Triple Negative Breast Cancer
Conditions
Brief summary
Triple-negative breast cancer constitutes 15-20% of cases of breast cancer and is defined by the absence of estrogen receptors, progesterone receptors, and overexpression or gene amplification of HER2. Although the addition of immune checkpoint inhibitors could improve the outcome of patients with metastatic triple-negative breast cancer (mTNBC), chemotherapy has been the standard of care for systemic treatment for patients with mTNBC. Prognoses remain poor, with reported median overall survival estimates of approximately 18 months or less with available treatments. A meta-analysis of seven clinical trials showed that the median objective response rate (ORR) of second or later line of chemotherapy in mTNBC was only 11%. Patient-derived xenograft (PDX) tumor model, which preserves the histologic and genetic characteristics of patients' tumors, has shown its predictive value of clinical outcomes and are used for preclinical drug evaluation, biomarker identification, biological studies, and personalized medicine strategies. However, long time period and low success rate has limited its application in clinical practice. Mini patient derived xenograft (miniPDX) offers an effective alternative as it only takes about 7 days for drug sensitivity test and could thus provide guidance for prompt personalized treatment for each patient. Thus, the investigators conduct this single-center, prospective, randomized controlled clinical study to investigate the efficacy of guided treatment based on Mini-PDX in patients with metastatic refractory triple negative breast cancer.
Interventions
DRUGPersonalized treatment guided by mini-PDX and RNA sequencing
Personalized treatment guided by mini-PDX and RNA sequencing
DRUGNab paclitaxel
Nab-paclitaxel 125 mg/m2，ivgtt，d1, 8, 15, q4w
DRUGEribulin
Eribulin 1.4 mg/m2, d1,8 q3w
DRUGVinorelbine
Vinorelbine 25mg/m2 d1,8, q3w
DRUGGemcitabine
Gemcitabine 1000 mg/m2, d1,8, q3w
DRUGCapecitabine
Capecitabine 1250 mg/m2 bid po
Sponsors
Fudan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* 1\) Women aged 18-70 years; * 2\) an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; * 3\) Estimated lifetime is ≥ 3 months; * 4\) Histopathologically confirmed recurrent (unresectable) or metastatic triple-negative breast cancer; ER and PR negative is defined as ER \<1% positive, PR \<1% positive. HER-2 negative is defined as HER-2 (-) or (1+) by immunohistochemistry, HER-2 (2+) must be tested by FISH with negative result, HER-2 (1+) (1+), FISH is optional and negative; * 5\) Have at least one measurable target lesion according to RECIST 1.1 criteria; * 6\) Biopsy of the tumor lesion and the specimen passes laboratory quality control; * 7\) A minimum of 2 prior cytotoxic chemotherapy regimens (including at least one line of platinum-containing regimen) in metastatic settings are required prior to enrollment in this trial; * 8\) Adequate organ function, i.e. meeting the following criteria. 1. Hb ≥ 90 g/L (no transfusion within 14 days); ANC ≥ 1.5 × 109 /L; PLT ≥ 75 × 109 /L. 2. Liver function: total bilirubin TBIL ≤ 1.5×ULN (upper limit of normal); ALT and AST ≤ 3×ULN. 3. serum Cr ≤ 1.5×ULN. * 9\) Subjects voluntarily joined the study, signed the informed consent form, were compliant and cooperated with the follow-up.
Exclusion criteria
* 1）Pregnancy or lactation； * 2）History of autoimmune disease； * 3）Anticancer- and radiation therapy-related toxicities have not resolved or downgraded to Grade 1 or less; * 4\) Symptomatic central nervous system (CNS) disease; * 5\) Previous treatment of Immune checkpoint inhibitors; * 6\) History of other malignancies within the past five years, with the exception of cured non-malignant melanoma of the skin and carcinoma in situ of the cervix.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective response rate | Through study completion, an expected average of 1 year | To compare the Objective Response Rate (ORR) of patients who recieve persionalized treatment based on mini-PDX model with ORR of patients who receive Treatment of Physician's Choice (TPC). ORR is defined as the proportion of patients with a confirmed Complete Response (CR) or Partial Response (PR) according to RECIST 1.1. ORR will be calculated based on the Investigator assessment of response. CR = Disappearance of all non-nodal target lesions. In addition, any pathological lymph nodes assigned as target lesions must have a reduction in short axis to \< 10 mm; PR = At least a 30% decrease in the sum of diameter of all target lesions, taking as reference the baseline sum of diameters. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Through study completion, an expected average of 1 year | Overall survival is defined as the time from the date of randomization to the date of death from any cause. Patients will be followed until their date of death or until final database closure. Patients who are lost-to-follow-up or are alive at the time of analysis will be censored at the time they were last known to be alive or at the date of event cut-off for OS analysis. |
| Progression-Free Survival | Through study completion, an expected average of 1 year | Progression-free survival is defined as the time from the date of randomization to the first evidence of documented disease progression as defined by response evaluation criteria in solid tumors (RECIST) v1.1 or death from any cause. Progressive Disease (PD) was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions. If a participant was not known to have died or have objective progression as of the data inclusion cutoff date for the analysis, the PFS time was censored at the last adequate tumor assessment date. |
| Adverse events | Through study completion, an expected average of 1 year | Number of participants with adverse events as assessed by Common Terminology Criteria for Adverse Events (CTCAE) v 5.0 |
Countries
China
Contacts
Primary ContactXichun Hu, M.D.
Backup ContactJian Zhang, M.D.
Outcome results
None listed