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This is a phase II, open-labeled, multi-centered, single-arm, investigator-initiated clinical trial of camrelizumab (an anti-PD-1 antibody) in combination with apatinib (a VEGFR2 TKI) for neoadjuvant treatment of patients with triple-negative breast cancer and >10% tumor-infiltrating lymphocytes (TILs) in baseline breast tumors. We will enroll 58 subjects (Simon's two stage design). The study is designed to evaluate the efficacy and safety of camrelizumab in combination with apatinib in the neoadjuvant treatment of TNBC with a high proportion of TILs.
This a phase II, open-labeled, multi-centered, single-arm, investigator-initiated clinical trial to assess the efficacy and safety of camrelizumab combination with apatinib in female patients age of 18 to 70 with TNBC, and baseline tumor-infiltrating lymphocytes > 10%. The number of patients to be included is 58 patients (Simon's two stage design). The primary objective is to assess the pCR. All enrolled patients will be treated with camrelizumab 200mg (iv. 3mg/kg for patient whose weight is below 50kg) on day 1 of each 21-day cycle, and apatinib 250mg daily (po, d1-d21).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experiment | Experimental | Eligible patients enrolled receive camrelizumab 200 mg, iv, d1, every 21 days (3 mg/kg if weight <50 kg) in combination with apatinib 250 mg, po, qd for neoadjuvant treatment for 8 cycles. Patients evaluated after neoadjuvant therapy with pCR receive 9 cycles of postoperative adjuvant camrelizumab (200 mg, iv, or 3 mg/kg if weight <50 kg, d1,q3W) + apatinib (250 mg, po, qd). Patients with non-pCR after neoadjuvant therapy receive adjuvant chemotherapy of the physician's choice (TPC). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Anti-PD-1 monoclonal antibody | Drug | Camrelizumab 200 mg, iv, d1, q3W (3 mg/kg if weight <50 kg) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pathological Complete Remission (pCR) rate | pCR rate (ypT0/Tis ypN0) is defined as the percentage of participants without residual invasive cancer on hematoxylin and eosin evaluation of the complete resected breast specimen and all sampled regional lymph nodes following completion of neoadjuvant systemic therapy by current American Joint Committee on Cancer (AJCC) staging criteria assessed by the local pathologist at the time of definitive surgery. | After neoadjuvant study treatment and surgery, up to approximately 24-26 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Objective Response Rate (ORR) | The propotion of subjects with CR or PR according to RECIST v1.1. | After neoadjuvant study treatment and surgery, up to approximately 24-26 weeks |
| Breast Conservation Rate |
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Inclusion Criteria:
Patients sign the written informed consent.
Women aged 18-70.
Patients with histologically confirmed operable invasive breast cancer (T1cN1-2 or T2-4N0-2)[ER-negative(IHC<1%), PR-negative(IHC<1%), HER2-negative(IHC-/+ or IHC++ and FISH/CISH-)].
Percentage of tumor-infiltrating lymphocytes >10% in baseline breast tumor.
Patients with at least one measuring lesion that was conformed to RECIST v1.1 standard.
No previous breast cancer-related treatment, including chemotherapy, immunotherapy, endocrine therapy, radical surgery, or radiotherapy.
Patients can swallow pills.
Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 1.
Patients with a life expectancy of at least 12 weeks.
The patient's blood test results prior to enrollment met the following criteria: • Hb≥90g/L; • Plt≥100^9/L; • Serum albumin ≥3g/dL; • Neutrophils≥1.5^9/L;
• TSH≤ normal upper limit (ULN);
Female subjects of childbearing potential must have a negative serum pregnancy test within 7 days before the first dose and must be willing to use very efficient barrier methods of contraception for the course of the study through 6 months after the last dose of study treatment.
Exclusion Criteria:
(1) NYHA class 2 or higher heart failure; (2) Unstable angina pectoris; (3) Myocardial infarction within 1 year; (4) clinically significant supraventricular or ventricular arrhythmias requiring treatment or intervention.
10. Urine routine suggestive of urine protein ≥++, or confirmed 24-hour urine protein amount ≥1.0g.
11. Known presence of hereditary or acquired bleeding and thrombotic tendencies (e.g., hemophiliacs, coagulation disorders, thrombocytopenia, hypersplenism, etc.).
12. Patients with congenital or acquired immune deficiencies (e.g., HIV-infected individuals).
13. Live vaccines administered less than 4 weeks prior to study drug administration or possibly during the study.
14. Active tuberculosis. 15. Patients have received oral or intravenous antibiotic therapy within 2 weeks prior to neoadjuvant therapy.
16. Major surgical procedure within 4 weeks prior to the start of study treatment or anticipated need for major surgical procedure during the course of the study.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jieqiong Liu, MD,PhD | Contact | 020-34071156 | liujieqiong01@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Jieqiong Liu, M.D., Ph.D. | Sun Yet-sen Memorial Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University | Recruiting | Guangzhou | Guangdong | 510120 | China |
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| VEGFR2 Tyrosine Kinase Inhibitor | Drug | Apatinib 250 mg, po, qd |
|
|
The percentage of patients who undergo breast-conserving surgery after neo-adjuvant therapy.
| Up to approximately 24-26 weeks |
| Incidence of Treatment-Emergent Adverse Events | Adverse events/serious adverse events. | From the first drug administration to within 90 days for the last dose |
| Event-Free Survival (EFS) | Event-free survival (EFS) defined as the time from recruitment until documented disease recurrence, progression, or death from any cause in all participants. EFS events covered under "disease recurrence" will include local, regional, or distant recurrence and contralateral breast cancer. Ipsilateral or contralateral in situ disease and second primary non-breast cancers will not be counted as EFS events. | Up to approximately 8 years |
| Overall Survival (OS) | defined as the time from randomization to death due to any cause. | Up to approximately 8 years |
| Frequencies of Biomarkers | Biomarkers (including tumor/stromal PD-L1, stromal PD-1, tumor-infiltrating lymphocytes and tumor-infiltrating B cells, eg). | Up to approximately 24-26 weeks |
| Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University | Recruiting | Shanwei | Guangdong | 516600 | China |
|
| The First Affiliated Hospital of Nanjing Medical University | Recruiting | Nanjing | Jiangsu | 210029 | China |
|
| Second Military Medical University | Recruiting | Shanghai | Shanghai Municipality | 200433 | China |
|
| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D064726 | Triple Negative Breast Neoplasms |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
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| ID | Term |
|---|---|
| C000711728 | spartalizumab |
| C000631724 | camrelizumab |
| C553458 | apatinib |
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