NeoAdjuvant study comparing sacituzumab govitecan versus sacituzumab govitecan+pembrolizumab treatment in low-risk, triple-negative early breast cancer (ADAPT-TN-III)

Overview

Sponsor-declared trial summary

Key facts

Sponsor

WSG Westdeutsche Studiengruppe GmbH

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Neoplasms [C04]

Trial duration

10 Oct 2024 → ongoing

Decision date (initial)

2024-03-28

Transition trial

No

Low-intervention

No

Rare-disease indication

No

Vulnerable population

Yes

Funding sources

Gilead Sciences Ireland UC (GILEAD) · MERCK SHARP & DOHME (MSD)

External identifiers

EU CT number

2023-508787-29-00

ClinicalTrials.gov

NCT06081244

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy, Therapy, Safety

1. The first co-primary objective of the study is to demonstrate superiority of treatment with SG+PEM vs. SG alone with regards to achieved pCR rates.
2. The second co-primary objective is to demonstrate that 3 year-iDFS in the whole study (consisting of two arms) exceeds 88% in historical control.

Secondary objectives 3

1. To assess clinical response in both arms
2. To assess 3-year dDFS, dDFI, relapse free survival (RFS), locoregional relapse free survival (LRFS), breast cancer-free interval (BCFI), and OS in the whole study as well as in both arms
3. To assess health-related quality of life (EORTC-QLQ-C30, version 3.0, EORTC QLQ-BR45, version 1.0)

Conditions and MedDRA coding

Triple-negative early breast cancer with low risk for recurrence

Study design 5 periods

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 18

1. ER + PR negative or low positive (≤10% positive cells in IHC), and HER2 negative (i.e., IHC 0 – 1+ or IHC 2+ with FISH negative) breast cancer
2. All patients, independent from gender
3. ≥18 years at diagnosis
4. Histologically confirmed unilateral, primary invasive carcinoma of the breast Note: bilateral, multicentric, or multifocal carcinoma may be included, if there is a clear target (primary) lesion, that is subject to treatment decisions and solely evaluated and documented for study purposes.
5. Clinical stage I: cT1a-c/cN0,(clinical stage II only, if patient does not qualify for neoadjuvant polychemotherapy+PEM, e.g., elderly population, per investigator´s decision)
6. No clinical evidence for distant metastasis (M0)
7. Tumour block available for central pathology review
8. Performance Status ECOG ≤ 1 or KI ≥ 80 %
9. Negative pregnancy test (urine or serum) within 7 days prior to registration in premenopausal patients
10. Written informed consent prior to beginning specific protocol procedures, including expected cooperation of the patients for the treatment and follow-up, must be obtained and documented according to the local regulatory requirements
11. The patient must be willing and able to comply with the requirements and restrictions in this protocol and accessible for treatment and follow-up
12. Laboratory requirements: • Leucocytes  3.5 109/L, • Neutrophils >1.5 109/L, • Platelets  100 109/L, • Haemoglobin  10 g/dL, • AP < 5.0 ULN, • AST  2.5 x ULN, • ALT  2.5 x ULN, • Total bilirubin  1 x ULN, • Creatinine ≤1.5 × ULN OR clearance ≥30 mL/min for participant with creatinine levels >1.5 × institutional ULN
13. Clinical assessments: • LVEF within normal limits of each institution, measured by echocardiography and normal ECG (within 42 days prior to treatment)
14. The following age-specific requirements apply: • Women aged <50 years will be considered post-menopausal if they have been amenorrhoeic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the post-menopausal range for the site. • Women aged ≥ 50 years will be considered post-menopausal if they have been amenorrhoeic for 12 months or more following cessation of all exogenous hormonal treatments.
15. Females on hormone replacement therapy (HRT) and whose menopausal status is in doubt will be required to use one of the contraception methods outlined for women of child-bearing potential and need to discontinue HRT to allow confirmation of post-menopausal status prior to randomization/study enrolment. For most forms of HRT, at least 2-4 weeks will elapse between the cessation of therapy and the blood draw; this interval depends on the type and dosage of HRT. Following confirmation of their post-menopausal status, they can participate in the study without use of a contraceptive method.
16. Female patients of childbearing potential who are sexually active with a non-sterilized male partner must use at least one highly effective method of contraception, presented in Table 3 (see Section 3.8.2), from the time of enrolment and must agree to continue using such precautions for 7 months after the last dose of investigational medicinal product (IMP). Not all methods of contraception are highly effective. Female patients must refrain from breastfeeding while on study and for 7 months after the last dose of IMP. Complete heterosexual abstinence for the duration of the study and drug washout period is an acceptable contraceptive method if it is line with the patient’s usual lifestyle (consideration must be made to the duration of the clinical trial); however, periodic, or occasional abstinence, the rhythm method, and the withdrawal method are not acceptable.
17. Female patients must not donate, or retrieve for their own use, ova from the time of randomisation and throughout the study treatment period, and for at least 7 months after the final study drug administration. They should refrain from breastfeeding throughout this time. Preservation of ova may be considered prior to enrolment in this study.
18. A male participant must agree to use a contraception as detailed in Appendix C of this protocol during the treatment period and for at least 7 months after the last dose of study treatment and refrain from donating sperm during this period.

