Sacituzumab Govitecan In TNBC (NeoSTAR)

• ClinicalTrials.gov Identifier: NCT04230109
• Recruitment Status: Recruiting
• First Posted: January 18, 2020
• Last Update Posted: March 19, 2024
• Sponsor: Massachusetts General Hospital
• Collaborator: Gilead Sciences
• Information provided by (Responsible Party): Laura M. Spring, MD, Massachusetts General Hospital

Study Description

Brief Summary:

This research study is studying to evaluate sacituzumab govitecan for individuals with localized triple negative breast cancer (TNBC)

The names of the study drugs involved in this study is:

• Sacituzumab govitecan (SG)
• Pembrolizumab (combination therapy with SG)

Condition or disease	Intervention/treatment	Phase
Invasive Breast Cancer; Triple Negative Breast Cancer; ER-Negative Breast Cancer; PR-Negative Breast Cancer; HER2-negative Breast Cancer	Drug: Sacituzumab Govitecan; Drug: Pembrolizumab	Phase 2

Detailed Description:

This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational drug to learn whether the drug works in treating a specific disease. "Investigational" means that the drug is being studied.

This research study involves an experimental study treatment. The names of the study drugs involved in this study is:

• Sacituzumab govitecan (SG)
• Pembrolizumab (combination therapy with SG)

The study is a umbrella study multi-arm phase II study of neoadjuvant SG-based therapy in patients with localized BC. The first cohort involves SG monotherapy. After the monotherapy cohort completes enrollment, the combination therapy cohort (SG with pembrolizumab) for patients with localized BC will open.

Future planned arms include SG with/without pembrolizumab for patients with Hormone Receptor positive (HR+) breast cancer and inflammatory breast cancer (IBC).

The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits.

• Eligible participants will receive Sacituzumab govitecan for up to 12 weeks.
• This can be followed by standard chemotherapy at the discretion of the treating physician.
• It is expected that about 50 people will take part in this research study.

The U.S. Food and Drug Administration (FDA) has not approved Sacituzumab govitecan as a treatment for patients with metastatic TNBC.

Sacituzumab govitecan (SG) is an antibody-drug conjugate which means it's made up of an antibody attached to an anticancer drug. An antibody is a protein normally made the immune system. Sacituzumab govitecan is believed to work by binding the antibody portion of the drug in the tumor(s) while the anticancer drug portion works to prevent cancer cells from growing/spreading.

After the SG monotherapy cohort completes enrollment, the combination therapy cohort (SG with immunotherapy) will open.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 260 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 2 Study of Response-guided Neoadjuvant Sacituzumab Govitecan (IMMU-132) in Patients With Localized Triple-Negative Breast Cancer (NeoSTAR)
• Actual Study Start Date: July 14, 2020
• Estimated Primary Completion Date: October 2025
• Estimated Study Completion Date: October 2026

Arms and Interventions

Arm	Intervention/treatment
Experimental: Sacituzumab Govitecan (monotherapy cohort); - The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits.; Sacituzumab govitecan via iv, predetermined dosage per protocol, IV, 2 days per each 21-day cycle, for 4 cycles.; This can be followed by standard chemotherapy at the discretion of treating physician.	Drug: Sacituzumab Govitecan; Sacituzumab Govitecan via iv, predetermined dosage per protocol, two days per 21-day cycle, for 4 cycles (monotherapy cohort); Other Name: IMMU-132
Experimental: Sacituzumab Govitecan and Pembrolizumab (combination cohort); - The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits.; Sacituzumab govitecan via iv, predetermined dosage per protocol, IV, 2 days per each 21-day cycle, for 4 cycles.; Pembrolizumab via iv, predetermined dosage per protocol, IV, 1 day per each 21-day cycle, for 4 cycles.; This can be followed by standard chemotherapy at the discretion of treating physician.	Drug: Sacituzumab Govitecan; Sacituzumab Govitecan via iv, predetermined dosage per protocol, two days per 21-day cycle, for 4 cycles (monotherapy cohort); Other Name: IMMU-132; Drug: Pembrolizumab; Pembrolizumab via iv, predetermined dosage per protocol, per 21-day cycle, for 4 cycles (combination cohort)

