- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT01367028
En fas II-studie av Neoadjuvant Trastuzumab+Docetaxel+NPLD+/-Bevacizumab i Her2-pos. Tidig bröstcancer (ABCSG 32)
Multicenter randomiserad fas II-studie av Neoadjuvant Trastuzumab Plus Docetaxel med och utan Bevacizumab och Trastuzumab Plus Docetaxel Plus Icke-pegylerat liposominkapslat doxorubicin (NPLD) med och utan Bevacizumab vid HER2-positiv tidig bröstcancer
Studieöversikt
Status
Betingelser
Detaljerad beskrivning
Målgruppen för studien består av manliga och kvinnliga pre- och postmenopausala patienter med HER2-positivt, adenokarcinom i bröstet (förutom inflammatorisk bröstcancer, T4d) planerade att få neoadjuvant cytotoxisk behandling.
Patienter måste ha patologiskt bekräftad bröstcancer med histologiskt bekräftad HER2-överuttryck. Vid screening måste patienterna ha en adekvat vänsterkammarejektionsfraktion (LVEF); en ECOG-prestandastatus på 0 eller 1; adekvat lever-, njur- och benmärgsfunktion; och vara fri från andra allvarliga sjukdomar som kan påverka protokollefterlevnad eller tolkning av resultat.
Patienter bör inte löpa ökad risk för GI-perforation, hypertoni, proteinuri, sårläkningskomplikationer, tromboembolism eller blödning. Patienterna får inte ha haft en annan primär malignitet som kan påverka överensstämmelse med protokollet eller tolkning av resultat. Patienter med metastaser i centrala nervsystemet (CNS) är uteslutna. Dräktiga eller ammande kvinnor är uteslutna. Patienter med hypertoni (>150 mmHG systolisk eller >100 mmHG diastolisk) och patienter med en historia av GI-perforation, bukfistel eller intraabdominal abscess inom 6 månader efter studiestart exkluderas.
Full antikoagulationsbehandling vid studiestart är tillåten så länge som patienten har haft en stabil nivå av antikoagulantia i minst 2 veckor vid tidpunkten för studiebehandlingens start.
Studietyp
Inskrivning (Faktisk)
Fas
- Fas 2
Kontakter och platser
Studieorter
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Salzburg, Österrike, 5020
- Paracelsus Medical University Salzburg-Oncology, Coop. Group
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Vienna, Österrike, 1090
- Medical University Vienna, General Hospital
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Vienna, Österrike, 1130
- State Hospital Vienna-Hietzing
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Vienna, Österrike, 1090
- Med. Univ. Vienna; General Hospital Vienna
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Styria
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Graz, Styria, Österrike, 8036
- Medical University of Graz-Oncology; Coop. Group
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Leoben, Styria, Österrike, 8700
- State Hospital Leoben
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Tyrol
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Innsbruck, Tyrol, Österrike, 6020
- Gynaegological Medical University Innsbruck
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Kufstein, Tyrol, Österrike, 6330
- District Hospital Kufstein
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Upper Austria
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Linz, Upper Austria, Österrike, 4010
- Hospital BHS Linz, Coop. Study Group
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Linz, Upper Austria, Österrike, 4020
- AKH Linz
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Vorarlberg
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Feldkirch, Vorarlberg, Österrike, 6807
- State Hospital Feldkirch, Coop. Group
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inklusionskriterier:
- Kvinna eller man, ålder ≥ 18 år
- Patologiskt bekräftat invasivt primärt bröstadenokarcinom (förutom inflammatorisk bröstcancer, T4d) planerat för taxaninnehållande neoadjuvant systemisk behandling med/utan palpabla lymfkörtlar.
- Dokumenterat HER2-proteinöveruttryck som bestämts av immunhistokemi (IHC) 3+ eller genom demonstrerad HER2/c-erbB2-genamplifiering av den primära tumören av ett lokalt laboratorium.
- LVEF ≥ 55 % mätt med ekokardiografi eller MUGA inom 4 veckor före randomisering
- ECOG-prestandastatus ≤ 1
- Kan och är villig att följa schemalagda besök, behandlingsplaner, laboratorietester och andra studieprocedurer.
