Effect of Peri-operative anti-HER2 therapy On early breast cancer Study - Biological phase

ISRCTN ISRCTN15004993
DOI https://doi.org/10.1186/ISRCTN15004993
EudraCT/CTIS number 2008-005466-30
IRAS number 6930
ClinicalTrials.gov number NCT01104571
Secondary identifying numbers ICR-CTSU/2008/10017, IRAS 6930
Submission date
23/02/2009
Registration date
19/03/2009
Last edited
21/12/2023
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-effect-having-trastuzumab-or-lapatinib-before-surgery-early-breast-cancer-ephos-b

Study website

Contact information

Prof Nigel Bundred
Scientific

University of Manchester
c/o University of South Manchester NHS Foundation Trust
2nd Floor, Education and Research Centre
Southmoor Road
Manchester
M23 9LT
United Kingdom

Email bundred@manchester.ac.uk
Ms Jane Banerji
Public

ICR-CTSU
Sir Richard Doll Building
Institue of Cancer Research
Cotswold Road
Sutton
SM2 5NG
United Kingdom

Phone +44(0)0208 722 4349
Email EPHOS-B-icrctsu@icr.ac.uk

Study information

Study designRandomized phase III open-label multicentre clinical trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleEffect of peri-operative anti-HER2 therapy on early breast cancer: a randomised phase III open-label multicentre clinical trial
Study acronymEPHOS-B
Study objectivesThe EPHOS-B study will test the hypothesis that peri-operative anti-HER2 therapy causes a significant increase in tumour apoptosis and a significant decrease in tumour cell proliferation.

Please note that as of 19/02/10 this record has been updated. All updates can be found in the relevant field with the above update date. Please also note that the start and end dates of this trial have been updated from 01/06/2009 and 01/12/2009 to 01/04/2010 and 01/11/2021 respectively. This includes the follow up period.
Ethics approval(s)

Approved 12/01/2010, West Midlands Research Ethics Committee (1st Floor, NHSBT Newcastle Blood Donor Centre, Holland Drive, Newcastle Upon Tyne, NE2 4NQ, United Kingdom; +44 (0)2071048357; edgbaston.rec@hra.nhs.uk), ref: 09/H1208/52

Health condition(s) or problem(s) studiedEarly breast cancer
InterventionCurrent information as of 19/02/10:
Group I: control (i.e. no peri-operative treatment)
Group II: trastuzumab 6 mg/kg intravenous (iv) given on days 1 and 8 pre-surgery, and 2 mg/kg iv on day 15 post-operatively
Group III: Lapatinib 1500mg/day p.o. continuously for 28 days, starting 11 days (± 1 day) pre-surgery.

Initial information at time of registration:
Group I: control (i.e. no peri-operative treatment)
Group II: trastuzumab 6 mg/kg intravenous (iv) given on days 1 and 8 pre-surgery, and 2 mg/kg iv on days 15 and 22 post-operatively
Group III: lapatinib 1500 mg/day orally (p.o.) for approximately 6 weeks, starting 11 days (± 1 day) pre-operatively and continued for 4 weeks post-operatively

Patients should be followed-up 28 days after surgery and then every 6 months until the end of year 2. Patients will then be followed up annually for at least 10 years after completion of recruitment.

Joint sponsors:
University Hospital of South Manchester NHS Foundation Trust (UK)
2nd Floor, Education and Research Centre
Southmoor Road
Manchester M23 9LT
United Kingdom
Email: Bundred@manchester.ac.uk
http://www.uhsm.nhs.uk/Pages/Home.aspx

Institute of Cancer Research (ICR) (UK)
123 Old Brompton Road
London SW7 3PR
Tel: +44 (0)20 8722 4188
Fax: +44 (0)20 8770 7876
Email: Barbara.Pittam@icr.ac.uk
http://www.icr.ac.uk
Intervention typeDrug
Pharmaceutical study type(s)
PhasePhase III
Drug / device / biological / vaccine name(s)Trastuzumab, lapatinib
Primary outcome measure1. Increase in apoptosis: change in the tumour (morphological apoptosis and activated caspase 3) measured at diagnosis and at surgery
2. Fall in proliferation between diagnosis and surgery: change in proliferation measured by Ki67 immunohistochemical assessment (%) at diagnosis and at surgery
Secondary outcome measures1. Changes in the angiogenic serum markers vascular endothelial growth factor A (VEGF-A), VEGF-R1 and CD105, measured at diagnosis, surgery (plus also tumour CD31) and 28 days post-surgery
2. To establish if the expression of molecular markers (epidermal growth factor receptor [EGFR], Her-3, insulin-like growth factor 1 receptor [IGF1R], c-myc, Akt, p-ERK, pS6 Kinase, activated Src, or truncated p95HER-2 expression) predict increases in apoptosis or decreases in proliferation in response to therapy
Overall study start date01/04/2010
Completion date19/12/2022

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexFemale
Target number of participants250
Total final enrolment257
Key inclusion criteria1. Women aged greater than or equal to 18 years old
2. HER2 (3+ on immunohistochemistry [IHC] or amplification proven by fluorescent in-situ hybridisation [FISH]) positive operable invasive breast cancer diagnosed by core biopsy
3. Planned surgery within one month of diagnosis
4. Serum creatinine and bilirubin less than 2 times the upper limits of normal for the institution, or creatinine clearance greater than 30 mg/dL (Marginally
abnormal test results should be repeated)
5. Eastern Cooperative Oncology Group (ECOG) performance status 0,1, or 2 (Karnofsky greater than or equal to 60%)
6. Non-pregnant and non-lactating with no intention of pregnancy during study treatment
7. Written informed consent obtained for trial and to donation of tissue and blood samples

