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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

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT06103864
Recruitment Status : Recruiting
First Posted : October 27, 2023
Last Update Posted : January 24, 2024
Sponsor:
Collaborator:
Daiichi Sankyo
Information provided by (Responsible Party):
AstraZeneca

Brief Summary:
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.

Condition or disease Intervention/treatment Phase
Breast Cancer Drug: Dato-DXd Drug: Durvalumab Drug: Paclitaxel Drug: Nab-paclitaxel Drug: Gemcitabine Drug: Carboplatin Drug: Pembrolizumab Phase 3

Detailed 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.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 625 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Participants will be randomised either 1:1 to Arm 1 (Dato-DXd + durvalumab) and Arm 2 (ICC + pembrolizumab), or in selected countries, 1:1:1 to Arms 1, 2 and 3 (Dato-DXd monotherapy). Once approximately 75 participants are randomised to Arm 3, this cohort will close, and all countries will continue with a 1:1 randomisation strategy for Arms 1 and 2.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III, Open-label, Randomised Study of Datopotamab Deruxtecan (Dato-DXd) With or Without Durvalumab Compared With Investigator's Choice of Chemotherapy (Paclitaxel, Nab-paclitaxel or Gemcitabine + Carboplatin) in Combination With Pembrolizumab in Patients With PD-L1 Positive Locally Recurrent Inoperable or Metastatic Triple-negative Breast Cancer (TROPION-Breast05)
Actual Study Start Date : November 23, 2023
Estimated Primary Completion Date : September 1, 2026
Estimated Study Completion Date : April 23, 2029

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Breast Cancer

Arm Intervention/treatment
Experimental: Dato-DXd + durvalumab
Arm 1: Dato-DXd + durvalumab
Drug: Dato-DXd
Provided in 100mg vials. IV infusion. Experimental drug.
Other Name: Datopotamab deruxtecan (Dato-DXd, DS-1062a)

Drug: Durvalumab
Provided in 500mg vials. IV infusion. Experimental drug.
Other Name: MEDI4736

Active Comparator: Investigator's Choice of Chemotherapy (ICC) in combination with pembrolizumab
Arm 2: Investigator's Choice of Chemotherapy (ICC) in combination with pembrolizumab (paclitaxel, nab-paclitaxel, or gemcitabine + carboplatin)
Drug: Paclitaxel
IV infusion. Active comparator.

Drug: Nab-paclitaxel
IV infusion. Active comparator.

Drug: Gemcitabine
IV infusion. Active comparator.

Drug: Carboplatin
IV infusion. Active comparator.

Drug: Pembrolizumab
IV infusion. Active comparator.

Experimental: Dato-DXd
Arm 3: Dato-DXd
Drug: Dato-DXd
Provided in 100mg vials. IV infusion. Experimental drug.
Other Name: Datopotamab deruxtecan (Dato-DXd, DS-1062a)




Primary Outcome Measures :
  1. Progression Free Survival (PFS) [ Time Frame: From randomisation until progression per RECIST 1.1 as assessed by BICR, or death due to any cause (anticipated to be up to 33 months). ]

    PFS is defined as time from randomisation until progression per RECIST 1.1 as assessed by BICR, or death due to any cause. The comparison will include all randomised participants, as randomised, regardless of whether the participant withdraws from randomised therapy, receives another anticancer therapy or clinically progresses prior to RECIST 1.1 progression.

    However, if the participant progresses or dies immediately after 2 or more consecutive missed visits, the participant will be censored at the time of the latest evaluable assessment prior to the 2 missed visits.

    The measure of interest is the HR of PFS.



Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: From randomisation until the date of death due to any cause (anticipated to be up to 64 months). ]
    OS is defined as the time from randomisation until the date of death due to any cause.

  2. Objective Response Rate (ORR) [ Time Frame: From randomisation up until progression (anticipated to be up to 33 months). ]
    ORR is defined as the proportion of participants who have a CR or PR, as determined by the BICR/investigator assessment, per RECIST 1.1.

  3. Duration of Response (DoR) [ Time Frame: From the date of first documented response until date of documented progression per RECIST 1.1, as assessed by BICR/investigator assessment or death due to any cause (anticipated to be up to 33 months). ]
    DoR is defined as the time from the date of first documented response until date of documented progression per RECIST 1.1, as assessed by BICR/investigator assessment or death due to any cause.

  4. Progression-Free Survival (PFS) by Investigator assessment [ Time Frame: From randomisation until progression per RECIST 1.1 as assessed by the investigator, or death due to any cause (anticipated to be up to 33 months). ]
    PFS is defined as time from randomisation until progression per RECIST 1.1 as assessed by investigator, or death due to any cause.

  5. Clinical Benefit Rate (CBR) at 24 weeks [ Time Frame: From randomisation up until progression, or the last evaluable assessment in the absence of progression (anticipated to be up to 33 months). ]
    CBR at 24 weeks is defined as the percentage of participants who have a CR or PR or who have SD, per RECIST 1.1, as assessed by BICR/per investigator assessment and derived from the raw tumour data for at least 23 weeks after randomisation.