- Skriftligt informerat samtycke
Exklusions kriterier:
Aktuell behandling
- Krav på samtidig användning av det antivirala medlet sorivudin eller kemiskt relaterade analoger, såsom brivudin.
- Kronisk daglig behandling med kortikosteroider exkl. inhalerade steroider.
- Kronisk daglig behandling med aspirin och aspirinanaloger eller klopidogrel
- Större kirurgiska ingrepp, öppen biopsi eller betydande traumatisk skada inom 28 dagar före randomisering eller förväntan om behov av större operation under studiebehandlingen
- Pågående eller nyligen (inom 30 dagar före randomisering) behandling med ett annat prövningsläkemedel eller deltagande i en annan prövningsstudie.
Laboratorium
- Otillräcklig benmärgsfunktion
- Otillräcklig leverfunktion
- Otillräcklig njurfunktion
- Patienter som inte får antikoagulantia och som har aktiverat partiell tromboplastintid (aPTT) inom 7 dagar före dag 1 i cykel 1.
Samtidiga förhållanden
- Annan malignitet under de senaste 5 åren före randomisering förutom kurativt behandlad karcinom in situ i livmoderhalsen eller icke-melanomatös hudcancer
- Bevis på fjärrmetastaser bedömda kliniskt och åtminstone genom lungröntgen, leversonografi och benskanning. Om det finns någon klinisk misstanke om hjärnmetastas, måste en CT-skanning eller MRT av hjärnan göras inom 4 veckor före randomisering.
Allvarlig samtidig sjukdom som kan påverka efterlevnaden av protokollet eller tolkningen av resultat, inklusive men inte begränsat till:
- Aktiv infektion som kräver i.v. antibiotika
- Okontrollerad hypertoni
- Kliniskt signifikant historia av kardiovaskulär sjukdom som indikeras av: cerebrovaskulär olycka eller stroke; hjärtinfarkt; instabil angina; NYHA Grad II eller högre CHF; hjärtarytmi som kräver medicinering; kliniskt signifikant hjärtklaffsjukdom.
- Dyspné i vila som kräver stödjande syrgasbehandling eller med betydande pleurautgjutning
- Dåligt kontrollerad diabetes mellitus
- Historik eller bevis vid fysisk/neurologisk undersökning av CNS-sjukdom som inte är relaterad till cancer (t.ex. okontrollerade anfall) om de inte behandlas adekvat med medicinsk standardbehandling
- Historik eller tecken på ärftlig blödningsdiates eller koagulopati med risk för blödning
- Historik med bukfistel, GI-perforation eller intraabdominal abscess inom 6 månader efter randomisering
- Allvarligt icke-läkande sår, magsår eller benfraktur
- Kliniskt signifikant malabsorptionssyndrom, ulcerös kolit, sjukdom som påverkar GI-funktionen, resektion av mage eller tunntarm, eller oförmåga att ta oral medicin
- Okorrigerad hypokalemi eller hypomagnesemi
- Organallotransplantat som kräver immunsuppressiv terapi
- Bevis på någon annan sjukdom, metabolisk eller psykologisk dysfunktion, fynd av fysisk undersökning eller kliniska laboratoriefynd som ger rimliga misstankar om en sjukdom eller tillstånd som kontraindicerar användningen av ett prövningsläkemedel, kan påverka patientens efterlevnad av studierutiner eller placera patienten på hög nivå. risk för behandlingsrelaterade komplikationer.
- Känd överkänslighet mot något av studieläkemedlen/hjälpämnena.
- Överkänslighet mot äggstocksprodukter från kinesisk hamster eller andra rekombinanta humana eller humaniserade antikroppar.
