Invasive Breast CancerPhase 3APTneoNCT03595592
Neoadjuvant Treatment of HER2 Positive Early High-risk and Locally Advanced Breast Cancer
A Phase 3 study testing Trastuzumab, Pertuzumab and Carboplatin in people with Invasive Breast Cancer, run by Fondazione Michelangelo at 65 sites in 4 countries.
Trial summary
n the present study the neoadjuvant approach with the anti-HER2 trastuzumab and pertuzumab combined with carboplatin and paclitaxel will be used to compare the Event-Free Survival (EFS) in regimens with and without atezolizumab. Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Invasive Breast Cancer
- What is being tested?
- Trastuzumab, Pertuzumab and Carboplatin
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 650 participants
- Where
- 65 sitesin 4 countries
- Study dates
- 7 Sep 2018to 15 Mar 2027
- Phase
- Phase 3
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Female patients aged 18 years or older with early high-risk ((T1cN1; T2N1; T3N0) or locally advanced and inflammatory breast cancers (stage III A-C according to AJCC) suitable for neoadjuvant treatment
- Histologically confirmed unilateral invasive breast cancer
- HER2 positive disease according to ASCO/CAP guidelines 2013 [defined as IHC 3+ or ISH positive (by gene copy number or HER2 gene/CEP17 ratio of 2 or greater)]
- Known estrogen (ER) and progesterone receptor (PgR)
- Availability of a representative paraffin-embedded (FFPE) tumor block taken at diagnostic biopsy for central confirmation of HER2 eligibility, for assessment of ER, PgR, Ki67 and PD-L1 expression and for biomarker evaluation is mandatory. Note: the diagnostic biopsy of the breast lesion may have been taken before the required screening procedures. If diagnostic sentinel node biopsy if performed, an FFPE block must be available. An FFPE tumor block is also mandatory after the first cycle of therapy. Surgery tissue (residual tumor or tumor bed in case of pCR and axillary node material) is also mandatory.
- Consent to the collection of blood samples mandatorily before starting neoadjuvant treatment, after the first cycle of therapy, at the end of neoadjuvant treatment (before surgery), 6 months after surgery and at the end of all treatments.
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- ECOG performance status 0 or 1
- For women who are not postmenopausal (≥ 12 months of non-therapy-induced amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to remain abstinent or use single or combined contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 6 months after the last dose of study drugs. Abstinence is only acceptable if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception. Examples of contraceptive methods with a failure rate of < 1% per year include tubal ligation, male sterilization, hormonal implants, established, proper use of combined oral or injected hormonal contraceptives, and certain intrauterine devices. Alternatively, two methods (e.g., two barrier methods such as a condom and a cervical cap) may be combined to achieve a failure rate of < 1% per year. Barrier methods must always be supplemented with the use of a spermicide
- Written informed consent to participate in the trial (approved by the Institutional Review Board [IRB]/ Independent Ethics Committee [IEC]) obtained prior to any study specific screening procedures
- Willing and able to comply with the protocol
Who cannot join
- Evidence of bilateral breast cancer or metastatic disease (M1)
- Patients with HER2-negative defined as 0-1+ by immunohistochemistry or 2+ by immunohistochemistry without HER2 amplification by either In Situ Hybridization (ISH) or other amplification tests done locally are considered not eligible for the study
- Pregnant or lactating women. Documentation of a negative pregnancy test must be available for premenopausal women with intact reproductive organs and for women less than one year after the last menstrual cycle
- Women with childbearing potential unless (1) surgically sterile or (2) using adequate measures of contraception, for example abstinence, an intra-uterine device, or double barrier method of contraception
- Previous treatment with chemotherapy, hormonal therapy or an investigational drug for any type of malignancy
- Previous investigational treatment for any condition other than malignancy within 4 weeks of randomization date
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- Administration of a live, attenuated vaccine within 4 weeks before Day 1 or anticipation that such a live attenuated vaccine will be required during the study
- Previous or concomitant malignancy of any other type that could affect compliance with the protocol or interpretation of results. Patients with curatively treated basal cell carcinoma of the skin or in situ cervix cancer are generally eligible
- Pre-existing motor or sensory neuropathy of grade > 1 for any reason
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity or allergy to biopharmaceuticals produced in Chinese hamster ovary cells or any component of the atezolizumab formulation
- Patients with prior allogeneic stem cell or solid organ transplantation
- History of autoimmune disease including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Bell's palsy, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis
- History of idiopathic pulmonary fibrosis (including bronchiolitis obliterans with organizing pneumonia) or evidence of active pneumonitis on screening chest computed tomography scan
- Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis, cirrhosis, fatty liver, and inherited liver disease
- History of HIV infection, active hepatitis B (chronic or acute), or hepatitis C infection. Patients with past or resolved hepatitis B infection (defined as having a negative HBsAg test and a positive hepatitis B core antigen [anti-HBc] test) are eligible.
- Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction assay (PCR) is negative for HCV RNA
- Active tuberculosis
- Severe infections within 4 weeks prior to Day 1, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia. Signs or symptoms of significant infection within 2 weeks prior to Day 1
- Received oral or IV antibiotics within 2 weeks prior to Cycle 1 Day 1
- Other serious illness or medical condition including: history of documented congestive cardiac failure; New York Heart Association (NYHA) Class II or greater CHF; angina pectoris requiring anti-anginal medication or unstable angina within 6 months prior to Day 1; evidence of transmural infarction on ECG; myocardial infarction stroke or transient ischemic attack (TIA) within 6 months prior to Day 1; poorly controlled hypertension (e.g. systolic >180 mm Hg or diastolic >100 mm Hg; however, patients with hypertension which is well controlled on medication are eligible); clinically significant valvular heart disease; high-risk uncontrolled arrhythmias
- Patients with a history of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the investigator to be clinically significant and precluding informed consent or adversely affecting compliance with study drugs
- Serious uncontrolled infections (bacterial or viral) or poorly controlled diabetes mellitus
- Any of the following abnormal baseline hematological values:
- White blood count (WBC) < 2.5 x 109/L
- Absolute Neutrophil Count (ANC) < 1.5 x 109/L
- Lymphocyte count < 0.5 x 109/L
- Platelet count < 100 x 109/L
- Hemoglobin (Hb) < 10 g/dL
- Any of the following abnormal baseline laboratory tests
- Serum total bilirubin > 1.5 x ULN (upper limit of normal) (except for patients with clearly documented Gilbert's syndrome)
- Alanine transaminase (ALT) or aspartate transaminase (AST) > 1.25 x ULN
- Alkaline phosphatase > 2.5xx ULN
- Serum creatinine > 1.5 x ULN
- INR and aPTT > 1.5 × ULN within 2 weeks prior to enrollment. This applies only to patients who are not receiving therapeutic anticoagulation; patients receiving therapeutic anticoagulation should be on a stable dose.
- Baseline left ventricular ejection fraction (LVEF) < 50% by echocardiography or multi-gated scintigraphic scan (MUGA)
- Major surgical procedure within 28 days prior to Day 1 or anticipation of need for a major surgical procedure during the course of the study
- Influenza vaccination should be given during influenza season only (approximately October to March). Patients must not receive live, attenuated influenza vaccine (e.g., FluMist®) within 4 weeks prior to Day 1 or at any time during the study.
Trial locations and contacts
65 sites in 4 countries.
65 sites in 4 countries
Spain27 sites
Centro Oncologico de Galicia
A Coruña, 15009
Hospital Virgen de Los Lirios
Alcoy, 03804
Hospital General Unv. Alicante
Alicante, 03010
"Hospital Infanta Cristina de Badajoz (CICAB - Centro de Investigación Clínica del Área de Salud de Badajoz)"
Badajoz, 06007
Hospital de la Santa Creu i Sant Pau
Barcelona, 08025
Hospital Clinic Provincial
Barcelona, 08036
Hospital del Mar - IMAS
Barcelona, Hospital del Mar - IMAS
Hospital de Basurto
Bilbao, 48013
Hospital San Pedro de Alcantara
Cáceres, 10003
Hospital Virgen de la Nieves
Granada, 18012
Hospital Juan Ramón Jimenez
Huelva, 21005
Hospital Gregorio Marañon
Madrid, 28007
MD Anderson Cancer Center
Madrid, 28033
Hospital Clinico San Carlos
Madrid, 28040
Hospital Unv. Fundación Jimenez Diaz
Madrid, 28040
Hospital de Fuenlabrada
Madrid, 28942
Complejo Hospitalario de Especialidades Virgen de la Victoria
Málaga, 29010
Hospital General Universitario Morales Meseguer
Murcia, 30008
Clinica Universitaria de Navarra
Pamplona, 31008
Complejo Hospitalario de Salamanca
Salamanca, 37007
Hospital de Donostia
San Sebastián, 20014
Hospital Onkologikoa
San Sebastián, 20014
Hospital Clinico Unv. de Santiago
Santiago de Compostela, 15706
Hospital Virgen de la Salud de Toledo
Toledo, 45004
Hospital Clínico Universitario de Valencia
Valencia, 46010
Hospital Lozano Blesa
Zaragoza, 50009
Hospital Miguel Servet
Zaragoza, 50009
Germany17 sites
Klinik für Gynäkologie am Campus Charité Mitte (CCM)
Berlin, 10113
Department of Gynecology and Obstetrics, Marienhospital
Bottrop, 46236
Klinikum Coburg, Frauenklinik
Coburg, 96450
St Johannes Hospital
Dortmund, 44137
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe - Universitätsklinikum Carl Gustav Carus
Dresden, 01307
Markus Krankenhaus - Klinik für Gynäkologie und Geburtshilfe
Frankfurt, 60431
SRH Waldklinikum
Gera, 07548
Universitätsklinikum Greifswald, Frauenklinik
Greifswald, 17475
Klinik und Poliklinik für Gynäkologie am Universitätsklinikum (Saale)
Halle, 06120
Gynäkologisch-Onkologische Praxis
Hanover, 30177
NCT Nationales Zentrum für Tumorerkrankungen Gynäkologische Onkologie, Frauenklinik
Heidelberg, 69120
St. Marien-Klinik GmbH Frauenklinik der St. Vincentius-Kliniken gAG - Gynäkologisches Krebszentrum Karlsruhe - Brustzentrum Karlsruhe
Karlsruhe, 76135
Städtisches Klinikum Magdeburg - Klinik für Allgemein - und Viszeralchirurgie
Magdeburg, 39130
Am Schillerhain 1-8
Marktredwitz, 95615
Klinikum Nürnberg Nord
Nuremberg, 90419
Onkologische Praxis Velbert
Velbert, 42551
Marien Hospital Witten
Witten, 58452
Italy17 sites
Ospedale Papa Giovanni XXIII
Bergamo, 24128
Presidio Ospedaliero Di Summa-Perrino
Brindisi, 72100
Dipartimento di Oncologia Medica AUSL della Romagna
Faenza, 48018
IST San Martino
Genova, 16132
Istituto Scientifico Romagnolo per lo studio e la cura dei tumori
Meldola, 47014
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, 20133
Istituto Europeo di Oncologia
Milan, 20141
Ospedale Luigi Sacco
Milan, 20160
Ospedale San Raffaele
Milan
AO Universitaria Policlinico di Modena
Modena, 41124
Ospedale Sacro Cuore - Don Calabria
Negrar, 37024
Fondazione Salvatore Maugeri
Pavia, 27100
Azienda Ospedaliero Universitaria Pisana Ospedale S. Chiara
Pisa, 56100
Arcispedale Santa Maria Nuova - A.O. Reggio Emilia
Reggio Emilia, 42123
Ospedale Infermi AUSL della Romagna
Rimini, 247900
Istituto Nazionale Tumori - Regina Elena
Roma, 00144
Ospedale Santa Maria della Misericordia
Udine, 33100
Austria4 sites
Klinikum Klagenfurt am Wörthersee Abteilung für Innede Medizin und Hämatologie und internistische Onkologie
Klagenfurt, 9020
Krankenhaus der Barmherzigen Schwestern
Linz, 4010
Universitätsklinikum St. Pölten Klinische Abteilung für Innere Medizin
Sankt Pölten, 3100
Klinische Abteilung für Allgemeine Gynäkologie und Gynäkologische Onkologie - Universitätsklinik für Frauenheilkunde Medizinische Universität Wien / AKH "
Vienna, 1090
About this study
Official title: Atezolizumab, Pertuzumab and Trastuzumab With Chemotherapy as Neoadjuvant Treatment of HER2 Positive Early High-risk and Locally Advanced Breast Cancer (APTneo)
n the present study the neoadjuvant approach with the anti-HER2 trastuzumab and pertuzumab combined with carboplatin and paclitaxel will be used to compare the Event-Free Survival (EFS) in regimens with and without atezolizumab. Following the neoadjuvant part of the study, after surgery all patients will continue to receive trastuzumab and pertuzumab to complete one year of anti-HER2 therapy. Similarly, patients allocated to receive atezolizumab will continue atezolizumab to complete one year In addition, several IHC and molecular assays will be performed before and during the period of chemotherapy administration and at surgery with the goal of defining a marker of efficacy to be later validated in a larger adjuvant setting.
