Breast Cancer
Conditions
Brief summary
This single arm study will assess the efficacy and safety of preoperative treatment with Avastin combined with Herceptin-based chemotherapy in patients with primary inflammatory HER2-positive breast cancer. Patients will be treated with a total of 8 cycles of pre-operative chemotherapy + Avastin + Herceptin. The anticipated time on study treatment is 3-12 months, and the target sample size is \<100 individuals.
Interventions
As prescribed
15mg/kg iv 3 weekly in cycles 1-8
8mg/kg iv loading dose followed by 6mg/kg iv 3 weekly in cycles 5-8.
Sponsors
Study design
Eligibility
Inclusion criteria
* adult females, \>=18 years of age; * inflammatory breast cancer; * HER2-positive tumors; * performance status 0-2.
Exclusion criteria
* metastases; * previous treatment with chemotherapy, radiation therapy or hormone therapy for a breast tumor; * clinically significant cardiovascular disease, or history of thrombotic disorders.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With a Pathological Complete Response (PCR) According to the Sataloff Classification | From baseline through Week 25 (Up to 6 months) | PCR was assessed at the time of definitive surgery according to Sataloff classification and centrally reviewed by an independent committee under blinded conditions. Pathological response was defined based on the therapeutic response at the primary tumor site and axillary lymph nodes. Primary tumor response criteria were as follows: T-A (Total / near total therapeutic effect), T-B (Subjectively greater than \[\>\] 50 percent \[%\] therapeutic effect but less than \[\<\] T-A), T-C (\<50% therapeutic effect, but effect evident), T-D (No therapeutic effect). Axillary lymph node response: N-A (Evidence of therapeutic effect, no metastases), N-B (No therapeutic effect, no nodal metastases), N-C (Nodal metastasis but evident therapeutic effect), N-D (Nodal metastasis with no therapeutic effect). T-A and N-A or T-A and N-B responses were defined as PCR and all other tumor responses as non-responders. Participants with missing values were considered as non-responders. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Were Responders Based on Inflammatory Signs From Baseline at Cycle 5 and Final Treatment Visit | Baseline, Cycle 5 (Week 15), Neo-adjuvant treatment final visit (Week 25) | Breast tumor was physically evaluated during the study which included assessment for inflammatory signs and for overall clinical response. Participant with response from baseline based on inflammatory signs at Cycle 5 and final treatment visit were presented. |
| Percentage of Participants Who Were Responders Based on Overall Clinical Response From Baseline at Cycle 5 and Final Treatment Visit | Baseline, Cycle 5 (Week 15), Neo-adjuvant treatment final visit (Week 25) | Breast tumor was physically evaluated during the study which included assessment for inflammatory signs and for overall clinical response. Participant with response from baseline based on overall clinical response at Cycle 5 and final treatment visit were presented. |
| Number of Participants Who Underwent Mastectomy | Anytime between Week 26 and Week 29 | Surgery included a mastectomy with axillary node dissection and had to be performed at least 4 weeks after the last infusion of neoadjuvant bevacizumab treatment. |
| Percentage of Participants With Macroscopically Visible Tumor | Anytime between Week 26 and Week 29 | Local pathologists assessed the tumor whether it was macroscopically visible or not and percentage of participants for whom the tumor was macroscopically visible was reported. |
| Percentage of Participants Who Underwent Lymph Node Resection | Anytime between Week 26 and Week 29 | Among the participants who were planned to undergo mastectomy, lymph node resection was also performed by the physician depending up on the participant's breast cancer grades. |
| Breast Cancer Marker CA15.3 at Baseline, Neoadjuvant Final Visit and Change From Baseline at Neoadjuvant Final Visit | Baseline, Neoadjuvant Final Visit (Week 25) | — |
