- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04578106
Omission of Surgery in Clinically Low-risk HER2positive Breast Cancer With High HER2 Addiction and a Complete Response Following Standard Anti-HER2-based Neoadjuvant Therapy (ELPIS)
January 23, 2022 updated by: Fundacio Clinic Barcelona
Omission of Surgery and Sentinel Lymph Node Dissection in Clinically Low-risk HER2positive Breast Cancer With High HER2 Addiction and a Complete Response Following Standard Anti-HER2-based Neoadjuvant Therapy
This is a prospective, single arm, open-label, unicenter, exploratory study in women with primary operable HER2-positive, HER2-enriched/ERBB2-high breast cancer according to PAM50 intrinsic subtype and a ERBB2 pre-defined cutoff (high vs low ERBB2 expression), to evaluate the omission of surgery and sentinel lymph node dissection in patients with HER2-E and ERBB2 high breast cancer who achieving a complete response following standard anti-HER2-based neoadjuvant therapy with paclitaxel/trastuzumab/pertuzumab.
The primary trial objective is to estimate the loco-regional invasive disease-free survival at 3-year of patients who achieve a complete response based on imaging (i.e.
Magnetic resonance imaging) and a stereotactic-guided vacuum-assisted breast biopsy, and omit loco-regional surgery.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
17
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Laia Arenas
- Phone Number: 3456 93 2275400
- Email: ELPIS@clinic.cat
Study Locations
-
-
-
Barcelona, Spain, 08036
- Recruiting
- Hospital Clínic de Barcelona
-
Contact:
- Laia Arenas
- Phone Number: +34 93 227 54 00
- Email: elpis@clinic.cat
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
40 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Female
Description
Inclusion Criteria:
- Female participants who are at least 40 years of age on the day of signing the informed consent form with histologically confirmed diagnosis of breast cancer.
- A participant is eligible to participate if she is not pregnant, not breastfeeding.
- The participant (or legally acceptable representative if applicable) provides written informed consent for the trial.
Histologically confirmed invasive adenocarcinoma of the breast, with all of the following characteristics:
- HER2-positive status by local determination according to 2018 ASCO/CAP guidelines.
- PAM50 HER2-enriched subtype and ERBB2-high as predefined cutoff as per central determination.
- Unifocal invasive carcinoma: only 1 invasive focus can be observed (the tumor focus containing or not containing an in situ component)
- Tumor largest diameter ≤4 cm as defined by breast MRI.
- No nodal involvement (i.e. cN0). Any suspicious axillary node by ultrasound must be biopsied. If the biopsy or the FNA is negative of tumor cells, patient is eligible.
- No evidence of distant metastasis (M0) by routine clinical assessment.
- Patient must have known ER and PR status locally determined prior to study entry.
- Eligible for taxane therapy.
- Willingness of the patient to omit surgery if all criteria are met following neoadjuvant therapy.
- Estimated life expectancy of at least 5 years irrespective of the diagnosis of breast cancer.
- Breast cancer eligible for primary surgery
- Have provided archival tumor tissue sample or newly obtained core. Formalin-fixed,paraffin embedded (FFPE) tissue blocks are mandatory. Available pre-treatment FFPE core biopsy evaluable for PAM50 or possibility to obtain one.
- Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
- Ability and willingness to comply with study visits, treatment, testing and to comply with the protocol.
- Have adequate organ function.
Exclusion Criteria:
- Has received prior anti-cancer therapy, including investigational agents, or treatment for primary invasive breast cancer.
- Known hypersensitivity to any of the excipients of trastuzumab, pertuzumab, TDM1 or paclitaxel.
- Clinical stage II, III or IV.
- History of radiotherapy in the ipsilateral breast or axilla.
- History of surgery of the ipsilateral axilla.
- Bilateral invasive breast cancer.
- Infiltrating lobular carcinoma.
- Multicentric or multifocal breast cancer, defined as the presence of two or more foci of cancer in the same or different quadrants of the same breast.
- Patients who have undergone sentinel lymph node biopsy prior to study treatment.
- Patient has active cardiac disease or a history of cardiac dysfunction
- Has an active infection requiring systemic therapy.
