Neoadjuvant Study With Chemotherapy, Lapatinib And Trastuzumab In Breast Cancer (CHERLOB)
2016年2月22日 更新者：GlaxoSmithKline
Chemotherapy Plus Lapatinib or Trastuzumab or Both in Her2+ Primary Breast Cancer. A Randomized Phase IIb Study With Biomarker Evaluation.
Evaluate the activity of Trastuzumab, Lapatinib, and a combination of both agents with chemotherapy in the preoperative (neoadjuvant) treatment of early breast cancer.
調査の概要
状態
完了
条件
研究の種類
介入
入学 (実際)
121
段階
- フェーズ2
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
-
-
-
Cremona、イタリア、26100
- GSK Investigational Site
-
Pavia、イタリア、27100
- GSK Investigational Site
-
Perugia、イタリア、06156
- GSK Investigational Site
-
Reggio Emilia、イタリア、42100
- GSK Investigational Site
-
Varese、イタリア、21100
- GSK Investigational Site
-
-
Emilia-Romagna
-
Carpi (MO)、Emilia-Romagna、イタリア、41012
- GSK Investigational Site
-
Forlì、Emilia-Romagna、イタリア、47100
- GSK Investigational Site
-
Modena、Emilia-Romagna、イタリア、41100
- GSK Investigational Site
-
Parma、Emilia-Romagna、イタリア、43100
- GSK Investigational Site
-
Piacenza、Emilia-Romagna、イタリア、29100
- GSK Investigational Site
-
Rimini、Emilia-Romagna、イタリア、47900
- GSK Investigational Site
-
-
Lombardia
-
Treviglio (BG)、Lombardia、イタリア、24047
- GSK Investigational Site
-
-
Piemonte
-
Candiolo (TO)、Piemonte、イタリア、10060
- GSK Investigational Site
-
-
Puglia
-
Brindisi、Puglia、イタリア、72100
- GSK Investigational Site
-
-
Toscana
-
Pisa、Toscana、イタリア、56126
- GSK Investigational Site
-
-
-
-
-
Berlin、ドイツ、13125
- GSK Investigational Site
-
-
-
-
-
Warszawa、ポーランド、00-909
- GSK Investigational Site
-
-
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年～65年 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
女性
説明
Inclusion criteria:
- Histologically confirmed infiltrating primary breast cancer of > 2.0 cm in largest clinical diameter
HER2 positive tumor (either IHC 3+ or FISH+)
- Availability of tumor tissue suitable for biological and molecular examination before starting primary treatment
- Age >18, < 65 years
- ECOG PS 0-1
- Normal organ and marrow function as defined below:
leukocytes ³ 3000/microL
absolute neutrophil count ³ 1,500/microL
platelets ³ 100,000/microL
total bilirubin <= 1.5x ULN. In case of Gilbert's syndrome, <2 x ULN is allowed
AST (SGOT)/ALT(SGPT)<= 2.5 X institutional upper limit of normal
Alkaline phosphatase <= 2.5 x ULN
Creatinine within normal institutional limits
- Cardiac ejection fraction within the institutional range of normal as measured by echocardiogram or MUGA scan
- Eligibility of patients receiving medications or substances known to affect, or with the potential to affect the activity or pharmacokinetics of lapatinib will be determined following review of their use by the Principal Investigator. A list of medications and substances known or with the potential to interact with CYP450 isoenzymes is provided
- The effects of lapatinib on the developing human fetus at the recommended therapeutic dose are unknown; women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately, the patient should be apprised of the potential hazard to the fetus and potential risk for loss of the pregnancy
- Ability to understand and the willingness to sign a written informed consent document
- Ability to swallow and retain oral medication
Exclusion criteria:
- Stage IIIB, IIIC, and inflammatory breast cancer
- Stage IV breast cancer
- Contraindication to the treatment with anthracycline, paclitaxel and/or trastuzumab
- Prior treatment with chemotherapy, endocrine therapy or radiotherapy. Prior treatment with EGFR targeting therapies
- Treatment with any other investigational agents, or with all herbal (alternative) medicines
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to lapatinib
- Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Pregnancy or breastfeeding; (breast feeding should be discontinued to be enrolled in the study)
- Women of childbearing potential that refusal to adopt adequate contraceptive measures
- HIV-positive patients receiving combination anti-retroviral therapy
- GI tract disease resulting in an inability to take oral medication, malabsorption syndrome, a requirement for IV alimentation, prior surgical procedures affecting absorption, uncontrolled inflammatory GI disease (e.g., Crohn's, ulcerative colitis)
- Concomitant requirement for medication classified as CYP3A4 inducers or inhibitors
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
アクティブコンパレータ：Arm A
Chemotherapy plus trastuzumab
|
First dose 4mg/kg in 60mins, then weekly 2mg/kg in 30 mins
他の名前：
80mg/sqm 1 hour infusion for 12 weeks
他の名前：
600mg/sqm iv day 1 q21 days for four coursess
75mg/sqm iv day 1 q21 days for four courses
600mg/sqm day 1 q21 days for four courses
|
|
実験的：Arm B
Chemotherapy plus lapatinib
|
80mg/sqm 1 hour infusion for 12 weeks
他の名前：
600mg/sqm iv day 1 q21 days for four coursess
75mg/sqm iv day 1 q21 days for four courses
600mg/sqm day 1 q21 days for four courses
Arm B 1250mg/d PO Arm C 750mg/d PO
他の名前：
|
|
アクティブコンパレータ：Arm C
Chemotherapy plus trastuzumab plus lapatinib
|
First dose 4mg/kg in 60mins, then weekly 2mg/kg in 30 mins
他の名前：
80mg/sqm 1 hour infusion for 12 weeks
他の名前：
600mg/sqm iv day 1 q21 days for four coursess
75mg/sqm iv day 1 q21 days for four courses
600mg/sqm day 1 q21 days for four courses
Arm B 1250mg/d PO Arm C 750mg/d PO
他の名前：
|
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Percentage of Participants With Pathological Complete Response (pCR) in the Breast and in the Lymph Nodes
時間枠：At Baseline and surgery (within 5 weeks after the last chemotherapy administration) (assessed up to Study Week 29)
|
Pathological Complete Response (pCR) is defined by the complete absence of infiltrating tumor cells in the breast and in the lymph nodes.