| Percentage of Participants With a PCR According to the Chevallier Classification | From baseline through Week 25 (Up to 6 months) | PCR was assessed at the time of definitive surgery according to Chevallier classification and centrally reviewed by an independent committee under blinded conditions. The Chevallier classification for grading of therapeutic effect related to the primary tumor site and axillary lymph nodes was defined by microscopic changes as follows - Grade 1: Disappearance of all tumors either in the breast or in the nodes, Grade 2: Persistence of carcinoma in situ in the breast only and no nodal invasion, Grade 3: Presence of invasive carcinoma with stromal alteration, Grade 4: Presence of invasive carcinoma without modification. Grade 1 response was considered as PCR. Participants with missing values were considered as non-responders. |
| Disease Free Survival (DFS) Duration | Up to 5 Years | DFS was estimated using Kaplan-Meier method. |
| Percentage of Participants Who Were Recurrence Free at 3 and 5 Years | 3, 5 years | A participant was considered recurrence free if the participant did not experience local or regional recurrence (wall or axillaries nodes), or occurrence of distant metastases (including soft tissue and distal lymph nodes). |
| Recurrence Free Survival (RFS) Duration | Up to 5 Years | RFS was estimated using Kaplan-Meier method. |
| Percentage of Participants Who Were Alive at 3 and 5 Years | 3, 5 years | — |
| Overall Survival (OS) Duration | Up to 5 years | OS was defined as the time from the first administration of neoadjuvant treatment to death of any cause. OS was estimated using Kaplan-Meier method. |
| Percentage of Participants Who Were Disease Free at 3 and 5 Years | 3, 5 years | A participant was considered disease free if the participant did not experience any of the following events: local recurrence in the ipsilateral breast following lumpectomy, regional recurrence, distant recurrence, contralateral breast cancer, second primary cancer (other than squamous or basal cell carcinoma of the skin, melanoma in situ, carcinoma in situ of the cervix, colon carcinoma in situ, or lobular carcinoma in situ of the breast), or death from any cause. |
Countries
France
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Bevacizumab + Trastuzumab Neoadjuvant treatment (Cycles 1-8, 3-week cycle): Participants received 15 mg/kg IV bevacizumab q3w for 8 cycles, 4 cycles of 500 mg/m\^2 IV 5-fluorouracil, 100 mg/m\^2 IV epirubicin, and 500 mg/m\^2 IV cyclophosphamide, q3w, followed by 4 cycles of 100 mg/m\^2 IV docetaxel q3w plus trastuzumab (loading dose of 8 mg/kg and then 6 mg/kg q3w). Participants underwent surgery (mastectomy) after neoadjuvant treatment, maintaining trastuzumab (6 mg/kg). Adjuvant treatment: Participants received radiotherapy 2-4 weeks after surgery and lasted for 4-6 weeks, 6 mg/kg IV trastuzumab q3w and 15 mg/kg IV bevacizumab q3w administered along with/after the radiotherapy (administered up to a cumulative \[neoadjuvant + adjuvant\] total of 18 injections each. Hormonal therapy (at investigator discretion) after the end of radiotherapy was administered for 5 years, if participant was hormone receptor positive. | 52 |
| Total | 52 |
Baseline characteristics
| Characteristic | Bevacizumab + Trastuzumab |
|---|---|
| Age, Continuous | 51.48 years STANDARD_DEVIATION 9.78 |
| Sex: Female, Male Female | 52 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 52 / 52 |
| serious Total, serious adverse events | 20 / 52 |
Outcome results
Percentage of Participants With a Pathological Complete Response (PCR) According to the Sataloff Classification
PCR was assessed at the time of definitive surgery according to Sataloff classification and centrally reviewed by an independent committee under blinded conditions. Pathological response was defined based on the therapeutic response at the primary tumor site and axillary lymph nodes. Primary tumor response criteria were as follows: T-A (Total / near total therapeutic effect), T-B (Subjectively greater than \[\>\] 50 percent \[%\] therapeutic effect but less than \[\<\] T-A), T-C (\<50% therapeutic effect, but effect evident), T-D (No therapeutic effect). Axillary lymph node response: N-A (Evidence of therapeutic effect, no metastases), N-B (No therapeutic effect, no nodal metastases), N-C (Nodal metastasis but evident therapeutic effect), N-D (Nodal metastasis with no therapeutic effect). T-A and N-A or T-A and N-B responses were defined as PCR and all other tumor responses as non-responders. Participants with missing values were considered as non-responders.
