Addition of Carboplatin to Neoadjuvant Therapy for Triple-negative and HER2-positive Early Breast Cancer (GeparSixto)

This study has been completed.
Sponsor:
Collaborators:
TEVA
Roche Pharma AG
GlaxoSmithKline
Information provided by (Responsible Party):
German Breast Group
ClinicalTrials.gov Identifier:
NCT01426880
First received: August 17, 2011
Last updated: November 21, 2013
Last verified: November 2013
  Purpose

Study participants with primary breast cancer will receive a standard chemotherapy with an anthracycline and a taxane as well as trastuzumab in case of HER2-positive tumors at doses and duration in concordance to current treatment guidelines. Patients will be receive and benefit in addition currently not in the neoadjuvant setting registered medication as lapatinib or bevacizumab of which significant increases of cure (pCR) rates have been reported in previous phase III studies. Patients randomized to carboplatin will receive in addition to the described backbone therapies a potentially active agent which suggested synergy of efficacy with chemotherapies as well as targeted agents. Patients might have the risk of an increase in toxicities due to the added agents and will have additional burden due to investigations required for study participation. However, due to the severity of the underlying disease and the high risk of relapse and death due to the stage of disease, this increase in toxicity and burden appears less relevant compared to the potential higher efficacy and finally cure rate by the incorporated treatments.


Condition Intervention Phase
Tubular Breast Cancer Stage II
Mucinous Breast Cancer Stage II
Breast Cancer Female NOS
Invasive Ductal Breast Cancer
Tubular Breast Cancer Stage III
HER-2 Positive Breast Cancer
Inflammatory Breast Cancer Stage IV
Inflammatory Breast Cancer
Drug: Carboplatin
Drug: background treatment according to standards fpr triple negative and Her2pos breast cancer patients
Phase 2
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomized Phase II Trial Investigating the Addition of Carboplatin to Neoadjuvant Therapy for Triple-negative and HER2-positive Early Breast Cancer

Resource links provided by NLM:


Further study details as provided by German Breast Group:

Primary Outcome Measures:
  • Pathological complete response of breast and lymph nodes (ypT0 ypN0; primary endpoint) [ Time Frame: 24 weeks (time window -3 weeks) ] [ Designated as safety issue: No ]
    Pathological response will be assessed considering all removed breast and lymphatic tissues from all surgeries. Surgery takes place shortly after the 18 weeks (six 3-week cycles) chemotherapy treatment. No microscopic evidence of residual viable tumor cells in all resected specimens of the breast and axilla meets the primary endpoint.


Secondary Outcome Measures:
  • 1.ypT0/is ypN0; ypT0; ypT0/is; ypN0, and regression grades [ Time Frame: 24 weeks (time window -3 weeks) ] [ Designated as safety issue: No ]
  • Clinical and imaging response [ Time Frame: 24 weeks (time window -3 weeks) ] [ Designated as safety issue: No ]
    To determine the response rates of the breast tumor and axillary nodes based on physical examination and imaging tests. (sonography, mammography, or MRI) after treatment in both arms.

  • loco-regional invasive recurrence free survival (LRRFS), regional recurrence free survival (RRFS), local recurrence free survival (LRFS), distant-disease- free survival (DDFS), invasive disease-free survival (IDFS), and overall survival (OS) [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    LRRFS, RRFS, LRFS, DDFS, IDFS and OS are defined as the time period between registration and first event and will be analyzed after the end of the study by referring to data from GBG patient's registry.

  • Tolerability and Safety [ Time Frame: during treatment 18 weeks ] [ Designated as safety issue: Yes ]
    Tolerability and Safety: Descriptive statistics for the 4 treatments will be given on the number of patients whose treatment had to be reduced, delayed or permanently stopped

  • pCR rates per arm [ Time Frame: 24 weeks (time window -3 weeks) ] [ Designated as safety issue: No ]
    • To assess the pCR rates per arm separately in patients with triple-negative tumors and HER2-positive tumors.

  • Breast and axilla conservation rate [ Time Frame: 24 weeks (time window -3 weeks) ] [ Designated as safety issue: No ]
    To determine the breast and axilla conservation rate after each treatment.

  • pCR rate and local recurrence free survival in correlation to clinical complete response and negative core biopsy before surgery [ Time Frame: 5 years ] [ Designated as safety issue: No ]
    To determine the pCR rate and local recurrence free survival (LRFS) in patients with a clinical complete response (cCR) and a negative core biopsy before surgery.

  • Clinical and imaging response [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
    To determine the response rates of the breast tumor and axillary nodes based on physical examination and imaging tests. (sonography, mammography, or MRI) after treatment in both arms.