The pathological response in the breast was evaluated according to the criteria of Miller and Payne as follows: Grade 1, no change or some alteration to individual malignant cells, but no reduction in overall cellularity; Grade 2, a minor loss in tumor cells (up to 30%); Grade 3, between an estimated 30% and 90% reduction in tumor cells; Grade 4, marked disappearance of tumor cells, with only a small cluster or a dispersed cell remaining (more than 90% loss); Grade 5, no identifiable malignant cells.
Ductal carcinoma in situ (DCIS) may be present.
Grades were interpreted as follows: Grade 1-2=no response; Grade 3-4=partial response; Grade 5=complete response.
pCR was defined by comparing specimens obtained at Baseline (biopsy) to those obtained upon surgery.
|
At Baseline and surgery (within 5 weeks after the last chemotherapy administration) (assessed up to Study Week 29)
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Percentage of Participants With the Indicated Clinical Objective Response (Complete Response and Partial Response), Stable Disease, and Progressive Disease, as Assessed by Ultrasonography
時間枠：At Baseline and after primary treatment (within 2 weeks before surgery; up to Study Week 27)
|
The clinical response was evaluated by comparing the tumor size (largest tumor diameter) before (at Baseline [biopsy]) and after treatment (before surgery), as assessed by ultrasonography examination.
The clinical response was scored by Response Evaluation Criteria in Solid Tumors (RECIST) as follows: complete clinical response: the nodule is not detectable and all the ultrasound abnormality detected at diagnosis disappeared (margins circumscribed, round oval shape, parallel orientation, isoechoic echo pattern, no posterior acoustic features, echogenic lesion boundary, and tumor vascularity not present); partial clinical response: the longest diameter of the tumor has been reduced by >50%, and the ultrasound characteristics of the tumor persist; no response (stable disease): the longest diameter of the tumor has been reduced by <50% or has increased by no more than 20% from the starting value; progressive disease: tumor longest diameter has increased >20% from the starting value.
|
At Baseline and after primary treatment (within 2 weeks before surgery; up to Study Week 27)
|
|
Percentage of Participants Who Had Breast-conserving Surgery (BCS), Mastectomy, and Conversion From Mastectomy to BCS
時間枠：At Baseline and at surgery (up to Study Week 29)
|
The percentage of participants who had BCS and mastectomy and who were initiallycandidates for mastectomy and who actually had BCS was measured.
At Baseline, the surgeon stated, within 4 weeks before starting the primary treatment, which type of surgical treatment he would perform in the absence of primary therapy and in the case of primary therapy (if the tumor size was reduced by the primary treatment to less than 3 centimeters), and the reasons for these choices.
The rules for choosing the type of surgical treatment are reported in the Consensus Conference on Primary Treatment of Early Breast Cancer.
The surgeon was to have re-evaluated the participant after primary treatment.
In cases in which the type of surgical procedure was different from that originally programmed, the reason for this chance was to have been reported.
|
At Baseline and at surgery (up to Study Week 29)
|
|
Time to Treatment Failure From the Start of Primary Therapy
時間枠：From randomization up to Study Week 307
|
Time to treatment failure (TTF) is defined as the interval of time between the date of randomization and the earliest date of disease progression, premature treatment discontinuation and death due to any cause.
The overall disease progression date is the earlier of the two disease progression dates from ultrasonography and mammography assessments.
For ultrasonography, disease progression is defined as at least 20% increase in the longest diameter of the primary lesion at pre-surgery comparing to Baseline.
For mammography, disease progression is defined as at least 20% increase in the larger nodule dimension at pre-surgery comparing to Baseline.
