T-DM1 vs Paclitaxel/Trastuzumab for Breast (ATEMPT Trial)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01853748
Recruitment Status : Active, not recruiting
First Posted : May 15, 2013
Last Update Posted : February 1, 2018
Information provided by (Responsible Party):
Sara Tolaney, Dana-Farber Cancer Institute

Brief Summary:

This research study is a Phase II clinical trial. Phase II clinical trials test the effectiveness of an investigational drug to learn whether the drug works in treating a specific cancer. "Investigational" means that the drug is still being studied and that research doctors are trying to find out more about it-such as the safest dose to use, the side effects it may cause, and if the drug is effective for treating different types of cancer. It also means that the FDA has not approved this drug for use patients undergoing adjuvant treatment for HER2+ breast cancer. Trastuzumab emtansine (T-DM1) is a drug that may stop cancer cells from growing. This drug has been used in other research studies and information from those other research studies suggests that this drug may help to prevent the recurrence of breast cancer in this research study.

The use of T-DM1 in this research study is experimental, which means it is not approved by any regulatory authority for the adjuvant treatment of HER2-positive breast cancer. However, it FDA-approved for metastatic HER2-positive breast cancer. T-DM1 has caused cancer cells to die in laboratory studies. In preclinical studies, this drug has prevented or slowed the growth of breast cancer. The breast cancer treatments (paclitaxel and Trastuzumab) used in this study are considered part of standard-of-care regimens in early breast cancer. A standard treatment means that this is a treatment that would be accepted by the majority of the medical community as a suitable treatment for your type of breast cancer.

In this research study, the investigators are looking to see if the study drug T-DM1 will have less side effects than traditional HER2-positive breast cancer treatment of trastuzumab and paclitaxel. The investigators are also hoping to learn about the long term benefits and disease-free survival of participants who take the study drug T-DM1 in comparison to those participants to take the combination of trastuzumab and paclitaxel.

Condition or disease Intervention/treatment Phase
Breast Cancer Drug: Trastuzumab Drug: Paclitaxel Drug: Trastuzumab emtansine Phase 2

Detailed Description:

If a participant agrees to participate in this study she will be asked to undergo some screening tests or procedures to confirm that she is eligible. Many of these tests and procedures are likely to be part of regular cancer care and may be done even if turns out that she does not take part in this research study. If she has had some of these tests or procedures recently, they may or may not have to be repeated. These tests and procedures will include: a medical history, performance status, assessment of your tumor, blood tests, cardiac tests, pregnancy test and a collection of tumor tissue. If these tests show that she is eligible to participate in the research study, she will begin the study treatment. If she does not meet the eligibility criteria, she will not be able to participate in this research study.

Because no one knows which of the study options is best, the participant will be "randomized" into one of the study groups after she has had her breast surgery: Group 1 or Group 2. Randomization means that she is put into a group by chance. Neither the participant nor the research doctor will choose what group she will be in. The participant will have a one in three chance of being placed in any group. Approximately 375 study participants will receive the study drug, while 125 study participants will receive the standard therapy of trastuzumab and paclitaxel.

Group 1 participants will receive the study drug T-DM1 every three weeks by IV (intravenous injection) for 17 treatments (total of 51 weeks).

Group 2 participants will receive the FDA-approved drugs Paclitaxel and Trastuzumab once per week by IV for 12 weeks. Then beginning week 13, participants will receive Trastuzumab only by IV injection every three weeks for the next 13 treatments.

During all cycles the participant will have a physical exam and tumor assessment.

The investigators would like to keep track of the participant's medical condition for the next five years after the final dose of study drug. The investigators would like to do this by regular visits every 6 months for 3 years after completion of study treatment, and then once a year for the next two years. The investigators may ask for additional follow-up by phone after completion of these visits.

