A Phase III Study of Dato-DXd With or Without Durvalumab Compared With Investigator's Choice of Chemotherapy in Combination With Pembrolizumab in Patients With PD-L1 Positive Locally Recurrent Inoperable or Metastatic Triple-negative Breast Cancer

AstraZeneca

Status and phase: Enrolling; Phase 3

Conditions: Breast Cancer

Treatments: Drug: Paclitaxel; Drug: Dato-DXd; Drug: Durvalumab; Drug: Nab-paclitaxel; Drug: Gemcitabine; Drug: Carboplatin; Drug: Pembrolizumab

Study type: Interventional

Funder types: Industry

Identifiers

NCT06103864

D7630C00001

Details and patient eligibility

About

This is a Phase III, randomised, open-label, 3-arm, multicentre, international study assessing the efficacy and safety of Dato-DXd with or without durvalumab compared with investigator's choice chemotherapy in combination with pembrolizumab in participants with PD-L1 positive locally recurrent inoperable or metastatic TNBC.

Full description

The primary objective of the study is to demonstrate superiority of Dato-DXd + durvalumab relative to ICC + pembrolizumab by assessment of PFS as assessed by BICR in participants with PD-L1 positive locally recurrent inoperable or metastatic TNBC.

The study will be stratified based on geographic location (US/Canada/Europe vs. Dato-DXd monotherapy enrolling countries vs. rest of world), disease-free interval (DFI) history (de novo vs. prior DFI 6 to 12 months vs. prior DFI > 12 months), and prior PD-1/PD-L1 treatment for early stage TNBC (yes vs. no).

This study aims to see if Dato-DXd with durvalumab allows patients to live longer without their breast cancer getting worse, or simply to live longer, compared to patients receiving standard of care chemotherapy and pembrolizumab. This study is also looking to see how the treatment and the breast cancer affects patients' quality of life.

Enrollment: 625 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Key Inclusion Criteria

• Histologically or cytologically documented locally recurrent inoperable, which cannot be treated with curative intent, or metastatic TNBC, as defined by the ASCO-CAP guidelines.

• ECOG PS 0 or 1.

• All participants must provide a FFPE tumour sample (primary, metastatic (location excluding bone), or locally recurrent inoperable tumour sample) collected ≤ 3 months prior to signing of informed consent (ie, start of screening).

• PD-L1 positive TNBC based on results from an appropriately validated investigational PD-L1 (22C3) assay (CPS ≥ 10) from a sponsor designated central laboratory.

• No prior chemotherapy or targeted systemic anti-cancer therapy for metastatic or locally recurrent inoperable breast cancer.

  • Patients with recurrent disease will be eligible if they have completed treatment for Stage I-III breast cancer, if indicated, and ≥6 months have elapsed between completion of treatment with curative intent and the first documented recurrence.

• Eligible for one of the chemotherapy options listed as ICC (paclitaxel, nab-paclitaxel, or gemcitabine + carboplatin).

• Measurable disease as per RECIST 1.1.

• Adequate bone marrow reserve and organ function.

• Male and female participants of childbearing potential must agree to use protocol-specified method(s) of contraception.

Key Exclusion Criteria

• As judged by investigator, severe or uncontrolled medical conditions including systemic diseases, history of allogeneic organ transplant and active bleeding diseases, ongoing or active infection, significant cardiac or psychological conditions.

• History of another primary malignancy except for malignancy treated with curative intent with no known active disease within 3 years before Cycle 1 Day 1 and of low potential risk for recurrence.

• Neoplastic spinal cord compression or active brain metastases, leptomeningeal carcinomatosis or history of leptomeningeal carcinomatosis.

  • Participants with treated clinically inactive brain metastases that are no longer symptomatic, who require no treatment with corticosteroids or anticonvulsants, may be included in the study if they have recovered from acute toxic effects of radiotherapy.

• Uncontrolled infection requiring IV antibiotics, antivirals or antifungals.

• Active or uncontrolled hepatitis B or C virus infection.

• Known HIV infection that is not well controlled.

• Uncontrolled or significant cardiac disease.

• History of non-infectious ILD/pneumonitis (including radiation pneumonitis) that required steroids, current ILD/pneumonitis, or suspected ILD/pneumonitis that cannot be ruled out by imaging at screening.

• Severe pulmonary function compromise.

• Clinically significant corneal disease.

• Active or prior documented autoimmune or inflammatory disorders.

• Prior exposure to any treatment including ADC containing a chemotherapeutic agent targeting topoisomerase I and TROP2-targeted therapy.

• Any concurrent anti-cancer treatment.

• Participants with a known severe hypersensitivity to PD-1/PD-L1 inhibitors or Dato-DXd.

• Currently pregnant (confirmed with positive pregnancy test), breastfeeding or planning to become pregnant.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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625 participants in 3 patient groups

Dato-DXd + durvalumab

Experimental group

Description:

Arm 1: Dato-DXd + durvalumab

Treatment:

Drug: Durvalumab

Drug: Dato-DXd

Investigator's Choice of Chemotherapy (ICC) in combination with pembrolizumab

Active Comparator group

Description:

Arm 2: Investigator's Choice of Chemotherapy (ICC) in combination with pembrolizumab (paclitaxel, nab-paclitaxel, or gemcitabine + carboplatin)

Treatment:

Drug: Pembrolizumab

Drug: Carboplatin

Drug: Gemcitabine

Drug: Nab-paclitaxel

Drug: Paclitaxel

Dato-DXd

Experimental group

Description:

Arm 3: Dato-DXd

Treatment:

Drug: Dato-DXd