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Trial record 3 of 173 for:    Breast Cancer | Marseille, France

Real Time Molecular Analysis of Breast Cancer Receiving Neo-adjuvant Chemotherapy (NEO-R)

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ClinicalTrials.gov Identifier: NCT04504747
Recruitment Status : Not yet recruiting
First Posted : August 7, 2020
Last Update Posted : August 18, 2020
Sponsor:
Information provided by (Responsible Party):
Institut Paoli-Calmettes

Tracking Information
First Submitted Date August 5, 2020
First Posted Date August 7, 2020
Last Update Posted Date August 18, 2020
Estimated Study Start Date January 2021
Estimated Primary Completion Date January 2025   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures
 (submitted: August 5, 2020)
Identify robust candidates - "innate, "acquired stable" and/or reversible" [ Time Frame: 5 years ]
comparison of pre and/or post NAC molecular profiles in tumors, PDO models and CTCs - will be targeted with a drug in relevant models
Original Primary Outcome Measures Same as current
Change History
Current Secondary Outcome Measures
 (submitted: August 5, 2020)
  • public repertoire of whole transcriptome and targeted-NGS [ Time Frame: 5 years ]
    NAC" database will be constructed from well documented RNAseq and targeted-NGS profiles established from serial HER2+ and TN tumors before/after NAC treatment
  • Identify molecular signatures associated with response to NAC [ Time Frame: 5 years ]
    Comparison of serial molecular profiles
  • Establish PDO samples exposed to NAC [ Time Frame: 5 years ]
    Percentage of PDO exposed to NAC that will parallel the patient's clinical response to NAC
  • Evaluation of CTCs features [ Time Frame: 5 years ]
    phenotype, RNA-seq-based transcriptome
Original Secondary Outcome Measures Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title Real Time Molecular Analysis of Breast Cancer Receiving Neo-adjuvant Chemotherapy
Official Title Real Time Molecular Analysis of Breast Cancer Receiving Neo-adjuvant Chemotherapy: Identification of Preclinical Models Predictive for Therapeutic Resistance
Brief Summary The present project aims at identifying robust candidates for drug resistance in BC patients eligible for NAC. Its originality lies upon the combination of three different and complementary prospective approaches: from the molecular analyses of biopsies sampled before and after NAC, from in vitro BC Patient-Derived Organoids (PDO) mimicking patient's response to NAC, and from Circulating Tumor Cells (CTCs) isolated before/during/after NAC.
Detailed Description

Breast cancer (BC) is a major public health problem in France, with an increasing incidence, estimated at ~60,000 new cases in 2017 and 12,000 deaths. Despite survival improvement in the recent years, resistance to chemotherapy (CT) remains a paramount challenge in BC: the molecular mechanisms remain poorly known and the current interventions are inadequate to target chemoresistance. Neo-adjuvant chimiotherapy (NAC) is now used increasingly in women with operable but aggressive BC such as triple-negative (TN) or HER2+ tumor (Pusztai et al, Lancet Oncol 2019). It provides at least three advantages: i) tumor debulking authorizing conservative surgery, ii) tailoring of adjuvant systemic therapy according to the pathological response, with delivery of capecitabine in TN patients (Masuda N. et al, N Engl J Med. 2017) and T-DM1 in HER2+ patients (von Minckwitz G et al., N Engl J Med. 2019) in the absence of pathological complete response (pCR), and iii) providing resources for investigating the molecular mechanisms of chemoresistance. The current standard NAC regimen is based on a sequential association of anthracycline and taxane (and trastuzumab if HER2+) (Huober & von Minckwitz, Breast Care 2011), and the achievement of pCR, defined as the absence of residual invasive cancer on pathological evaluation of the operative specimen (resected breast specimen and sampled ipsilateral lymph nodes (i.e., ypT0/Tis ypN0 in the AJCC staging system), is a good-prognosis feature; the patients without pCR being at high relapse risk (≈50% of the TN and HER2+ subtypes).

The major bottleneck in improving treatment efficiency for these patients is the identification of candidates effectively involved in the resistance to NAC, their validation in relevant and predictive models, and their detection from surrogate markers. Of course, the search for molecular alterations differentially represented in the pre-NAC samples between the resistant (no pCR) versus sensitive (pCR) patients, or between the paired post- versus pre-NAC samples may reveal candidates involved in resistance ("innate" and "acquired stable" respectively), but ignores the alterations that occur during the NAC that may be reversible ("acquired reversible") and not identified in the resected specimen (Echeverria GV, Sci Transl Med 2019), but only identifiable by analysis of serial samples during NAC regimen, difficult and traumatic in clinical practice.

