Breast Neoplasm, Breast Cancer, Breast Tumors, Triple-Negative Breast Cancer (TNBC), HER2-positive Breast Cancer, HER2-negative Breast Cancer, Hormone Receptor Positive Tumor, Hormone Receptor Negative Tumor, Early-stage Breast Cancer, Locally Advanced Breast Cancer
Conditions
Brief summary
The purpose of this study is to establish a prospective, single-center platform research based on clinical subtypes to explore precision neoadjuvant therapy in patients with operable breast cancer who met the indications for neoadjuvant chemotherapy and by the update of basic translational research in the center, especially the refinement of typing, the discovery of new targets and the development of novel targeted drugs, verified the effectiveness of new targeted drugs in neoadjuvant therapy.
Detailed description
FASCINATE-N is a platform that will compare the efficacy of novel drugs alone or in combination with standard chemotherapy with the efficacy of standard therapy alone. The goal is to identify improved treatment regimens for subsets on the basis of clinical subtyping. In this trial, breast cancer patients eligible for inclusion can be randomly divided into the precision treatment group and conventional neoadjuvant chemotherapy group according to molecular typing and subtyping. The research therapy arm can be updated with the update of basic translational research in our center, especially the refinement of typing, the discovery of new targets and the development of novel targeted drugs. As described for previous adaptive trials, regimens that show to be more effective than standard therapy will graduate from the trial with their corresponding biomarker signature(s). Regimens will be dropped if they show a low probability of improved efficacy with any biomarker signature. New drugs will enter as those that have undergone testing complete their evaluation.
Interventions
Pertuzumab
an oral cyclin-dependent kinases (CDK) 4/6 inhibitor
an irreversible dual pan-erbb receptor tyrosine kinase receptor tyrosine kinase (ERBB) inhibitor
an anti-HER2 antibody-drug conjugate (ADC)
an anti-programmed death ligand 1 (PD-L1) antibody
an anti-programmed death-1 (PD1) antibody
Trophoblast cell-surface antigen 2 (TROP2) ADC
Trastuzumab
goserelin
letrozole
Albumin paclitaxel
Carboplatin
Epirubicin
Cyclophosphamide
an original poly adenosine diphosphate-ribose polymerase (PARP) inhibitor
tyrosine kinase inhibitors
tyrosine kinase inhibitors
Albumin docetaxel
liposome-entrapped mitoxantrone
an anti-HER2 ADC
an anti-PDL1 antibody
an tyrosine kinase inhibitor
anti-PD-1/TGF-βRII
an anti-PD-1/VEGF bispecific antibody
an anti-PD-1/VEGF bispecific antibody
an anti-HER2 ADC
an HER2 inhibitor
an anti-HER2 ADC
paclitaxel
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically confirmed invasive cancer of the breast and meet the clinical stage II(T2N0-1M0/T3N0M0)or III(T2N2M0/T3N1-2M0) criteria; * Age between18-70 years; * Eastern Cooperative Oncology Group (ECOG) performance status 0-1; * ER, PR and HER2 status were measured by immunohistochemistry (IHC); * LVEF≥55%; * Definition of SNF subtypes: SNF subtypes confirmed by digital pathology of H&E slices; * Triple negative subtyping: On the basis of triple-negative pathological diagnosis, AR, cluster of differentiation 8 (CD8) and Forkhead Box C1 (FOXC1) were combined to define the subtyping; * At least one measurable lesion according to RECIST version 1.1 * Normal organ and marrow function: Hemoglobin (HB) ≥90 g/L (No blood was transfused within 14 days), Absolute neutrophil count ≥ 1500/μL, Platelets ≥ 75,000/μL, Total bilirubin ≤ 1.5 x ULN), aspartate aminotransferase (AST) (SGOT) and alanine aminotransferase (ALT) (SGPT) ≤ 3 x ULN, creatinine \< 1 x ULN, endogenous creatinine clearance \> 50 ml/min (Cockcroft-Gault formula); * Non-pregnant and non-lactating, fertile female subjects were required to use a medically approved contraceptive method for the duration of the study treatment and at least 3 months after the last use of the study drug; * Ability to understand and willingness to sign a written informed consent
Exclusion criteria
* Previous cytotoxic chemotherapy, endocrine therapy, biological therapy or radiotherapy for any reason; * Patients with New York Heart Association (NYHA) grade II or above heart disease (including grade II); * Patients with severe systemic infections or other serious diseases; * Patients with known allergy or intolerance to the study drug or its excipients; * Other malignant tumors in the past 5 years, except cured cervical carcinoma in situ and non-melanoma skin cancer; * Pregnant or lactating patients of childbearing age who refused to take appropriate contraceptive measures during the course of the study; * Participated in other trial studies within 30 days before the administration of the first dose of the study drug; * Patients who were judged by the investigator to be unsuitable for this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pathological complete response rate (pCR) | through study completion, up to 24 weeks | Pathological complete response rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| invasive disease-free survival (iDFS) | Three-year Post-surgery Follow-up | To determine three-year invasive disease-free survival (iDFS) among the treatment arms |
| Overall response rate (ORR) | up to 24 weeks | Complete response (CR) + partial response (PR) |
| CTCAE scale (V4.0) | through study completion, an average of 1 year | 4\) To evaluate the rate of adverse effects of patient by the standard CTCAE scale (V4.0) |
| Evaluate gene expression profile during treatment | through study completion, up to 24 weeks | To measure gene expression profile of baseline and sequential tumor samples during treatment, through RNA-seq platform |
| Number of peripheral blood mononuclear cells (PBMC) count during treatment | through study completion, up to 24 weeks | To measure number of peripheral blood mononuclear cells (PBMC) count from baseline and sequential blood samples during treatment, through Flow CytoMetry platform |
Countries
China