For participants who has neither progressed, pre-maturely withdrawn or died, time to treatment failure will be censored at the latest date of ultrasonography and mammography tumor assessments.
|
From randomization up to Study Week 307
|
|
Number of Participants With Treatment Failure
時間枠：From randomization up to 29 weeks
|
Treatment failure is defined as the occurrence of local tumor progression (including ipsilateral and controlateral breast), distant tumor progression, permanent treatment discontinuation (either for the experimental or conventional arm), or death due to any cause.
|
From randomization up to 29 weeks
|
|
Percentage of Inhibition of Biomarkers Ki67, pAKT, pMAPK, Tunel Test, PTEN, and pEGFR After Treatment
時間枠：At Baseline and Withdrawal (assessed up to Study Week 29)
|
The percentage of inhibition of intermediate (EGFR, HER2, pMAPK, pAKT, PTEN, and PI3KCA) and final (TUNEL and Ki67) biomarkers of the proliferation and apoptosis pathways was calculated as the difference between the staining scores before (Baseline [biopsy]) and after treatment (withdrawal).
|
At Baseline and Withdrawal (assessed up to Study Week 29)
|
|
Number of Participants With Any Adverse Event (AE), Including Serious Adverse Events (SAEs), Occurring in >=5% of Participants
時間枠：From the first dose of randomized therapy to 30 days after the last dose of randomized therapy (assessed up to Study Week 29)
|
An AE is defined as any untoward medical occurrence in a participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.
An SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, or is a congenital anomaly/birth defect.
Medical or scientific judgment had been exercised in deciding whether reporting was appropriate in other situations.
|
From the first dose of randomized therapy to 30 days after the last dose of randomized therapy (assessed up to Study Week 29)
|
|
Number of Variations/Somatic Mutation in PI3KCA at Baseline
時間枠：Baseline
|
Analysis of mutations in the PI3KCA gene was performed from RNA extracted from frozen tumor tissue samples (sections).
A gene is either a wild-type (no mutation) or mutated (presence of a mutation).
Exons 9 and 20 of the PI3KCA gene were accessed (high frequency mutation at these two spots).
|
Baseline
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
スポンサー
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- Guarneri V, Frassoldati A, Bottini A, Cagossi K, Bisagni G, Sarti S, Ravaioli A, Cavanna L, Giardina G, Musolino A, Untch M, Orlando L, Artioli F, Boni C, Generali DG, Serra P, Bagnalasta M, Marini L, Piacentini F, D'Amico R, Conte P. Preoperative chemotherapy plus trastuzumab, lapatinib, or both in human epidermal growth factor receptor 2-positive operable breast cancer: results of the randomized phase II CHER-LOB study. J Clin Oncol. 2012 Jun 1;30(16):1989-95. doi: 10.1200/JCO.2011.39.0823. Epub 2012 Apr 9.
- Guarneri V, Dieci MV, Griguolo G, Miglietta F, Girardi F, Bisagni G, Generali DG, Cagossi K, Sarti S, Frassoldati A, Gianni L, Cavanna L, Pinotti G, Musolino A, Piacentini F, Cinieri S, Prat A, Conte P; of the CHER-Lob study team. Trastuzumab-lapatinib as neoadjuvant therapy for HER2-positive early breast cancer: Survival analyses of the CHER-Lob trial. Eur J Cancer. 2021 Aug;153:133-141. doi: 10.1016/j.ejca.2021.05.018. Epub 2021 Jun 19.
- Guarneri V, Dieci MV, Frassoldati A, Maiorana A, Ficarra G, Bettelli S, Tagliafico E, Bicciato S, Generali DG, Cagossi K, Bisagni G, Sarti S, Musolino A, Ellis C, Crescenzo R, Conte P. Prospective Biomarker Analysis of the Randomized CHER-LOB Study Evaluating the Dual Anti-HER2 Treatment With Trastuzumab and Lapatinib Plus Chemotherapy as Neoadjuvant Therapy for HER2-Positive Breast Cancer. Oncologist. 2015 Sep;20(9):1001-10. doi: 10.1634/theoncologist.2015-0138. Epub 2015 Aug 5.
- Guarneri V, Generali DG, Frassoldati A, Artioli F, Boni C, Cavanna L, Tagliafico E, Maiorana A, Bottini A, Cagossi K, Bisagni G, Piacentini F, Ficarra G, Bettelli S, Roncaglia E, Nuzzo S, Swaby R, Ellis C, Holford C, Conte P. Double-blind, placebo-controlled, multicenter, randomized, phase IIb neoadjuvant study of letrozole-lapatinib in postmenopausal hormone receptor-positive, human epidermal growth factor receptor 2-negative, operable breast cancer. J Clin Oncol. 2014 Apr 1;32(10):1050-7. doi: 10.1200/JCO.2013.51.4737. Epub 2014 Mar 3.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2006年8月1日
一次修了 (実際)
2012年6月1日
研究の完了 (実際)
2012年6月1日
試験登録日
最初に提出
2007年1月29日
QC基準を満たした最初の提出物
2007年1月29日
最初の投稿 (見積もり)
2007年1月31日
学習記録の更新
投稿された最後の更新 (見積もり)
2016年3月22日
QC基準を満たした最後の更新が送信されました
2016年2月22日
最終確認日
2016年1月1日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- EGF106988
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。