E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
triple negative breast cancer with newly diagnosed or progressing brain metastases |
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E.1.1.1 | Medical condition in easily understood language |
triple negative breast cancer ith newly diagnosed or progressing brain metastases |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
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 ability of Dato-DXd to induce objective CNS responses in patients with TNBC and newly diagnosed or progressive brain metastases. |
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E.2.2 | Secondary objectives of the trial |
To evaluate the activity of Dato-DXd on extracranial disease; to evaluate progression-free-survival (PFS) and overall survival (OS) in patients with active TNBC BM treated with Dato-DXd; and to evaluate safety and tolerability of Dato-DXd in a patient population of patients with active TNBC brain metastases; to evaluate QoL and neurocognitive functioning of study participants on Dato-DXd. Exploratory Objectives To evaluate tissue, blood and imaging biomarkers associated with response to Dato-DXd.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Histologically confirmed breast cancer • Triple-negative disease • Newly diagnosed untreated brain metastases or brain metastases progressing after prior local therapy • Measurable disease (RANO-BM criteria) • No indication for immediate local treatment • Accompanying type II leptomeningeal disease allowed (suspected LMD by clinical findings and neuroimaging) • KPS ≥70%, ECOG ≤2 • Indication for systemic anti-cancer treatment • Prior exposure to PD-1, PD-L1 inhibitors and TROP-2 targeted agents allowed • Life expectancy of at least 3 months • Age ≥18 years • Patient must be able to tolerate therapy • Adequate bone-marrow, liver and kidney function • Adequate treatment washout period before enrolment, defined as: • Major Surgery: ≥3 weeks • Radiation therapy to the chest: ≥4 weeks • Palliative radiation therapy to other areas: ≥2 weeks • Chemotherapy, small-molecule targeted agents: ≥3 weeks • Antibody-based treatment: ≥4 weeks (concurrent therapy with denosumab allowed) • Patient must be capable of understanding the purpose of the study and have given written informed consent
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E.4 | Principal exclusion criteria |
• Known hypersensitivity to Dato-DXd or any of the drug components • Use of any investigational agent within 28 days prior to initiation of treatment • History of malignancies other than squamous cell carcinoma, basal cell carcinoma of the skin or carcinoma in situ of the cervix within the last 3 years including contralateral breast cancer • Other anticancer therapy • Concomitant radiotherapy • A history of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the investigator to be clinically significant and adversely affecting compliance to study drugs • Clinically significant cardiac disease including unstable angina, acute myocardial infarction within six months prior to randomization, congestive heart failure (NYHA III-IV), left ventricular ejection fraction <50%, arrhythmia unless controlled by therapy, with the exception of extra systoles or minor conduction abnormalities, and long QT syndrome (QTc interval >470 ms) • Inadequate bone marrow function at baseline prior to study entry: Dependency on red blood cell and/or platelet transfusions, ANC (absolute neutrophil count (segmented + bands) <1.0 x 109/L; platelets <80 x 109/L • Inadequate kidney function: serum-creatinine >1.5 times upper normal limit • Subjects who have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment) including active or uncontrolled infections with hepatitis B and C • Participants with known hepatitis B and C are eligible if they: 1) Have been curatively treated for HCV infection as demonstrated clinically and by viral serologies 2) Have received HBV vaccination with only anti-HBs positivity and no clinical signs of hepatitis 3) Are HBsAg- and anti-HBc+ (i.e., those who have cleared HBV after infection) and meet conditions i-iii below: 4) Are HBsAg+ with chronic HBV infection (lasting 6 months or longer) and meet conditions 1-3 below: 5) HBV DNA viral load <2000 IU/mL 6) Have normal transaminase values, or, if liver metastases are present, abnormal transaminases, with a result of AST/ALT <3 × ULN, which are not attributable to HBV infection 7) Start or maintain antiviral treatment if clinically indicated as per the investigator • Clinically severe pulmonary compromise resulting from intercurrent pulmonary illnesses including, but not limited to, any underlying pulmonary disorder (i.e., pulmonary emboli within three months of the study enrolment, severe asthma, severe COPD, restrictive lung disease, pleural effusion etc.), and any autoimmune, connective tissue or inflammatory disorders with pulmonary involvement (i.e., rheumatoid arthritis, Sjogren's syndrome, sarcoidosis etc.), or prior pneumonectomy • Has a history of non-infectious ILD/pneumonitis that required steroids, has current ILD/pneumonitis, or has suspected ILD/pneumonitis that cannot be ruled out by imaging at screening • Subjects with bronchopulmonary disorders who require intermittent use of bronchodilators (such as albuterol) will not be excluded from this study • Patients with active opportunistic infections • Known human immunodeficiency virus (HIV) infection that is not well controlled. All of the following criteria are required to define an HIV infection that is well controlled: undetectable viral RNA, CD4+ count ≥350, no history of AIDS-defining opportunistic infection within the past 12 months, and stable for at least 4 weeks on the same anti-HIV medications (meaning there are no expected further changes in that time to the number or type of antiretroviral drugs in the regimen). If an HIV infection meets the above criteria, monitoring of viral RNA load and CD4+ count is recommended • Pregnant or lactating women. Women with childbearing potential must have a negative pregnancy test at screening • Women with childbearing potential, including women whose last menstrual period was less than one year prior to screening, unable or unwilling to use adequate contraception from study start to one year after the last dose of protocol therapy. Acceptable contraception methods included the application of an intrauterine device, barrier method or total abstinence • Male subjects unable or unwilling to use adequate contraception methods • Patients with known substance abuse or any other medical conditions such as clinically significant cardiac or psychological conditions, that may, in the opinion of the investigator, interfere with the subject’s participation in the clinical study or evaluation of the clinical study results • Patients requiring concomitant use of chronic systemic (IV or oral) corticosteroids at doses higher than 8 mg dexamethasone per day or other immunosuppressive medications except for managing adverse events; (inhaled steroids or intra articular steroid injections are permitted in this study) • Patients with significant corneal disease
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E.5 End points |
E.5.1 | Primary end point(s) |
intracranial response rate at any timepoint as judged by best response during the study period (response measured according to RANO-BM criteria) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
extracranial response rate (response measured according to RECIST 1.1), bicompartmental clinical benefit rate (CBR; CR+PR+SD ≥6 months; intracranial CBR measured by RANO-BM; extracranial CBR measured by RECIST 1.1), progression-free survival, overall survival |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | 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 | Yes |
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 | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | |