A Study to Evaluate the Pharmacokinetics, Efficacy, and Safety of Subcutaneous Administration of the Fixed-Dose Combination of Pertuzumab and Trastuzumab in Combination With Chemotherapy in Participants With HER2-Positive Early Breast Cancer (FeDeriCa)

Roche

Status and phase: Completed; Phase 3

Conditions: Early Breast Cancer

Treatments: Drug: Cyclophosphamide; Drug: Paclitaxel; Drug: Trastuzumab IV; Procedure: Surgery; Radiation: Post-operative Radiotherapy; Drug: Hormone Therapy; Drug: Doxorubicin; Drug: FDC of Pertuzumab and Trastuzumab SC; Drug: Trastuzumab SC; Drug: Docetaxel; Drug: Pertuzumab IV

Study type: Interventional

Funder types: Industry

Identifiers

NCT03493854

WO40324

2017-004897-32 (EudraCT Number)

Details and patient eligibility

About

This is a global Phase III, two-arm, open-label, multicenter, randomized study to investigate the pharmacokinetics, efficacy, and safety of the fixed-dose combination (FDC) of pertuzumab and trastuzumab for subcutaneous (SC) administration in combination with chemotherapy in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer in the neoadjuvant/adjuvant setting.

Enrollment: 500 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Ability to comply with the study protocol, in the investigator's judgment
• Eastern Cooperative Oncology Group (ECOG) Performance Status ≤1
• Female and male patients with Stage II - IIIC (T2-T4 plus any N, or any T plus N1-N3, M0), locally advanced, inflammatory, or early-stage, unilateral, and histologically confirmed invasive breast cancer
• Primary tumor >2 cm in diameter, or node-positive disease (clinically or on imaging, and node positivity confirmed with cytology and/or histopathology)
• HER2-positive breast cancer confirmed by a central laboratory prior to study enrollment. HER2-positive status will be determined based on pretreatment breast biopsy material.
• Hormone receptor status of the primary tumor, centrally confirmed
• Patient agreement to undergo mastectomy or breast conserving surgery after neoadjuvant therapy
• Availability of formalin-fixed, paraffin-embedded (FFPE) tumor tissue block for central confirmation of HER2 and hormone receptor status and additional biomarker research
• Baseline left ventricular ejection fraction (LVEF) ≥55% measured by echocardiogram (ECHO) or multiple-gated acquisition scan (MUGA)
• For women of childbearing potential (WOCBP) who are sexually active: agreement to remain abstinent or use one highly effective non-hormonal contraceptive method with a failure rate of <1% per year, or two effective non-hormonal contraceptive methods during the treatment period and for 7 months after the last dose of HER2-targeted therapy, and agreement to refrain from donating eggs during this same period
• For men: men must remain abstinent or use a condom with a spermicidal product during the treatment period and for 7 months after the last dose of HER2-targeted therapy to avoid exposing the embryo. Men must refrain from donating sperm during this same period.
• A negative serum pregnancy test must be available prior to randomization for WOCBP, unless they have undergone surgical sterilization
• No major surgical procedure unrelated to breast cancer within 28 days prior to randomization or anticipation of the need for major surgery during the course of study treatment

