This clinical trial is focused on studying treatments for breast cancer, specifically for patients with Triple-Negative Breast Cancer (TNBC) or hormone receptor-low/HER2-negative breast cancer. The study will evaluate the effectiveness of a new treatment combination involving Datopotamab Deruxtecan (Dato-DXd) and Durvalumab, both given before and after surgery. This will be compared to the current standard treatment, which includes Pembrolizumab and chemotherapy, also administered before and after surgery. The purpose of the study is to determine if the new treatment combination is more effective than the standard treatment.
Participants in the study will receive either the new treatment combination or the standard treatment. The new treatment involves the use of Dato-DXd, a medication designed to target and destroy cancer cells, and Durvalumab, which helps the immune system fight cancer. These medications will be given through an intravenous infusion, which means they are delivered directly into the bloodstream. The standard treatment includes Pembrolizumab, another medication that boosts the immune system, along with chemotherapy, which uses drugs to kill cancer cells. Some participants may also receive a placebo, which is a substance with no active medication, to help compare the effects of the treatments.
The study will follow participants over a period of time to monitor their response to the treatments. This includes checking for the absence of cancer in the breast and lymph nodes after surgery, as well as tracking the time until any signs of cancer return or other health events occur. The goal is to see if the new treatment can improve outcomes for patients with these specific types of breast cancer. Participants will be closely monitored by healthcare professionals throughout the study to ensure their safety and well-being.
1joining the study
Upon joining the study, the patient will be randomly assigned to one of two treatment groups. This assignment is done to compare the effectiveness of different treatment combinations for breast cancer.
2neoadjuvant treatment phase
In this phase, the patient will receive treatment before surgery. The treatment involves either datopotamab deruxtecan and durvalumab or pembrolizumab with chemotherapy.
The medications are administered through intravenous infusion, which means they are given directly into the bloodstream through a vein.
3surgery
After completing the neoadjuvant treatment, the patient will undergo surgery to remove the breast cancer. The goal is to achieve a pathological complete response, meaning no cancer is found in the tissue removed during surgery.
4adjuvant treatment phase
Following surgery, the patient will receive additional treatment to help prevent cancer from returning. This phase includes durvalumab or pembrolizumab with or without chemotherapy, depending on the group assigned.
The medications are again administered through intravenous infusion.
5follow-up
The patient will be monitored regularly to assess the effectiveness of the treatment and to check for any signs of cancer recurrence. This involves scheduled visits and tests as determined by the study protocol.
Who Can Join the Study?
Participants must be 18 years or older at the time of signing the informed consent form.
Participants must have Stage II or III breast cancer that is either triple-negative or hormone receptor-low/HER2-negative. This means the cancer does not have certain proteins that are usually found in breast cancer.
Participants must have an ECOG Performance Status of 0 or 1. This is a scale used to measure how well a person can perform daily activities. A score of 0 means fully active, and 1 means some symptoms but still able to do light work.
Participants must provide an acceptable tumor sample for testing.
Participants must have adequate bone marrow reserve and organ function. This means their blood and organs are working well enough to handle the treatment.
Participants must use contraception if they are male or female, following local rules about birth control for people in clinical studies.
Who Cannot Join the Study?
Patients who have already received treatment for their breast cancer cannot participate.
Patients with a type of breast cancer that is not Triple Negative or Hormone Receptor low/HER2-negative are excluded. Triple Negative means the cancer does not have any of the three common types of receptors known to fuel most breast cancer growth. Hormone Receptor low/HER2-negative means the cancer has low levels of hormone receptors and does not have the HER2 protein.
Patients who are not within the specified age range for the study cannot participate.
Both male and female patients are eligible, but those who do not meet other criteria will be excluded.
Patients who are considered part of a vulnerable population, which may include those unable to give informed consent, may be excluded.
Datopotamab Deruxtecan (Dato-DXd) is an experimental medication being studied for its potential to treat certain types of breast cancer. It is used in combination with other treatments to see if it can help shrink tumors before surgery and improve outcomes for patients with triple-negative or hormone receptor-low/HER2-negative breast cancer.
Durvalumab is a medication that helps the immune system recognize and attack cancer cells. In this trial, it is used both before and after surgery to see if it can improve the effectiveness of the treatment in patients with specific types of breast cancer.
Pembrolizumab is another medication that boosts the immune system’s ability to fight cancer. It is used in this study in combination with chemotherapy to evaluate its effectiveness in treating breast cancer before and after surgery.
Triple Negative Breast Cancer – This type of breast cancer is characterized by the absence of three common receptors known to fuel most breast cancer growth: estrogen, progesterone, and HER2. It tends to be more aggressive and has fewer treatment options compared to other breast cancer types. The cancer cells in triple negative breast cancer do not have the receptors that are targeted by some of the most effective therapies, making it more challenging to treat. It often grows and spreads more quickly than other types of breast cancer. This type of cancer is more likely to affect younger women and those with a BRCA1 gene mutation.
Hormone Receptor-Low/HER2-Negative Breast Cancer – This form of breast cancer has low levels of hormone receptors and lacks the HER2 protein, which is another common target for breast cancer treatments. The low presence of hormone receptors means that hormone therapy may not be as effective. It shares some characteristics with triple negative breast cancer but may have different growth patterns and responses to treatment. This type of cancer can be more difficult to treat due to the limited presence of targets for conventional therapies. It may require a combination of treatments to manage effectively.
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