Triple Negative Breast CancerPhase 2NCT04443348
Pre-op Pembro + Radiation Therapy in Breast Cancer (P-RAD)
A Phase 2 study testing Radiation Therapy Boost, Pembrolizumab and Paclitaxel in people with Triple Negative Breast Cancer and Hormone Receptor Positive (HR+), HER2-negative Breast Cancer, run by Laura M. Spring, MD at 10 sites in United States.
Trial summary
This research trial is studying a combination of neoadjuvant radiotherapy (RT), immunotherapy (pembrolizumab) and chemotherapy for lymph node-positive, triple negative (TN) or hormone receptor positive/HER2-negative breast cancer. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Triple Negative Breast Cancer, Hormone Receptor Positive (HR+), HER2-negative Breast Cancer, Biopsy-proven, Positive Lymph Node(s)
- What is being tested?
- Radiation Therapy Boost, Pembrolizumab and Paclitaxel
- Type of treatment
- Pill or oral medicine, Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 120 participants
- Where
- 10 sitesUnited States
- Study dates
- 16 Dec 2020to 31 Dec 2026
- Phase
- Phase 2
- 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
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age ≥18 years old
- Participant has non-metastatic, T1*-T2 and N1-3 and one of the following histologically confirmed disease subtypes:
- -- Triple negative breast cancer is defined as ER-negative (<1% cells), PR-negative (<1% cells) and HER2-negative (<2+ HER2 IHC or <2.2 HER2/CEP17 ratio by FISH), as per testing at local institution
- High-risk HR+/HER2-negative breast cancer is defined as ER≥1%, HER2-negative (<2+ Her2 IHC or <2.2 HER2/CEP17 ratio by FISH) and either histologic grade II-III or a high-risk genomic assay score (Oncotype RS>25, high risk Mammaprint, PAM-50, EndoPredict or ProSigna score).
- Note: Eligibility requires primary tumor size ≥1.0 cm in maximum diameter and axillary node-positive breast cancer
- Primary breast tumor measuring ≥1.5 cm in maximal diameter as measured by any available standard of care imaging (mammogram, breast ultrasound, breast MRI).
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- Biopsy-proven, axillary lymph node-positive breast cancer at diagnosis. Note: Clinically node-positive disease is classified as cN1-3. cN1: without matted nodes, even if several/multiple appear matted on ultrasound or MRI; cN2: clinically fixed or matted nodes on examination or clinically or imaging-detected internal mammary node involvement.
- Clips or fiducial placement within the biopsy-proven axillary lymph node and breast primary tumor are required.
- Multifocal and multicentric disease is permitted; however only one breast tumor may be preoperatively boosted.
- --Note: For patients with multifocal disease and are randomized to receive a preoperative RT boost, all sites of multifocal disease should be contained within the pre-operative boost volume. Subsequently, these patients will not need a post-op boost.
- Synchronous bilateral invasive breast cancer is permitted; however only one breast tumor may be preoperatively boosted.
- No indication of distant metastases. Staging scans are not required and are per the discretion of the treating physician.
- Neoadjuvant chemotherapy (NAC) with paclitaxel, dose-dense doxorubicin and cyclophosphamide (dd AC) is planned. Note: For TNBC patients, administration of carboplatin is optional, as per MD choice. For HR+ patients, carboplatin will not be administered.
- The boost volume is determined to be able to meet study dose constraints by the treating radiation oncologist.
- Breast-conserving surgery or mastectomy +/- reconstruction is planned following NAC.
- ECOG performance status score of 0 or 1.
- Have adequate organ function as defined in the following table. Bloodwork must be collected within 10 days prior to the start of study treatment.
- Hematological --- Absolute neutrophil count (ANC) ≥1500/µL
- Platelets ≥100 000/µL
- Hemoglobin ≥9.0 g/dL or ≥5.6 mmol/La
- Renal
- --- Creatinine ≤1.5 × ULN OR Measured or calculated b creatinine clearance (GFR can also be used in place of creatinine or CrCl) OR ≥30 mL/min for participant with creatinine levels >1.5 × institutional ULN
- Hepatic
- Total bilirubin ≤1.5 ×ULN OR direct bilirubin ≤ULN for participants with total bilirubin levels >1.5 × ULN
- AST (SGOT) and ALT (SGPT) ≤2.5 × ULN
- Coagulation
- International normalized ratio (INR) OR prothrombin time (PT) Activated partial thromboplastin time (aPTT)
- ≤1.5 × ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants
- ALT (SGPT)=alanine aminotransferase (serum glutamic pyruvic transaminase); AST (SGOT)=aspartate aminotransferase (serum glutamic oxaloacetic transaminase); GFR=glomerular filtration rate; ULN=upper limit of normal.