Read the detailed description
Dual targeting of HER2 with trastuzumab and pertuzumab in HER2-positive breast cancer is linked to clinical evidence of reversal of initial resistance to trastuzumab (Baselga J et al, J Clin Oncol 2010) in cases progressing on trastuzumab therapy, and in dramatic improvement in progression free and overall survival when the two monoclonal antibodies are used in combination with docetaxel (THP regimen) as first line therapy of metastatic disease as shown in the CLEOPATRA study (Swain S et al, ESMO abstract 2014). The randomized NeoSphere study showed that the same THP regimen given for 4 cycles as neoadjuvant treatment increased the rate of pathologic complete response (pCR) over that with conventional docetaxel and trastuzumab or docetaxel and pertuzumab (Gianni L et al, Lancet Oncol 2012).
Encouraging clinical data emerging in the field of tumor immunotherapy have demonstrated that therapies focused on enhancing T cell responses against cancer can result in a significant survival benefit in patients with advanced malignancies (Hodi FS and Dranoff G, J Cutan Pathol 2010; Kantoff PW et al, New Engl J Med 2010; Chen DS et al, Clin Cancer Res 2012). Many human tumors have been found to overexpress PD L1, which acts to suppress anti tumor immunity. PD 1 is an inhibitory receptor expressed on T cells following T cell activation, which is sustained in states of chronic stimulation, such as in chronic infection or canc Atezolizumab is a human monoclonal antibody containing an engineered Fc-domain to optimize efficacy and safety that targets PD-L1 and blocks binding of its receptors, including PD-1 and B7.1.
In addition to being involved in the natural progression of cancer, immunity can affect the activity of various anticancer agents. Accordingly, recent evidence suggests that some chemotherapeutic drugs, such as anthracyclines and oxaliplatin, rely on the induction of anticancer immune responses. Immune responses also play a major role in the efficacy of targeted therapies with monoclonal antibodies (Stagg J et al, Breast Care 2012). Studies have shown monoclonal antibodies such as trastuzumab and rituximab rely in part on immunemediated killing through antibody-dependent cellular cytotoxicity (ADCC). While innate immune responses appear to be important for tumor antigen-targeted monoclonal antibody therapies, recent studies in mice and correlative clinical evidence suggest that trastuzumab may also stimulate adaptive antitumor immunity. These studies raise the possibility that combination strategies may be used to capitalize on the adaptive tumor-specific immunity generated by anti-HER2 monoclonal antibodies.
Based on these considerations, we plan to conduct a randomized neoadjuvant study of the combination of trastuzumab, pertuzumab, carboplatin and paclitaxel with or without atezolizumab in women with early high-risk and locally advanced HER2-positive suitable for neoadjuvant therapy. One study arm will also include anthracycline and cyclophosphamide.
- Conditions
- Invasive Breast Cancer
- Being tested
- Trastuzumab, Pertuzumab, Carboplatin, Paclitaxel, Doxorubicin
- Keywords
- Unilateral, HER2 positive
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TrastuzumabDrug
Also called Herceptin
Trastuzumab will be given i.v. on day 1 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
PertuzumabDrug
Also called Perjeta
Pertuzumab will be given i.v. on day 1 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
CarboplatinDrug
Also called Carboplatin Hospiria
Carboplatin will be given i.v. on day 1 and day 8 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
PaclitaxelDrug
Also called Paclitaxel Hospiria
