Adjuvant Chemoradiation and Biomarkers of Response in High-risk Breast Cancer

Launched by UNIVERSITY OF VIRGINIA · Mar 10, 2022

Keywords

ClinConnect Summary

This clinical trial is exploring the safety and effectiveness of a treatment called adjuvant chemoradiation therapy for patients with high-risk breast cancer. This trial is specifically for individuals who have already received chemotherapy before their surgery (lumpectomy or mastectomy) and still have some cancer left after the operation. The study aims to understand how this combination treatment affects not only the cancer but also the immune system, which helps the body fight diseases.

To participate, you must be at least 18 years old, diagnosed with stage I to IIIB breast cancer, and have had prior chemotherapy followed by surgery. You should have some cancer remaining after surgery and be a candidate for the chemotherapy and radiation treatment that is part of standard care. If you join the trial, you'll receive this combined therapy within 12 weeks after your surgery, and you'll be closely monitored throughout the process. It's important to note that certain health conditions, such as severe heart issues or infections, might prevent you from participating. If you're interested in learning more or think you might qualify, please reach out to your healthcare provider for more details.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Provision of signed and dated informed consent form
• • 2. Stated willingness to comply with all study procedures and availability for the duration of the study
• • 3. Male or female, aged 18 or older
• • 4. Diagnosis of stage I-IIIB breast cancer
• • 5. Received neoadjuvant chemotherapy (minimum of 3 cycles) and surgical resection (lumpectomy and/or mastectomy)
• • 6. Discovered to have residual disease at least ypT1aNx or ypTxN1mic at surgical resection
• • 7. Candidate for adjuvant chemoradiation as part of standard clinical care
• • 8. Planned initiation of radiation within 12 weeks of their final oncologic surgery
• • 9. ECOG performance status ≤2
• • 10. Adequate cardiac function, with LVEF greater or equal to 45% (only for patients who will receive TDM-1 therapy)
• • 11. Adequate organ function per the following criteria within 21 days before the start of treatment. If a laboratory value required for study eligibility does not meet the below requirements, the value may be retested.
• • Absolute neutrophil count ≥1.5 k/uL
• • Platelets ≥100 k/uL
• • Hemoglobin ≥ 10 g/dL
• • Serum Creatinine ≤ 1.5 x ULN
• • Bilirubin ≤ 1.5 x ULN (except in patients with Gilbert's disease, where bilirubin to 4x ULN is allowed).
• • AST and ALT ≤ 2.5 x ULN
• • Alkaline phosphatase ≤ 2.5 x ULN
• • 12. For females and males of reproductive potential: agreement to use adequate contraception during study participation and for an additional 6 months after the end of chemoradiation administration or until advised by their medical oncologist
• • 13. Agreement to adhere to Lifestyle Considerations throughout study duration
• • 14. Subjects taking warfarin and plan to receive capecitabine will need their anticoagulant management assessed before starting treatment.
• Exclusion Criteria:
• • 1. Had a mastectomy with expander placement or immediate reconstructions
• • 2. Diagnosed with systemic lupus
• • 3. Diagnosed with scleroderma
• • 4. Diagnosed with a genetic mutation associated with increased sensitivity to radiation (e.g. ataxia-telangectasias (AT)). AT heterozygotes without known radiation sensitivity may be included.
• • 5. Acute bacterial or fungal infection requiring intravenous antibiotics at time of registration.
• • 6. Pathologic evidence of metastatic disease, or strong clinical/radiological evidence of metastatic disease, at the investigator's judgment.
• • 7. Pregnancy or lactation
• • 8. Incarceration
• • 9. Presence of cardiac pacemaker on side of the body that is being treated unless the pacemaker can be moved prior to treatment.
• • 10. Anthracycline exposure exceeding a cumulative doxorubicin dose of 264 mg/m2 (240 mg/m2 plus a 10% threshold)
• • 11. Known allergic reactions to components of capecitabine or T-DM1
• • 12. Known DPD deficiency for patients prescribed capecitabine
• • 13. Febrile illness within a week of starting treatment
• • 14. Incomplete healing of chest wall or breast in the treatment field within 12 weeks from surgery.
• • 15. Known HIV or active hepatitis.
• • 16. Unwilling to discontinue endocrine therapy if currently taking endocrine therapy.