HER2-positive Breast Cancer
Conditions
Brief summary
RATIONALE: According to previous results from PHARE study, a subgroup of patients with low-risk cancer (\< 3 cm) without axillary lymph node involvement or small (\< 2 cm) with minimal lymph node involvement (1 positive node) presented low risk of recurrence. Maintaining chemotherapy in this subgroup could cause toxicity and it is not yet known whether giving trastuzumab as monotherapy in neoadjuvant setting is as effective as giving trastuzumab combined with paclitaxel in patients with low risk early breast cancer. PURPOSE: This randomized phase III trial is studying trastuzumab as monotherapy in neoadjuvant setting to see if this treatment regimen is as efficient compared to trastuzumab combination with paclitaxel chemotherapy in treating women with low risk (tumor size\< 3 cm, N0) early breast cancer.
Detailed description
PHARE-C is an open-label, randomized, phase III, non-inferiority trial, that will recruit patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer to allow for comparison of neoadjuvant treatment with paclitaxel plus trastuzumab versus trastuzumab as monotherapy. Non-inferiority between the two treatment arms will be evaluated in terms of time to progression as primary objective. Treatment tolerance and cardiac toxicity will be assessed as secondary objectives. In case of non pCR, a rescue by Trastuzumab emtansine (T-DM1) is planned to control the survival outcome.
Interventions
DRUGPaclitaxel + Trastuzumab
Regarding neoadjuvant treatment : \- 9 to 12 weeks of neoadjuvant treatment Trastuzumab IV (8mg/kg loading dose followed by 6 mg/kg maintenance dose) or SubCutaneous (SC) (600mg fixed dose) every 3 weeks + weekly Paclitaxel IV : 80 to 90 mg/m2 Regarding adjuvant treatment patients will receive one of the following anti-HER2 therapy following the current standard to complete 1 year of anti-HER2 therapy in total : * in case of pCR : patient will receive trastuzumab * in case of non pCR : patients will receive trastuzumab emtansine (T-DM1)
DRUGTrastuzumab
Regarding neoadjuvant treatment : \- 9 to 12 weeks of neoadjuvant treatment Trastuzumab IV (8mg/kg loading dose followed by 6 mg/kg maintenance dose) or SC (600mg fixed dose) every 3 weeks Regarding adjuvant treatment patients will receive one of the following anti-HER2 therapy following the current standard to complete 1 year of anti-HER2 therapy in total : * in case of pCR : patient will receive trastuzumab * in case of non pCR : patients will receive trastuzumab emtansine (T-DM1)
Sponsors
Institut de cancérologie Strasbourg Europe
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed adenocarcinoma of the breast, nonmetastatic disease and non operated tumor * Without suspicious axillary nodes * Tumor size \< 30 mm * Eligibility to receive a weekly paclitaxel based chemotherapy for this cancer * Left Ventricular Ejection Fraction (LVEF) obtained and \> 50% as measured by echocardiography (Simpson method) or multigated acquisition scan (MUGA) at 3 months (-/+ 1 month) * Overexpression of HER-2 in the invasive component of the primary tumor as indicated by one of the following: 3+ by immunohistochemistry (IHC) 2+ by IHC and confirmation by fluorescent in situ hybridization (FISH) or chromogenic in situ hybridization (CISH) * With signed Informed consent
Exclusion criteria
* Previous anti-HER2 treatment (except for HERCEPTIN) * Cardiac disease or other medical conditions preventing trastuzumab administration * Known allergy to trastuzumab, murine proteins or other excipients * Pregnant or breastfeeding women * Patients that are not able to comply to the protocol assessments for geographic, social or psychological reasons
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to progression | up to 5 years | Time from the date of randomization to the date of progression |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Treatment toxicity | up to 5 years | Adverse Event and Serious Adverse Event due to trastuzumab or paclitaxel graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 |
| Total pathological Complete Response (tpCR) | through surgery completion, an average of 12 weeks | Defined by complete absence of cancerous cells in breast, axillary lymph node chain and/or axillary sentinel lymph node (ypT0/is) in excised tissues |
| Cardiac toxicity | up to 5 years | defined by Ventricular Ejection Fraction measure according to the technique used, clinical examination or any other appropriate exams |
| Distant metastasis Free Survival | up to 5 years | Time from the date of randomization to the date of 1st metastasis |
| Overall Survival | up to 5 years | — |
| Breast pathological Complete Response (bpCR) | through surgery completion, an average of 12 weeks | Defined by complete absence of cancerous cells in breast (ypT0/is, ypN0) in excised tissues |
Contacts
Primary ContactValérie SARTORI
Backup ContactManon VOEGELIN, PhD
Outcome results
None listed