Studieoverzicht - 2017-01 NEOLBC

• Primary objective:

  • Determine if ribociclib plus letrozole gives a ≥100% improvement in complete cell cycle arrest (CCCA; defined as Ki67 IHC <1%) as compared to chemotherapy in the surgical specimen*.

   

  Secondary objective

  • Study the correlation between Ki67 IHC scored manually, IHC scored automatically (Vectra

  ® 3) and Ki67 mRNA.

  • Correlate ER pathway activity at baseline, after two weeks letrozole and at surgery with clinical outcome (collaboration with Philips Netherlands). If sufficient material is available additional pathway activities (such as PI3K and others) can be determined.
  • Study the difference in pathologic response (pCR and response according to Miller and Payne) between the randomized study arms*.
  • Determine the change in tumor biology and biomarkers (ER, PR, HER2, Rb, Ki67) at baseline, after 2 weeks letrozole and at
  • Toxicity according to NCI CTCAE v4.03 all grades and grade III/IV*.
  • Study the correlation of tumor measurements between standard MRI and palpation at baseline, after AC/before T or 8 weeks of definitive neoadjuvant therapy and pre-surgery.
  • Descriptive analysis of event free survival (EFS) and overall survival (OS) at 3 and 5

   

  Side study objective:

  • Determine the change in ERα DNA binding and gene expression profiling between baseline and after 2 weeks

   

  • Indicates that the objective is not applicable to the group with a Ki67 of <1% (explained later in this protocol).

Primary endpoint:

• Difference in CCCA (defined as Ki67 IHC <1%) between ribociclib plus letrozole and chemotherapy in the surgical specimen*.

Secondary endpoints:

• Correlation between Ki67 IHC scored manually, IHC scored automatically (Vectra ® 3) and Ki67
• Correlation between ER pathway activity at baseline, after two weeks letrozole and at surgery and clinical outcome. If sufficient sample is available additional pathway activities (such as PI3K and others) can be
• Difference in pathologic response (pCR and response according to Miller and Payne) between the randomized study arms*.
• Change in tumor biology and biomarkers (ER, PR, HER2, Rb, Ki67) at baseline, after 2 weeks letrozole and at
• Toxicity according to NCI CTCAE v4.03 all grades and grade III/IV*.
• Correlation of tumor measurements between standard MRI (using RECIST 1.1) and palpation (largest diameter in cm) at baseline, after AC/before T or 8 weeks of definitive neoadjuvant therapy and pre-surgery.
• Descriptive analysis of event free survival (EFS) and overall survival (OS) at 3 and 5

Side study endpoint:

• Change in ERα DNA binding signatures (Chip-seq), and gene expression profiles (RNA-seq) between baseline and after 2 weeks

• Indicates that the objective is not applicable to the group with a Ki67 of <1%.

Population (base)

Postmenopausal patients with hormone receptor positive (ER≥50%, PR any), HER2 negative, stage II/III breast cancer, amenable to receive dose dense neoadjuvant AC - T (4x docetaxel 3-weekly or 12x paclitaxel weekly) chemotherapy for early breast cancer.

Inclusion criteria

In order to be eligible to participate in this study, a subject must meet all of the following criteria:

• Postmenopausal women presenting with histological proven (core biopsy material) hormone receptor positive (ER≥50%, PR any), HER2 negative, stage II/ III breast
• Measurable disease (breast and/or lymph nodes)
• WHO 0-2
• Adequate bone marrow function (within 4 weeks prior to registration): WBC≥3.0x10⁹/l, neutrophils ≥1.5 x 10⁹/l, platelets ≥100 x 10⁹/l
• Adequate liver function (within 4 weeks prior to registration): bilirubin ≤1.5 x upper limit of normal (UNL) range, ALAT and/or ASAT ≤2.5 x UNL, Alkaline Phosphatase ≤5 x UNL
• Adequate renal function (within 4 weeks prior to registration): the calculated creatinine clearance should be ≥50 ml/min
• Accessible for treatment and follow-up
• Written informed consent

Inclusion criteria – randomization specific

In order to be eligible to be randomized in this study, a subject must meet all of the following criteria:

• Registration in the NEOLBC trial before 2 weeks biopsy
• Use of letrozole
• Outcome central Ki67 determination in two weeks biopsy

Exclusion criteria

• Evidence of distant metastases (M1)
• Previous invasive breast cancer
• Prior chemotherapy, radiation therapy or hormonal therapy with the exception of patients who received letrozole ≤ 14 days (+ max. 4 days) prior to registration and who are still on letrozole.
• Previous malignancy within 5 years, with exception of a history of a previous basal cell carcinoma of the skin or pre-invasive carcinoma of the cervix.
• Peripheral neuropathy > grade 2, whatever the cause
• Serious other diseases as infections (hepatitis B, C and HIV), recent myocardial infarction, clinical signs of cardiac failure or clinically significant arrhythmias or on screening, any of the following cardiac parameters: bradycardia (heart rate <50 at rest) or QTcF ≥450 msec.
• Known hypersensitivity reaction to any of the components of the treatment (peanuts, soy)
• Currently receiving warfarin or other coumarin derived anti-coagulant, for treatment, prophylaxis or otherwise. Therapy with heparin, low molecular weight heparin (LMWH), or fondaparinux is allowed.
• Currently receiving any of the following substances and cannot be discontinued 7 days prior to randomisation:
  • Known strong inducers or inhibitors of CYP3A4/5, including grapefruit, grapefruit hybrids, pummelos, star-fruit, pomegranate and Seville oranges.
  • That have a known risk to prolong the QT interval or induce Torsades de Pointes.
  • That have a narrow therapeutic window and are predominantly metabolized through CYP3A4/5.
  • Herbal preparations/medications, dietary supplements.
• Medical or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or sign meaningful informed consent.

NEOLBC in Oncologie up-to-date:

https://www.oncologie.nu/neoadjuvante-behandeling-bij-hormoongevoelig-mammacarcinoom-meer-op-maat/?key=InmtsZ7czDkF29DKIg2nuwJ6Zvbbep5mFzPXF9emUW76aO

Informatie voor patiënten over deze studie en de deelnemende ziekenhuizen kunt u vinden op:

https://www.kanker.nl/trials/905-boog-2017-01-%E2%80%93-neolbc-studie-borstkanker