Time frame: From baseline through Week 25 (Up to 6 months)
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants With a Pathological Complete Response (PCR) According to the Sataloff Classification | 63.46 percentage of participants |
Breast Cancer Marker CA15.3 at Baseline, Neoadjuvant Final Visit and Change From Baseline at Neoadjuvant Final Visit
Time frame: Baseline, Neoadjuvant Final Visit (Week 25)
Population: Safety population: Number of participants included all the participants who received at least one infusion of bevacizumab. n included participants who were evaluable at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Bevacizumab + Trastuzumab | Breast Cancer Marker CA15.3 at Baseline, Neoadjuvant Final Visit and Change From Baseline at Neoadjuvant Final Visit | Baseline (n=52) | 39.66 Units per milliliter (U/mL) | Standard Deviation 79.49 |
| Bevacizumab + Trastuzumab | Breast Cancer Marker CA15.3 at Baseline, Neoadjuvant Final Visit and Change From Baseline at Neoadjuvant Final Visit | Neoadjuvant final visit (n=37) | 29.39 Units per milliliter (U/mL) | Standard Deviation 10.06 |
| Bevacizumab + Trastuzumab | Breast Cancer Marker CA15.3 at Baseline, Neoadjuvant Final Visit and Change From Baseline at Neoadjuvant Final Visit | Change in CA15.3 at neoadjuvant final visit (n=37) | -3.39 Units per milliliter (U/mL) | Standard Deviation 33.05 |
Disease Free Survival (DFS) Duration
DFS was estimated using Kaplan-Meier method.
Time frame: Up to 5 Years
Population: ITT population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Trastuzumab | Disease Free Survival (DFS) Duration | NA months |
Number of Participants Who Underwent Mastectomy
Surgery included a mastectomy with axillary node dissection and had to be performed at least 4 weeks after the last infusion of neoadjuvant bevacizumab treatment.
Time frame: Anytime between Week 26 and Week 29
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Trastuzumab | Number of Participants Who Underwent Mastectomy | 49 participants |
Overall Survival (OS) Duration
OS was defined as the time from the first administration of neoadjuvant treatment to death of any cause. OS was estimated using Kaplan-Meier method.
Time frame: Up to 5 years
Population: ITT population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Trastuzumab | Overall Survival (OS) Duration | NA months |
Percentage of Participants Who Underwent Lymph Node Resection
Among the participants who were planned to undergo mastectomy, lymph node resection was also performed by the physician depending up on the participant's breast cancer grades.
Time frame: Anytime between Week 26 and Week 29
Population: ITT population. Included participants who underwent mastectomy.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants Who Underwent Lymph Node Resection | 98.0 percentage of participants |
Percentage of Participants Who Were Alive at 3 and 5 Years
Time frame: 3, 5 years
Population: ITT population.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Alive at 3 and 5 Years | Alive at 3 years | 90.0 percentage of participants |
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Alive at 3 and 5 Years | Alive at 5 years | 81.8 percentage of participants |
Percentage of Participants Who Were Disease Free at 3 and 5 Years
A participant was considered disease free if the participant did not experience any of the following events: local recurrence in the ipsilateral breast following lumpectomy, regional recurrence, distant recurrence, contralateral breast cancer, second primary cancer (other than squamous or basal cell carcinoma of the skin, melanoma in situ, carcinoma in situ of the cervix, colon carcinoma in situ, or lobular carcinoma in situ of the breast), or death from any cause.
