I-SPY 2 TRIAL: Neoadjuvant and Personalized Adaptive Novel Agents to Treat Breast Cancer

Overview

About this study

The purpose of this study is to further advance the ability to practice personalized medicine by learning which new drug agents are most effective with which types of breast cancer tumors and by learning more about which early indicators of response (tumor analysis prior to surgery via magnetic resonance imaging (MRI) images along with tissue and blood samples) are predictors of treatment success.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

INCLUSION CRITERIA:

Eligibility Criteria for Initial Screening Phase of I-SPY 2 TRIAL

  • Histologically confirmed cancer of the breast. 
  • Clinically or radiologically measureable disease in the breast after diagnostic biopsy
  • Prior therapy: No prior cytotoxic regimens are allowed for this malignancy. Participants may not have had prior chemotherapy, other targeted anticancer therapies, or prior radiation therapy to the ipsilateral breast for this malignancy. Prior bis-phosphonate therapy is allowed.
  • Age ≥ 18 years
  • Women and men are eligible in this study
  • Core biopsy: Willing and able to undergo core biopsy of the primary breast lesion to assess baseline biomarkers to determine eligibility for treatment phase of I-SPY 2 TRIAL.  
  • Nonpregnant and non-breastfeeding
  • No ferromagnetic prostheses

Inclusion Criteria for Treatment Phase of I-SPY 2 TRIAL

  • Eligible breast tumors must also meet one of the following criteria:
    • Stage II or III;
    • T4, any N, M0, including clinical or pathologic inflammatory cancer;
    • Regional Stage III, where supraclavicular lymph nodes are the only sites of metastasis, will be evaluated at the time of surgery.
  • Breast Receptor status: Any tumor ER/PgR status, any HER2/neu status as measured by local hospital pathology laboratory, and meets any tumor assay profile described in protocol. Tumors will be considered positive when:
    • ≥ 5% tumor staining for ER and/or PgR is seen;
    • Any one of the following these conditions for HER2 are met:
      •  IHC 3+
      • Overexpression by FISH
      • Amplification of HER2 as assessed by an acceptable alternative probe FISH.
  • Normal organ and marrow function
  • No uncontrolled or severe cardiac disease
  • No clinical or imaging evidence of distant metastases by either:
    • Radiologic modalities (CT, PET/CT, PA and lateral CXR, or radionuclide bone scan); or
    • Laboratory levels of total bilirubin, ALT, and AST within normal range, assessed within 30 days of consenting to the treatment phase.
  • Breast tumor assay profile must include one of the following:
    • MammaPrint High, any ER status, any HER2 status
    • MammaPrint Low, ER– (< 5%), any HER2 status
    • MammaPrint Low, ER+, HER2/neu positive by any one of the three methods used (IHC, FISH/alternative probe).

EXCLUSION CRITERIA:

  • Use of any other investigational agents within 30 days of starting study treatment.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to Study Agent or accompanying supportive medications.
  • Uncontrolled intercurrent illness 
  • Sentinel lymph node dissection/biopsy on the nodes draining from the study index tumor site is not allowable prior to the start of chemotherapy. 
  • Patient has a history of any invasive malignancy within 5 years prior to randomization. Exceptions include:
    • Breast Cancer
      • Patient with a history of invasive BC are eligible if diagnosed with TNBC or HER2+/HR- disease and no evidence of recurrence at least 5 years from diagnosis. Patient with HR+ invasive BC at any time are not eligible;
      • Prior DCIS is allowed if patient had definitive surgical resection and radiation as indicated per SOC and no evidence of HR+ micro-invasion.
    • Non-Breast Malignancies
      • History of carcinoma in situ of the cervix, colorectal carcinoma in situ, melanoma in situ, and basal cell and squamous cell carcinomas of the skin;
      • History of papillary thyroid cancer.

 

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Rochester, Minn.

Mayo Clinic principal investigator

Judy Boughey, M.D.

Closed for enrollment

Contact information:

Cancer Center Clinical Trials Referral Office

(855) 776-0015

Scottsdale/Phoenix, Ariz.