Exclusion criteria

• Stage IV (metastatic) breast cancer
• Patients with a history of invasive breast cancer
• Patients with a history of concurrent or previously treated non-breast malignancies except for appropriately treated 1) non-melanoma skin cancer and/or 2) in situ carcinomas, including cervix, colon, and skin
• Patients who have received any previous systemic therapy for treatment or prevention of breast cancer, or radiation therapy for treatment of cancer
• Patients who have a past history of ductal carcinoma in situ or lobular carcinoma in situ if they have received any systemic therapy for its treatment or radiation therapy to the ipsilateral breast
• Patients with high-risk for breast cancer who have received chemo-preventative drugs in the past are not allowed to enter the study
• Patients with multicentric breast cancer, unless all tumors are HER2-positive
• Patients with bilateral breast cancer
• Patients who have undergone an excisional biopsy of primary tumor and/or axillary lymph nodes
• Axillary lymph node dissection prior to initiation of neoadjuvant therapy
• Sentinel lymph node biopsy prior to neoadjuvant therapy
• Treatment with any investigational drug within 28 days prior to randomization
• Serious cardiac illness or medical conditions
• Inadequate bone marrow function, renal function or impaired liver function
• Current severe, uncontrolled systemic disease that may interfere with planned treatment
• Pregnant or breastfeeding, or intending to become pregnant during the study or within 7 months after the last dose of HER2-targeted therapy
• Any serious medical condition or abnormality in clinical laboratory tests that, in the investigator's judgment, precludes the patient's safe participation in and completion of the study
• Known active liver disease, for example, active viral hepatitis infection, autoimmune hepatic disorders, or sclerosing cholangitis
• Concurrent, serious, uncontrolled infections, or known infection with HIV
• Known hypersensitivity to study drugs, excipients, and/or murine proteins
• Current chronic daily treatment with corticosteroids
• History of other malignancy within 5 years prior to screening, except for appropriately treated carcinoma in situ of the cervix, colon, skin, and/or non-melanoma skin carcinoma
• History of ventricular dysrhythmias or risk factors for ventricular dysrhythmias, such as structural heart disease, coronary heart disease, clinically significant electrolyte abnormalities, or family history of sudden unexplained death or long QT syndrome

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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500 participants in 2 patient groups

Arm A: Pertuzumab IV + Trastuzumab IV + Chemotherapy

Active Comparator group

Description:

Participants will receive 8 cycles of investigator's choice of neoadjuvant chemotherapy. This will include either: 1) 4 cycles of dose-dense doxorubicin plus cyclophosphamide (ddAC) once every 2 weeks (Q2W) (given with granulocyte colony-stimulating factor \[G-CSF\] support as needed according to local guidelines) followed by paclitaxel Q1W for 12 weeks; or 2) 4 cycles of doxorubicin plus cyclophosphamide (AC) once every 3 weeks (Q3W) followed by docetaxel Q3W for 4 cycles. Pertuzumab and trastuzumab will be given intravenously (IV) for 4 cycles Q3W concurrently with the taxane component of chemotherapy. After completing their neoadjuvant therapy, participants will undergo surgery. Thereafter, participants will receive an additional 14 cycles of pertuzumab IV and trastuzumab IV for a total of 18 cycles.

Treatment:

Drug: Pertuzumab IV

Drug: Docetaxel

Drug: Trastuzumab SC

Drug: Doxorubicin

Drug: Hormone Therapy

Radiation: Post-operative Radiotherapy

Procedure: Surgery

Drug: Trastuzumab IV

Drug: Paclitaxel

Drug: Cyclophosphamide

Arm B: FDC of Pertuzumab and Trastuzumab SC + Chemotherapy

Experimental group

Description:

Participants will receive 8 cycles of investigator's choice of neoadjuvant chemotherapy. This will include either: 1) 4 cycles of ddAC Q2W (given with G-CSF support as needed according to local guidelines) followed by paclitaxel once every week (QW) for 12 weeks; or 2) 4 cycles of AC Q3W followed by docetaxel Q3W for 4 cycles. The fixed-dose combination (FDC) of pertuzumab and trastuzumab will be given subcutaneously (SC) for 4 cycles (Q3W) concurrently with the taxane component of chemotherapy. After completing their neoadjuvant therapy, participants will undergo surgery. Thereafter, participants will receive an additional 14 cycles of the FDC of pertuzumab and trastuzumab SC for a total of 18 cycles.

Treatment:

Drug: Docetaxel

Drug: FDC of Pertuzumab and Trastuzumab SC

Drug: Doxorubicin

Drug: Hormone Therapy

Radiation: Post-operative Radiotherapy

Procedure: Surgery

Drug: Paclitaxel

Drug: Cyclophosphamide