Participants who undergo lumpectomy (breast conserving surgery) need to receive breast radiation therapy to participate in this study. Participants who have undergone a mastectomy may receive chest wall and lymph node radiation (as determined by discussion with their physician). Radiation Therapy will begin after the conclusion of all study paclitaxel doses, and after 12 weeks fo the study drug T-DM1.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 512 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Phase II Study of Trastuzumab Emtansine (T-DM1) vs. Paclitaxel in Combination With Trastuzumab for Stage I HER2-Positive Breast Cancer (ATEMPT Trial)
Study Start Date : May 2013
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : December 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Breast Cancer

Arm Intervention/treatment
Active Comparator: Study Drug
T-DM1 every three weeks by IV for 17 treatments (total of 51 weeks)
Drug: Trastuzumab emtansine
Other Name: T-DM1

Active Comparator: Standard of Care
Paclitaxel and Trastuzumab once per week by IV for 12 weeks. Beginning week 13, Trastuzumab only by IV injection every three weeks for 13 treatments
Drug: Trastuzumab
Drug: Paclitaxel

Primary Outcome Measures :
  1. Disease Free Survival in Patients Treated with T-DM1 [ Time Frame: 2 years ]
    Disease-free survival (DFS) in patients with Stage I HER2-positive breast cancer treated with trastuzumab emtansine

Secondary Outcome Measures :
  1. Disease Free Survival in Patient Groups Defined by Tumor Size [ Time Frame: 2 years ]
    Disease free survival in patient groups defined by tumor size (< 1cm or >/= 1 cm and hormone receptor status who are treated with trastuzumab emtansine

  2. Percentage of participants with Grade 3-4 Cardiac Dysfunction [ Time Frame: 2 years ]
    The incidence of grade 3-4 cardiac left ventricular dysfunction from adjuvant trastuzumab emtansine and paclitaxel and trastuzumab

  3. Percentage of participants with T-DM1 Induced Grade 2-4 Thrombocytopenia [ Time Frame: 2 years ]
    Calculate the incidence of trastuzumab emtansine-induced grade 2-4 thrombocytopenia

  4. Percentage of Patients with Amenorrhea at specific time points [ Time Frame: 2 years ]
    Investigate the percentage of patients with amenorrhea at various times after start of treatment in premenopausal women receiving treatment with trastuzumab emtansine and paclitaxel and trastuzumab for early stage breast cancer

  5. Overall Survival in Patients Treated with T-DM1 [ Time Frame: 2 years ]
    Calculate overall survival in participants treated with trastuzumab emtansine

Information from the National Library of Medicine

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, Learn About Clinical Studies.

Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • HER2-positive Stage I histologically confirmed invasive carcinoma of the breast
  • ER/PR determination is required
  • HER2 positive, confirmed by central testing: IHC 3+, FISH HER2/CEP17 <2.0 with an average HER2 copy number >/=6.0, or FISH HER2/CEP17 >/= 2.0
  • Bilateral breast cancers that individually meet eligibility criteria are allowed
  • Subjects with multifocal or multicentric disease are eligible as long as each tumor individually meets eligibility criteria
  • Subjects with a history of ipsilateral DCIS are eligible if they were treated with wide-excision alone, without radiation therapy; Patients with a history of contralateral DCIS are not eligible.
  • Should have tumor tissue available and a tissue block of sufficient size to make 15 slides, which must be sent to a DFCI site for testing
  • Less than or equal to 90 days since most recent breast surgery for this breast cancer
  • All tumor should be removed by either a modified radical mastectomy or a segmental mastectomy (lumpectomy) with either a sentinel node biopsy or axillary dissection
  • All margins should be clear of invasive cancer or DCIS
  • May have received up to 4 weeks of tamoxifen therapy or other hormonal therapy, for adjuvant therapy for this cancer
  • Prior oophorectomy for cancer prevention is allowed
  • Subjects who have undergone partial breast radiation (duration </= 7 days) prior to registration are eligible. Partial breast radiation must be completed prior to 2 weeks before starting protocol therapy.
  • Must have discontinued any investigational drug at least 2 weeks prior to participation
  • Willing to use one highly effective from of nonhormonal contraception or two effective forms of nonhormonal contraception while on study and for 7 months after end of study treatment
  • Subjects undergoing lumpectomy must have no contraindications to radiation therapy

Exclusion Criteria:

  • Pregnant or breastfeeding
  • Use of potent CYP3A4 inhibitors during the study treatment period
  • Excessive alcohol intake (more than 3 alcoholic beverages per day)
  • Locally advanced tumors at diagnosis
  • History of previous invasive breast cancer
  • History of prior chemotherapy in the past 5 years
  • History of prior trastuzumab or prior paclitaxel therapy
  • Active, unresolved infection
  • Active liver disease
  • History of a different malignancy except for the following: disease free for at least 5 years and at low risk for recurrence; cervical cancer in situ, basal or squamous cell carcinoma of the skin
  • Active cardiac disease

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01853748

  Hide Study Locations
United States, Alabama
University of Alabama Birmingham
Birmingham, Alabama, United States, 35249
United States, California
University of California San Francisco
San Francisco, California, United States, 94115
United States, Connecticut
Hartford Hospital
Hartford, Connecticut, United States, 06102
Midstate Medical Center
Meriden, Connecticut, United States, 06451
Hartford Healthcare Cancer Institute at The Hospital of Central Connecticut
New Britain, Connecticut, United States, 06050
William W Backus Hospital
Norwich, Connecticut, United States, 06360
United States, District of Columbia
Georgetown Hospital
Washington, District of Columbia, United States, 20007
Washington Cancer Institute at Medstar Washington Hospital Center
Washington, District of Columbia, United States, 20010
Sibley Memorial Hospital
Washington, District of Columbia, United States, 20016
United States, Florida
Florida Cancer Specialists
Fort Myers, Florida, United States, 33916
Florida Cancer Specialists
Saint Petersburg, Florida, United States, 337054
United States, Idaho
Mountain States Tumor Institute
Boise, Idaho, United States, 83712
Mountain States Tumor Institute
Fruitland, Idaho, United States, 83619
Mountain States Tumor Institute
Meridian, Idaho, United States, 83642
Mountain States Tumor Institute
Nampa, Idaho, United States, 83686
Mountain States Tumor Institute
Twin Falls, Idaho, United States, 83301
United States, Illinois
University of Chicago Medical Center
Chicago, Illinois, United States, 60637
Loyola University Medical Center
Maywood, Illinois, United States, 60153
University of Chicago Comprehensive Cancer Center at Silver Cross Hospital
New Lenox, Illinois, United States, 60451
United States, Indiana
Indiana University - Wishard Hospital
Indianapolis, Indiana, United States, 46202
Indiana University Health - Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States, 46202
Indiana University Health - University Hospital
Indianapolis, Indiana, United States, 46202
Indiana University - Springmill Medical Clinic
Indianapolis, Indiana, United States, 46290
United States, Maine
Eastern Maine Medical Center's Cancer Care
Brewer, Maine, United States, 04412
United States, Maryland
Johns Hopkins - Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland, United States, 21287
Johns Hopkins - Green Spring Station
Lutherville, Maryland, United States, 21093
United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02215
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02215
Mass General North Shore Cancer Center
Danvers, Massachusetts, United States, 01923
Lowell General Hospital
Lowell, Massachusetts, United States, 01854
Dana-Farber Cancer Institute at Milford Hospital
Milford, Massachusetts, United States, 01757
United States, Michigan
Univeristy of Michigan Health System
Ann Arbor, Michigan, United States, 48109
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
United States, Missouri
Barnes-Jewish Hospital
Saint Louis, Missouri, United States, 63110
Washington University, School of Medicine
Saint Louis, Missouri, United States, 63110
Siteman Cancer Center - South County
Saint Louis, Missouri, United States, 63129
Siteman Cancer Center - West County
Saint Louis, Missouri, United States, 63141
Siteman Cancer Center - St. Peters
Saint Peters, Missouri, United States, 63376
United States, New Hampshire
New Hampshire Oncology-Hematology, PA
Concord, New Hampshire, United States, 03301
New Hampshire Oncology-Hematology, PA