  • PCR rate in patients with a clinical complete response and a negative core biopsy [ Time Frame: 24 weeks (time window -3 weeks) ] [ Designated as safety issue: No ]
    To assess the pCR rate in patients with a clinical complete response and a negative core biopsy before surgery.

  • Regional recurrence free survival (RRFS)in patients with initial node-positive axilla [ Time Frame: until event occurs - no events for cured patients ] [ Designated as safety issue: No ]
    To assess regional recurrence free survival (RRFS) in patients with initial node-positive axilla converted to negative at surgery and treated with sentinel node biopsy alone.

  • Examination and comparison of molecular markers [ Time Frame: Baseline, 6 weeks and 24 weeks ] [ Designated as safety issue: No ]
    To examine and compare pre-specified molecular markers such as BRCA1-mRNA, P53, ALDH1, p4E-BP1, IL-8 metagene, B-Cell metagene as well as exploratory analyses and lymphocyte infiltration on core biopsies before and surgical tissue after end of chemotherapy. The aim is to identify potential predictive short and long term parameters.

  • CTC Substudy [ Time Frame: Baseline, 6 weeks and 24 weeks ] [ Designated as safety issue: No ]
    To assess, characterize, and correlate circulating tumor cells and proteins with the effect of treatment.

  • Pharmacogenetic substudy [ Time Frame: Baseline ] [ Designated as safety issue: No ]
    To correlate Single Nucleotide Polymorphisms (SNPs) of genes with the associated toxicity and histologically assessed treatment effect.

  • Ovarian Substudy [ Time Frame: Baseline, 6 months, 12 months, 18 months, 24 months, 30 months ] [ Designated as safety issue: No ]
    To assess ovarian function measured by amenorrhea rate in correlation with changes in E2, FSH, Anti-Müller Hormone, ultrasound-follicle count in patients aged <45 years.


Enrollment: 595
Study Start Date: August 2011
Study Completion Date: August 2013
Primary Completion Date: May 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Carboplatin AUC 2 min/mL weekly, infusion
Carboplatin will be used as Add on to the background therapy (same as comparator arm)
Drug: Carboplatin

Paclitaxel: 80 mg/m² i.v. given weekly on day 1 q day 8 for 18 weeks. NPLD (Myocet®): 20 mg/m² weekly on day 1 q day 8 for 18 weeks Trastuzumab (only for HER2-positive patients): Loading dose: 8 mg/kg, Maintenance dose: 6 mg/kg, day 1 q day 22 for 6 cycles. Post-surgery: up to a total duration of 1 year according to current AGO guidelines Lapatinib 750 mg/day p.o. continuously for 18 weeks; in case of good tolerability (no CTC grade II toxicity except alopecia and nausea/vomiting) during the first cycle the dose may be escalated to 1000 mg.

Bevacizumab: 15 mg/kg i.v., day 1 q day 22 for 6 cycles (only in TNBC patients).

These agents are used according to marketed formulation via normal procedures at each site and applied according to recommendations of the manufacturers.

Other Names:
  • Background therapy with
  • Paclitaxel
  • Myocet
  • Herceptin (Her2pos)
  • Tyverb (Her 2 pos)
  • Avastin (triple neg)
Active Comparator: Background treatment only
NLPD (Myocet), Paclitaxel, Herceptin (Trastuzumab fpr Her2 pos), Tyverb (Lapatinib for Her2 pos), Avastin (Bevacizumab for triple negative) agents are used according to marketed formulation via normal procedures at each site and applied according to recommendations of the manufacturers.
Drug: background treatment according to standards fpr triple negative and Her2pos breast cancer patients

Paclitaxel: 80 mg/m² i.v. given weekly on day 1 q day 8 for 18 weeks. NPLD (Myocet®): 20 mg/m² weekly on day 1 q day 8 for 18 weeks Trastuzumab (only for HER2-positive patients): Loading dose: 8 mg/kg, Maintenance dose: 6 mg/kg, day 1 q day 22 for 6 cycles. Post-surgery: up to a total duration of 1 year according to current AGO guidelines Lapatinib 750 mg/day p.o. continuously for 18 weeks; in case of good tolerability (no CTC grade II toxicity except alopecia and nausea/vomiting) during the first cycle the dose may be escalated to 1000 mg.

Bevacizumab: 15 mg/kg i.v., day 1 q day 22 for 6 cycles (only in TNBC patients).

