Molecular Testing and Imaging in Improving Response in Patients With Stage I-III Triple-Negative Breast Cancer Receiving Chemotherapy MDACC Breast Moonshot Initiative

Summary

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PRIMARY OBJECTIVE: I. To conduct a prospective single arm, non-randomized trial to determine the impact of implementation of a research platform that includes diagnostic imaging to assess response to the initial phase of neoadjuvant chemotherapy combined with subtyping of TNBC in order to select the...

PRIMARY OBJECTIVE: I. To conduct a prospective single arm, non-randomized trial to determine the impact of implementation of a research platform that includes diagnostic imaging to assess response to the initial phase of neoadjuvant chemotherapy combined with subtyping of TNBC in order to select the appropriate targeted therapy trial to complete neoadjuvant chemotherapy in patients found to have chemo-insensitive disease by imaging. SECONDARY OBJECTIVES: I. Measured as defined by Standardized Definitions for Efficacy End Points (STEEP) criteria using the following prioritization: distant recurrence free interval (DRFI), recurrence free survival (RFS), distant relapse-free survival (DRFS), overall survival (OS), invasive disease free survival (IDFS), disease free survival including ductal carcinoma in situ (DFS-DCIS). II. Evaluate the rates of enrollment into clinical trials for patients identified as having chemotherapy insensitive disease. III. Compare the rates of enrollment into therapeutic clinical trials between the two arms of the trial, i.e. those who do, versus do not, receive the results of molecular genomic prediction of chemotherapy response. IV. Evaluate the frequency of pathologic response rates (pCR, RCB I-III residual disease) in patients identified as chemotherapy sensitive versus insensitive. V. Compare the pathologic response rates of tumors between the two arms of the trial for the patients whose tumor was molecularly classified as chemotherapy- sensitive or chemotherapy-insensitive, and in whose neoadjuvant chemotherapy (NACT) followed the recommendation of the trial schema. VI. Determine the estimates of DRFI, RFS, DRFS, IDFS and DFS-DCIS at 3 years, and OS at 5 years in all patients. VII. Compare the estimates between the two arms of the trial for the patients whose tumor was molecularly classified as chemotherapy-sensitive or chemotherapy-insensitive, and for whose NACT followed the recommendation of the trial schema. VIII. Determine the pathologic response based on molecular characterization. IX. Determine the estimates of DRFI, RFS, DRFS, IDFS and DFS-DCIS at 3 years, and OS at 5 years. X. Subset analyses of pathologic response and 3-year DRFI, RFS, DRFS, IDFS and DFS-DCIS. XI. Estimate for the subsets where gene expression levels of receptor status (estrogen receptor [ER], progesterone receptor [PR] and HER2) were, or were not concordant with TNBC status as defined by routine diagnostic tests (immunohistochemistry and/or fluorescent in situ hybridization. XII. Compare the results of pathologic node-negative status (sentinel and/or non-sentinel nodes) after neoadjuvant chemotherapy according to a genomic predictor of nodal response to NACT, in subsets defined by pre-treatment clinical nodal status. EXPLORATORY OBJECTIVES: I. Future re-analysis of residual samples using a customized genomic diagnostic platform (integrated "prospective-retrospective" biomarker analysis) to predict chemotherapy sensitivity. II. Generation and subsequent molecular characterization of patient derived xenograph (PDX) models. III. Clinical diagnostic development studies using residual samples (fresh and/or formalin-fixed) within the Clinical Laboratory Improvement Amendments (CLIA)-compliant Molecular Diagnostics Laboratory and patient derived xenographs (PDX), to formally evaluate the clinical validity and utility of future clinical genomic diagnostic tests that would predict both response, recurrence, and survival from the treatments used in this clinical trial (correlative "retrospective-prospective" biomarker analyses). IV. Correlative science studies to identify molecular therapeutic targets for treatment-insensitive TNBC using residual samples and PDX models. V. Correlation of tumor features or changes as measured by diagnostic imaging to determine potential predictors of treatment response. VI. Determine polymerase chain reaction (pCR) rates in a cohort of patients who undergo surgical resection after achieving complete radiological response after 4 cycles of adjuvant chemotherapy (AC). OUTLINE: Patients undergo baseline molecular and immunohistochemistry (IHC) evaluation of their tumor biopsy, and receive the results. Patients then receive standard anthracycline-based chemotherapy and undergo standard ultrasound at baseline, after 2 courses, and after 4 courses of treatment. Patients and physicians are notified of the results of the molecular evaluation. Patients may then choose to continue with standard taxane +/- platinum-based chemotherapy or participate in an experimental clinical trial designed to match the molecular profile and triple-negative subtype. Patients with tumors predicted to be insensitive to chemotherapy are advised to participate in a clinical trial treating their tumor subtype. After completion of study treatment, patients are followed up for up to 5 years.

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