Paclitaxel will be given i.v. on day 1 and day 8 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
DoxorubicinDrug
Also called Doxorubicin Pfizer
Adriamycin will be delivered i.v. on day 1 every 3 weeks in arm ACy followed by HPCT for the first 3 cycles
CyclophosphamideDrug
Also called Cyclophosphamide Sandoz
Cyclophosphamide will be given i.v. on day 1 every 3 weeks in arm ACy followed by HPCT and atezolizumab for the first 3 cycles
AtezolizumabDrug
Also called Tecentriq
Atezolizumab will be given i.v. on day 1 every 3 weeks in arm ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab
SurgeryProcedure or surgery
Breast cancer surgery (breast and axilla) either conservative or radical not later than 4 weeks from the last dose of neoadjuvant therapy in all study arms
| Study group | Role | What they receive |
|---|---|---|
| HPCT | Active comparator | Patients will receive a combination of trastuzumab, pertuzumab, carboplatin and paclitaxel as neoadjuvant therapy for 6 cycles every 3 weeks. Trastuzumab (H) will be delivered on day 1 at the dose of 8 mg/kg loading dose i.v., then 6 mg/kg i.v. Pertuzumab (P) will be delivered on day 1 at the dose of 840 mg loading dose i.v., then 420 mg i.v. Carboplatin (C) will be administered at AUC 2 i.v. on day 1 and day 8. Paclitaxel (T) will be given at 90 mg/m2 i.v. on day 1 and day 8. Definite surgery will be performed not later than 4 weeks after the last dose of neoadjuvant therapy. Trastuzumab and pertuzumab will then be delivered for 12 additional cycles as adjuvant therapy. Receives: Drug: Trastuzumab; Drug: Pertuzumab; Drug: Carboplatin; Drug: Paclitaxel; Procedure: Surgery |
| ACy followed by HPCT and atezolizumab | Experimental | Patients will receive a combination of doxorubicin (A, 60 mg/m2 i.v.), cyclophosphamide (C, 600 mg/m2 i.v.) and atezolizumab (1200 mg i.v.) on day 1 every 3 week for 3 cycles. Subsequently they will be given trastuzumab on day 1 (H, at the loading dose of 8 mg/kg i.v. then 6 mg/kg i.v.), pertuzumab on day 1 (P, at the loading dose of 840 mg .v., then 420 mg i.v.), carboplatin (C) at AUC 2 i.v. on day 1 and day 8, paclitaxel (T) at 90 mg/m2 i.v. on day 1 and day 8, and atezolizumab 1200 mg i.v. on day 1 for 3 cycles every 3 weeks. Definite surgery will be performed not later than 4 weeks after the last dose of neoadjuvant therapy. Trastuzumab and pertuzumab will then be delivered for 15 additional cycles and atezolizumab for 12 additional cycles as adjuvant therapy. Receives: Drug: Trastuzumab; Drug: Pertuzumab; Drug: Carboplatin; Drug: Paclitaxel; Drug: Doxorubicin; Drug: Cyclophosphamide; Drug: Atezolizumab; Procedure: Surgery |
| HPCT and atezolizumab | Experimental | Patients will receive a combination of trastuzumab, pertuzumab, carboplatin, paclitaxel and atezolizumab as neoadjuvant therapy for 6 cycles every 3 weeks. Trastuzumab (H) will be delivered on day 1 at the dose of 8 mg/kg loading dose i.v., then 6 mg/kg i.v. Pertuzumab (P) will be delivered on day 1 at the dose of 840 mg loading dose i.v., then 420 mg i.v. Carboplatin (C) will be administered at AUC 2 i.v. on day 1 and day 8; paclitaxel (T) will be given at 90 mg/m2 i.v. on day 1 and day 8; atezolizumab at the dose of 1200 mg i.v. on day 1. Definite surgery will be performed not later than 4 weeks after the last dose of neoadjuvant therapy. Trastuzumab, pertuzumab and atezolizumab will then be delivered for 12 additional cycles as adjuvant therapy. Receives: Drug: Trastuzumab; Drug: Pertuzumab; Drug: Carboplatin; Drug: Paclitaxel; Drug: Atezolizumab; Procedure: Surgery |
What is being measured
The primary outcome is the main question the study is designed to answer.