Other Names:

Background therapy with Paclitaxel Myocet Herceptin (Her2pos) Tyverb (Her 2 pos) Avastin (triple neg)

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Detailed Description:

Anthracycline/taxane based combination chemotherapy of at least 18 weeks represents the standard of care in the neoadjuvant setting. In HER2-positive disease trastuzumab is given simultaneously to chemotherapy. Recent data from the Neo-Altto and Neosphere trials suggest that a dual blockage of the HER2 receptor with e.g. trastuzumab and lapatinib reach significantly higher pCR rates than trastuzumab alone and should therefore represent the treatment back-bone of new neoadjuvant trials. A preplanned subgroup analysis of the GeparQuinto study demonstrated that in TNBC the addition of bevacizumab resulted in a significant increase of pCR rates (HR 1.4).

Having a better cardiac tolerability profile compared to conventional anthracyclines, the non-pegylated liposomal encapsulated doxorubicin (NPLD) Myocet® might provide the possibility to combine taxane, anthracycline, platinum salt as well with targeted agents as double HER2 blockage or bevacizumab.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 1.Written informed consent for all study procedures according to local regulatory requirements prior to beginning specific protocol procedures.
  • 2.Complete baseline documentation must be submitted via Medcodes® and approved by GBG Forschungs GmbH.
  • 3.Unilateral or bilateral primary carcinoma of the breast, confirmed histologically by core biopsy. Fine-needle aspiration is not sufficient. Incisional biopsy is not allowed. In case of bilateral cancer, the investigator has to decide prospectively which side will be evaluated for the primary endpoint.
  • 4.Tumor lesion in the breast with a palpable size of ≥ 2 cm or a sonographical size of ≥ 1 cm in maximum diameter. The lesion has to be measurable in two dimensions, preferably by sonography. In case of inflammatory disease, the extent of inflammation can be used as measurable lesion.
  • 5.Patients should be in the following stages of disease: cT2 - cT4a-d or cT1c and cN+ or pNSLN+
  • 6.In patients with multifocal or multicentric breast cancer, the largest lesion should be measured.
  • 7.Centrally confirmed ER/PR/HER-2 and Ki-67 status detected on core biopsy. ER/PR positive is defined as >1% stained cells and HER2-positive is defined as HercepTest IHC 3+ or FISH ratio ≥ 2.2. Formalin-fixed, paraffin-embedded (FFPE) breast tissue from core biopsy has therefore to be sent to the Dept. of Pathology at the Charité, Berlin prior to randomization.
  • 8.Age ≥ 18 years.
  • 9.Karnofsky Performance status index ≥ 80%.
  • 10.Normal cardiac function must be confirmed by ECG and cardiac ultrasound (LVEF or shortening fraction) within 3 months prior to randomization. LVEF must be above 55%.
  • 11.Laboratory requirements: Hematology
  • Absolute neutrophil count (ANC) ≥ 2.0 x 109 / L and
  • Platelets ≥ 100 x 109 / L and
  • Hemoglobin ≥ 10 g/dL (≥ 6.2 mmol/L) Hepatic function
  • Total bilirubin < 1.5x UNL and
  • ASAT (SGOT) and ALAT (SGPT) ≤ 1.5x UNL and
  • Alkaline phosphatase ≤ 2.5x UNL. Renal function
  • Creatinine ≤ 175 µmol/L (2 mg/dL) < 1.5x UNL
  • Proteinuria: Urine dipstick for proteinuria < 2+. Patients discovered to have ≥ 2+ proteinuria on dipstick urinalysis should undergo a 24-hour urine collection and must demonstrate ≤ 1 g of protein in 24 hours. If creatinine is between 140 - 175 umol/L (1.6-2.0 mg/dL), the creatinine clearance (calculated or measured) should be ≥ 45 mL/min.
  • 12.Negative pregnancy test (urine or serum) within 14 days prior to randomization for all women of childbearing potential.
  • 13.Complete staging work-up within 3 months prior to randomization. All patients must have bilateral mammography, breast ultrasound (≤ 21 days), breast MRI (optional), chest X-ray (PA and lateral), abdominal ultrasound or CT scan or MRI, and bone scan done. In case of positive bone scan, bone X-ray (or CT or MRI) is mandatory. Other tests may be performed as clinically indicated.
  • 14.Patients must be available and compliant for central diagnostics, treatment and follow-up.

