Shorter Chemo-Immunotherapy Without Anthracycline Drugs for Early-Stage Triple Negative Breast Cancer
Purpose
This phase III trial compares the effects of shorter chemotherapy (chemo)-immunotherapy without anthracyclines to usual chemo-immunotherapy for the treatment of early-stage triple negative breast cancer. Paclitaxel is in a class of medications called anti-microtubule agents. It stops cancer cells from growing and dividing and may kill them. Carboplatin is in a class of medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of cancer cells. Cyclophosphamide is in a class of medications called alkylating agents. It works by damaging the cell's deoxyribonucleic acid (DNA) and may kill cancer cells. It may also lower the body's immune response. Docetaxel is in a class of medications called taxanes. It stops cancer cells from growing and dividing and may kill them. Doxorubicin is an anthracycline chemotherapy drug that damages DNA and may kill cancer cells. Pembrolizumab may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Shorter treatment without anthracycline chemotherapy may work the same as the usual anthracycline chemotherapy treatment for early-stage triple negative breast cancer.
Conditions
- Anatomic Stage I Breast Cancer AJCC v8
- Anatomic Stage II Breast Cancer AJCC v8
- Anatomic Stage IIIA Breast Cancer AJCC v8
- Anatomic Stage IIIB Breast Cancer AJCC v8
- Early Stage Triple-Negative Breast Carcinoma
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Sex
- All
- Accepts Healthy Volunteers
- No
Criteria
Inclusion Criteria:
- Participants must have histologically confirmed estrogen receptor (ER)-negative,
progesterone receptor (PR)-negative, and HER2-negative breast cancer (TNBC) defined
as ER < 5%, PR < 5%, and HER2 negative (per 2020 American Society of Clinical
Oncology [ASCO] College of American Pathologists [CAP] guidelines)
- NOTE: Participants with weakly ER or PR positive disease, defined as ER and/or
PR between 1-4% by immunohistochemistry, are eligible if adjuvant endocrine
therapy is not recommended/planned by the treating physician
- Participants must have American Joint Committee on Cancer (AJCC) 8 anatomic tumor
clinical stage either
- T2-T4, N0, M0 or
- T1-T3, N1-2, M0
- Note: All participants with clinically suspicious nodes must undergo core
needle biopsy or fine needle biopsy per standard clinical practice to
pathologically confirm nodal status
- Participants must have breast and axillary imaging with mammogram and/or ultrasound
and/or magnetic resonance imaging (MRI) within 49 days prior to randomization
- Note: Participants with bilateral invasive breast cancer are eligible if both
breast cancers are ER-negative, PR-negative, and HER2-negative provided they
meet the other eligibility criteria
- Participants must not have T4/N+, any N3, or inflammatory breast cancer
- Participants must not have metastatic disease (M1)
- Participants must not have received prior systemic therapy or radiation therapy with
curative intent for the current breast cancer
- Participants must not have had previous definitive ipsilateral breast surgery for
the current breast cancer
- Participants must not have current or anticipated use of other investigational
agents while participating in this study
- Participants must not have history of allergic reactions attributed to compounds of
similar chemical or biologic composition as study agents
- Participants must not have severe hypersensitivity (>= grade 3) to pembrolizumab or
any of its excipients
- Participants must not have received prior therapy with an anti-PD-1, anti-PD-L1, or
anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory
T-cell receptor (e.g. CTLA-4, OX-40, CD137)
- Participants must not be currently participating in or have participated in a study
of an investigational agent or used an investigational device within 28 days prior
to randomization
- Participants must be >= 18 years old
- Participants must have Zubrod performance status of 0-2
- Participants with evidence of peripheral neuropathy must have it at =< grade 1, by
Common Terminology Criteria for Adverse Events (CTCAE) version (v.) 5.0, within 28
days prior to randomization
- Participants must have a complete medical history and physical exam within 28 days
prior to randomization
- Hemoglobin >= 9.0 g/dL or >= 5.6 mol/L (within 28 days prior to randomization)
- (Criteria must be met without erythropoietin dependency and without packed red
blood cell transfusion within last 2 weeks)
- Leukocytes >= 3 x 10^3/uL (within 28 days prior to randomization)
- Absolute neutrophil count >= 1.5 x 10^3/uL (within 28 days prior to randomization)
- Platelets >= 100 x 10^3/uL (within 28 days prior to randomization)
- Total bilirubin =< 1.5 x institutional upper limit of normal (IULN), OR direct
bilirubin =< IULN for participants with total bilirubin > 1.5 x IULN (unless history
of Gilbert's disease. Participants with history of Gilbert's disease must have total
bilirubin =< 5 x institutional IULN) (within 28 days prior to randomization)
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x
institutional upper limit of normal (ULN) (within 28 days prior to randomization)
- Participants must have a serum creatinine =< the IULN OR calculated creatinine
clearance >= 50 mL/min/1.73m^2 using the following Cockcroft-Gault Formula. This
specimen must have been drawn and processed within 28 days prior to registration
- Participants must have adequate cardiac function. Participants must have left
ventricular ejection fraction >= 50% as assessed by either echocardiography (ECHO)
or multigated acquisition scan (MUGA) assessed within 28 days prior to registration.