Exclusion criteria 16

1. Known hypersensitivity reaction to the compounds or incorporated substances of the IMPs
2. Prior malignancy with a disease-free survival of < 5 years, except curatively treated basalioma of the skin or pTis of the cervix uteri
3. Any history of invasive breast cancer
4. Previous or concurrent treatment with cytotoxic agents for any reason unless clarified with sponsor
5. Concurrent treatment with other experimental drugs.
6. Participation in another interventional clinical trial with or without any investigational not marketed drug within 30 days prior to study entry
7. Concurrent pregnancy; patients of childbearing potential or potentially childbearing partners of male patients must implement a highly effective (less than 1% failure rate) non-hormonal contraceptive measures during the study treatment
8. Breast feeding woman
9. Reasons indicating risk of poor compliance
10. Patients not able to consent
11. Known polyneuropathy ≥ grade 2
12. Severe and relevant co-morbidity that would interact with the application of cytotoxic agents or the participation in the study including recovery from major surgery, autoimmune disease, known psychiatric/substance abuse disorders, acute cystitis, ischuria, and chronic kidney disease
13. Uncontrolled infection requiring i.v. antibiotics, antivirals, or antifungals
14. History of pneumonitis
15. Active primary immunodeficiency, known human immunodeficiency virus (HIV) infection,. Patients should be tested for HIV prior to randomisation if required by local regulations or ethics committee (EC). Patients who test positive for HIV-antibody are excluded.
16. Active hepatitis B virus (HBV) or hepatitis C virus (HCV). In patients with a history of HBV or HCV, patients with detectable viral loads will be excluded. • Patients who test positive for hepatitis B surface antigen (HBsAg). Patients who test positive for hepatitis B core antibody (anti-HBc) will require HBV DNA by quantitative polymerase chain reaction (PCR) for confirmation of active disease. • Patients who test positive for HCV antibody will require HCV RNA by quantitative PCR for confirmation of active disease. Patients with a known history of HCV or a positive HCV antibody test will not require a HCV antibody at enrolment and will only require HCV RNA by quantitative PCR for confirmation of active disease.

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. The two primary endpoints are: • pCR defined as no invasive tumour in breast and lymph nodes (ypT0/is, ypN0) • 3-year iDFS, defined as time from date of first diagnosis to any invasive breast cancer event, death, or secondary malignancy according to STEEP 2.0 criteria

Secondary endpoints 8

1. Clinical response measured by palpation, ultrasound, and mammography
2. Overall survival defined as time from date of first diagnosis to death
3. 3-year dDFS
4. 3-year dDFI
5. 3-year RFS
6. 3-year LRFS
7. 3-year BCFI
8. Change of health-related quality of life between baseline and after defined timepoints: after 2, 4, and 6 cycles (if applicable), before surgery, every 6 months in follow-up until year 3 and yearly afterwards.

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 2

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

WSG Westdeutsche Studiengruppe GmbH

Sponsor organisation

WSG Westdeutsche Studiengruppe GmbH

Address

Fliethstrasse 112-114, Stadtmitte Stadtmitte

City

Moenchengladbach

Postcode

41061

Country

Germany

Scientific contact point

Organisation

WSG Westdeutsche Studiengruppe GmbH

Contact name

Medical Board

Public contact point

Organisation

WSG Westdeutsche Studiengruppe GmbH

Contact name

Secretariat

Locations

1 EU/EEA country · 45 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Oversight and notifications

Regulatory notifications under CTR Articles 38, 52, 53, 54 and 77

Serious breaches 1 · Art. 52 CTR

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 16 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

4 submissions — initial application plus substantial / non-substantial modifications