Phase II Breast Ca Carboplatin + Paclitaxel With Pertuzumab + Trastuzumab or Bevacizumab

Sponsor

University of California, Irvine (Other)

Overall Status

Recruiting

CT.gov ID

NCT02436993

Collaborator

(none)

120

Enrollment

Location

Arms

Duration (Months)

1.3

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this phase II is to study the efficacy and toxicity of carboplatin and paclitaxel with pertuzumab and trastuzumab in HER2 positive and carboplatin and paclitaxel with bevacizumab in HER2 negative in the neoadjuvant setting for the treatment of breast cancer.

Condition or Disease	Intervention/Treatment	Phase
Breast Carcinoma	Drug: Carboplatin Drug: Paclitaxel Drug: Bevacizumab Drug: Trastuzumab Drug: Pertuzumab	Phase 2

Detailed Description

OBJECTIVES The study component is to evaluate the treatment response and toxicity of the protocol.

Objectives for treatment study component:

1.1 To estimate 2-year progression-free survival in patients with breast cancer with tumor more than 1 cm and/or with clinically detected lymph node treated with neoadjuvant weekly Carboplatin and Paclitaxel combined with Trastuzumab + Pertuzumab in HER2-positive disease or with Bevacizumab in HER2-negative disease.

1.2 To measure the microscopic complete pathological response (pCR) rates defined as ypT0 or ypTis tumors in patients treated with this regimen in the neoadjuvant setting.

1.3 To assess complete clinical response (cCR) rates after treatment by physical exam and imaging tests (ultrasonography, mammography, or magnetic resonance imaging) clinical objective response rate (by Response Evaluation Criteria In Solid Tumors (RECIST)) 1.4 To determine the toxicity of this regimen. 1.5 To determine treatment adherence and delivered dose intensity of this regimen.

1.6 To assess the correlation between pCR and cCR. 1.7 To determine the rate of breast conservation following neoadjuvant therapy. 1.8 Determine treatment efficacy according to subgroups defined according to stage and receptor status.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

120 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase II Study of Breast Cancer Treatment Using Weekly Carboplatin + Paclitaxel With Pertuzumab + Trastuzumab (HER2+) or Bevacizumab (HER2-) in the Neoadjuvant Setting

Study Start Date :

Apr 1, 2015

Anticipated Primary Completion Date :

Dec 1, 2021

Anticipated Study Completion Date :

Dec 1, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Carboplatin+Paclitaxel+Bevacizumab (HER2-) Carboplatin weekly 12 doses Paclitaxel weekly 12 doses Bevacizumab every other week, 5 doses	Drug: Carboplatin Area Under the Curve (AUC) 2 IV over 60 minutes weekly for 12 doses Other Names: Paraplatin Drug: Paclitaxel 80 mg/m^2 IV over 1-3 hours weekly for 12 doses Other Names: Taxol Drug: Bevacizumab 10mg/kg IV over 90 or 60 or 30 minutes every other week for 5 doses Other Names: Avastin
Experimental: Carboplatin+Paclitaxel+Trastuzumab+Pertuzumab (HER2+) Carboplatin weekly 12 doses Paclitaxel weekly 12 doses Trastuzumab weekly 12 doses Pertuzumab every 3 weeks, 4 doses	Drug: Carboplatin Area Under the Curve (AUC) 2 IV over 60 minutes weekly for 12 doses Other Names: Paraplatin Drug: Paclitaxel 80 mg/m^2 IV over 1-3 hours weekly for 12 doses Other Names: Taxol Drug: Trastuzumab 4mg/kg induction, followed by weekly 2mg/kg IV-induction over 90 minutes, then weekly over 30-60 minutes for 12 doses Other Names: Herceptin Drug: Pertuzumab 840mg induction, followed by 420mg every 3 weeks IV-induction over 60 minutes, then every 3 weeks over 30-60 minutes for 4 doses Other Names: Perjeta

Arm

Intervention/Treatment

Experimental: Carboplatin+Paclitaxel+Bevacizumab (HER2-)

Carboplatin weekly 12 doses Paclitaxel weekly 12 doses Bevacizumab every other week, 5 doses

Drug: Carboplatin

Area Under the Curve (AUC) 2 IV over 60 minutes weekly for 12 doses

Other Names:

Paraplatin

Drug: Paclitaxel

80 mg/m^2 IV over 1-3 hours weekly for 12 doses

Other Names:

Taxol

Drug: Bevacizumab

10mg/kg IV over 90 or 60 or 30 minutes every other week for 5 doses

Other Names:

Avastin

Experimental: Carboplatin+Paclitaxel+Trastuzumab+Pertuzumab (HER2+)

Carboplatin weekly 12 doses Paclitaxel weekly 12 doses Trastuzumab weekly 12 doses Pertuzumab every 3 weeks, 4 doses