Participants with known history or current symptoms of cardiac disease, or history
of treatment with cardiotoxic agents, must have a clinical risk assessment of
cardiac function using the New York Heart Association Functional Classification and
must be class 2B or better
- Participants with known human immunodeficiency virus (HIV)-infection must be on
effective anti-retroviral therapy at randomization and have undetectable viral load
test on the most recent test results obtained within 6 months prior to randomization
- Participants with evidence of chronic hepatitis B virus (HBV) infection must have
undetectable HBV viral load while on suppressive therapy on the most recent test
results obtained within 6 months prior to randomization, if indicated
- Note: No testing for Hepatitis B is required unless mandated by local health
authority
- Participants with a history of hepatitis C virus (HCV) infection must have been
treated and cured. Participants currently being treated for HCV infection must have
undetectable HCV viral load test on the most recent test results obtained within 6
months prior to randomization, if indicated
- Note: No testing for hepatitis C is required unless mandated by local health
authority
- Participants with history of diabetes must not have uncontrolled diabetes in the
opinion of the treating investigator
- Participants must not have uncontrolled hypertension in the opinion of the treating
investigator
- Participants must not have had a major surgery within 14 days prior to
randomization. Participants must have fully recovered from the effects of prior
major surgery in the opinion of the treating investigator
- Participants must not have severe or active infections within 14 days prior to
Randomization, including but not limited to hospitalization for infection,
bacteremia, or severe pneumonia
- Participants must not have a diagnosis of immunodeficiency and be receiving chronic
systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent)
or any other form of immunosuppressive therapy within 7 days prior to randomization
- Participants must not have active autoimmune disease that has required systemic
treatment in 2 years prior to randomization (i.e., with use of disease modifying
agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g.,
thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or
pituitary insufficiency) is not considered a form of systemic treatment
- Participants must not have a history of (non-infectious) pneumonitis that required
steroids, or has current (non-infectious) pneumonitis
- Participants must not have received a live vaccine within 30 days prior to
randomization. Examples of live vaccines include, but are not limited to, the
following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever,
rabies, Bacillus Calmette-Guerin (BCG), and typhoid vaccine. Seasonal influenza
vaccines for injection are generally killed virus vaccines and are allowed; however,
intranasal influenza vaccines (e.g., FluMist [registered trademark]) are live
attenuated vaccines and are not allowed
- Participants must not have a prior or concurrent malignancy whose natural history or
treatment (in the opinion of the treating physician) has the potential to interfere
with the safety or efficacy assessment of the treatment regimen
- Participants must not be pregnant or nursing. Individuals who are of reproductive
potential must have agreed to use an effective contraceptive method with details
provided as a part of the consent process. A person who has had menses at any time
in the preceding 12 consecutive months or who has semen likely to contain sperm is
considered to be of "reproductive potential." In addition to routine contraceptive
methods, "effective contraception" also includes refraining from sexual activity
that might result in pregnancy and surgery intended to prevent pregnancy (or with a
side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy,
bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in
the semen
- Participants must have one (1) physical 4-5-micron single hematoxylin and eosin
(H&E) slide from the archival pretreatment diagnostic biopsy available for
submission
- Participants must be offered the opportunity to participate in specimen banking.
