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Detect V / CHEVENDO (Chemo vs. Endo)

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ClinicalTrials.gov Identifier: NCT02344472
Recruitment Status : Recruiting
First Posted : January 26, 2015
Last Update Posted : October 25, 2019
Sponsor:
Collaborators:
Roche Pharma AG
Novartis Pharmaceuticals
Eisai GmbH
Celgene Corporation
Information provided by (Responsible Party):
Prof. W. Janni, University of Ulm

Study Description
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Brief Summary:
Chemo- versus endocrine therapy in combination with dual HER2-targeted therapy of Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus Kisqali® (ribociclib) in patients with HER2 positive and hormone-receptor positive metastatic breast cancer.

Condition or disease Intervention/treatment Phase
Metastatic Breast Cancer Drug: pertuzumab Drug: Trastuzumab Drug: Capecitabine Drug: Paclitaxel Drug: Vinorelbine Drug: Docetaxel Drug: Exemestane Drug: Letrozole Drug: Anastrozole Drug: Fulvestrant Drug: Ribociclib Drug: nab-Paclitaxel Drug: eribulin Drug: leuprorelin Drug: goserelin Phase 3

Detailed Description:
Especially for diseases that are not curable such as metastatic breast cancer (MBC), the maintenance of quality of life is one of the main aims of treatments. Adverse events are well-known side effects of any cytostatic treatment and impact the patients' quality of life. Therefore, new treatment options are developed that should stop or at least slow down metastatic spread of cancer without causing negative side effects in terms of high-grade adverse events. For patients with hormone-receptor positive and HER2 positive MBC the combination of HER2-targeted therapy with endocrine therapy has already been proven to be an effective and in many cases valuable alternative to the combination of HER2-targeted therapy with chemotherapy. The high relevance of HER2-neu-targeted/endocrine treatment combinations derives from the fact that potential chemotherapy-related toxicity can be avoided, which in turn positively affects quality of life. Clinical trials suggest an additional benefit when a CDK4/6 inhibitor is added to the combination of endocrine therapy and anti HER2 treatment. DETECT V is a randomized phase III study comparing the safety and efficacy of trastuzumab plus pertuzumab and the CDK 4/6 inhibitor ribociclib in combination with either endocrine therapy or chemotherapy.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 270 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: DETECT V / CHEVENDO A Multicenter, Randomized Phase III Study to Compare Chemo- Versus Endocrine Therapy in Combination With Dual HER2-targeted Therapy of Herceptin® (Trastuzumab) and Perjeta® (Pertuzumab) Plus Kisqali® (Ribociclib) in Patients With HER2 Positive and Hormone-receptor Positive Metastatic Breast Cancer.
Study Start Date : September 2015
Estimated Primary Completion Date : September 2021
Estimated Study Completion Date : June 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Pertuzumab

Arms and Interventions
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Arm Intervention/treatment
Experimental: Chemotherapy with docetaxel
dual HER2-targeted therapy with Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus docetaxel. Up to three weeks after completion of chemotherapy, patients will be treated with maintenance endocrine therapy plus dual HER2-targeted therapy and Kisqali® (Ribociclib).
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Docetaxel
Chemotherapy
Experimental: Chemotherapy with paclitaxel
dual HER2-targeted therapy with Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus paclitaxel.Up to three weeks after completion of chemotherapy, patients will be treated with maintenance endocrine therapy plus dual HER2-targeted therapy and Kisqali® (Ribociclib).
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Paclitaxel
Chemotherapy
Experimental: Chemotherapy with vinorelbine
dual HER2-targeted therapy with Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus vinorelbine. Up to three weeks after completion of chemotherapy, patients will be treated with maintenance endocrine therapy plus dual HER2-targeted therapy and Kisqali® (Ribociclib).
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Vinorelbine
Chemotherapy
Experimental: Chemotherapy with capecitabine
dual HER2-targeted therapy with Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus capecitabine. Up to three weeks after completion of chemotherapy, patients will be treated with maintenance endocrine therapy plus dual HER2-targeted therapy and Kisqali® (Ribociclib).
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Capecitabine
Chemotherapy
Experimental: endocrine therapy with exemestane
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus exemestane.
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Exemestane
endocrine therapy

Drug: Ribociclib
CDK 4/6 inhibitor
Other Name: Kisqali®
Experimental: endocrine therapy with fulvestrant
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus fulvestrant.
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Fulvestrant
endocrine therapy

Drug: Ribociclib
CDK 4/6 inhibitor
Other Name: Kisqali®
Experimental: endocrine therapy with anastrozole
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus anastrozole.
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Anastrozole
endocrine therapy

Drug: Ribociclib
CDK 4/6 inhibitor
Other Name: Kisqali®
Experimental: endocrine therapy with letrozole
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus letrozole.
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Letrozole
endocrine therapy

