Neoadjuvant Trastuzumab, Pertuzumab and Tucatinib Without Chemotherapy in HER2-positive Breast Cancer: the TRAIN-4 Study

Overview

This is a single-center, phase 1b study evaluating the safety and feasibility of a neoadjuvant treatment with tucatinib, trastuzumab and pertuzumab in stage II-IIIA HER2-positive breast cancer.

Detailed description

High pathological complete response (pCR)-rates are seen using different neoadjuvant chemotherapy schedules with trastuzumab and pertuzumab in HER2-positive stage II - III breast cancer patients. However, a subset of patients with stage II-III HER2-positive breast cancer can be treated with HER2-blockade alone. These patients can potentially be totally spared from chemotherapy-associated toxicity. The proportion of patients whom can successfully be treated without chemotherapy could potentially be increased by selecting great responders using DCE-MRI and by adding tucatinib to trastuzumab and pertuzumab alone. The aim of this study is to evaluate the safety and efficacy of neoadjuvant treatment with tucatinib, trastuzumab and pertuzumab.

Interventions

• Drug Tucatinib
  Tucatinib 300mg is taken orally twice daily
• Drug Trastuzumab
  Trastuzumab 6mg/kg is administered intravenously on day 1 (loading dose 8mg/kg) or subcutaneously 600mg on day 1 of each cycle
• Drug Pertuzumab
  Pertuzumab 420mg is administered intravenously on day 1 (loading dose 840mg) or subcutaneously 600mg/kg (loading dose 1200mg) on day 1 of each cycle

Primary outcome measures

• Incidence and severity of adverse events [Time frame: an average of 8 months]

Secondary outcome measures (8)

• Incidence of serious adverse events [Time frame: an average of 8 months]
• Incidence of disease progression [Time frame: an average of 8 months]
• Incidence of dose reductions and treatment discontinuations [Time frame: an average of 8 months]
• Radiologic complete response [Time frame: an average of 8 months]
• Pathological complete response [Time frame: an average of 8 months]
• Residual Cancer Burden [Time frame: an average of 8 months]
• Event-free survival [Time frame: 3, 5, 10 years]
• Overall survival [Time frame: 3, 5, 10 years]

Eligibility criteria

Inclusion criteria

• Signed written informed consent
• Histologically confirmed primary invasive breast cancer
• Stage II - IIIA primary breast cancer according to TNM-staging (8th edition, AJCC); (largest tumor diameter on DCE-MRI ≥ 2cm (cT2-3) and/or cN1-2 confirmed with FNA or histology)
• HER2 overexpression defined as circumferential membrane staining that is complete, intense and in >10% of invasive tumor cells (IHC 3+) on pre-treatment biopsy
• Known estrogen- and progesterone-receptor expression of the invasive tumor

a. ER-negative or PR-negative is defined as <10% of invasive tumor cell nuclei are immunoreactive in the presence of evidence that the sample can express ER and/or PR

• WHO performance status 0-1
• Age ≥ 18 years
• LVEF ≥50% measured by echocardiography or MUGA
• Eligible for neoadjuvant treatment
• Laboratory requirements within 21 days prior to enrollment:

• Adequate bone marrow function (ANC ≥1.5 x 109/l, platelets ≥100 x 109/l);
• Adequate hepatic function (ALAT, ASAT and bilirubin ≤2.5 times upper limit of normal). Subjects with Gilbert's syndrome may have a total bilirubin ≥2.5 × the ULN range, if no evidence of biliary obstruction exists.
• Adequate renal function: creatinine clearance >50 ml/min estimated using the Cockcroft-Gault equation or MDRD equation, or based on a 24-hour urine collection measurement.

Exclusion criteria

• Current pregnancy or breastfeeding
• Current or previous other malignancy unless treated without systemic therapy and more than five years ago
• Psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
• Use of a strong CYP3A4 or CYP2C8 inhibitor within five half-lives of the inhibitor, or used a strong CYP3A4 or CYP2C8 inducer within five days prior to first dose of study treatment
• Known chronic liver disease
• History of inflammatory bowel disease or bowel resection
• Contraindications for MRI
• Inflammatory breast cancer, cT4 and/or cN3 tumors
• Occult breast cancer (cT0)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

Netherlands · 1 center

• Netherlands Cancer Institute — Amsterdam

Identifiers

NCT: NCT06162559 · N21TRV

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