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Triple-negative breast cancer (TNBC), defined by the lack of ER, PR and HER2 expression, is refractory to endocrine therapy and anti-HER2 agents. Chemotherapy was once the mainstay for advanced TNBC, but its limited efficacy necessitates optimized therapeutic strategies. TNBC's high TIL infiltration and elevated PD-L1 expression confer sensitivity to immune checkpoint inhibitors (ICIs), with ICI-chemotherapy combinations initially establishing first-line standard status. Emerging clinical evidence shows that ICI-antibody-drug conjugate (ADC) combinations outperform ICI-chemotherapy regimens, yet immune-related adverse events (irAEs) remain a critical clinical challenge. Expert consensus recommends continuing ICI therapy in advanced TNBC patients achieving CR, PR or SD after ICI-based combination therapy until disease progression or intolerable toxicity. Mechanistically, once ICIs reach target receptor saturation, dose escalation or high-frequency administration fails to boost efficacy but raises toxicity risk. Thus the investigators hypothesize that an ICI maintenance strategy with fixed dose and extended intervals can preserve efficacy, reduce toxicity, improve patient compliance, enhance quality of life and alleviate economic burden for advanced TNBC patients with CR/PR/SD after ICI-chemotherapy or ICI-ADC treatment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Extended-Dose Interval | Experimental | During the maintenance therapy phase, the dose of PD-1 inhibitors is consistent with that of the standard therapy phase, administered every 6 weeks (q6w); the dose of chemotherapy or TROP2-ADC drugs is consistent with that of the standard therapy phase, administered every 3 weeks (q3w). |
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| Standard-Dose Interval | Active Comparator | During the maintenance therapy phase, the dosages of PD-1 inhibitors, chemotherapy, or TROP2-ADC drugs are maintained at the same levels as those in the standard treatment phase, administered every 3 weeks (q3w). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Extended-Dose Interval Immunotherapy | Drug | During the maintenance therapy phase, the dose of PD-1 inhibitors is maintained at the same level as in the standard treatment phase, with the dosing interval extended to every 6 weeks (q6w). |
| Measure | Description | Time Frame |
|---|---|---|
| mPFS | Refers to the time from randomization date to the first observation of disease progression (based on RECIST v1.1 criteria) or death from any cause, whichever occurs first. | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years. |
| Measure | Description | Time Frame |
|---|---|---|
| mOS | The time from randomization date to any cause of death date. | From date of randomization until the date of death from any cause, assessed up to 3 years. |
| DoR | Refers to the time from the date of achieving CR or PR to the first disease progression (PD) or death from any cause, whichever occurs first. |
| Measure | Description | Time Frame |
|---|---|---|
| Biomarker | Compare the differences in immune cell proportion, PD-1 saturation and other aspects among blood and tissue samples in both arms to identify biomarkers that may predict treatment outcomes. | 3 years (before and after therapy). |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jieqiong Liu | Contact | 86-13922272706 | liujieqiong01@163.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Breast Tumor Center, Sun Yat-sen Memorial Hospital | Recruiting | Guangzhou | Guangdong | 510000 | China |
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| Standard-Dose Interval Immunotherapy | Drug | During the maintenance therapy phase, the dosage and dosing interval of PD-1 inhibitors are consistent with those in the standard therapy phase, administered every 3 weeks (q3w). |
|
| From date of achieving CR or PR until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years. |
| DDC | Refers to the time from the date of achieving CR, PR, or SD to the first evaluation as PD or death from any cause, whichever occurs first. | From date of achieving CR, PR, or SD until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years. |
| Assessment of quality of life via the EORTC QLQ-C30 questionnaire. | Patient reported outcomes via the European Organisation for Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30). It contains 30 items and measures 5 functional scales (physical, role, emotional, cognitive, and social), a global health and quality of life scale, 3 symptom scales (fatigue, nausea/vomiting, and pain), and 6 single items (dyspnea, sleep disturbance, appetite loss, constipation, diarrhea, and financial impact). The global health and quality of life scale uses a 7-point scale scoring with anchors (1=very poor and 7=excellent); the other items are scored on a 4 point scale (1=not at all, 2=a little, 3= quite a bit, 4=very much). | 3 years. |
| Assessment of quality of life via the EORTC QLQ-BR42 questionnaire. | Patient reported outcomes via the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Breast Cancer 42 (EORTC QLQ-BR42). It consists of 42 items that formed ten scales (Breast Symptoms, Body Image, Sexual Functioning, Arm Symptoms, Systemic Chemotherapy Side Effects, Hand/Feet Symptoms/Neuropathy, Skeletal Symptoms Scale, Endocrine Symptoms, Breast Satisfaction, Vaginal Symptoms) and 3 single items (Weight Gain, Sexual Enjoyment, and Future Perspective). The items are scored on a 4 point scale (1=not at all, 2=a little, 3= quite a bit, 4=very much). | 3 years. |
| Assessment of quality of life via the EQ-5D-5L questionnaire. | Patient reported outcomes via the 5-level EuroQol-5D (EQ-5D-5L questionnaire). It consists of 5 health state dimensions: mobility, self-care, usual activities, pain, and anxiety. Each dimension is rated on a five-point scale from 1 (extreme problem) to 5 (no problem). It also includes a vertical visual analog scale with a graded scoring system: 0 represents the worst imaginable health status, while 100 represents the best. | 3 years. |
| Assessment of quality of life via the HADS questionnaire. | Patient reported outcomes via the Hospital anxiety and depression scale (HADS). It is a 14 items questionnaire: 7 items related to anxiety and 7 items related to depression scored on a scale. Each item is rated on a 4-point Likert scale (0 = "not at all", 1 = "a little", 2 = "quite a bit", and 3 = "very much"), with higher scores indicating more distress. | 3 years. |
| Assessment of quality of life via the FCRI questionnaire. | Patient reported outcomes via the Fear of Cancer Recurrence Inventory (FCRI). The scale is assessed using a 5-point Likert scale, where level 0 indicates "never or not at all" and level 4 indicates "a lot or always". | 3 years. |
| AE | Incidence and severity of adverse events | 3 years. |
| Cost-Utility Analysis | Measured by incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life year (QALY) gained. | 3 years. |
| ID | Term |
|---|---|
| D064726 | Triple Negative Breast Neoplasms |
| D001943 | 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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