Outcome Measures

Primary Outcome Measures :

1. Pathological complete response(pCR) rate with sacituzumab govitecan [ Time Frame: 12 Weeks ]
   pCR is defined as no residual invasive carcinoma in the breast and in the lymph node. The two-sided 95% CIs for pCR rate will be calculated.

Secondary Outcome Measures :

1. Disease-Free Survival [ Time Frame: Time from the first dose of study treatment to disease recurrence/progression by RECIST v1.1 or death due to any cause, up to 36 months ]
   Kaplan-Meier methods and descriptive statistics
2. Overall Survival [ Time Frame: defined as the time from the first dose of study treatment to the date of death or last contact up to 36 months ]
   Kaplan-Meier methods and descriptive statistics
3. Change in Breast Conserving Surgery Rate (BCS) rate [ Time Frame: 12 Weeks ]
   RCB calculator: http:// RCB calculator: http://www3.mdanderson.org/app/medcalc/index.cfm?pagename=jsconvert3
4. Number of Participants with Treatment Related Adverse Events as Assessed by CTCAE v5.0 [ Time Frame: Baseline to 12 weeks ]
   CTCAE v5.0
5. Assessment of Quality of life (QOL) [ Time Frame: Baseline up to 12 Weeks ]
   EORTC questionnaire

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Female or male patients ≥ 18 years of age.
• Histologically confirmed diagnosis of invasive breast cancer, previously untreated.
• Participants must have biopsy proven ER negative (ER-), PR negative (PR-), HER2 negative (HER2-), invasive breast cancer. ER, PR, and HER2 positivity would be determined per ASCO/CAP guidelines by institutional (local) assessment. Patients with multi-focal and multicentric disease are eligible provided all histologically examined lesions are ER-/PR-/HER2- (local assessment). The need to biopsy additional lesions is at the discretion of the treating physician. Patients with bilateral invasive breast cancer are eligible provided all histologically examined lesions are ER-/PR-/HER2- (local assessment).
• Primary tumor (at least one lesion) 1 cm or greater measured by radiological imaging. Regional lymph node AJCC (v7) TNM stages N0-N2. If node positive, any primary tumor size is permissible. Absence of distant metastatic disease (AJCC TNM stage M0). Staging scans are not required and are per discretion of the treating physician.
• Pre- and postmenopausal women are eligible.
• ECOG performance status = 0, 1 (Karnofsky ≥60%, see Appendix A)
• Ability to understand and the willingness to sign a written informed consent form (ICF). Patient has signed the ICF prior to any screening procedures being performed and is able to comply with protocol requirements, including research biopsy.
• Patient has adequate bone marrow and organ function as defined by the following laboratory values at screening:
• Absolute neutrophil count (ANC) ≥ 1,500 per mm3
• Platelets ≥ 100,000 per mm3
• Hemoglobin ≥9.0 g/dL
• INR ≤1.5
• Serum creatinine <1.5 mg/dL or creatinine clearance ≥50 mL/min
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <2.5 x ULN.
• Total bilirubin ≤1.5 x ULN or in patients with well-documented Gilbert's Syndrome direct bilirubin ≤1.5 x ULN.

Exclusion Criteria:

• Inflammatory breast cancer, or locally recurrent breast cancer
• Participants currently receiving systemic therapy for any other malignancy or having received systemic therapy for a malignancy in the preceding 3 years.
• Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia,or psychiatric illness/social situations that would limit compliance with study requirements.