13. Patients with a history of previous breast cancer are excluded.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Omission of surgery
Neoadjuvant period: paclitaxel IV 80mg/m2 every week for 12 weeks with trastuzumab and pertuzumab Subcutaneous Fixed-Dose Combination (FDC) (a loading dose of 1200 mg pertuzumab and 600 mg trastuzumab followed by a maintenance dose of 600 mg pertuzumab and 600 mg trastuzumab once every 3 weeks) for 5 cycles.
Adjuvant period: If no invasive tumor cells and no in situ disease are identified in the stereotactic-guided VAB,patients will be eligible to omit loco-regional surgery.
Whole breast radiotherapy without nodal radiotherapy will then be performed.
Trastuzumab and pertuzumab FDC will be continued to complete 1 year of treatment and adjuvant endocrine therapy will be indicated according to hormonal receptor status by IHC.
|
After 13 weeks of neoadjuvant treatment, a breast MRI will be performed.
If a complete response is observed on breast MRI, patients will undergo a stereotactic-guided VAB of the marker area to obtain 12 cylinders of breast parenchyma, which is equivalent to 2 grams of tissue.
If no invasive tumor cells and no in situ disease are identified in the stereotactic-guided VAB, patients will be eligible to omit loco-regional surgery.
Other Names:
|
No Intervention: Surgery
Neoadjuvant period: paclitaxel IV 80mg/m2 every week for 12 weeks with trastuzumab and pertuzumab Subcutaneous Fixed-Dose Combination (FDC) (a loading dose of 1200 mg pertuzumab and 600 mg trastuzumab followed by a maintenance dose of 600 mg pertuzumab and 600 mg trastuzumab once every 3 weeks) for 5 cycles.
Surgery: If invasive tumor cells and/or in situ disease are identified, patients will undergo surgery.
Adjuvant period: All patients will continue with Trastuzumab-emtansine (T-DM1) completing 1 year of treatment (14 cycles) and adjuvant endocrine therapy will be indicated according to hormonal receptor status by IHC.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To evaluate the possibility of omission of surgery and sentinel lymph node dissection in clinically low-risk HER2-positive breast cancer with high HER2 addiction and a complete response following standard neoadjuvant chemotherapy and dual HER2 blockade.
Time Frame: 3 years
|
To estimate the loco-regional invasive disease-free survival (LR-IDFS) at 3-year of patients who achieve a complete response based on imaging and a stereotactic-guided vacuum-assisted breast biopsy, and omit loco-regional surgery.
|
3 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Aleix Prat, MD, Hospital Clinic of Barcelona
- Principal Investigator: Tomas Pascual, MD, Hospital Clinic of Barcelona
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 23, 2020
Primary Completion (Anticipated)
December 1, 2023
Study Completion (Anticipated)
December 1, 2026
Study Registration Dates
First Submitted
September 29, 2020
First Submitted That Met QC Criteria
October 2, 2020
First Posted (Actual)
October 8, 2020
Study Record Updates
Last Update Posted (Actual)
January 25, 2022
Last Update Submitted That Met QC Criteria
January 23, 2022
Last Verified
January 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HCB-ONC001 (ML41519)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stage I Breast Cancer
-
University of WashingtonTerminatedBreast Cancer | Breast Cancer Stage I | Breast Cancer Stage II | Breast Cancer Stage III | Breast Cancer Stage IIB | Breast Cancer Stage IIA | Breast Cancer Stage IIIA | Breast Cancer Stage IIIB | Breast Cancer Stage IIIcUnited States
-