- Criteria must be met without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within last 2 weeks.
- Creatinine clearance (CrCl) should be calculated per institutional standard.
- Note: This table includes eligibility-defining laboratory value requirements for treatment; laboratory value requirements should be adapted according to local regulations and guidelines for the administration of specific chemotherapies.
- A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least one of the following conditions applies:
- -- a) Not a woman of childbearing potential (WOCBP) OR b) A WOCBP who agrees to follow the contraceptive guidance throughout the study and for at least 4 months after the last dose of pembrolizumab in such a manner that the risk of pregnancy is minimized.
- A male participant must agree to use a contraception as detailed in Appendix A of this protocol during the treatment period and for at least 4 months after the last dose of after the last dose of study treatment and refrain from donating sperm during this period.
- Willingness to adhere to the study visit schedule and the prohibitions and restrictions specified in this protocol.
- Willingness to undergo mandatory research biopsy of the breast tumor between weeks 2-3 of Cycle 1.
- Written informed consent obtained from participant and ability for participant to comply with the requirements of the study.
- Patients unable to read/write English are eligible to participate in the overall study, but will not be required to participate in the Patient-Reported Outcome questionnaires.
Who cannot join
- HER2-positive breast cancer by ASCO/CAP guidelines (HER2 IHC 3+ or ≥ 2.2 HER2/CEP17 ratio by FISH)
- Inflammatory (cT4d) breast cancer
- Metastatic breast cancer (M1)
- Contraindication(s) to breast-conserving therapy or mastectomy
- Contraindication to radiation therapy including: prior ipsilateral breast or mantle RT, active scleroderma, systemic lupus erythematosis and pregnancy.
- --Note: All cardiac implantable electronic devices are permitted, provided that methods to assess radiation doses and minimize damage to the devices during RT is planned, per institutional guidelines.
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- Prior ipsilateral breast, chest wall or thoracic radiotherapy
- Prior ipsilateral invasive breast cancer, contralateral breast cancer or a known additional, invasive malignancy that is progressing or required active treatment in the last 5 years.
- --Note: Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin or cervical carcinoma in situ that has undergone potentially curative therapy and a previous diagnosis of ductal carcinoma in situ are not excluded.
- Has a known history of active tuberculosis (Bacillus tuberculosis
- Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX 40, CD137).
- Has received prior systemic anti-cancer therapy including investigational agents within 4 weeks prior to randomization.
- --Note: Participants must have recovered from all AEs due to previous therapies to ≤ Grade 1 or baseline. Participants with ≤ Grade 2 neuropathy may be eligible. If participant received major surgery, she/he must have recovered adequately from the toxicity and/or complications from the intervention prior to starting study treatment.
- Has a history of (non-infectious) pneumonitis that required steroids or has current pneumonitis.
- Has known severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients.
- Participants with active, known or suspected autoimmune disease. Participants with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
- Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
- Known history of Human Immunodeficiency Virus (HIV). Note: No HIV testing is required unless mandated by local health authorities.
- Known active Hepatitis B (defined as hepatitis B surface antigen [HBsAg] reactive) or known active hepatitis C virus (defined as HCV RNA [qualitative] is detected). Note: Testing for hepatitis B or hepatitis C is not required, unless mandated by local health authorities or institutional guidelines.
- Has received a live vaccine within 30 days prior to the first dose of study drug. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. FluMist®) are live attenuated vaccines and are not allowed.
- Has had an allogenic tissue/solid organ transplant
- A WOCBP who has a positive urine pregnancy test within 72 hours before the first dose of study treatment (see Appendix A). If the urine test cannot be confirmed as negative, a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
- Prohibited Treatments and/or Therapies:Use of immunosuppressants and/or systemic corticosteroids is exclusionary, except the following in the absence of active autoimmune disease:
- As premedication for chemotherapy
- For the prevention of nausea in the three days following chemotherapy
- Participants are permitted the use of corticosteroids with minimal systemic absorption (e.g. topical, ocular, intra-articular, intranasal and inhaled)
- Systemic corticosteroids at physiologic doses ≤ 10 mg/day of prednisone or equivalent permitted
- Adrenal replacement steroid doses including doses >10 mg daily prednisone is permitted
- A brief (less than 3 weeks) course of corticosteroids for prophylaxis (e.g. CT scan premedication against contrast dye allergy) or for treatment of non-autoimmune conditions (e.g. delayed-type hypersensitivity reaction caused by a contact allergen is permitted (used in the management of cancer or non-cancer-related illnesses). However, use of corticosteroids is allowed for the treatment of immune-related Adverse Events (irAEs), or adrenal insufficiency.
