- ICH GCP
- Register voor klinische proeven in de VS.
- Klinische proef NCT00429299
Neoadjuvant Study With Chemotherapy, Lapatinib And Trastuzumab In Breast Cancer (CHERLOB)
Chemotherapy Plus Lapatinib or Trastuzumab or Both in Her2+ Primary Breast Cancer. A Randomized Phase IIb Study With Biomarker Evaluation.
Studie Overzicht
Toestand
Conditie
Studietype
Inschrijving (Werkelijk)
Fase
- Fase 2
Contacten en locaties
Studie Locaties
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Berlin, Duitsland, 13125
- GSK Investigational Site
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Cremona, Italië, 26100
- GSK Investigational Site
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Pavia, Italië, 27100
- GSK Investigational Site
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Perugia, Italië, 06156
- GSK Investigational Site
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Reggio Emilia, Italië, 42100
- GSK Investigational Site
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Varese, Italië, 21100
- GSK Investigational Site
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Emilia-Romagna
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Carpi (MO), Emilia-Romagna, Italië, 41012
- GSK Investigational Site
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Forlì, Emilia-Romagna, Italië, 47100
- GSK Investigational Site
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Modena, Emilia-Romagna, Italië, 41100
- GSK Investigational Site
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Parma, Emilia-Romagna, Italië, 43100
- GSK Investigational Site
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Piacenza, Emilia-Romagna, Italië, 29100
- GSK Investigational Site
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Rimini, Emilia-Romagna, Italië, 47900
- GSK Investigational Site
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Lombardia
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Treviglio (BG), Lombardia, Italië, 24047
- GSK Investigational Site
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Piemonte
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Candiolo (TO), Piemonte, Italië, 10060
- GSK Investigational Site
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Puglia
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Brindisi, Puglia, Italië, 72100
- GSK Investigational Site
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Toscana
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Pisa, Toscana, Italië, 56126
- GSK Investigational Site
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Warszawa, Polen, 00-909
- GSK Investigational Site
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
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
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Actieve vergelijker: Arm A
Chemotherapy plus trastuzumab
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First dose 4mg/kg in 60mins, then weekly 2mg/kg in 30 mins
Andere namen:
80mg/sqm 1 hour infusion for 12 weeks
Andere namen:
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
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Experimenteel: Arm B
Chemotherapy plus lapatinib
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80mg/sqm 1 hour infusion for 12 weeks
Andere namen:
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
Andere namen:
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Actieve vergelijker: Arm C
Chemotherapy plus trastuzumab plus lapatinib
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First dose 4mg/kg in 60mins, then weekly 2mg/kg in 30 mins
Andere namen:
80mg/sqm 1 hour infusion for 12 weeks
Andere namen:
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
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Percentage of Participants With Pathological Complete Response (pCR) in the Breast and in the Lymph Nodes
Tijdsspanne: At Baseline and surgery (within 5 weeks after the last chemotherapy administration) (assessed up to Study Week 29)
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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.
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At Baseline and surgery (within 5 weeks after the last chemotherapy administration) (assessed up to Study Week 29)
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Percentage of Participants With the Indicated Clinical Objective Response (Complete Response and Partial Response), Stable Disease, and Progressive Disease, as Assessed by Ultrasonography
Tijdsspanne: At Baseline and after primary treatment (within 2 weeks before surgery; up to Study Week 27)
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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.
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At Baseline and after primary treatment (within 2 weeks before surgery; up to Study Week 27)
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Percentage of Participants Who Had Breast-conserving Surgery (BCS), Mastectomy, and Conversion From Mastectomy to BCS
Tijdsspanne: At Baseline and at surgery (up to Study Week 29)
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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.
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At Baseline and at surgery (up to Study Week 29)
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Time to Treatment Failure From the Start of Primary Therapy
Tijdsspanne: From randomization up to Study Week 307
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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.
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From randomization up to Study Week 307
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Number of Participants With Treatment Failure
Tijdsspanne: From randomization up to 29 weeks
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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.
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From randomization up to 29 weeks
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Percentage of Inhibition of Biomarkers Ki67, pAKT, pMAPK, Tunel Test, PTEN, and pEGFR After Treatment
Tijdsspanne: At Baseline and Withdrawal (assessed up to Study Week 29)
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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).
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At Baseline and Withdrawal (assessed up to Study Week 29)
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Number of Participants With Any Adverse Event (AE), Including Serious Adverse Events (SAEs), Occurring in >=5% of Participants
Tijdsspanne: From the first dose of randomized therapy to 30 days after the last dose of randomized therapy (assessed up to Study Week 29)
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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.
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From the first dose of randomized therapy to 30 days after the last dose of randomized therapy (assessed up to Study Week 29)
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Number of Variations/Somatic Mutation in PI3KCA at Baseline
Tijdsspanne: Baseline
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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).
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Baseline
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Medewerkers en onderzoekers
Sponsor
Publicaties en nuttige links
Algemene publicaties
- 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.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
- Huidziektes
- Neoplasmata
- Neoplasmata per site
- Borst ziekten
- Borstneoplasmata
- Fysiologische effecten van medicijnen
- Moleculaire mechanismen van farmacologische werking
- Enzymremmers
- Antireumatische middelen
- Antimetabolieten, antineoplastische
- Antimetabolieten
- Antineoplastische middelen
- Immunosuppressieve middelen
- Immunologische factoren
- Tubuline-modulatoren
- Antimitotische middelen
- Mitose modulatoren
- Antineoplastische middelen, alkylering
- Alkyleringsmiddelen
- Myeloablatieve agonisten
- Antineoplastische middelen, fytogeen
- Topoisomerase II-remmers
- Topoisomeraseremmers
- Antineoplastische middelen, immunologisch
- Proteïnekinaseremmers
- Antibiotica, antineoplastiek
- Cyclofosfamide
- Paclitaxel
- Trastuzumab
- Fluoruracil
- Epirubicine
- Lapatinib
Andere studie-ID-nummers
- EGF106988
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .
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