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A Phase III Clinical Trial Comparing Trastuzumab Given Concurrently With Radiation Therapy and Radiation Therapy Alone for Women With HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Ductal Breast Carcinoma in Situ

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Trial Information

A Phase III Clinical Trial Comparing Trastuzumab Given Concurrently With Radiation Therapy and Radiation Therapy Alone for Women With HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy


PRIMARY OBJECTIVES:

I. To determine the value of radiotherapy with vs without trastuzumab (Herceptin®) in
preventing subsequent occurrence of ipsilateral breast cancer recurrence, ipsilateral skin
cancer recurrence, or ipsilateral ductal carcinoma in situ (DCIS) in women with
HER2-positive DCIS resected by lumpectomy.

SECONDARY OBJECTIVES:

I. To determine the value of these regimens in prolonging invasive or DCIS disease-free
survival.

II. To determine the value of these regimens in increasing invasive or DCIS recurrence-free
interval.

III. To determine the value of these regimens in improving regional or distant recurrence.

IV. To determine the value of these regimens in improving the incidence of contralateral
invasive or DCIS breast cancer.

V. To determine the value of these regimens in improving overall survival. VI. To explore
the effect of trastuzumab on ovarian function. VII. To determine if the benefit of
trastuzumab added to radiotherapy will be significantly higher in cMYC-amplified tumors than
in the cMYC nonamplified subset.

VIII. To determine if the benefit of trastuzumab added to radiotherapy will be less in
tumors with mutations in the PI3 kinase gene than in tumors without PI3 kinase gene
mutations.

OUTLINE: Patients are stratified according to menopausal status (pre- vs post-), plan for
hormonal therapy (yes vs no), and nuclear grade (low or intermediate vs high). Patients are
randomized to 1 of 2 treatment arms.

ARM I: Patients undergo standard whole breast irradiation (WBI) over 5-6 weeks.

ARM II: Patients receive trastuzumab (Herceptin®) IV over 30-90 minutes once in weeks 1 and
4. Patients also undergo WBI as in arm I.

Tumor tissue samples are analyzed for mRNA and DNA copy numbers of HER2, cMYC, and other
candidate predictive genes; PI3K gene mutation status; other candidate predictors of
trastuzumab response; and candidate prognostic markers of ductal carcinoma in situ.

After completion of study therapy, patients are followed every 6 months for 5 years and then
every 12 months for 5 years.


Inclusion Criteria:



- Histologically confirmed ductal carcinoma in situ (DCIS)

- Mixed DCIS and lobular carcinoma in situ (LCIS) allowed

- HER2 receptor-positive as determined by central testing

- Must have undergone resection by lumpectomy and meets the following criteria:

- Margins of the resected specimen must be histologically free of DCIS
(re-excision to obtain clear margins allowed)

- No more than 120 days since the last surgery for excision of DCIS (lumpectomy or
re-excision of lumpectomy margins)

- None of the following allowed:

- Patients who require mastectomy

- Invasive (including microinvasion staged as T1mic) breast cancer (DCIS
"suspicious" for microinvasion, but not confirmed, allowed)

- Nodal staging of pN1 (including pN1mi) (axillary staging not required)

- DCIS present in more than one quadrant (multicentric)

- Masses or clusters of calcification that are clinically or mammographically
suspicious unless biopsied and proven to be benign

- Contralateral breast cancer (including DCIS)

- History of breast cancer, including DCIS (history of LCIS allowed)

- Hormone receptor status:

- Estrogen receptor and/or progesterone receptor-positive or -negative

- Must submit tumor block for correlative studies

- Pre- or postmenopausal

- ECOG performance status 0-1

- Life expectancy ≥ 10 years (excluding diagnosis of DCIS)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective non-hormonal contraception during and for 6
months after completion of treatment with trastuzumab (Herceptin®)

- No psychiatric or addictive disorders or other conditions that, in the opinion of the
investigator, would preclude the patient from meeting the study requirements

- No cardiac disease that would preclude the use of study treatment drugs, including,
but not limited to, any of the following:

- Active cardiac disease

- Angina pectoris that requires the use of anti-anginal medication

- Ventricular arrhythmias except for benign premature ventricular
contractions controlled by medication

- Conduction abnormality requiring a pacemaker

- Supraventricular and nodal arrhythmias requiring a pacemaker or not
controlled with medication

- Clinically significant valvular disease

- History of cardiac disease

- Myocardial infarction documented by elevated cardiac enzymes or persistent
regional wall abnormalities on assessment of left ventricular function

- Documented congestive heart failure

- Documented cardiomyopathy

- No uncontrolled hypertension (i.e., systolic BP > 180 mm Hg and/or diastolic BP > 100
mm Hg) (hypertension that is well controlled on medication allowed)

- No other nonmalignant systemic disease that would preclude a patient from receiving
trastuzumab or radiotherapy or would prevent prolonged follow-up

- No other malignancies unless patient has been disease-free ≥ 5 years and at low risk
for recurrence, except for treated carcinoma in situ of the cervix, carcinoma in situ
of the colon, melanoma in situ, or basal cell or squamous cell carcinoma of the skin

- No other cancer therapy until the time of first cancer recurrence or second primary
cancer

- No prior whole or partial breast irradiation

- No prior anthracycline chemotherapy for any malignancy

- No investigational agents within the past 30 days

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Time from randomization to ipsilateral invasive breast cancer, ipsilateral skin cancer recurrence, or ipsilateral ductal carcinoma in situ (DCIS)

Outcome Description:

Time to IIBCR-SCR-DCIS will be compared across treatment arms using cumulative incidence curves, Cox proportional hazard models, and the Kaplan-Meier method.

Outcome Time Frame:

Up to 10 years

Safety Issue:

No

Principal Investigator

Melody Cobleigh

Investigator Role:

Principal Investigator

Investigator Affiliation:

National Surgical Adjuvant Breast and Bowel Project (NSABP)

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00702

NCT ID:

NCT00769379

Start Date:

November 2008

Completion Date:

Related Keywords:

  • Ductal Breast Carcinoma in Situ
  • Breast Neoplasms
  • Carcinoma
  • Carcinoma in Situ
  • Carcinoma, Intraductal, Noninfiltrating
  • Carcinoma, Ductal, Breast
  • Carcinoma, Ductal

Name

Location

National Surgical Adjuvant Breast and Bowel Project Pittsburgh, Pennsylvania  15212-5234