Trial locations and contacts
10 sites in 1 country.
10 sites in 1 country
United States10 sites
Johns Hopkins
Baltimore, Maryland, 21231
Massachusetts General Hospital
Boston, Massachusetts, 02115
Dana Farber Cancer Institute
Boston, Massachusetts, 02215
University of North Carolina Medical Center
Chapel Hill, North Carolina, 27514
Duke University Medical Center
Durham, North Carolina, 27710
MD Anderson Cancer Center
Houston, Texas, 77030
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
Mayo Clinic - Rochester
Rochester, Minnesota, 55905
Montefiore Medical Center
The Bronx, New York, 10467
Sibley Memorial Hospital
Washington D.C., District of Columbia, 20016
About this study
Official title: P-RAD: A Randomized Study of Preoperative Chemotherapy, Pembrolizumab and No, Low or High Dose RADiation in Node-Positive, HER2-Negative Breast Cancer
This research trial is studying a combination of neoadjuvant radiotherapy (RT), immunotherapy (pembrolizumab) and chemotherapy for lymph node-positive, triple negative (TN) or hormone receptor positive/HER2-negative breast cancer.
The names of the study interventions involved in this study are:
- Radiation Therapy (RT)
- Immunotherapy: Pembrolizumab (MK-3475)
- Chemotherapies:
- Paclitaxel
- Doxorubicin (also called Adriamycin)
- Cyclophosphamide
- Carboplatin (optional, and in TN only)
- Capecitabine (optional, and in TN only)
Read the detailed description
The main purpose of this study is to find out what is the best dose of preoperative RT when combined with pembrolizumab and chemotherapy. The study will assess if combining the RT with the immunotherapy agent, pembrolizumab, will increase the ability of the immune system to destroy cancer cells.
The research study procedures include: screening for eligibility and study treatment, including evaluations and follow-up visits.
The study aims to assess the effectiveness of pembrolizumab (study drug) with or without RT directed to the breast tumor. Participants will then undergo neoadjuvant chemotherapy with pembrolizumab, followed by treatment that can consist of one or more of the following:
- Pembrolizumab (optional, per MD discretion)
- Standard of Care Treatment
- Breast surgery (lumpectomy or mastectomy) and axillary surgery
- Adjuvant radiation to the entire breast or chest wall, plus or minus the lymph nodes after surgery
- Adjuvant chemotherapy (optional Capecitabine for TNBC patients)
- Hormone therapy
Participants will be randomized to 1 of 3 groups. Neither the participant not the research doctor will choose the group that the participant is assigned to. However, the participant will be notified of the group prior to the start of study treatment. Participants will receive study treatment for up to 13 months. Participants will be followed for 2 years after the end of the study treatment.
It is expected that a total of 120 people will be participating in total.
This research study is a randomized, phase II study. The U.S. Food and Drug Administration (FDA) has not approved pembrolizumab for your specific disease, but it has been approved for other uses. The U.S. Food and Drug Administration (FDA) has approved the chemotherapies being used in this study (Paclitaxel, Doxorubicin, Cyclophosphamide, Carboplatin, Capecitabine).
- Conditions
- Triple Negative Breast Cancer, Hormone Receptor Positive (HR+), HER2-negative Breast Cancer, Biopsy-proven, Positive Lymph Node(s)
- Being tested
- Radiation Therapy Boost, Pembrolizumab, Paclitaxel, Carboplatin, Cyclophosphamide
- Keywords
- Triple Negative Breast Cancer, Hormone Receptor Positive breast cancer, Estrogen Receptor Positive breast cancer
- Medical subject headings
- Triple Negative Breast Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Radiation Therapy BoostRadiation
Participants randomized to the low-dose or high-dose RT boost group will be receiving treatment on Day 1-3 of Cycle 1 of pembrolizumab. Proton therapy may be used in the high dose RT group.