Event Free Survival (EFS)
Assess EFS (disease progression while on neoadjuvant therapy or disease recurrence after surgery) in the study arms
Measured: 5 years after the randomization of the last patient
Secondary outcomes (5)
Pathological complete response (pCR)
Assess the rate of pCR defined as absence of invasive cancer in both breast and axillary nodes (ypT0Tis ypN0)
Measured: At surgery, an expected average of 26 weeks after the randomization of the last patients
Clinical objective response
Assess the rate of clinical response rate after neoadjuvant therapy
Measured: Participants will be followed for the duration of neoadjuvant therapy, an expected average of 22 weeks
Distant Event Free Survival (DEFS)
Assess DEFS (defined as the occurrence of distant disease progression while on neoadjuvant therapy or distant disease recurrence after surgery) in the study arms
Measured: 5 years after the randomization of the last patients
Overall Survival (OS)
Assess OS in all arms
Measured: 5 years after the randomization of the last patient
Number of participants with adverse events as a measure of safety and tolerability
Number of participants with adverse events and related grades in all arms
Measured: Participants will be followed for up to 5 years from the last randomized patient
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jul 2018
- Study start7 Sep 2018
- Primary completion15 Dec 2026 (estimated)
- Study completion15 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Invasive Breast CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Parallel randomization to the study arms
- Masking
- None (open label)
- Enrolment
- 650 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Fondazione Michelangelo
- Sponsor type
- University, hospital or other
- Collaborators
- Hoffmann-La Roche
- Responsible party
- Sponsor
- Investigators
- Luca Gianni, MD, Study chair, Ospedale San Raffaele
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03595592
- Sponsor's protocol ID
- FM-17-B01
- Other IDs
- 2017-000981-31, 2017
- Acronym
- APTneo
- Status last verified
- Mar 2024
- First submitted
- 11 Jul 2018
- Last updated
- 6 Mar 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 6 Mar 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Atezolizumab, Pertuzumab and Trastuzumab With Chemotherapy as Neoadjuvant Treatment of HER2 Positive Early High-risk and Locally Advanced Breast Cancer (APTneo)
- ClinicalTrials.gov ID
- NCT03595592
- Acronym / sponsor ID
- APTneo / FM-17-B01
- Conditions
- Invasive Breast Cancer
- Keywords
- Unilateral, HER2 positive
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 650 participants (estimated)
- Lead sponsor
- Fondazione MichelangeloUniversity, hospital or other
- Collaborators
- Hoffmann-La Roche
- Study start
- 7 Sep 2018 (actual)
- Primary completion
- 15 Dec 2026 (estimated)
- Study completion
- 15 Mar 2027 (estimated)
- First posted
- 23 Jul 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
n the present study the neoadjuvant approach with the anti-HER2 trastuzumab and pertuzumab combined with carboplatin and paclitaxel will be used to compare the Event-Free Survival (EFS) in regimens with and without atezolizumab. Following the neoadjuvant part of the study, after surgery all patients will continue to receive trastuzumab and pertuzumab to complete one year of anti-HER2 therapy. Similarly, patients allocated to receive atezolizumab will continue atezolizumab to complete one year In addition, several IHC and molecular assays will be performed before and during the period of chemotherapy administration and at surgery with the goal of defining a marker of efficacy to be later validated in a larger adjuvant setting.
Detailed description
Dual targeting of HER2 with trastuzumab and pertuzumab in HER2-positive breast cancer is linked to clinical evidence of reversal of initial resistance to trastuzumab (Baselga J et al, J Clin Oncol 2010) in cases progressing on trastuzumab therapy, and in dramatic improvement in progression free and overall survival when the two monoclonal antibodies are used in combination with docetaxel (THP regimen) as first line therapy of metastatic disease as shown in the CLEOPATRA study (Swain S et al, ESMO abstract 2014). The randomized NeoSphere study showed that the same THP regimen given for 4 cycles as neoadjuvant treatment increased the rate of pathologic complete response (pCR) over that with conventional docetaxel and trastuzumab or docetaxel and pertuzumab (Gianni L et al, Lancet Oncol 2012).
Encouraging clinical data emerging in the field of tumor immunotherapy have demonstrated that therapies focused on enhancing T cell responses against cancer can result in a significant survival benefit in patients with advanced malignancies (Hodi FS and Dranoff G, J Cutan Pathol 2010; Kantoff PW et al, New Engl J Med 2010; Chen DS et al, Clin Cancer Res 2012). Many human tumors have been found to overexpress PD L1, which acts to suppress anti tumor immunity. PD 1 is an inhibitory receptor expressed on T cells following T cell activation, which is sustained in states of chronic stimulation, such as in chronic infection or canc Atezolizumab is a human monoclonal antibody containing an engineered Fc-domain to optimize efficacy and safety that targets PD-L1 and blocks binding of its receptors, including PD-1 and B7.1.
In addition to being involved in the natural progression of cancer, immunity can affect the activity of various anticancer agents. Accordingly, recent evidence suggests that some chemotherapeutic drugs, such as anthracyclines and oxaliplatin, rely on the induction of anticancer immune responses. Immune responses also play a major role in the efficacy of targeted therapies with monoclonal antibodies (Stagg J et al, Breast Care 2012). Studies have shown monoclonal antibodies such as trastuzumab and rituximab rely in part on immunemediated killing through antibody-dependent cellular cytotoxicity (ADCC). While innate immune responses appear to be important for tumor antigen-targeted monoclonal antibody therapies, recent studies in mice and correlative clinical evidence suggest that trastuzumab may also stimulate adaptive antitumor immunity. These studies raise the possibility that combination strategies may be used to capitalize on the adaptive tumor-specific immunity generated by anti-HER2 monoclonal antibodies.
