm Hg o diastolica ¿ 100 mmHg)
    10. 10. Storia di disritmie ventricolari o fattori di rischio per le disritmie ventricolari, come la malattia cardiaca strutturale (ad esempio, LVSD grave, ipertrofia ventricolare sinistra), malattia coronarica (sintomatica o con ischemia dimostrata da test diagnostici), anomalie elettrolitiche clinicamente significative (ad esempio, ipokaliemia, ipomagnesemia, ipocalcemia), o storia familiare di morte improvvisa inspiegabile o sindrome del QT lungo.
    11. Neuropatia periferica (CTCAE versione 5) grado =2.
    12. Intervento chirurgico maggiore entro 14 giorni prima dell'arruolamento.
    13. Soggetto con infezione da HIV, epatite B o epatite C documentata dalla sierologia, ad eccezione dei soggetti con una precedente esposizione all'epatite B che hanno sviluppato una risposta immunitaria efficace (HBSAg-negativi e anti-HBS-positivi).
    14. Precedente trapianto allogenico di midollo osseo.
    15. 15. Ipersensibilità grave nota in precedenza al prodotto in sperimentazione o a qualsiasi componente delle sue formulazioni, comprese le reazioni di ipersensibilità grave note agli anticorpi monoclonali (grado CTCAE =3).
    16. Soggetti che hanno ricevuto vaccini vivi attenuati entro 14 giorni prima dell'arruolamento.
    E.5 End points
    E.5.1Primary end point(s)
    3-year RFS, defined as the time from enrolment until the first occurrence of one of the following events: Invasive ipsilateral breast tumour recurrence, local/regional invasive recurrence, distant recurrence, death from breast cancer, death attributable to any cause other than breast cancer, death from unknown cause; in subjects with HER2-enriched, ER-negative/PR-negative, clinically node-negative breast cancers who achieve a pCR after neoadjuvant treatment.
    RFS a 3 anni, definito come il tempo trascorso dall'arruolamento fino al primo verificarsi di uno dei seguenti eventi: Recidiva invasiva del tumore al seno omolaterale, recidiva invasiva locale/regionale, recidiva a distanza, morte per cancro al seno, morte attribuibile a qualsiasi causa diversa dal cancro al seno, morte per causa sconosciuta; in soggetti con tumori al seno arricchiti di HER2, ER-negativi/PR-negativi, clinicamente nodosi-negativi che ottengono una pCR dopo il trattamento neoadiuvante.
    E.5.1.1Timepoint(s) of evaluation of this end point
    end of trial
    fine del processo
    E.5.2Secondary end point(s)
    3-year RFS in all subjects who achieve a pCR.
    RFS a 3 anni in tutti i soggetti che ottengono una pCR.
    E.5.2.1Timepoint(s) of evaluation of this end point
    end of trial
    fine del processo
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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.8.4.1Number of sites anticipated in Member State concerned26
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA85
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Australia
    Canada
    Israel
    Korea, Republic of
    New Zealand
    Switzerland
    E.8.7Trial 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 end of study is declared when all the following criteria have been met:
    • The last visit of the last subject.
    • 5 years after the enrolment of the last subject
    • The database has been fully cleaned and locked for all analyses.
    La fine dello studio viene dichiarata quando tutti i seguenti criteri sono stati soddisfatti:
    - L'ultima visita dell'ultimo soggetto.
    - 5 anni dopo l'arruolamento dell'ultimo soggetto
    - Il database è stato completamente pulito e bloccato per tutte le analisi.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years8
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years8
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 905
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 160
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state130
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 555
    F.4.2.2In the whole clinical trial 1065
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    at the physician's discretion according to local practices and guidelines
    a discrezione del medico secondo le pratiche e le linee guida locali
    G. Investigator Networks to be involved in the Trial
    G.4 Investigator Network to be involved in the Trial: 1
    G.4.1Name of Organisation Breast International Group
    G.4.3.4Network Country Belgium
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-04-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-20
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2023-10-02
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