Drug: Ribociclib
CDK 4/6 inhibitor
Other Name: Kisqali®
Experimental: Chemotherapy with nab-Paclitaxel
dual HER2-targeted therapy with Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus nab-Paclitaxel. Up to three weeks after completion of chemotherapy, patients will be treated with maintenance endocrine therapy plus dual HER2-targeted therapy and Kisqali® (Ribociclib).
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: nab-Paclitaxel
chemotherapy
Experimental: Chemotherapy with eribulin
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus eribulin. Up to three weeks after completion of chemotherapy, patients will be treated with maintenance endocrine therapy plus dual HER2-targeted therapy and Kisqali® (Ribociclib).
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: eribulin
chemotherapy
Experimental: endocrine therapy with leuprorelin
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus leuprorelin.
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Ribociclib
CDK 4/6 inhibitor
Other Name: Kisqali®

Drug: leuprorelin
endocrine therapy
Experimental: endocrine therapy with goserelin
dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (Ribociclib) plus goserelin.
 Drug: pertuzumab
HER2 targeted Therapy
Other Name: Perjeta®

Drug: Trastuzumab
HER2 targeted Therapy
Other Name: Herceptin®

Drug: Ribociclib
CDK 4/6 inhibitor
Other Name: Kisqali®

Drug: goserelin
endocrine therapy


Outcome Measures
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Primary Outcome Measures :
  1. Number of Participants with Adverse Events [ Time Frame: 3 - 9 weeks ]
    safety of a dual HER2-targeted therapy with Herceptin® (trastuzumab), Perjeta® (pertuzumab) and Kisqali® (riobciclib) plus endocrine therapy as compared to a dual HER2-targeted therapy with Herceptin® (trastuzumab) and Perjeta® (pertuzumab) plus chemotherapy (followed by endocrine therapy plus ribociclib in combination with trastuzumab and pertuzumab as maintenance therapy) by the proportion of patients experiencing any adverse event (as defined by the modified adverse event score)


Secondary Outcome Measures :
  1. quality-adjusted survival [ Time Frame: 3 - 9 weeks ]
    to assess quality-adjusted survival (as assessed by the Q-TWiST method) and to compare it between the two treatment arms

  2. overall response rate (ORR) [ Time Frame: 3 - 9 weeks ]
    compare efficacy between the two treatment arms as assessed by overall response rate (ORR)

  3. incidence of central nervous system (CNS) metastases and their control rate [ Time Frame: 3 - 9 weeks ]
    assess the incidence of CNS metastases and control rate of preexisting CNS metastases

  4. Analysis of Quality of life [ Time Frame: 3 - 9 weeks ]
    assess additional aspects of quality of life based on the evaluation of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) QLQ-C30 and QLQ-BR23 questionnaires

  5. presence and number of circulating tumor cell (CTC) at different time points [ Time Frame: 6 weeks ]
    determine presence and number of CTC in the peripheral blood at baseline and at different time points after the start of palliative treatment including the time of progression, and to assess the value of CTCs as indicator for therapy success

  6. Evaluation of all reported events and all grades in both treatment arms (chemotherapy and endocrine therapy) [ Time Frame: 3 - 9 weeks ]
    All reported events with all grades for evaluation of safety and tolerability of the study treatments and to to evaluate and compare toxicity of chemotherapy arm vs. endocrine treatment arm

  7. disease control rate (DCR) [ Time Frame: 3 - 9 weeks ]
    compare efficacy between the two treatment arms as assessed by disease control rate (DCR)

  8. progression-free survival (PFS) [ Time Frame: 3 - 9 weeks ]
    compare efficacy between the two treatment arms as assessed by progression-free survival (PFS)

  9. overall survival (OS) [ Time Frame: 3 - 9 weeks ]
    compare efficacy between the two treatment arms as assessed by overall survival (OS)


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

  • Signed, written informed consent in study participation
  • The primary tumor and/or biopsies from metastatic sites or locoregional recurrences have been confirmed as HER2-positive (FISH-positive or IHC 3+) and hormone receptor positive breast cancer by histopathology according to local testing
  • Metastatic breast cancer or locally advanced BC, which cannot be treated by surgery or radiotherapy only
  • Pre- and postmenopausal women are allowed
  • No more than two prior chemotherapies for metastatic disease
  • No more than two prior anti-HER2 therapies for metastatic disease
  • Pertuzumab retreatment is allowed if prior pertuzumab treatment was finished 12 months before
  • At least one measurable lesion assessable using standard techniques by Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST v1.1)
  • Tumor evaluation according to RECIST version 1.1 has been performed within 4 weeks before randomization based on local assessment
  • Age ≥ 18 years

  • Standard 12-lead ECG values assessed by the local laboratory:

    • QTcF interval at screening < 450 msec (using Fridericia's correction)
    • Resting heart rate 50-90 bpm
  • Left ventricular cardiac ejection fraction (LVEF) ≥ 50% at baseline (as measured by echocardiogram)
  • ECOG Score ≤ 2

  • Adequate organ function within 14 days before randomization, evidenced by the following laboratory results below:

