HER2-positive Metastatic Breast CancerPhase 2TrasTUCANNCT05583110
Efficacy and Safety of the Combination of Trastuzumab Plus TUCAtinib Plus viNorelbine in Patients With HER2-positive Non-resectable Locally Advanced or Metastatic Breast Cancer
A Phase 2 study testing Tucatinib, Trastuzumab and Vinorelbine in people with HER2-positive Metastatic Breast Cancer and Locally Advanced HER2 Positive Breast Carcinoma, run by Spanish Breast Cancer Research Group at 18 sites in Spain.
Trial summary
Breast cancer (BC) is the most common neoplasm in the world. In Spain, one in 8 women is diagnosed with BC. The human epidermal growth factor receptor 2 (HER2)-positive BC subtype (that represents around 20% of all BC) was associated with poor prognosis however, new therapeutic advances have significantly increased… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- HER2-positive Metastatic Breast Cancer, Locally Advanced HER2 Positive Breast Carcinoma
- What is being tested?
- Tucatinib, Trastuzumab and Vinorelbine
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 13 participants
- Where
- 18 sitesSpain
- Study dates
- 8 Mar 2023to 30 May 2025
- Phase
- Phase 2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients are eligible to be enrolled in the study only if they meet all of the following criteria:
- Written and signed informed consent obtained prior to any study-specific procedure.
- Male or female patients at least 18 years of age.
- Availability of pre-treatment archival Formalin-Fixed Paraffin-Embedded (FFPE) tumor tissue (preferably the most recent available), otherwise possibility to perform a biopsy, to carry out exploratory biomarker analyses.
- Documented HER2-positive status by local laboratory determination, preferably on the most recent available FFPE tumor sample, according to the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) international guidelines valid at the time of the assay.
- Previous therapy with at least two prior anti-HER2 treatment regimens (either in early stage or advanced disease). Prior taxanes and trastuzumab are mandatory. Prior treatment with pertuzumab, T-DM1, trastuzumab-deruxtecan and anti-HER2 TKI agents is allowed.
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- Measurable disease according to RECIST 1.1 criteria, defined as at least 1 extra-osseous lesion that can be accurately measured in at least 1 dimension.
- Mandatory contrast brain magnetic resonance imaging (MRI) must be performed at baseline and patients must have at least one of the following:
- No evidence of brain metastases.
- Untreated brain metastases not needing immediate local therapy.
- Previously treated brain metastases.
- Brain metastases previously treated with local therapy may either be stable since treatment or may have progressed since prior local central nervous system (CNS) therapy, provided that there is no clinical indication for immediate re-treatment with local therapy.
- Subjects treated with CNS local therapy for newly identified lesions may be eligible to enroll if all of the following criteria are met:
- Time since stereotactic radiosurgery (SRS) is at least 1 week prior to first dose of study treatment, time since whole brain radiation therapy (WBRT) is at least 3 weeks prior to first dose, or time since surgical resection is at least 4 weeks.
- Other sites of evaluable disease are present.
- Relevant records of any CNS treatment must be available to allow for classification of target and non-target lesions.
- Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1.
- Life expectancy ≥ 12 weeks.
- Adequate organ and marrow function defined as follows:
- Absolute Neutrophil Count (ANC) ≥ 1,500/mm3 (1.5x109/L).
- Platelet count ≥ 100,000/mm3 (100x109/L).
- Hemoglobin ≥ 9g/dL (90g/L).
- Serum creatinine ≤ 1,5x upper limit of the normal range (ULN) or estimated creatinine clearance ≥ 60 mL/min as calculated using the standard method for the institution.
- Total serum bilirubin ≤ 1,5 x ULN (≤ 3.0 x ULN if Gilbert´s disease).
- Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT ≤ 3.0 x ULN (≤5.0 x ULN if liver metastases are present).
- Alkaline phosphatase ≤ 2.5 x ULN (≤5.0 x ULN if bone or liver metastases are present).