With participant consent, specimens must be collected and submitted via the
Southwest Oncology Group (SWOG) Specimen Tracking System
- Participants who can complete questionnaires in English, Spanish, or French must be
offered the opportunity to participate in the Patient-Reported Outcome study
- NOTE: As a part of the Oncology Patient Enrollment Network (OPEN) registration
process the treating institution's identity is provided in order to ensure that the
current (within 365 days) date of institutional review board approval for this study
has been entered in the system
- Participants must be informed of the investigational nature of this study and
must sign and give informed consent in accordance with institutional and
federal guidelines
- For participants with impaired decision-making capabilities, legally authorized
representatives may sign and give informed consent on behalf of study
participants in accordance with applicable federal, local, and Central
Institutional Review Board (CIRB) regulations
- As part of the registration process the treating institution's identity is provided
in order to ensure that the current (within 365 days) date of institutional review
board approval for this study has been entered in the system
Study Design
- Phase
- Phase 3
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Primary Purpose
- Treatment
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Active Comparator Arm I (usual chemo-immunotherapy) |
Patients receive paclitaxel IV, carboplatin IV, and pembrolizumab IV on study. Patients then receive doxorubicin IV, cyclophosphamide IV, and pembrolizumab IV on study. Patients then undergo surgery. Patients may receive pembrolizumab after surgery. Patients may optionally undergo collection of blood samples throughout the trial. |
|
|
Experimental Arm II (shorter chemo-immunotherapy) |
Patients receive docetaxel IV, carboplatin IV, and pembrolizumab IV on study. Patients then undergo surgery. Patients may receive pembrolizumab after surgery. Patients may optionally undergo collection of blood samples throughout the trial. |
|
Recruiting Locations
Birmingham, Alabama 35233
Anchorage, Alaska 98508
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Anchorage, Alaska 99508
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Baldwin Park, California 91706
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Burlingame, California 94010
Cameron Park, California 95682
Carmichael, California 95608
Carmichael, California 95608
Castro Valley, California 94546
Davis, California 95616
Duarte, California 91010
Elk Grove, California 95758
Emeryville, California 94608
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Fremont, California 94538
Harbor City, California 90710
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Macomb, Michigan 48044
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Midland, Michigan 48670
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Niles, Michigan 49120
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Pontiac, Michigan 48341
Pontiac, Michigan 48341
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Pontiac, Michigan 48341
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Saint Joseph, Michigan 49085
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Wyoming, Michigan 49519
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Aitkin, Minnesota 56431
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Princeton, Minnesota 55371
Robbinsdale, Minnesota 55422
Saint Cloud, Minnesota 56303
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Shakopee, Minnesota 55379
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Virginia, Minnesota 55792
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Wyoming, Minnesota 55092
Columbus, Mississippi 39705
Grenada, Mississippi 38901
Jackson, Mississippi 39216
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New Albany, Mississippi 38652
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Ballwin, Missouri 63011
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Bolivar, Missouri 65613
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Cape Girardeau, Missouri 63703
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Cape Girardeau, Missouri 63703
City of Saint Peters, Missouri 63376
Creve Coeur, Missouri 63141
Farmington, Missouri 63640
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Joplin, Missouri 64804
Joplin, Missouri 64804
Kansas City, Missouri 64108
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Osage Beach, Missouri 65065
Rolla, Missouri 65401
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Rolla, Missouri 65401
Saint Joseph, Missouri 64506
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Springfield, Missouri 65804
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Springfield, Missouri 65807
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St Louis, Missouri 63109
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St Louis, Missouri 63110
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Sullivan, Missouri 63080
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Sunset Hills, Missouri 63127
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Washington, Missouri 63090
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Anaconda, Montana 59711
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Billings, Montana 59102
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Bozeman, Montana 59715
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Great Falls, Montana 59405
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Bellevue, Nebraska 68123