PembrolizumabDrug
Also called Keytruda®.
Neoadjuvant Phase: Day 1 (once every 6 weeks) of Cycles 1-4 (by intravenous infusion) over about 30 minutes.
Adjuvant Phase: Pembrolizumab may be given post-surgery for up to 4 cycles (once every 6 weeks) by intravenous infusion over about 30 minutes. Pembrolizumab after surgery is optional and should be discussed with the study doctor.
PaclitaxelDrug
Also called Taxol
Starting Week 3 and administered once per week for 12 weeks (up to 12 doses) by intravenous infusion over about 30 minutes.
CarboplatinDrug
Also called Paraplatin
Carboplatin is optional for TNBC patients and should be discussed with the study doctor.
Starting Week 3 and administered once per week for 12 weeks (up to 12 doses) by intravenous infusion over about 30 minutes.
CyclophosphamideDrug
Also called Cytophosphane
Starting Week 15 and administered every 2 weeks for 4 cycles (up to 4 doses) into your vein (by intravenous infusion).
DoxorubicinDrug
Also called Adriamycin
Starting Week 15 and administered every 2 weeks for 4 cycles (up to 4 doses) into your vein (by intravenous infusion). Doxorubicin will be administered after pembrolizumab.
CapecitabineDrug
Capecitabine after surgery is optional for TNBC patients and should be discussed with the study doctor.
Starting 3-6 weeks after surgery, administered orally twice daily for 6 courses, each 3 weeks long (for a total of 18 weeks).
| Study group | Role | What they receive |
|---|---|---|
| Group A (No RT Boost) | Experimental | No RT boost plus pembrolizumab, followed by pembrolizumab plus paclitaxel, doxorubicin and cyclophosphamide chemotherapy.There will be up to a total of 8 cycles of pembrolizumab (4 cycle before surgery and 4 cycles after surgery at the discretion of the study doctor). Receives: Drug: Pembrolizumab; Drug: Paclitaxel; Drug: Carboplatin; Drug: Cyclophosphamide; Drug: Doxorubicin; Drug: Capecitabine |
| Group B (Low Dose RT Boost) | Experimental | Low-dose RT boost plus pembrolizumab, followed by pembrolizumab plus paclitaxel, doxorubicin and cyclophosphamide chemotherapy. There will be up to a total of 8 cycles of pembrolizumab (4 cycle before surgery and 4 cycles after surgery at the discretion of the study doctor). Receives: Radiation: Radiation Therapy Boost; Drug: Pembrolizumab; Drug: Paclitaxel; Drug: Carboplatin; Drug: Cyclophosphamide; Drug: Doxorubicin; Drug: Capecitabine |
| Group C (High Dose RT Boost) | Experimental | High-dose RT boost plus pembrolizumab followed by pembrolizumab plus paclitaxel, doxorubicin and cyclophosphamide chemotherapy. There will be up to a total of 8 cycles of pembrolizumab (4 cycle before surgery and 4 cycles after surgery at the discretion of the study doctor). Receives: Radiation: Radiation Therapy Boost; Drug: Pembrolizumab; Drug: Paclitaxel; Drug: Carboplatin; Drug: Cyclophosphamide; Drug: Doxorubicin; Drug: Capecitabine |
What is being measured
The primary outcome is the main question the study is designed to answer.
Tumor Infiltrating Lymphocytes (TILs; CD3+/CD8+ T-cell Breast Immunoscore)
Quantitative immunofluorescence in post-treatment tumor biopsy samples collected on day 14-21 of C1 of Pembrolizumab.
Measured: 14 through 21 Days
Rate of pathologic response in the lymph node
Defined as the percentage of patients no evidence of residual cancer cells in all sampled regional lymph nodes following completion of neoadjuvant systemic therapy assessed by the study pathologist at the time of definitive surgery.
Measured: 7 Months
Secondary outcomes (17)
Residual Cancer Burden (RCB) score
RCB is a measure of residual cancer burden in the breast and regional lymph nodes at the time of definitive surgery following completion of neoadjuvant systemic therapy.
Measured: 24 Weeks
Pathologic response rate
Pathologic response rate is measured by the presence or absence of residual cancer cells in all sampled regional lymph nodes. RCB measures residual disease in the breast and lymph nodes at the time of definitive surgery. CD3+/CD8+ T cell Breast Immunoscore greater than 75% versus patients with Post-treatment CD3+/CD8+ T cell Breast Immunoscore less than or equal to 75%.