Memorial Sloan Kettering Cancer CenterActive, not recruitingGynecologic Cancer | Stage I Breast Cancer | Stage II Breast Cancer | Stage I Prostate Cancer | Stage II Prostate Cancer | Stage III Prostate Cancer | Stage III Breast Cancer | Stage III Gynecologic Cancer | Stage III Colorectal Cancer | Stage I Colorectal Cancer | Stage II Colorectal Cancer | Stage I Gynecologic... and other conditionsUnited States
-
University of Southern CaliforniaNational Cancer Institute (NCI)CompletedStage I Breast Cancer | Stage II Breast Cancer | Stage IIIA Breast Cancer | Stage IIIB Breast Cancer | Stage IIIC Breast CancerUnited States
-
National Cancer Institute (NCI)CompletedStage I Breast Cancer | Stage II Breast Cancer | Stage IIIA Breast Cancer | Stage IIIB Breast Cancer | Stage IIIC Breast CancerUnited States
-
City of Hope Medical CenterTerminatedStage I Breast Cancer | Cancer Survivor | Stage II Breast Cancer | Stage IIIA Breast Cancer | Stage IIIB Breast Cancer | Stage IIIC Breast CancerUnited States
-
Mayo ClinicNational Cancer Institute (NCI)Active, not recruitingAnatomic Stage I Breast Cancer AJCC v8 | Anatomic Stage IA Breast Cancer AJCC v8 | Anatomic Stage IB Breast Cancer AJCC v8 | Anatomic Stage IIA Breast Cancer AJCC v8 | Prognostic Stage I Breast Cancer AJCC v8 | Prognostic Stage IA Breast Cancer AJCC v8 | Prognostic Stage IB Breast Cancer AJCC v8 | Prognostic Stage IIA Breast Cancer AJCC...United States
-
Wake Forest University Health SciencesCompletedStage I Breast Cancer | Stage IV Breast Cancer | Stage II Breast Cancer | Stage IIIA Breast Cancer | Stage IIIB Breast Cancer | Stage IIIC Breast CancerUnited States
-
Thompson Cancer Survival CenterRecruitingBreast Cancer | Breast Cancer Stage I | Breast Cancer Stage II | Breast Cancer Stage IIIUnited States
-
Dana-Farber Cancer InstituteCompletedEarly Stage Breast Cancer | Breast Cancer Stage I | Breast Cancer Stage IIUnited States
-
Dana-Farber Cancer InstituteCURE FoundationCompletedBreast Cancer Stage I | Breast Cancer Stage II | Breast Cancer Stage IIIUnited States
Clinical Trials on Trastuzumab and pertuzumab Subcutaneous Fixed-Dose Combination
-
Genentech, Inc.Approved for marketing
-
Hoffmann-La RocheCompletedHER2-Positive Early Breast CancerUnited States, Finland, Hong Kong, Panama, Portugal, Spain, Mexico, Sweden, Brazil, Serbia, Argentina, Lebanon, Cuba, Qatar, Saudi Arabia, Chile, Jordan
-
Jules Bordet InstituteHoffmann-La Roche; Breast International Group; Institut Curie; International Drug...SuspendedHER2-positive Breast Cancer | ER-Negative Breast Cancer | PR-Negative Breast Cancer | Node-negative Breast CancerKorea, Republic of, France, Israel, Belgium, Switzerland, Australia
-
Hoffmann-La RocheCompleted
-
Hoffmann-La RocheRecruitingLocally Advanced or Metastatic Breast CancerFrance, Belgium, United States, Korea, Republic of, Taiwan, China, Italy, Argentina, Jordan, Mexico, Brazil, Germany, Portugal, Thailand, Turkey, United Kingdom, Kenya, Spain, Hungary, Colombia, India, Oman, Poland, Uganda, United Arab...
-
Hoffmann-La RocheActive, not recruitingInflammatory Breast Cancer | Early Breast Cancer | Locally Advanced Breast CancerCanada, Croatia, Spain, Argentina, Mexico, Korea, Republic of, Bosnia and Herzegovina, Brazil, Costa Rica, Turkey, Singapore, Bulgaria, South Africa, India, Peru, Kenya, Chile
-
Hospices Civils de LyonNot yet recruiting
-
University of Western Ontario, CanadaPfizerCompleted
-
International Union Against Tuberculosis and Lung...United States Agency for International Development (USAID)UnknownTuberculosisAlgeria, Bolivia, Colombia, Guinea, Mozambique, Nepal, Peru, Tanzania, Vietnam
-
European Organisation for Research and Treatment...Hoffmann-La RocheCompletedElderly Metastatic Breast Cancer PopulationBelgium, Italy, Netherlands, France, Poland, United Kingdom, Portugal, Sweden