Drug: Carboplatin

Area Under the Curve (AUC) 2 IV over 60 minutes weekly for 12 doses

Other Names:

Paraplatin

Drug: Paclitaxel

80 mg/m^2 IV over 1-3 hours weekly for 12 doses

Other Names:

Taxol

Drug: Trastuzumab

4mg/kg induction, followed by weekly 2mg/kg IV-induction over 90 minutes, then weekly over 30-60 minutes for 12 doses

Other Names:

Herceptin

Drug: Pertuzumab

840mg induction, followed by 420mg every 3 weeks IV-induction over 60 minutes, then every 3 weeks over 30-60 minutes for 4 doses

Other Names:

Perjeta

Outcome Measures

Primary Outcome Measures

2-year progression free survival in patients treated with weekly carboplatin and paclitaxel combined with either trastuzumab and pertuzumab for HER2-positive patients or bevacizumab for HER2-negative patients in the neoadjuvant setting [2 years]
Progression of disease-A new lesion or a greater than or equal to 25% increase in the product of the largest perpendicular diameters of any one lesion on clinical exam or by U/S or MRI Survival-from date of registration to date of death

Secondary Outcome Measures

Clinical complete response rates [2 years]
Clinical complete response (cCR)-Normal breast on physical exam. No mass, no thickening, no erythema, no peau d'orange
Pathologic complete response rates [2 years]
Pathologic complete response (pCR)-No histologic evidence of microscopic invasive tumor at the primary tumor site in the surgical specimen (ypT0 or DCis)
Number of toxicities in Carboplatin+Paclitaxel+Bevacizumab (HER2) arm [Up to 42 days after discontinued treatment]
This study will utilize the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 for toxicity and Adverse Event reporting.
Number of toxicities in Carboplatin+Paclitaxel+Trastuzumab+Pertuzumab (HER2+) [Up to 42 days after discontinued treatment]
This study will utilize the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 for toxicity and Adverse Event reporting.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Inclusion Criteria:

Histologically proven unilateral or bilateral primary breast carcinoma. (In case of bilateral cancer, the investigator has to decide prospectively which side will be evaluated for the primary endpoint.)
Tumor size is clinically at least 1 cm in greatest diameter (palpable or by imaging) and/or with involved lymph node. In case of inflammatory disease, the extent of inflammation may be the measurable lesion.
Documentation of inflammatory breast cancer
Woman age > or = 18
Performance status of 0-2 by Eastern Cooperative Oncology Group (ECOG) criteria
Known HER2 status
Normal cardiac function must be documented within 90 days prior to registration either via an ECHO or MUGA or per physician's review of symptoms and medical history. If an ECHO is performed as standard of care, the ejection fraction must be above the normal limit of the institution.. If not available in the medical chart, the ECHOs or MUGAs are not required to be repeated for research purposes.

Date of Echo or multigated acquisition (MUGA) (within 90 days) if performed

Staging work-up prior to registration
Date of physical examination (within 90 days)
Date of bilateral mammogram (within 90 days)
Date of breast ultrasound (within 90 days)
Date of MRI breast (within 30 days)
Chest X-ray or CT- Chest or CT/PET Scan that includes the Chest may be done at physician's discretion (within 90 days). If not available in the medical chart, the Chest X-ray or CT- Chest or CT/PET Scan that includes the Chest is not required to be repeated for research purposes.
Other tests as clinically indicated
Laboratory requirements:
Hematology:

Absolute Neutrophil Count (ANC) ≥ 1,500/μl
Platelets ≥ 100,000/μl

Hepatic Function

Total Bilirubin <1x upper limit of normal (ULN)
aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2x ULN

Renal Function

Creatinine <1.5x ULN

Proteinuria

Random urine total protein <100mg/dL. Urine Protein Creatinine (UPC) ratio <2g

Negative pregnancy test for women of childbearing potential within 14 days prior to registration.
All patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines.

Exclusion Criteria:

Evidence of distant metastasis. If radiographic suspicion of distant metastatic site, a negative biopsy must be available in the medical record. If not available in the medical record, the subject may be included and a confirmatory biopsy is not required to be performed for research purposes.
Known or suspected congestive heart failure, angina pectoris requiring antianginal medication, or other clinically significant cardiac condition.
Pregnant or nursing women may not participate due to the possibility of harm to fetus or nursing infants from this treatment regimen. Women of childbearing potential may not participate unless they have agreed to use an adequate contraceptive method throughout study treatment and for one month after completion of treatment.
Male patients
Pre-existing peripheral neuropathy of severity grade ≥ 2 (limiting instrumental activities of daily living).
Incomplete wound healing.
Active and significant bleeding
Known allergy, hypersensitivity or prior infusion reaction to one or more of the therapies incorporated into this treatment protocol.
Bone marrow depression or hematologic parameters in the range that would increase the risk for severe bleeding.