The present project aims at identifying robust candidates for drug resistance in BC patients eligible for NAC. Its originality lies upon the combination of three different and complementary prospective approaches: from the molecular analyses of biopsies sampled before and after NAC, from in vitro BC Patient-Derived Organoids (PDO) mimicking patient's response to NAC, and from Circulating Tumor Cells (CTCs) isolated before/during/after NAC. This project will combine the most advanced technologies (RNA and DNA-sequencing from small amount of biologic material, rare subsets/single-cell isolation, and multi-omics analyses) with innovative models (drug testing on breast PDO, identification of reversible drug-induced changes) and clever combination of robust markers involved in drug resistance that have all been established and are running in the laboratory (cf Part B). The last two points have only recently become feasible thanks to two recent technological advances: breast cancer PDO cultures (Sachs N, et al. Cell. 2018) and CTCs isolation and characterization (Gkountela S, et al. Cell. 2019). Briefly, the investigators will use serial tumor biopsies and blood samples from a cohort of BC patients treated with NAC (Figure 1). Tumor biopsies will be collected before and after NAC. They will be analyzed by RNA-seq and targeted-NGS (exome) approaches to capture the differences resulting from NAC in patients with different pathological response. They will also be used to generate BC PDO models. The PDO models predictive for NAC response will be exploited as relevant models to investigate NAC resistance. Specifically, investigators will use these models to look at in vitro "acquired reversible" drug-induced resistance mechanisms (i.e only detectable during the drug exposure). Blood samples will be collected before, during, and after NAC to analyze CTCs, and aim at identifying "acquired reversible" drug-induced resistance mechanisms ex vivo, which the investigators might fail to detect with the before/after NAC samples only.

To our knowledge, this is the first time that these three innovative approaches will be used together to investigate in depth the topic of "resistance" in patients receiving NAC. The strength of this combination is to anticipate different - not mutually exclusive - situations that might occur ("innate", "acquired stable" and/or "reversible" drug-induced resistance). Each approach will provide original, precise and specific information that will contribute to build a more complete answer to this question than the scattered and incomplete data currently available in the literature.

Study Type Observational
Study Design Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration Not Provided
Biospecimen Retention:   Samples With DNA
Description:
Bllod and tumor tissue
Sampling Method Probability Sample
Study Population Brest cancer females with a non metastatic cancer
Condition Breast Cancer Female
Intervention Other: molecular analysis of blood and tumor
RNAseq, DNAseq, CTCs
Study Groups/Cohorts
  • RH+
    Prospective blood and biopsie analyses
    Intervention: Other: molecular analysis of blood and tumor
  • HER2+
    Prospective blood and biopsie analyses
    Intervention: Other: molecular analysis of blood and tumor
  • TN
    Prospective blood and biopsie analyses
    Intervention: Other: molecular analysis of blood and tumor
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Not yet recruiting
Estimated Enrollment
 (submitted: August 5, 2020)
150
Original Estimated Enrollment Same as current
Estimated Study Completion Date January 2030
Estimated Primary Completion Date January 2025   (Final data collection date for primary outcome measure)
Eligibility Criteria

Inclusion Criteria:

  1. Woman over 18
  2. Signed consent to participate
  3. Invasive mammary adenocarcinoma proven histologically and / or cytologically
  4. Indication of CNA retention by the referring clinical team.
  5. No contraindication to CNA.
  6. Selected indication of the post-CNA surgery sequence, then radiotherapy
  7. Performance index ≤ 1 (WHO).
  8. Affiliation to a social security scheme, or beneficiary of such a scheme

Exclusion Criteria:

  1. Planned therapeutic sequence: CNA, followed by neoadjuvant radiotherapy (HIST-RIC clinical trial for example) before surgery
  2. Metastatic disease at diagnosis
  3. Patient relapsed from breast cancer precede
  4. Other malignant disease in the previous 3 years, with the exception of cervical carcinoma in situ or skin basal cell carcinoma and any other cancerous pathology considered to have been properly treated and at low risk of relapse.
  5. Woman pregnant or likely to be (without effective contraception) or breastfeeding
  6. Person in an emergency situation, adult person subject to a legal protection measure (adult under guardianship, guardianship or legal protection), or unable to express consent.
  7. Inability to undergo medical monitoring of the trial for geographical, social or psychological reasons
Sex/Gender
Sexes Eligible for Study: Female
Ages 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers No
Contacts
Contact: Dominique GENRE, Dr 0491223778 drci.up@ipc.unicancer.fr
Listed Location Countries France
Removed Location Countries  
 
Administrative Information
NCT Number NCT04504747
Other Study ID Numbers NEO-R-IPC 2019-041
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement
Plan to Share IPD: No
Responsible Party Institut Paoli-Calmettes
Study Sponsor Institut Paoli-Calmettes
Collaborators Not Provided
Investigators
Principal Investigator: François BERTUCCI, Pr Institut Paoli-Calmettes
PRS Account Institut Paoli-Calmettes
Verification Date August 2020