Mayo Clinic principal investigator

Donald Northfelt, M.D.

Closed for enrollment

Contact information:

Cancer Center Clinical Trials Referral Office

(855) 776-0015

More information

Publications

  • Neoadjuvant chemotherapy for breast cancer provides critical information about tumor response; how best to leverage this for predicting recurrence-free survival (RFS) is not established. The I-SPY 1 TRIAL (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis) was a multicenter breast cancer study integrating clinical, imaging, and genomic data to evaluate pathologic response, RFS, and their relationship and predictability based on tumor biomarkers. Read More on PubMed
  • To compare magnetic resonance (MR) imaging findings and clinical assessment for prediction of pathologic response to neoadjuvant chemotherapy (NACT) in patients with stage II or III breast cancer. Read More on PubMed
  • Interval cancers (ICs), defined as cancers detected between regular screening mammograms, have been shown to be of higher grade, larger size, and associated with lower survival, compared with screen-detected cancers (SDCs) and comprise 17% of cancers from population-based screening programs. We sought to determine the frequency of ICs in a study of locally advanced breast cancers, the I-SPY 1 TRIAL. Screening was defined as having a mammogram with 2 years, and the proportion of ICs at 1 and 2 years was calculated for screened patients. Differences in clinical characteristics for ICs versus SDCs and screened versus non-screened cancers were assessed. For the 219 evaluable women, mean tumor size was 6.8 cm. Overall, 80% of women were over 40 and eligible for screening; however, only 31% were getting screened. Among women screened, 85% were ICs, with 68% diagnosed within 1 year of a previously normal mammogram. ICs were of higher grade (49% vs. 10%) than SDCs. Among non-screened women, 28% (43/152) were younger than the recommended screening age of 40. Of the entire cohort, 12% of cancers were mammographically occult (MO); the frequency of MO cancers did not differ between screened (11%) and non-screened (15%). ICs were common in the I-SPY 1 TRIAL suggesting the potential need for new approaches beyond traditional screening to reduce mortality in women who present with larger palpable cancers. Read More on PubMed
  • Neoadjuvant chemotherapy for breast cancer allows individual tumor response to be assessed depending on molecular subtype, and to judge the impact of response to therapy on recurrence-free survival (RFS). The multicenter I-SPY 1 TRIAL evaluated patients with ≥ 3 cm tumors by using early imaging and molecular signatures, with outcomes of pathologic complete response (pCR) and RFS. The current analysis was performed using data from patients who had molecular profiles and did not receive trastuzumab. The various molecular classifiers tested were highly correlated. Categorization of breast cancer by molecular signatures enhanced the ability of pCR to predict improvement in RFS compared to the population as a whole. In multivariate analysis, the molecular signatures that added to the ability of HR and HER2 receptors, clinical stage, and pCR in predicting RFS included 70-gene signature, wound healing signature, p53 mutation signature, and PAM50 risk of recurrence. The low risk signatures were associated with significantly better prognosis, and also identified additional patients with a good prognosis within the no pCR group, primarily in the hormone receptor positive, HER-2 negative subgroup. The I-SPY 1 population is enriched for tumors with a poor prognosis but is still heterogeneous in terms of rates of pCR and RFS. The ability of pCR to predict RFS is better by subset than it is for the whole group. Molecular markers improve prediction of RFS by identifying additional patients with excellent prognosis within the no pCR group. Read More on PubMed
  • I-SPY 2 (investigation of serial studies to predict your therapeutic response with imaging and molecular analysis 2) is a process targeting the rapid, focused clinical development of paired oncologic therapies and biomarkers. The framework is an adaptive phase II clinical trial design in the neoadjuvant setting for women with locally advanced breast cancer. I-SPY 2 is a collaborative effort among academic investigators, the National Cancer Institute, the US Food and Drug Administration, and the pharmaceutical and biotechnology industries under the auspices of the Foundation for the National Institutes of Health Biomarkers Consortium. Read More on PubMed
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CLS-20116766

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