Hooksett, New Hampshire, United States, 03106
New Hampshire Oncology-Hematology, PA
Laconia, New Hampshire, United States, 03246
Dana-Farber Cancer Insitute at Londonderry Hospital
Londonderry, New Hampshire, United States, 03053
United States, New Jersey
Memorial Sloan Kettering Cancer Center-Basking Ridge
Basking Ridge, New Jersey, United States, 07920
United States, New York
Memorial Sloan Kettering Cancer Center-Suffolk
Commack, New York, United States, 11725
Memorial Sloan Kettering Cancer Center-West Harrison
Harrison, New York, United States, 10591
Queens Hospital Center, Comprehensive Cancer Center
Jamaica, New York, United States, 11432
North Shore-LIJ Health System/Monter Cancer Center
Lake Success, New York, United States, 11042
Memorial Sloan Kettering Cancer Center
New York, New York, United States, 10065
Memorial Sloan Kettering Cancer Center-Mercy
Rockville Centre, New York, United States, 11570
Memorial Sloan Kettering Cancer Center-Sleepy Hollow
Sleepy Hollow, New York, United States, 10591
United States, North Carolina
University of North Carolina
Chapel Hill, North Carolina, United States, 27599
Duke University Medical Center
Durham, North Carolina, United States, 27710
Rex Cancer Center
Raleigh, North Carolina, United States, 27607
United States, Ohio
The Ohio State University
Columbus, Ohio, United States, 43212
United States, Pennsylvania
Lehigh Valley Hospital/Lehigh Valley Health Network
Allentown, Pennsylvania, United States, 18103
UPMC/HVHS Cancer Center, UPMC Beaver
Beaver, Pennsylvania, United States, 15143
UPMC CancerCenters Butler
Butler, Pennsylvania, United States, 16001
UPMC Horizon (Shenango)
Farrell, Pennsylvania, United States, 16121
Arnold Palmer Cancer Center-Greensburg
Greensburg, Pennsylvania, United States, 15601
UPMC Horizon (Greenville)
Greenville, Pennsylvania, United States, 16125
UPMC Cancer Center Jefferson Regional Med Ctr
Jefferson Hills, Pennsylvania, United States, 15025
UPMC Conemaugh Cancer Center
Johnstown, Pennsylvania, United States, 15905
UPMC McKeesport
McKeesport, Pennsylvania, United States, 15132
Monroeville, Pennsylvania, United States, 15146
Arnold Palmer Medical Oncology-Mt Pleasant
Mount Pleasant, Pennsylvania, United States, 15666
UPMC Jameson Cancer Center
New Castle, Pennsylvania, United States, 16105
Arnold Palmer Medical Oncology Oakbrook
North Huntingdon, Pennsylvania, United States, 15642
UPMC St. Margaret
Pittsburgh, Pennsylvania, United States, 15215
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States, 15232
UPMC Cancer Center St. Clair Hospital
Pittsburgh, Pennsylvania, United States, 15232
UPMC Presbyterian Shadyside
Pittsburgh, Pennsylvania, United States, 15232
UPMC Passavant
Pittsburgh, Pennsylvania, United States, 15237
UPMC Northwest (Franklin)
Seneca, Pennsylvania, United States, 16346
UPMC Northwest (Oil City)
Seneca, Pennsylvania, United States, 16346
UPMC and the Washington Hospital Center
Washington, Pennsylvania, United States, 15301
United States, Tennessee
Tennessee Oncology/Sarah Cannon Research Institute
Nashville, Tennessee, United States, 37203
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee, United States, 37232
United States, Texas
Baylor College of Medicine-Baylor Clinic
Houston, Texas, United States, 77030
Harris County Hospital District-Ben Taub General Hospital
Houston, Texas, United States, 77030
MD Anderson Cancer Center
Houston, Texas, United States, 77030
Harris County Hospital District-Smith Clinic
Houston, Texas, United States, 77054
United States, Washington
University of Washington Seattle Cancer Care Alliance
Seattle, Washington, United States, 98109
Sponsors and Collaborators
Dana-Farber Cancer Institute
Principal Investigator: Sara Tolaney, MD, MPH Dana-Farber Cancer Institute

Responsible Party: Sara Tolaney, Principal Investigator, Dana-Farber Cancer Institute Identifier: NCT01853748     History of Changes
Other Study ID Numbers: 13-048
First Posted: May 15, 2013    Key Record Dates
Last Update Posted: February 1, 2018
Last Verified: January 2018

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
Ado-trastuzumab emtansine
Albumin-Bound Paclitaxel
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action