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Kearney, Nebraska 68847
Omaha, Nebraska 68118
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Carson City, Nevada 89703
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Pahrump, Nevada 89048
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Concord, New Hampshire 03301
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Manchester, New Hampshire 03103
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Cherry Hill, New Jersey 08002
Englewood, New Jersey 07631
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Red Bank, New Jersey 07701
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Summit, New Jersey 07902
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Vineland, New Jersey 08360
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Voorhees Township, New Jersey 08043
Bay Shore, New York 11706
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Brooklyn, New York 11220
Glens Falls, New York 12801
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Greenlawn, New York 11740
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Lake Success, New York 11042
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Mineola, New York 11501
New York, New York 10016
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Poughkeepsie, New York 12601
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Southampton, New York 11968
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Staten Island, New York 10305
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Stony Brook, New York 11794
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Webster, New York 14580
Asheboro, North Carolina 27205
Asheville, North Carolina 28803
Burlington, North Carolina 27215
Chapel Hill, North Carolina 27599
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Goldsboro, North Carolina 27534
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Bismarck, North Dakota 58501
Fargo, North Dakota 58103
Fargo, North Dakota 58103
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Fargo, North Dakota 58103
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Jamestown, North Dakota 58401
Akron, Ohio 44304
Alliance, Ohio 44601
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Barberton, Ohio 44203
Beavercreek, Ohio 45431
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Dayton, Ohio 45415
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Lawton, Oklahoma 73505
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Baker City, Oregon 97814
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Cranberry Township, Pennsylvania 16066
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717-721-4840
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Monroeville, Pennsylvania 15146
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Providence, Rhode Island 02903
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Westerly, Rhode Island 02891
Bluffton, South Carolina 29910
Boiling Springs, South Carolina 29316
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Hilton Head Island, South Carolina 29926-3827
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Sioux Falls, South Dakota 57104
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Collierville, Tennessee 38017
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Memphis, Tennessee 38120
Austin, Texas 78701
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512-324-7991
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713-873-2000
Berlin Corners, Vermont 05602
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802-225-5400
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Charlottesville, Virginia 22908
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Richmond, Virginia 23223
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Tappahannock, Virginia 22560
Aberdeen, Washington 98520
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360-788-8223
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206-606-5800
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Sedro-Woolley, Washington 98284
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Vancouver, Washington 98686
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Walla Walla, Washington 99362
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Morgantown, West Virginia 26506
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Princeton, West Virginia 24740
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304-487-7515
Wheeling, West Virginia 26003
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304-243-6442
Antigo, Wisconsin 54409
Appleton, Wisconsin 54911
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Ashland, Wisconsin 54806
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Brookfield, Wisconsin 53045
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Chilton, Wisconsin 53014
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Eau Claire, Wisconsin 54701
Franklin, Wisconsin 53132
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Germantown, Wisconsin 53022
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Green Bay, Wisconsin 54301
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920-435-8326
Green Bay, Wisconsin 54301
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Greenfield, Wisconsin 53228
Hayward, Wisconsin 54843
Hayward, Wisconsin 54843
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218-568-4416
Kenosha, Wisconsin 53142
Madison, Wisconsin 53718
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Marinette, Wisconsin 54143
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Milwaukee, Wisconsin 53209
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Minocqua, Wisconsin 54548