Based on these considerations, we plan to conduct a randomized neoadjuvant study of the combination of trastuzumab, pertuzumab, carboplatin and paclitaxel with or without atezolizumab in women with early high-risk and locally advanced HER2-positive suitable for neoadjuvant therapy. One study arm will also include anthracycline and cyclophosphamide.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
- Model description
- Parallel randomization to the study arms
| Arm | Type | Receives |
|---|---|---|
| HPCT | Active comparator | Drug: Trastuzumab, Drug: Pertuzumab, Drug: Carboplatin, Drug: Paclitaxel, Procedure: SurgeryPatients will receive a combination of trastuzumab, pertuzumab, carboplatin and paclitaxel as neoadjuvant therapy for 6 cycles every 3 weeks. Trastuzumab (H) will be delivered on day 1 at the dose of 8 mg/kg loading dose i.v., then 6 mg/kg i.v. Pertuzumab (P) will be delivered on day 1 at the dose of 840 mg loading dose i.v., then 420 mg i.v. Carboplatin (C) will be administered at AUC 2 i.v. on day 1 and day 8. Paclitaxel (T) will be given at 90 mg/m2 i.v. on day 1 and day 8. Definite surgery will be performed not later than 4 weeks after the last dose of neoadjuvant therapy. Trastuzumab and pertuzumab will then be delivered for 12 additional cycles as adjuvant therapy. |
| ACy followed by HPCT and atezolizumab | Experimental | Drug: Trastuzumab, Drug: Pertuzumab, Drug: Carboplatin, Drug: Paclitaxel, Drug: Doxorubicin, Drug: Cyclophosphamide, Drug: Atezolizumab, Procedure: SurgeryPatients will receive a combination of doxorubicin (A, 60 mg/m2 i.v.), cyclophosphamide (C, 600 mg/m2 i.v.) and atezolizumab (1200 mg i.v.) on day 1 every 3 week for 3 cycles. Subsequently they will be given trastuzumab on day 1 (H, at the loading dose of 8 mg/kg i.v. then 6 mg/kg i.v.), pertuzumab on day 1 (P, at the loading dose of 840 mg .v., then 420 mg i.v.), carboplatin (C) at AUC 2 i.v. on day 1 and day 8, paclitaxel (T) at 90 mg/m2 i.v. on day 1 and day 8, and atezolizumab 1200 mg i.v. on day 1 for 3 cycles every 3 weeks. Definite surgery will be performed not later than 4 weeks after the last dose of neoadjuvant therapy. Trastuzumab and pertuzumab will then be delivered for 15 additional cycles and atezolizumab for 12 additional cycles as adjuvant therapy. |
| HPCT and atezolizumab | Experimental | Drug: Trastuzumab, Drug: Pertuzumab, Drug: Carboplatin, Drug: Paclitaxel, Drug: Atezolizumab, Procedure: SurgeryPatients will receive a combination of trastuzumab, pertuzumab, carboplatin, paclitaxel and atezolizumab as neoadjuvant therapy for 6 cycles every 3 weeks. Trastuzumab (H) will be delivered on day 1 at the dose of 8 mg/kg loading dose i.v., then 6 mg/kg i.v. Pertuzumab (P) will be delivered on day 1 at the dose of 840 mg loading dose i.v., then 420 mg i.v. Carboplatin (C) will be administered at AUC 2 i.v. on day 1 and day 8; paclitaxel (T) will be given at 90 mg/m2 i.v. on day 1 and day 8; atezolizumab at the dose of 1200 mg i.v. on day 1. Definite surgery will be performed not later than 4 weeks after the last dose of neoadjuvant therapy. Trastuzumab, pertuzumab and atezolizumab will then be delivered for 12 additional cycles as adjuvant therapy. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- Female patients aged 18 years or older with early high-risk ((T1cN1; T2N1; T3N0) or locally advanced and inflammatory breast cancers (stage III A-C according to AJCC) suitable for neoadjuvant treatment
- Histologically confirmed unilateral invasive breast cancer
- HER2 positive disease according to ASCO/CAP guidelines 2013 [defined as IHC 3+ or ISH positive (by gene copy number or HER2 gene/CEP17 ratio of 2 or greater)]
- Known estrogen (ER) and progesterone receptor (PgR)
- Availability of a representative paraffin-embedded (FFPE) tumor block taken at diagnostic biopsy for central confirmation of HER2 eligibility, for assessment of ER, PgR, Ki67 and PD-L1 expression and for biomarker evaluation is mandatory. Note: the diagnostic biopsy of the breast lesion may have been taken before the required screening procedures. If diagnostic sentinel node biopsy if performed, an FFPE block must be available. An FFPE tumor block is also mandatory after the first cycle of therapy. Surgery tissue (residual tumor or tumor bed in case of pCR and axillary node material) is also mandatory.
