Breast Cancer Early Stage Breast Cancer (Stage 1-3)
Conditions
Keywords
triple negative breast cancer, high-risk luminal (ER+/HER2neg)
Brief summary
This study explores early breast cancer, focusing on triple-negative and high-risk luminal subtypes. It combines single-cell RNA sequencing and spatial imaging of tumor samples collected at different time points during treatment. The aim is to better understand how cancer cells and immune cells interact and to identify biomarkers that can predict whether a patient will respond to chemo-immunotherapy or develop resistance. The study assumes that early molecular and spatial changes at the single-cell level can predict treatment response. This knowledge could help doctors adapt therapies, avoiding unnecessary treatment while improving effectiveness. The project seeks to reveal, for the first time, how cellular diversity and spatial relationships contribute to treatment resistance and disease progression. Tumor samples will be analyzed before treatment, after the first treatment cycle (C1D1), and at surgery. Only the biopsy taken after C1D1 is collected specifically for this study; all other samples come from routine clinical care.
Detailed description
This exploratory translational study investigates early breast cancer (EBC), focusing on triple-negative (TNBC) and high-risk luminal (ER+/HER2-) subtypes. By integrating single-cell RNA sequencing, using the 10x Genomics platform (or similar technologies if it will be not available at the time of experiment), and spatial imaging analyses from serial tumor biopsies, the project aims to characterize tumor-immune interactions and identify predictive biomarkers of response or resistance to neoadjuvant chemo-immunotherapy. We hypothesize that early molecular and spatial features, when detected at the single-cell level, can predict treatment sensitivity or resistance. This would enable adaptive therapeutic strategies that minimize overtreatment while maximizing efficacy in EBC. Our goal is to reveal, for the first time, the cellular heterogeneity and spatial interactions that drive therapy resistance and disease progression. The analysis will be performed on tumor biopsies collected before the start of treatment, after C1D1 and on surgical material. The only tissue sample collected specifically for the study is the biopsy after C1D1.
Interventions
PROCEDUREon treatment biopsy (after C1)
Serial tumor tissue collection and analysis for the identification of early tumor response biomarkers. Tumor samples will be obtained at three predefined time points: (i) prior to initiation of treatment (baseline biopsy), (ii) after Cycle 1 Day 1 (C1D1) of therapy, and (iii) at the time of surgery (surgical specimen)
Sponsors
IRCCS San Raffaele
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Masking description
Patients will receive standard-of-care (SOC) neoadjuvant chemotherapy according to sequential anthracycline and taxane regimens. In addition, patients with triple-negative breast cancer (TNBC) will receive immunotherapy with pembrolizumab as per the KEYNOTE-522 schema. No modifications to the SOC treatments need to be reported. Patients enrolled in the study will undergo a single on-treatment biopsy after the first cycle of neoadjuvant therapy, that is not required as per SOC, and two biopsies (at diagnosis and at surgery) already planned for clinical practice to assess biomarkers predictive of early response/progression with single-cell sequencing technique.
Intervention model description
the intervention is about the on treatment biopsy that is not required for standard of care
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Female patients aged ≥18 years. 2. ECOG performance status 0-1. 3. Histologically confirmed early breast cancer with one of the following molecular profiles: * TNBC: ER and PR negative (IHC \<10%) and HER2 negative (IHC 0-1+ or FISH non-amplified). * High-risk luminal (ER+/HER2-): ER positive (IHC ≥10%) HER2 negative (IHC 0-1+ or FISH non-amplified), with high-risk features (e.g., Grade 3, PR-negative, high proliferation, high TILS). 4. Clinical indication for neoadjuvant treatment according to standard practice: * TNBC: cT1c and/or cN positive, or cT2 (\>2 cm) and/or cN positive (stage II,III). * High-risk luminal: features as defined above (Grade 3, PR-negative, high proliferation, ER low). 5. Ability to understand and sign written informed consent for participation in the study, approved by the local Ethics Committee.
Exclusion criteria
1. HER2-positive tumors. 2. Multifocal tumors - exclusion if a single index lesion cannot be identified and sampled; otherwise allowed if a representative lesion can be biopsied. 3. Known metastatic disease. 4 Clinical contraindications to the planned neoadjuvant therapy. 5\. Decision for upfront surgery as determined by the multidisciplinary team. 6. Inability to provide informed consent. 7. Pregnancy or breastfeeding. 8. Prior systemic therapy (chemotherapy, immunotherapy, or endocrine therapy) for the current breast cancer before baseline biopsy 9. On-treatment biopsy clinically not feasible or controindicated
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To characterize the dynamic changes in tumor and immune cell populations in TNBC and to prospectively collect serial samples from high-risk luminal (ER+/HER2-) breast cancer patients. | Pre-treatment, on-treatment (after first cycle of therapy), and post-treatment (surgery or residual disease) | Gene expression levels per single-cell and relative cell clustering (%) by comparing pre-treatment, on-treatment (after first cycle of standard of care neoadiuvant therapy), and post-treatment (surgery or residual disease) |
Countries
Italy
Contacts
CONTACTGiulia Viale, MD
Outcome results
None listed