Mukwonago, Wisconsin 53149
Neenah, Wisconsin 54956
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Oconomowoc, Wisconsin 53066
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262-928-7878
Oconto Falls, Wisconsin 54154
Oshkosh, Wisconsin 54904
Oshkosh, Wisconsin 54904
Racine, Wisconsin 53405
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Rhinelander, Wisconsin 54501
Rice Lake, Wisconsin 54868
Sheboygan, Wisconsin 53081
Sheboygan, Wisconsin 53081
Spooner, Wisconsin 54801
Stevens Point, Wisconsin 54481
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Sturgeon Bay, Wisconsin 54235-1495
Summit, Wisconsin 53066
Superior, Wisconsin 54880
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701-364-6272
Two Rivers, Wisconsin 54241
Waukesha, Wisconsin 53188
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262-928-7632
Waukesha, Wisconsin 53188
Wausau, Wisconsin 54401
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877-405-6866
Wauwatosa, Wisconsin 53226
Wauwatosa, Wisconsin 53226
West Allis, Wisconsin 53227
Weston, Wisconsin 54476
Wisconsin Rapids, Wisconsin 54494
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715-422-7718
Wisconsin Rapids, Wisconsin 54494
Cody, Wyoming 82414
Bayamón, Puerto Rico 00959-5060
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787-395-7085
Bayamón, Puerto Rico 00961
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787-780-2865
Manatí, Puerto Rico 00674
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787-621-4397
San Juan, Puerto Rico 00917
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787-274-3387
San Juan, Puerto Rico 00927
San Juan, Puerto Rico 00927
San Juan, Puerto Rico 00936
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787-763-1296
More Details
- NCT ID
- NCT05929768
- Status
- Recruiting
- Sponsor
- SWOG Cancer Research Network
Detailed Description
PRIMARY OBJECTIVE: I. To assess whether participants with early stage triple negative breast cancer (TNBC) randomized to receive anthracycline-free, taxane-platinum neoadjuvant chemotherapy with pembrolizumab have non-inferior breast cancer event-free survival (BC-EFS) compared to participants randomized to taxane-platinum-anthracycline neoadjuvant chemotherapy with pembrolizumab. SECONDARY OBJECTIVES: I. To compare pathological complete response (pCR) and residual cancer burden (RCB) rates by randomized arm. II. To compare pCR and RCB rates between randomized arms by tumor infiltrating lymphocytes (TIL) status. III. To compare BC-EFS between randomized arms in the TIL-enriched and non-TIL enriched subgroups. IV. To compare distant relapse-free survival and overall survival by randomized arm. V. To compare invasive breast cancer-free survival after surgery between randomized arms in pCR and residual disease groups. VI. To compare the safety and tolerability by randomized arm among those that initiate therapy. TRANSLATIONAL MEDICINE OBJECTIVE: I. To evaluate concordance and accuracy of an automated stromal TIL (sTIL) algorithm versus (vs.) central pathologist assessed sTILs quantification. PATIENT REPORTED OUTCOME (PRO) OBJECTIVES: I. To compare patient-reported fatigue at 3 weeks after the last neoadjuvant systemic therapy (NAST) dose and, separately, at 18 months after randomization, using the Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue-7a in participants undergoing NAST with taxane-platinum-anthracycline chemo-immunotherapy vs taxane-platinum chemo-immunotherapy. (Quality of Life, Primary) II. To compare physical function experienced by participants undergoing neoadjuvant systemic chemotherapy (NAST) with taxane-platinum-anthracycline chemo-immunotherapy vs taxane-platinum chemo-immunotherapy, within 3-5 weeks post last neoadjuvant systemic therapy dose using the PROMIS-29 Profile physical function subscale score. (Quality of Life, Secondary) III. To compare physical function experienced by participants undergoing NAST taxane-platinum-anthracycline chemo-immunotherapy vs taxane-platinum chemo-immunotherapy at 18 months post registration using the PROMIS-29 Profile physical function subscale score. (Quality of Life, Secondary) IV. To compare other PROMIS-29 Profile subscale scores (sleep disturbance, depression, anxiety, social, pain interference, and pain sensitivity) and GP5 question response by arm within 3-5 weeks post last neoadjuvant systemic therapy dose and at 18 months post registration. (Quality of Life, Exploratory) V. To compare the GP-5 item scores by arm within 3-5 weeks post last neoadjuvant systemic therapy dose and at 18 months post registration. (Quality of Life, Exploratory) VI. To compare select patient-reported outcomes using the Common Terminology Criteria for Adverse Events (PRO-CTCAE) by arm. (Patient-Reported Symptoms of Treatment) BANKING OBJECTIVE: I. To bank physical specimens and digital slides for future correlative studies. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive paclitaxel intravenously (IV), carboplatin IV, and pembrolizumab IV on study. Patients then receive doxorubicin IV, cyclophosphamide IV, and pembrolizumab IV on study. Patients then undergo surgery. Patients may receive pembrolizumab after surgery. Patients may optionally undergo collection of blood samples throughout the trial. ARM II: Patients receive docetaxel IV, carboplatin IV, and pembrolizumab IV on study. Patients then undergo surgery. Patients may receive pembrolizumab after surgery. Patients may optionally undergo collection of blood samples throughout the trial. Patients are followed up every 6 months for the first 2 years and then annually until 5 years from registration.