Measured: 24 Weeks
Percent change in pre- versus post-treatment intra-tumoral TILs
Intra-tumoral, peri-tumoral and stromal CD3+, CD8+, and CD3+CD8+ T cell densities will be measured using pan-cytokeratin staining and multiplexed QIF
Measured: 24 Weeks
Percent changes in pre- versus post-treatment peri-tumoral
Intra-tumoral, peri-tumoral and stromal CD3+, CD8+, and CD3+CD8+ T cell densities will be measured using pan-cytokeratin staining and multiplexed QIF
Measured: 24 Weeks
Percent changes in pre- versus post-treatment stromal CD3+ or CD8+ T cell
Intra-tumoral, peri-tumoral and stromal CD3+, CD8+, and CD3+CD8+ T cell densities will be measured using pan-cytokeratin staining and multiplexed QIF
Measured: 24 Weeks
Change in TIL counts by H&E in pre-treatment versus post-RT boost tumor biopsy
TIL counts by H\&E in pre-treatment versus post-RT boost tumor biopsy specimens in each RT dose and breast cancer subtype cohort.
H\&E will be performed according to Salgado Criteria [1].
Measured: 24 Weeks
Changes in PD-L1 expression
To quantify changes in PD-L1 expression levels after treatment with Pembro + no, low or high RT boost (at the time of the time of interval biopsy).
QIF for PD-L1 will be performed in pre- and post-treatment FFPE tumor biopsy samples.
Measured: 24 Weeks
Changes in intratumoral, per-tumoral, and stromal CD4+Foxp3+ T regulatory cell densities
To quantify changes in intratumoral, per-tumoral, and stromal CD4+Foxp3+ T regulatory cell densities in response to treatment with preoperative Pembro + no, low, or high dose RT boost (at the time of interval biopsy).
QIF for CD4 and Foxp3 will be performed in pre- and post-treatment FFPE tumor biopsy samples. Pan-cytokeratin staining will be used to identify tumor regions
Measured: 24 Weeks
Number of Participants with Treatment Related Adverse Events as Assessed NCI CTCAE version 5.0
NCI CTCAE version 5.0
Measured: Baseline up 6 months post surgery up to 13 months
Invasive disease-free survival
iDFS is defined as time from completion of surgery to the first occurrence of the following events: invasive ipsilateral, local, regional, or distant recurrence, or death due to breast cancer.
Measured: time from completion of surgery to the first occurrence of the following events: invasive ipsilateral, local, regional, or distant recurrence, or death due to breast cancer up to 31 months
Event-free survival (EFS)
EFS is defined as the time from the initiation of the study treatment to any of the following events: progression of disease (precluding surgery), recurrence (local or distant), or death due to any cause.
Measured: time from completion of surgery to the first occurrence of the following events: progression of disease (precluding surgery), recurrence (local or distant), or death due to any cause up to 31 months.
Symptomatic Improvement
PROMIS Global Health Measure Quality of life (e.g., global, physical, mental, and social health) outcomes will be measured by two PROMIS (Patient-Reported Outcomes Measurement Information System) short forms consisting of 4 questions total. This instrument has demonstrated content-validity, cross-sectional validity, and responsiveness to change in numerous publications[93].
Measured: baseline to 21 Weeks
Change in Symptoms and Satisfaction with Treatment
(Breast-Q), four domains will be evaluated both before and after surgery: satisfaction with breasts, psychosocial, sexual, and physical well-being. Scores for each domain range from 0-100, with higher scores indicative of better quality of life
Measured: baseline to Week 3
Change in Symptoms and Satisfaction with Treatment
(Breast-Q), four domains will be evaluated both before and after surgery: satisfaction with breasts, psychosocial, sexual, and physical well-being. Scores for each domain range from 0-100, with higher scores indicative of better quality of life
Measured: baseline to week 21
Change Patient Reported Outcomes
PRO-CTCAE will evaluate symptom burden in the previous week using a Likert scale to assess presence/absence, frequency, severity and/or interference for different symptoms. Each symptom will be presented descriptively, using summary statistics and graphical representations across time points.
