Combining PD-1 inhibitors with PARPi or capecitabine for high-risk triple-negative breast cancer

PARPi or Capecitabine Combined With PD-1 Inhibitors Was Selected Based on the Germline BRCA1/2 Mutation vs. PD-1 Inhibitors Alone as Adjuvant Therapy in High-risk Non-pCR TNBC

This study is testing if combining PD-1 inhibitors with either a specific cancer drug or chemotherapy can help people with high-risk triple-negative breast cancer who didn't respond fully to earlier treatment.

Quick facts

• Phase: Phase 3
• Study type: Interventional
• Enrollment: 310 (estimated)
• Ages: 18 Years to 70 Years
• Sex: Female
• Sponsor: Guangdong Provincial People's Hospital (Academic / other)
• Drugs / interventions: radiation, chemotherapy, immunotherapy
• Locations: 1 site (Guangzhou, Guangdong)
• Trial ID: NCT06533384 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the efficacy and safety of combining PD-1 inhibitors with either PARPi or capecitabine as adjuvant therapy for patients with high-risk triple-negative breast cancer (TNBC) who have not achieved a pathological complete response after neoadjuvant treatment. Patients are stratified based on their BRCA mutation status, with those having mutations receiving a combination of PD-1 inhibitors and PARPi, while others receive PD-1 inhibitors with capecitabine. The trial is a phase III, randomized, controlled, open-label study conducted at a single center. The goal is to determine if these combination therapies can improve outcomes compared to standard PD-1 inhibitor monotherapy.

Who should consider this trial

Good fit: Ideal candidates are patients with pathologically confirmed high-risk triple-negative breast cancer who have completed neoadjuvant immunotherapy and local treatment.

Not a fit: Patients with non-invasive breast cancer or those with ER/PR positive or HER2 positive tumors may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly improve treatment outcomes for patients with high-risk TNBC.

How similar studies have performed: Other studies have shown promising results with similar combination therapies in treating triple-negative breast cancer, indicating potential for success.

Eligibility criteria

Inclusion Criteria:

* Pathologically confirmed invasive breast cancer.
* Negative expression of estrogen receptor (ER) and progesterone receptor (PR) according to immunohistochemistry (i.e., tumor cells showing positive staining in less than 1% of all tumor cells).
* Negative human epidermal growth factor receptor 2 (HER2) status as determined by immunohistochemistry: HER2 score of 0/1+ or, if the score is 2+, HER2/CEP17 ratio less than 2.0 or HER2 gene copy number less than 4, as confirmed by in situ hybridization (ISH).
* Clinical tumor staging: T1c, N1-N2 or T2, N0-N2 or T3, N0-N2 or T4a-d, N0-N2.
* The subjects were required to have good organ function, as evidenced by the following tests conducted within 7 days before randomization:

Hematology examination (excluding blood transfusion or use of hematopoietic stimulating agents for correction):

* Hemoglobin (Hb) ≥ 90 g/L.
* Absolute neutrophil count (ANC) ≥ 1.5 × 109/L.
* Absolute lymphocyte count (ALC) ≥ 0.5 × 109/L.
* Platelet count (PLT) ≥ 100 × 109/L.
* White blood cell count (WBC) ≥ 3.0 × 109/L and ≤ 15 × 109/L.

Serum biochemistry examination (excluding recent blood transfusion or albumin administration):

* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 1.5 times the upper limit of normal (ULN).
* Alkaline phosphatase (ALP) ≤ 2.5 ULN.
* Total bilirubin (TBIL) ≤ 1.5 ULN.
* Serum creatinine (Cr) ≤ 1.5 ULN, with creatinine clearance (CrCL) ≥ 50 mL/min (calculated using the Cockcroft-Gault formula).
* Prothrombin time (PT) and activated partial thromboplastin time (APTT) ≤ 1.5 ULN, and international normalized ratio (INR) ≤ 1.5 ULN (if not receiving anticoagulant therapy).

  * Thyroid-stimulating hormone (TSH) within the normal range; if TSH is abnormal, levels of free triiodothyronine (FT3) and free thyroxine (FT4) should be examined. If FT3/FT4 results are not available, T3 and T4 measurements can be considered, and if T3/T4 levels are within the normal range, the subject can be included.
  * Urine analysis: Urinary protein \< 2+; if urinary protein is ≥ 2+, a 24-hour urine protein quantification should demonstrate protein ≤ 1g.
  * Cardiac echocardiography: Left ventricular ejection fraction (LVEF) ≥ 55%.
  * 12-lead electrocardiogram: Fridericia-corrected QT interval (QTcF) \< 470 msec.
  * Women of childbearing potential must have a negative serum pregnancy test within 3 days prior to initiating medication, and they and their partners must agree to use highly effective methods of contraception during the study and for 180 days after the last administration of the investigational drug.
  * Voluntary participation in the clinical trial and signing of the informed consent form are required.

Exclusion Criteria:

* Known history of allergy to the components of the investigational drug.
* Previous receipt of antitumor treatment or radiation therapy for any malignancy (excluding previously cured cervical carcinoma in situ and basal cell carcinoma).
* Undergone major surgery unrelated to breast cancer within the past 4 weeks, or patients who have not fully recovered from such surgery.
* Inability to swallow, intestinal obstruction, or other factors that may affect the administration and absorption of the medication.
* Severe cardiac disease or discomfort that prevents treatment.
* Presence of mental illness or substance abuse that interferes with compliance.
* Pregnant or breastfeeding women.
* Concurrent participation in other clinical trials.
* Subjects deemed by the investigator to have conditions that pose a serious risk to the safety of the participant or may affect the completion of the study, or individuals who are considered unsuitable for inclusion based on other reasons.

Where this trial is running

Guangzhou, Guangdong

• Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University — Guangzhou, Guangdong, China (Recruiting)

Study contacts

• Study coordinator: Liulu Zhang, MD

Conditions Triple-negative Breast Cancer