Key exclusion criteria (38 listed)
- Evidence of bilateral breast cancer or metastatic disease (M1)
- Patients with HER2-negative defined as 0-1+ by immunohistochemistry or 2+ by immunohistochemistry without HER2 amplification by either In Situ Hybridization (ISH) or other amplification tests done locally are considered not eligible for the study
- Pregnant or lactating women. Documentation of a negative pregnancy test must be available for premenopausal women with intact reproductive organs and for women less than one year after the last menstrual cycle
- Women with childbearing potential unless (1) surgically sterile or (2) using adequate measures of contraception, for example abstinence, an intra-uterine device, or double barrier method of contraception
- Previous treatment with chemotherapy, hormonal therapy or an investigational drug for any type of malignancy
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| TrastuzumabAlso: HerceptinTrastuzumab will be given i.v. on day 1 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab | Drug | ACy followed by HPCT and atezolizumab, HPCT, HPCT and atezolizumab |
| PertuzumabAlso: PerjetaPertuzumab will be given i.v. on day 1 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab | Drug | ACy followed by HPCT and atezolizumab, HPCT, HPCT and atezolizumab |
| CarboplatinAlso: Carboplatin HospiriaCarboplatin will be given i.v. on day 1 and day 8 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab | Drug | ACy followed by HPCT and atezolizumab, HPCT, HPCT and atezolizumab |
| PaclitaxelAlso: Paclitaxel HospiriaPaclitaxel will be given i.v. on day 1 and day 8 every 3 weeks in arms HPCT, ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab | Drug | ACy followed by HPCT and atezolizumab, HPCT, HPCT and atezolizumab |
| DoxorubicinAlso: Doxorubicin PfizerAdriamycin will be delivered i.v. on day 1 every 3 weeks in arm ACy followed by HPCT for the first 3 cycles | Drug | ACy followed by HPCT and atezolizumab |
| CyclophosphamideAlso: Cyclophosphamide SandozCyclophosphamide will be given i.v. on day 1 every 3 weeks in arm ACy followed by HPCT and atezolizumab for the first 3 cycles | Drug | ACy followed by HPCT and atezolizumab |
| AtezolizumabAlso: TecentriqAtezolizumab will be given i.v. on day 1 every 3 weeks in arm ACy followed by HPCT and atezolizumab and in arm HPCT and atezolizumab | Drug | ACy followed by HPCT and atezolizumab, HPCT and atezolizumab |
| SurgeryBreast cancer surgery (breast and axilla) either conservative or radical not later than 4 weeks from the last dose of neoadjuvant therapy in all study arms | Procedure or surgery | ACy followed by HPCT and atezolizumab, HPCT, HPCT and atezolizumab |
Primary outcome
Event Free Survival (EFS)
Time frame: 5 years after the randomization of the last patient
Assess EFS (disease progression while on neoadjuvant therapy or disease recurrence after surgery) in the study arms
5 secondary outcomes
Pathological complete response (pCR)
Time frame: At surgery, an expected average of 26 weeks after the randomization of the last patients
Clinical objective response
Time frame: Participants will be followed for the duration of neoadjuvant therapy, an expected average of 22 weeks
Distant Event Free Survival (DEFS)
Time frame: 5 years after the randomization of the last patients
Overall Survival (OS)
Time frame: 5 years after the randomization of the last patient
Number of participants with adverse events as a measure of safety and tolerability
Time frame: Participants will be followed for up to 5 years from the last randomized patient
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Mar 2024.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Luca Gianni, MD study chair
Ospedale San Raffaele
65 sites in 4 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Trastuzumab, Pertuzumab and Carboplatin in people with Invasive Breast Cancer, run by Fondazione Michelangelo at 65 sites in 4 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 38 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 6 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 65 sites in Spain, Germany, Italy, Austria. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Event Free Survival (EFS) (time frame: 5 years after the randomization of the last patient). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Mar 2024; AzTrials last refreshed its copy on 8 Nov 2026.