Measured: 3 years
Financial Burden
Recently coined term used to describe the potential financial burden patients experience while receiving medical care. Two questions were adapted from the National Health Interview Survey[95] and a survey administered to caregivers of participants of the Cancer Car Outcomes Research and Surveillance (CanCORS) study[96] to assess financial burden and impact on employment-related metrics (e.g., sick leave, unpaid time off work). Financial burden will be assessed at the post-surgery visit.
Measured: 3 to 6 wks after last dose in the Neoadjuvant Period up to 8 Months
Trial Satisfaction
The Was It Worth It (WIWI) instrument, also called the "Trial Satisfaction" survey, was developed to investigate the patient experience on clinical trials. Multiple cooperative group studies have utilized this instrument at the completion of treatment to measure patient satisfaction relating to clinical trial enrollment, although formal validity and reliability data is not yet available[
Measured: 3 to 6 wks after last dose in the Neoadjuvant Period up to 8 Months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jun 2020
- Study start16 Dec 2020
- Primary completion31 Dec 2025
- Study completion31 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Triple Negative 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 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 120 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Laura M. Spring, MD
- Sponsor type
- University, hospital or other
- Collaborators
- Merck Sharp & Dohme LLC, Breast Cancer Research Foundation, Translational Breast Cancer Research Consortium
- Responsible party
- Sponsor-investigator, Laura M. Spring, MD, Massachusetts General Hospital
- Investigators
- Laura M Spring, MD, Principal investigator, Massachusetts General Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04443348
- Sponsor's protocol ID
- 20-157
- Status last verified
- Jul 2026
- First submitted
- 19 Jun 2020
- Last updated
- 13 Jul 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- Yes
- Individual data sharing
- Yes: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to Sponsor Investigator or designee. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
Study at a glance
From the registry record, last updated by the sponsor on 13 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- P-RAD: A Randomized Study of Preoperative Chemotherapy, Pembrolizumab and No, Low or High Dose RADiation in Node-Positive, HER2-Negative Breast Cancer
- ClinicalTrials.gov ID
- NCT04443348
- Acronym / sponsor ID
- 20-157
- Conditions
- Triple Negative Breast Cancer, Hormone Receptor Positive (HR+), HER2-negative Breast Cancer, Biopsy-proven, Positive Lymph Node(s)
- Keywords
- Triple Negative Breast Cancer, Hormone Receptor Positive breast cancer, Estrogen Receptor Positive breast cancer
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 120 participants (estimated)
- Lead sponsor
- Laura M. Spring, MDUniversity, hospital or other
- Collaborators
- Merck Sharp & Dohme LLC, Breast Cancer Research Foundation, Translational Breast Cancer Research Consortium
- Study start
- 16 Dec 2020 (actual)
- Primary completion
- 31 Dec 2025 (actual)
- Study completion
- 31 Dec 2026 (estimated)
- First posted
- 23 Jun 2020 (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.
This research trial is studying a combination of neoadjuvant radiotherapy (RT), immunotherapy (pembrolizumab) and chemotherapy for lymph node-positive, triple negative (TN) or hormone receptor positive/HER2-negative breast cancer.
The names of the study interventions involved in this study are:
- Radiation Therapy (RT)
- Immunotherapy: Pembrolizumab (MK-3475)
- Chemotherapies:
- Paclitaxel
- Doxorubicin (also called Adriamycin)
- Cyclophosphamide
- Carboplatin (optional, and in TN only)
- Capecitabine (optional, and in TN only)
Detailed description
The main purpose of this study is to find out what is the best dose of preoperative RT when combined with pembrolizumab and chemotherapy. The study will assess if combining the RT with the immunotherapy agent, pembrolizumab, will increase the ability of the immune system to destroy cancer cells.
The research study procedures include: screening for eligibility and study treatment, including evaluations and follow-up visits.
The study aims to assess the effectiveness of pembrolizumab (study drug) with or without RT directed to the breast tumor. Participants will then undergo neoadjuvant chemotherapy with pembrolizumab, followed by treatment that can consist of one or more of the following:
- Pembrolizumab (optional, per MD discretion)
- Standard of Care Treatment
- Breast surgery (lumpectomy or mastectomy) and axillary surgery
- Adjuvant radiation to the entire breast or chest wall, plus or minus the lymph nodes after surgery
- Adjuvant chemotherapy (optional Capecitabine for TNBC patients)
- Hormone therapy
Participants will be randomized to 1 of 3 groups. Neither the participant not the research doctor will choose the group that the participant is assigned to. However, the participant will be notified of the group prior to the start of study treatment. Participants will receive study treatment for up to 13 months. Participants will be followed for 2 years after the end of the study treatment.