Time frame: 3, 5 years
Population: ITT population.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Disease Free at 3 and 5 Years | 3 years | 66.7 percentage of participants |
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Disease Free at 3 and 5 Years | 5 years | 60.8 percentage of participants |
Percentage of Participants Who Were Recurrence Free at 3 and 5 Years
A participant was considered recurrence free if the participant did not experience local or regional recurrence (wall or axillaries nodes), or occurrence of distant metastases (including soft tissue and distal lymph nodes).
Time frame: 3, 5 years
Population: ITT population.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Recurrence Free at 3 and 5 Years | 3 years | 69.7 percentage of participants |
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Recurrence Free at 3 and 5 Years | 5 years | 65.4 percentage of participants |
Percentage of Participants Who Were Responders Based on Inflammatory Signs From Baseline at Cycle 5 and Final Treatment Visit
Breast tumor was physically evaluated during the study which included assessment for inflammatory signs and for overall clinical response. Participant with response from baseline based on inflammatory signs at Cycle 5 and final treatment visit were presented.
Time frame: Baseline, Cycle 5 (Week 15), Neo-adjuvant treatment final visit (Week 25)
Population: ITT population. Number of participants analyzed included participants for whom tumor physical examination was performed and were evaluated for response from baseline assessment of inflammatory signs. n included number of participants who were evaluable at a particular time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Responders Based on Inflammatory Signs From Baseline at Cycle 5 and Final Treatment Visit | Response from baseline at Week 15 (n=43) | 88.4 percentage of participants |
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Responders Based on Inflammatory Signs From Baseline at Cycle 5 and Final Treatment Visit | Response from baseline at Week 25 (n=42) | 100.0 percentage of participants |
Percentage of Participants Who Were Responders Based on Overall Clinical Response From Baseline at Cycle 5 and Final Treatment Visit
Breast tumor was physically evaluated during the study which included assessment for inflammatory signs and for overall clinical response. Participant with response from baseline based on overall clinical response at Cycle 5 and final treatment visit were presented.
Time frame: Baseline, Cycle 5 (Week 15), Neo-adjuvant treatment final visit (Week 25)
Population: ITT population. Number of participants analyzed included participants for whom tumor physical examination was performed. n included number of participants who were evaluable at a particular time point.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Responders Based on Overall Clinical Response From Baseline at Cycle 5 and Final Treatment Visit | Response from baseline at Week 15 (n=44) | 90.9 percentage of participants |
| Bevacizumab + Trastuzumab | Percentage of Participants Who Were Responders Based on Overall Clinical Response From Baseline at Cycle 5 and Final Treatment Visit | Response from baseline at Week 25 (n=45) | 97.8 percentage of participants |
Percentage of Participants With a PCR According to the Chevallier Classification
PCR was assessed at the time of definitive surgery according to Chevallier classification and centrally reviewed by an independent committee under blinded conditions. The Chevallier classification for grading of therapeutic effect related to the primary tumor site and axillary lymph nodes was defined by microscopic changes as follows - Grade 1: Disappearance of all tumors either in the breast or in the nodes, Grade 2: Persistence of carcinoma in situ in the breast only and no nodal invasion, Grade 3: Presence of invasive carcinoma with stromal alteration, Grade 4: Presence of invasive carcinoma without modification. Grade 1 response was considered as PCR. Participants with missing values were considered as non-responders.
Time frame: From baseline through Week 25 (Up to 6 months)
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants With a PCR According to the Chevallier Classification | 53.85 percentage of participants |
Percentage of Participants With Macroscopically Visible Tumor
Local pathologists assessed the tumor whether it was macroscopically visible or not and percentage of participants for whom the tumor was macroscopically visible was reported.
Time frame: Anytime between Week 26 and Week 29
Population: ITT population. Included participants who underwent mastectomy.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Bevacizumab + Trastuzumab | Percentage of Participants With Macroscopically Visible Tumor | 26.5 percentage of participants |
Recurrence Free Survival (RFS) Duration
RFS was estimated using Kaplan-Meier method.
Time frame: Up to 5 Years
Population: ITT population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Bevacizumab + Trastuzumab | Recurrence Free Survival (RFS) Duration | NA months |