  6. Time to deterioration (TTD) in breast and arm symptoms in participants treated with Dato-DXd + durvalumab compared with ICC + pembrolizumab [ Time Frame: From the date of randomisation to the date of deterioration (from randomization to 18 weeks post-progression). ]

    TTD in breast symptoms and arm symptoms as measured by the arm symptoms scale from EORTC IL116 TTD is defined as time from the date of randomisation to the date of deterioration.

    Deterioration is defined as change from baseline that reaches a clinically meaningful deterioration threshold.


  7. Time to deterioration (TTD) in pain in participants treated with Dato-DXd + durvalumab compared with ICC + pembrolizumab [ Time Frame: Time from the date of randomisation to the date of deterioration (from randomization to 18 weeks post-progression). ]
    TTD in pain as measured by the EORTC IL199.

  8. Time to deterioration (TTD) in physical functioning in participants treated with Dato-DXd + durvalumab compared with ICC + pembrolizumab [ Time Frame: From the date of randomisation to the date of deterioration (from randomization to 18 weeks post-progression). ]
    TTD in physical function as measured by the PROMIS Short Form v2.0 - Physical Function 8c.

  9. Time to deterioration (TTD) in GHS/QoL in participants treated with Dato-DXd + durvalumab compared with ICC + pembrolizumab [ Time Frame: From the date of randomisation to the date of deterioration (from randomization to 18 weeks post-progression). ]
    TTD in GHS/QoL as measured by the GHS/QoL scale from EORTC IL172.

  10. Time to First Subsequent Therapy (TFST) [ Time Frame: From randomisation until the start date of the first subsequent anticancer therapy after discontinuation of randomised treatment, or death due to any cause (anticipated to be up to 64 months). ]
    TFST is defined as the time from randomisation until the start date of the first subsequent anticancer therapy after discontinuation of randomised treatment, or death due to any cause.

  11. Time to Second Subsequent Therapy (TSST) [ Time Frame: From randomisation until the start date of the second subsequent anti cancer therapy after discontinuation of first subsequent treatment, or death due to any cause (anticipated to be up to 64 months). ]
    TSST is defined as the time from randomisation until the start date of the second subsequent anticancer therapy after discontinuation of first subsequent treatment, or death due to any cause.

  12. Progression Free Survival 2 (PFS2) [ Time Frame: From the randomisation to the earliest of the progression event (following the initial progression), subsequent to first subsequent therapy, or death (anticipated to be up to 64 months). ]
    PFS2 will be defined as the time from the randomisation to the earliest progression event (following the initial progression), subsequent to first subsequent therapy, or death. The date of second progression will be recorded by the investigator in the eCRF and defined according to local standard clinical practice based on radiological or clinical progression.

  13. Pharmacokinetics of Dato-DXd in combination with durvalumab [ Time Frame: From first dose to end of treatment (anticipated to be up to 33 months). ]
    Concentration of Dato-DXd, total anti-TROP2 antibody, and DXd (payload) in plasma.

  14. Immunogenicity of Dato-DXd in combination with durvalumab [ Time Frame: From first dose to end of treatment safety follow-up (anticipated to be up to 33 months). ]
    Presence of antidrug antibodies for Dato-DXd (confirmatory results: positive or negative, titres).

  15. Safety and tolerability of Dato-DXd + durvalumab as compared with ICC + pembrolizumab [ Time Frame: From first dose to end of treatment safety follow-up (anticipated to be up to 33 months). ]
    Safety and tolerability will be evaluated in the safety population in terms of AEs.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
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 metastatic or locally recurrent inoperable tumour sample.
  • 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.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06103864


Contacts
Layout table for location contacts
Contact: AstraZeneca Clinical Study Information Center 1-877-240-9479 information.center@astrazeneca.com

Locations
Show Show 188 study locations
Sponsors and Collaborators
AstraZeneca
Daiichi Sankyo
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Responsible Party: AstraZeneca
ClinicalTrials.gov Identifier: NCT06103864    
Other Study ID Numbers: D7630C00001
First Posted: October 27, 2023    Key Record Dates
Last Update Posted: January 24, 2024
Last Verified: January 2024
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal Vivli.org. All requests will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.

"Yes", indicates that AZ are accepting requests for IPD, but this does not mean all requests will be approved.

Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA/PhRMA Data-Sharing Principles. For details of our timelines, please refer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.
Access Criteria: When a request has been approved AstraZeneca will provide access to the anonymized individual patient-level data via secure research environment Vivli.org. A Signed Data Usage Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information.
URL: https://vivli.org/

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by AstraZeneca:
Breast Cancer
Triple-negative
Metastatic
Inoperable
Datopotamab deruxtecan
Dato-DXd
DS1062a
DS1062
Durvalumab
Paclitaxel
Nab-paclitaxel
Gemcitabine
Carboplatin
Pembrolizumab
PD-1/PD-L1 Therapy
TROP2
Antibody Drug Conjugate (ADC)
Immune Checkpoint Inhibitor (ICI)
Additional relevant MeSH terms:
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Breast Neoplasms
Triple Negative Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Paclitaxel
Albumin-Bound Paclitaxel
Carboplatin
Gemcitabine
Pembrolizumab
Durvalumab
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antimetabolites
Antineoplastic Agents, Immunological
Immune Checkpoint Inhibitors