It is expected that a total of 120 people will be participating in total.
This research study is a randomized, phase II study. The U.S. Food and Drug Administration (FDA) has not approved pembrolizumab for your specific disease, but it has been approved for other uses. The U.S. Food and Drug Administration (FDA) has approved the chemotherapies being used in this study (Paclitaxel, Doxorubicin, Cyclophosphamide, Carboplatin, Capecitabine).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Group A (No RT Boost) | Experimental | Drug: Pembrolizumab, Drug: Paclitaxel, Drug: Carboplatin, Drug: Cyclophosphamide, Drug: Doxorubicin, Drug: CapecitabineNo RT boost plus pembrolizumab, followed by pembrolizumab plus paclitaxel, doxorubicin and cyclophosphamide chemotherapy.There will be up to a total of 8 cycles of pembrolizumab (4 cycle before surgery and 4 cycles after surgery at the discretion of the study doctor). |
| Group B (Low Dose RT Boost) | Experimental | Radiation: Radiation Therapy Boost, Drug: Pembrolizumab, Drug: Paclitaxel, Drug: Carboplatin, Drug: Cyclophosphamide, Drug: Doxorubicin, Drug: CapecitabineLow-dose RT boost plus pembrolizumab, followed by pembrolizumab plus paclitaxel, doxorubicin and cyclophosphamide chemotherapy. There will be up to a total of 8 cycles of pembrolizumab (4 cycle before surgery and 4 cycles after surgery at the discretion of the study doctor). |
| Group C (High Dose RT Boost) | Experimental | Radiation: Radiation Therapy Boost, Drug: Pembrolizumab, Drug: Paclitaxel, Drug: Carboplatin, Drug: Cyclophosphamide, Drug: Doxorubicin, Drug: CapecitabineHigh-dose RT boost plus pembrolizumab followed by pembrolizumab plus paclitaxel, doxorubicin and cyclophosphamide chemotherapy. There will be up to a total of 8 cycles of pembrolizumab (4 cycle before surgery and 4 cycles after surgery at the discretion of the study doctor). |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (39 listed)
- Age ≥18 years old
- Participant has non-metastatic, T1*-T2 and N1-3 and one of the following histologically confirmed disease subtypes:
- -- Triple negative breast cancer is defined as ER-negative (<1% cells), PR-negative (<1% cells) and HER2-negative (<2+ HER2 IHC or <2.2 HER2/CEP17 ratio by FISH), as per testing at local institution
- Primary breast tumor measuring ≥1.5 cm in maximal diameter as measured by any available standard of care imaging (mammogram, breast ultrasound, breast MRI).
- Biopsy-proven, axillary lymph node-positive breast cancer at diagnosis. Note: Clinically node-positive disease is classified as cN1-3. cN1: without matted nodes, even if several/multiple appear matted on ultrasound or MRI; cN2: clinically fixed or matted nodes on examination or clinically or imaging-detected internal mammary node involvement.
Key exclusion criteria (29 listed)
- HER2-positive breast cancer by ASCO/CAP guidelines (HER2 IHC 3+ or ≥ 2.2 HER2/CEP17 ratio by FISH)
- Inflammatory (cT4d) breast cancer
- Metastatic breast cancer (M1)
- Contraindication(s) to breast-conserving therapy or mastectomy
- Contraindication to radiation therapy including: prior ipsilateral breast or mantle RT, active scleroderma, systemic lupus erythematosis and pregnancy.