    • absolute neutrophil count ≥ 1500 cells/µL,
    • platelet count ≥ 100000 cells/µL,
    • hemoglobin ≥ 9 g/dL,
    • ALT (SGPT) ≤ 2.0 × ULN (≤ 3.0 × ULN in case of liver metastases)
    • AST (SGOT) ≤ 2.0 × ULN (≤ 3.0 × ULN in case of liver metastases)
    • bilirubin ≤ 1.5 × ULN (with the exception of Gilbert's syndrome)
    • creatinine ≤ 2.0 mg/dl or 177µmol/L INR ≤ 1,5

  • Patients must have the following laboratory values within normal limits or corrected to within normal limits with supplemets before the first dose of study medication:

    • Sodium
    • Potassium
    • Total calcium
  • In case of patients of child bearing potential:

Negative serum pregnancy test at baseline (within 7 days prior to randomization) and agreement to remain abstinent (if it is in line with the preferred and usual lifestyle) or use single or combined non-hormonal contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 7 months after the last dose of study treatment

Exclusion criteria:

Patients will be excluded from the study for any of the following reasons:

  • History of hypersensitivity reactions attributed to trastuzumab, pertuzumab, ribociclib or to other components of drug formulation
  • Mandatory need for cytostatic treatment at time of study entry based on clinical judgment and national/international treatment guidelines
  • Known CNS metastases
  • Any concurrent severe, uncontrolled systemic disease, social or psychiatric condition that might interfere with the planned treatment and with the patient's adherence to the protocol
  • Progression on prior Pertuzumab therapy
  • Treatment with Pertuzumab within the last 12 months
  • Prior treatment with any mTOR- or CDK4/6-inhibitor
  • Treatment with any other investigational agents during trial
  • Known hypersensitivity to lecithin (soya) or peanuts
  • Life expectancy < 6 months
  • Patients with pre-existing grade ≥2 peripheral neuropathy are excluded from taxane-based chemotherapy

  • History of serious cardiac disease, including but not confined to:

    • history of documented heart failure or systolic dysfunction (LVEF < 50%)
    • high-risk uncontrolled arrhythmias i.e., atrial tachycardia with a heart rate ≥100/min at rest, significant ventricular arrhythmia (ventricular tachycardia) or higher-grade AV-block (second degree AV-block Type 2 [Mobitz 2] or third degree AV-block)
    • angina pectoris requiring anti-anginal medication
    • clinically significant valvular heart disease
    • evidence of transmural infarction on ECG
    • poorly controlled hypertension (e.g., systolic >180 mm Hg or diastolic >100 mm Hg)
    • any other cardiac condition, which in the opinion of the treating physician would make this protocol unreasonably hazardous for the patient
  • Dyspnea at rest or other diseases that require continuous oxygen therapy
  • Patients with poorly controlled diabetes or with evidence of clinically significant diabetic vascular complications
  • Patients with known infection with HIV, hepatitis B virus, or hepatitis C virus
  • Male patients
  • Pregnant, lactating or women of childbearing potential without a negative pregnancy test (serum) within 7 days prior to randomization, irrespective of the method of contraception used
  • Medical or psychological conditions that would not permit the subject to complete the study or sign informed consent
  • Participation in another clinical study within the 30 days before registration
  • Legal incapacity or limited legal capacity
Contacts and Locations
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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): NCT02344472


Contacts
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Contact: Wolfgang Janni, MD PhD +49 731 500 58 501 studienzentrale.ufk@uniklinik-ulm.de
Contact: Sabrina Krause, M. sc. +49 731 500 58 652 sabrina.krause@uniklinik-ulm.de

Locations
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Germany
University Hospital Ulm Gynecology/Obstetrics Recruiting
Ulm, Germany
Sponsors and Collaborators
Prof. W. Janni
Roche Pharma AG
Novartis Pharmaceuticals
Eisai GmbH
Celgene Corporation
Investigators
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Principal Investigator: Jens Huober, MD PhD Studienzentrale Dpt. Gyn/OB University Ulm
More Information
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Additional Information:

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Responsible Party: Prof. W. Janni, Director Department of Obstetrics and Gynecology, University of Ulm
ClinicalTrials.gov Identifier: NCT02344472    
Other Study ID Numbers: D-V
2014-002249-22 ( EudraCT Number )
First Posted: January 26, 2015    Key Record Dates
Last Update Posted: October 25, 2019
Last Verified: October 2019
Keywords provided by Prof. W. Janni, University of Ulm:
MBC
HER2
CTC
endocrine therapy
 Pertuzumab
Trastuzumab
HER2 therapy
Ribociclib
Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Paclitaxel
Vinorelbine
Docetaxel
Albumin-Bound Paclitaxel
Capecitabine
Trastuzumab
Letrozole
Fulvestrant
Anastrozole
Exemestane
 Goserelin
Pertuzumab
Leuprolide
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antimetabolites
Antineoplastic Agents, Immunological
Aromatase Inhibitors
Steroid Synthesis Inhibitors
Enzyme Inhibitors