Exclusion Criteria:

  1. Prior chemotherapy for any malignancy.
  2. Prior radiation therapy for breast cancer.
  3. Pregnant or lactating patients. Patients of childbearing potential must implement adequate non-hormonal contraceptive measures (barrier methods, intrauterine contraceptive devices, sterilization) during study treatment.
  4. Inadequate general condition (not fit for anthracycline-taxane-targeted agents-based chemotherapy).
  5. Previous malignant disease being disease-free for less than 5 years (except CIS of the cervix and non-melanomatous skin cancer).
  6. Known or suspected congestive heart failure (>NYHA I) and / or coronary heart disease, angina pectoris requiring antianginal medication, previous history of myocardial infarction, evidence of transmural infarction on ECG, uncontrolled or poorly controlled arterial hypertension (i.e. BP >160 / 90 mm Hg under treatment with two antihypertensive drugs), rhythm abnormalities requiring permanent treatment, clinically significant valvular heart disease.
  7. Previous thromboembolic event (except when thrombophily screening is negative).
  8. Known hemorrhagic diathesis or coagulopathy with increased bleeding risk.
  9. History of significant neurological or psychiatric disorders including psychotic disorders, dementia or seizures that would prohibit the understanding and giving of informed consent
  10. Pre-existing motor or sensory neuropathy of a severity ≥ grade 2 by NCI-CTC criteria v 4.0.
  11. Currently active infection.
  12. Active peptic ulcer.
  13. Incomplete wound healing or unhealed bone fracture.
  14. Disease significantly affecting gastrointestinal function, e.g. malabsorption syndrome, resection of the stomach or small bowel, ulcerative colitis.
  15. History of abdominal fistula or any grade 4 non-gastrointestinal fistula, gastrointestinal perforation or intra-abdominal abscess within 6 months of enrolment.
  16. Severe pulmonary condition / illness.
  17. Major surgery within the last 28 days or anticipation of the need for major surgery during study treatment with bevacizumab. Minor surgeries including insertion of an indwelling catheter or sentinel lymph node biopsy within 24 h prior to chemotherapy.
  18. Definite contraindications for the use of corticosteroids except inhalative corticoids.
  19. Known hypersensitivity reaction to one of the compounds or incorporated substances used in this protocol;
  20. Concurrent treatment with:

    • chronic corticosteroids unless initiated > 6 months prior to study entry and at low dose (≤ 10 mg methylprednisolone or equivalent).
    • sex hormones. Prior treatment must be stopped before study entry.
    • virostatic agents like sorivudine or analogs like brivudine, concurrent treatment with aminoglycosides.
    • anticoagulants: heparin, warfarin as well as acetylic acid (e.g. Aspirin®) at a dose of > 325 mg/day or clopidogrel at a dose of > 75 mg/day.
    • other experimental drugs or any other anti-cancer therapy.
    • drugs recognized as being strong inhibitors or inducers of the isoenzyme CYP3A, e.g. Rifabutin, Rifampicin, Clarithromycin, Ketoconazole, Itraconazole, Ritonavir, Telithromycin, Erythromycin, Verapamil, Diltiazem within the last 5 days or the expected need for these treatments during study participation.
  21. Participation in another clinical trial with any investigational, not marketed drug within 30 days prior to study entry.
  22. Male patients.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01426880

Locations
Germany
Praxis Dr. Heinrich
Fürstenwalde, Brandenburg, Germany, 15517
Luisenkrankenhaus
Düsseldorf, Nordrhein-Westfalen, Germany, 40235
NCT Heidelberg
Heidelberg, Germany
Sponsors and Collaborators
German Breast Group
TEVA
Roche Pharma AG
GlaxoSmithKline
Investigators
Principal Investigator: Gunter von Minckwitz, MD, Prof ASCO, AACR, ESMO, DKG, DGGG, AGO, DGS, BIG, BCIRG, St. Gallen Consensus Panel
  More Information

Additional Information:
No publications provided

Responsible Party: German Breast Group
ClinicalTrials.gov Identifier: NCT01426880     History of Changes
Other Study ID Numbers: GBG 66, 2011-000553-23
Study First Received: August 17, 2011
Last Updated: November 21, 2013
Health Authority: Germany: Federal Institute for Drugs and Medical Devices

Keywords provided by German Breast Group:
Tubular breast cancer stage II - Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Mucinous breast cancer stage II
Invasive ductal breast cancer
Tubular breast cancer stage III
HER-2 positive breast cancer
Inflammatory breast cancer stage IV
Inflammatory breast cancer
GeparSixto
GBG 66
GBG
German Breast Group
neo-adjuvant
GBG Forschungs GmbH

Additional relevant MeSH terms:
Breast Neoplasms
Inflammatory Breast Neoplasms
Carcinoma, Ductal, Breast
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Carcinoma, Ductal
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Ductal, Lobular, and Medullary
Trastuzumab
Bevacizumab
Carboplatin
Paclitaxel
Doxorubicin
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Antineoplastic Agents, Phytogenic
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on August 28, 2014