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 |
|---|---|---|
| Radiation Therapy BoostParticipants randomized to the low-dose or high-dose RT boost group will be receiving treatment on Day 1-3 of Cycle 1 of pembrolizumab. Proton therapy may be used in the high dose RT group. | Radiation | Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
| PembrolizumabAlso: Keytruda®.Neoadjuvant Phase: Day 1 (once every 6 weeks) of Cycles 1-4 (by intravenous infusion) over about 30 minutes. Adjuvant Phase: Pembrolizumab may be given post-surgery for up to 4 cycles (once every 6 weeks) by intravenous infusion over about 30 minutes. Pembrolizumab after surgery is optional and should be discussed with the study doctor. | Drug | Group A (No RT Boost), Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
| PaclitaxelAlso: TaxolStarting Week 3 and administered once per week for 12 weeks (up to 12 doses) by intravenous infusion over about 30 minutes. | Drug | Group A (No RT Boost), Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
| CarboplatinAlso: ParaplatinCarboplatin is optional for TNBC patients and should be discussed with the study doctor. Starting Week 3 and administered once per week for 12 weeks (up to 12 doses) by intravenous infusion over about 30 minutes. | Drug | Group A (No RT Boost), Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
| CyclophosphamideAlso: CytophosphaneStarting Week 15 and administered every 2 weeks for 4 cycles (up to 4 doses) into your vein (by intravenous infusion). | Drug | Group A (No RT Boost), Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
| DoxorubicinAlso: AdriamycinStarting Week 15 and administered every 2 weeks for 4 cycles (up to 4 doses) into your vein (by intravenous infusion). Doxorubicin will be administered after pembrolizumab. | Drug | Group A (No RT Boost), Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
| CapecitabineCapecitabine after surgery is optional for TNBC patients and should be discussed with the study doctor. Starting 3-6 weeks after surgery, administered orally twice daily for 6 courses, each 3 weeks long (for a total of 18 weeks). | Drug | Group A (No RT Boost), Group B (Low Dose RT Boost), Group C (High Dose RT Boost) |
Primary outcome
Tumor Infiltrating Lymphocytes (TILs; CD3+/CD8+ T-cell Breast Immunoscore)
Time frame: 14 through 21 Days
Quantitative immunofluorescence in post-treatment tumor biopsy samples collected on day 14-21 of C1 of Pembrolizumab.
Rate of pathologic response in the lymph node
Time frame: 7 Months
Defined as the percentage of patients no evidence of residual cancer cells in all sampled regional lymph nodes following completion of neoadjuvant systemic therapy assessed by the study pathologist at the time of definitive surgery.
17 secondary outcomes
Residual Cancer Burden (RCB) score
Time frame: 24 Weeks
Pathologic response rate
Time frame: 24 Weeks
Percent change in pre- versus post-treatment intra-tumoral TILs
Time frame: 24 Weeks
Percent changes in pre- versus post-treatment peri-tumoral
Time frame: 24 Weeks
Percent changes in pre- versus post-treatment stromal CD3+ or CD8+ T cell
Time frame: 24 Weeks
Change in TIL counts by H&E in pre-treatment versus post-RT boost tumor biopsy
Time frame: 24 Weeks
Changes in PD-L1 expression
Time frame: 24 Weeks
Changes in intratumoral, per-tumoral, and stromal CD4+Foxp3+ T regulatory cell densities
Time frame: 24 Weeks
Number of Participants with Treatment Related Adverse Events as Assessed NCI CTCAE version 5.0
Time frame: Baseline up 6 months post surgery up to 13 months
Invasive disease-free survival
Time frame: time from completion of surgery to the first occurrence of the following events: invasive ipsilateral, local, regional, or distant recurrence, or death due to breast cancer up to 31 months
Event-free survival (EFS)
Time frame: time from completion of surgery to the first occurrence of the following events: progression of disease (precluding surgery), recurrence (local or distant), or death due to any cause up to 31 months.
Symptomatic Improvement
Time frame: baseline to 21 Weeks
Change in Symptoms and Satisfaction with Treatment
Time frame: baseline to Week 3
Change in Symptoms and Satisfaction with Treatment
Time frame: baseline to week 21
Change Patient Reported Outcomes
Time frame: 3 years
Financial Burden
Time frame: 3 to 6 wks after last dose in the Neoadjuvant Period up to 8 Months
Trial Satisfaction
Time frame: 3 to 6 wks after last dose in the Neoadjuvant Period up to 8 Months
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 13 Jul 2026.
- Individual participant dataSharing planned: Yes. The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to Sponsor Investigator or designee. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
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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.
Laura M Spring, MD principal investigator
Massachusetts General Hospital
10 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Radiation Therapy Boost, Pembrolizumab and Paclitaxel in people with Triple Negative Breast Cancer and Hormone Receptor Positive (HR+), HER2-negative Breast Cancer, run by Laura M. Spring, MD at 10 sites in United States.
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 39 inclusion and 29 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 13 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 10 sites in United States. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
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?
Tumor Infiltrating Lymphocytes (TILs; CD3+/CD8+ T-cell Breast Immunoscore) (time frame: 14 through 21 Days). The study lists 2 primary outcomes in all. 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 13 Jul 2026.