Added 19/02/10:
8. Patients must be candidates for and willing to undergo adjuvant chemotherapy and trastuzumab post surgery
Key exclusion criteriaCurrent information as of 19/02/10:
1. HER2 negative cancers and those with unknown HER2 status
2. Inoperable breast cancer (T4 category) or suspicion of distant metastases
3. Diagnosis of inflammatory breast cancer
4. Clinical evidence of metastatic disease
5. Prior herceptin therapy within the last 3 months or local (radiotherapy) cancer treatments
6. Previous cancer at any other site that has been treated within the last 6 months (except previous basal cell carcinoma and cervical carcinoma in situ)
7. Have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment)
8. Impaired gastro-intestinal function thought sufficient to reduce lapatinib absorption
9. Contra-indicated to receive adjuvant chemotherapy and/or trastuzumab (ECOG >2)
10. Known immediate or delayed hypersensitivity, reaction to drugs chemically related to trastuzumab or lapatinib
11. Other concomitant investigational agents or concurrent anti-cancer therapy
12. Regular use of systemic steroids or other agents that could influence study endpoints (inhaled steroids are allowed)
13. Any altered mental state that would preclude obtaining written informed consent
14. Patients who have clinically significant cardiac abnormalities or uncontrolled hypertension
15. Previous myocardial infarction, heart failure, or significant angina. Cardiac function should be assessed by physical examination, ECG, and baseline LVEF should be ≥55% as measured by echocardiography or MUGA.

Initial information at time of registration:
1. HER2 negative cancers and those with unknown HER2 status
2. Inoperable breast cancer (T4 category) or suspicion of distant metastases
3. Diagnosis of inflammatory breast cancer
4. Clinical evidence of metastatic disease
5. No prior systemic (i.e. chemotherapy) or local (radiotherapy) cancer treatments
6. Previous cancer at any other site (except previous basal cell carcinoma and cervical carcinoma in situ)
7. Abnormal renal function
8. Abnormal liver function tests
9. Have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment)
10. Impaired gastro-intestinal function thought sufficient to reduce lapatinib absorption
11. Contra-indication to receive adjuvant chemotherapy and/or trastuzumab (ECOG greater than 2)
12. Known immediate or delayed hypersensitivity, reaction to drugs chemically related to trastuzumab or lapatinib
13. Other concomitant investigational agents or concurrent anti-cancer therapy. In addition all herbal (alternative) therapies are prohibited.
14. Regular use of systemic steroids or other agents that could influence study endpoints
15. Patient must not have clinically significant cardiac abnormalities or uncontrolled hypertension
16. No previous myocardial infarction, heart failure, or significant angina. Cardiac function should be assessed by physical examination, electrocardiogram (ECG), and baseline left ventricular ejection fraction (LVEF) should be greater than or equal to 50% as measured by echocardiography or multiple-gated acquisition (MUGA) scan.
Date of first enrolment01/04/2010
Date of final enrolment30/09/2015

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

University of Manchester
Manchester
M23 9LT
United Kingdom

Sponsor information

University of Manchester (UK)
University/education

Oxford Road
Manchester
M13 9PL
England
United Kingdom

Website http://www.manchester.ac.uk
ROR logo "ROR" https://ror.org/027m9bs27

Funders

Funder type

Charity

Cancer Research UK (CRUK) (UK) (ref: C7525/A8965)
Private sector organisation / Other non-profit organizations
Alternative name(s)
CR_UK, Cancer Research UK - London, CRUK
Location
United Kingdom
GlaxoSmithKline (UK)
Government organisation / For-profit companies (industry)
Alternative name(s)
GlaxoSmithKline plc., GSK plc., GSK
Location
United Kingdom

Results and Publications

Intention to publish date01/12/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planHas been presented at international conferences and published in Clinical Cancer Research April 2022
IPD sharing planThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
EPHOS-B-icrctsu@icr.ac.uk

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Abstract results 01/03/2016 09/03/2023 No No
Poster results version 2 07/12/2021 09/03/2023 No No
Results article 01/04/2022 09/03/2023 Yes No
HRA research summary 28/06/2023 No No
Plain English results 17/07/2023 No Yes
Protocol file version 8.0 04/09/2019 21/12/2023 No No

Additional files

18515 Abstract EBBC March 2016-EPHOS-B session.pdf
18515 Poster 07.12.21 EPHOS-B SABCS 2021 v2.pdf
ISRCTN15004993_Protocol_v8.0_ 04Sept2019.pdf

Editorial Notes

21/12/2023: The following changes were made:
1. EudraCT/CTIS number added.
2. IRAS number added.
3. The study website was added.
4. Protocol file (not peer reviewed added).
17/07/2023: Results in plain English added to the study outputs table. Total final enrolment added.
09/03/2023: The following changes were made to the trial record:
1. The overall end date was changed from 01/11/2021 to 19/12/2022.
2. The participant level data sharing statement was added.
3. The publication and dissemination plan was added.
4. Publication reference, abstract, and poster added.
23/07/2019: The following changes were made to the trial record:
1. The recruitment end date was changed from 01/11/2021 to 30/09/2015.
2. The intention to publish date was added.
3. Jane Banerji was added as public contact.