Övrig
- Gravida, ammande kvinnor eller fertila kvinnor utan negativt graviditetstest
- Fertila hanar eller honor i fertil ålder
- Patienter som inte är tillgängliga för behandling eller uppföljning
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
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Övrig: A: Trastuzumab+Docetaxel
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6 cykler - Dag1 (Dag22 = Dag1): Trastuzumab: 8 mg/kg laddningsdos (1:a cykeln) i.v.; 6 mg/kg underhållsdos i efterföljande cykler i.v. Docetaxel: 100 mg/m2 med 60 min i.v. infusion
Andra namn:
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Experimentell: B: Trastuzumab+Docetaxel+Bevacizumab
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6 cykler - Dag1 (Dag22 = Dag1): Trastuzumab: 8 mg/kg laddningsdos (1:a cykeln) i.v.; 6 mg/kg underhållsdos i efterföljande cykler i.v. Docetaxel: 100 mg/m2 med 60 min i.v. infusion Bevacizumab 15 mg/kg
Andra namn:
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Experimentell: C: Trastuzumab+Docetaxel+NPLD
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6 cykler - Dag1 (Dag22=Dag1): Trastuzumab: 8 mg/kg laddningsdos (1:a cykeln) i.v.; 6 mg/kg underhållsdos i efterföljande cykler i.v. Docetaxel: 75 mg/m2 vid 60 min IV-infusion NPLD 50 mg/m2 vid 60 min i.v. infusion
Andra namn:
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Experimentell: D: Trastuzumab+Docetaxel+NPLD+Bevacizumab
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6 cykler - Dag1 (Dag22= Dag1): Trastuzumab: 8 mg/kg laddningsdos (1:a cykeln) i.v.; 6 mg/kg underhållsdos i efterföljande cykler i.v. Docetaxel: 75 mg/m2 vid 60 min i.v. infusion NPLD: 50 mg/m2 med 60 min i.v. infusion; Bevacizumab 15 mg/kg
Andra namn:
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Hjärttoxicitet
Tidsram: mellan dag 1 i cykel 1 och dag 28 efter dagen för den sista operationen
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för att utvärdera hjärttoxiciteten av kombinationen trastuzumab+docetaxel+bevacizumab och trastuzumab+docetaxel+NPLD +/- bevacizumab i jämförelse med standardterapin, trastuzumab+docetaxel med hjälp av ett sammansatt effektmått som uppträder mellan dag 1 i cykel 1 och dag 28 efter dagen slutlig operation.
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mellan dag 1 i cykel 1 och dag 28 efter dagen för den sista operationen
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Patologiskt komplett svar (ypCR)
Tidsram: upp till 22 veckor
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ypCR definieras som frånvaro av invasiv tumör vid tidpunkten för den sista operationen
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upp till 22 veckor
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Totalt patologiskt fullständigt svar (ytpCR)
Tidsram: upp till 22 veckor
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ytpCR definieras som frånvaro av invasiva tumör- och tumörceller i bröstet och axillära lymfnoder (ypT0 eller yDCIS och ypN=0)
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upp till 22 veckor
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Total klinisk svarsfrekvens (cORR)
Tidsram: upp till 22 veckor
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cORR definieras som andelen patienter med antingen ett fullständigt kliniskt svar (cCR) eller ett partiellt kliniskt svar (cPR), men ingen ypCR
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upp till 22 veckor
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Säkerhetsutvärdering enligt patientantal av AE, SAE, abnormiteter i laboratorietest, hjärtbedömning, klinisk utvärdering
Tidsram: upp till 22 veckor
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Säkerhet (AE, SAE, abnormiteter i laboratorier, hjärtbedömning, klinisk utvärdering) av kombinationen trastuzumab och docetaxel med bevacizumab och trastuzumab, docetaxel och NPLD plus/minus bevacizumab vid tidpunkten för den sista operationen
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upp till 22 veckor
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Samarbetspartners och utredare
Utredare
- Huvudutredare: Guenther Steger, MD, Austrian Breast & Colorectal Cancer Study Group
Publikationer och användbara länkar
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Ytterligare relevanta MeSH-villkor
- Hudsjukdomar
- Neoplasmer
- Neoplasmer efter plats
- Bröstsjukdomar
- Bröstneoplasmer
- Läkemedels fysiologiska effekter
- Molekylära mekanismer för farmakologisk verkan
- Antineoplastiska medel
- Tubulin modulatorer
- Antimitotiska medel
- Mitosmodulatorer
- Antineoplastiska medel, immunologiska
- Angiogeneshämmare
- Angiogenesmodulerande medel
- Tillväxtämnen
- Tillväxthämmare
- Docetaxel
- Trastuzumab
- Bevacizumab
Andra studie-ID-nummer
- ABCSG 32
- 2010-023324-25 (EudraCT-nummer)
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