• Clinically significant, uncontrolled heart disease and/or cardiac reppolarization abnormality including any of the following:

  • History of angina pectoris, symptomatic pericarditis, coronary artery bypass graft (CABG) or myocardial infarction within 6 months prior to study entry.
  • History of cardiac failure, known cardiomyopathy (LVEF < 50%; new LVEF assessment is not specifically required for this trial), significant/symptomatic bradycardia, Long QT syndrome, family history of idiopathic sudden death or congenital long QT syndrome or any of the following:
• Known risk to prolong the QT interval or induce Torsade's de Pointes.
• Uncorrected hypomagnesemia or hypokalemia.
• Systolic Blood Pressure (SBP) >160 mmHg or <90 mmHg.
• Bradycardia (heart rate <50 at rest), by ECG or pulse. On screening, inability to determine the QTcF interval on the ECG (i.e.: unreadable or not interpretable) or QTcF >470 screening ECG
• Pregnant or breast-feeding women are excluded from this study because the safety of study medications is not established.
• Known HIV-positive participants on combination antiretroviral therapy are ineligible.
• These participants are at increased risk of lethal infections when treated with marrow-suppressive therapy. Separate HIV testing for this trial is not required. Similarly, separate Hepatitis B or C testing for this trial is not required, but patients with known (or history) of hepatitis B positive, or hepatitis C positive infection will be excluded

Contacts and Locations

Contacts

Contact: Laura Spring, MD; 617-726-6500; LSPRING2@PARTNERS.ORG

Locations

United States, Massachusetts

Beth Israel Deaconess Medical Center; Recruiting

Boston, Massachusetts, United States, 02115

Contact: Neelam Desai, MD 617-667-2100

Principal Investigator: Neelam Desai, MD

Dana Farber Cancer Institute; Recruiting

Boston, Massachusetts, United States, 02115

Contact: Sara Tolaney, MD, MPH 617-632-3800

Principal Investigator: Sara Tolaney, MD, MPH

Massachusetts General Hospital; Recruiting

Boston, Massachusetts, United States, 02115

Contact: Laura Spring, MD 617-726-6500 LSPRING2@PARTNERS.ORG

Principal Investigator: Laura Spring, MD

Massachusetts General Hospital - North Shore Cancer Center; Recruiting

Danvers, Massachusetts, United States, 01923

Contact: Therese Mulvey, MD 978-882-6060

Principal Investigator: Therese Mulvey, MD

Massachusetts General Hospital at Newton-Wellesley Hospital; Recruiting

Newton, Massachusetts, United States, 02462

Contact: Amy Comander, MD 617-219-1230

Principal Investigator: Amy Comander, MD

Sponsors and Collaborators

Massachusetts General Hospital

Gilead Sciences

Investigators

• Principal Investigator: Laura Spring, MD; Massachusetts General Hospital

More Information

• Responsible Party: Laura M. Spring, MD, Principal Investigator, Massachusetts General Hospital
• ClinicalTrials.gov Identifier: NCT04230109
• Other Study ID Numbers: 19-578
• First Posted: January 18, 2020
• Last Update Posted: March 19, 2024
• Last Verified: March 2024

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to Sponsor Investigator or designee. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF)
• Time Frame: Data can be shared no earlier than 1 year following the date of publication
• Access Criteria: Contact the Partners Innovations team at http://www.partners.org/innovation

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Laura M. Spring, MD, Massachusetts General Hospital:

Invasive Breast Cancer; Triple Negative Breast Cancer; ER-Negative Breast Cancer; PR-Negative Breast Cancer; HER2-negative Breast Cancer

Additional relevant MeSH terms:

Breast Neoplasms; Triple Negative Breast Neoplasms; Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases; Pembrolizumab; Sacituzumab govitecan; Antineoplastic Agents, Immunological; Antineoplastic Agents; Immune Checkpoint Inhibitors; Molecular Mechanisms of Pharmacological Action; Immunoconjugates; Immunologic Factors; Physiological Effects of Drugs