- Left ventricular ejection fraction (LVEF) ≥ 50% measured by multiple-gated acquisition scan (MUGA) or echocardiogram (ECHO).
- Negative urine or serum pregnancy test for females of childbearing potential.
Who cannot join
- Patients will be excluded from the study if they meet any of the following criteria:
- Have received more than 4 lines of systemic therapy for locally advanced or MBC.
- Have received prior treatment with tucatinib, vinorelbine for locally advanced or MBC or anti-HER2 TKI agents if administered less than 12 months prior to study entry.
- Have used a strong CYP3A4 or CYP2C8 inhibitor or CYP3A substrate within 2 weeks, or a strong CYP3A4 or CYP2C8 inducer within 5 days prior to the first dose of study treatment (see Protocol Attachment 2 for more information).
- Require therapy with warfarin or other coumarin derivatives (non-coumarin anticoagulants are allowed).
- Patients who received before inclusion:
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- Any investigational agent within 4 weeks.
- Chemotherapy within a period of time that is shorter than the cycle duration used for that treatment (e.g. < 3 weeks for fluorouracil, doxorubicine, epirubicin or < 1 week for weekly chemotherapy).
- Biologic therapy (e.g., antibodies): up to 4 weeks prior to starting study treatment.
- Endocrine therapy: tamoxifen or aromatase inhibitor (AI) within 2 weeks prior to starting study treatment.
- Corticosteroids within 2 weeks prior to starting study treatment. Note: the following uses of corticosteroids are permitted at any time: single doses, topical applications (e.g., for rash), inhaled sprays (e.g., for obstructive airways diseases), eye drops or local injections (e.g., intra-articular).
- Radiotherapy within 2 weeks (3 weeks if WBRT) prior to starting study treatment (all acute toxic effects must be resolved to NCI-CTCAE version 5.0 grade <1, except toxicities not considered a safety risk for the patient at investigator´s discretion). Patients who received prior radiotherapy to >25% of bone marrow are not eligible regardless of when it was administered.
- Major surgery or other anti-cancer therapy not previously specified within 4 weeks prior to starting study treatment, Resolution of all acute toxic effects of prior anti-cancer therapy or surgical procedures to NCI-CTCAE version 5.0 grade ≤ 1 (except alopecia or other toxicities not considered a safety risk for the patient at investigator´s discretion) is mandatory.
- Are unable for any reason to undergo MRI of the brain.
- Have any of the following with regards to CNS disease:
- Any untreated brain lesions >2 cm in size.
- Any brain lesion thought to require immediate local therapy, including (but not limited to) a lesion in an anatomic site where increase in size or possible treatment-related edema may pose risk to patient (e.g. brain stem lesions). Patients who undergo local treatment for such lesions identified by screening contrast brain MRI may still be eligible for the study based on criteria described under CNS inclusion criteria 7b.
- Known or concurrent leptomeningeal disease as documented by the investigator.
- Ongoing use of corticosteroids for control of symptoms of brain metastases at a total daily dose of >2 mg of dexamethasone (or equivalent).
- Poorly controlled (> 1/week) generalized or complex partial seizures or manifest neurologic progression due to brain metastases notwithstanding CNS-directed therapy.
- Have clinically significant, uncontrolled heart disease and/or recent cardiac events including any of the following:
- Ventricular arrhythmia requiring therapy.
- Myocardial infarction or unstable angina within 6 months prior to first dose of study treatment.
- Uncontrolled hypertension (defined as persistent systolic blood pressure > 150 mm Hg and/or diastolic blood pressure > 100 mm Hg on antihypertensive medications).
- Any history of symptomatic congestive heart failure (CHF).
- History of LVEF decline below 50% during or after prior trastuzumab therapy or other cardiac toxicity during previous trastuzumab treatment that necessitated discontinuation of trastuzumab.
- Have a diagnosis of any other malignancy within 3 years prior to inclusion, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ of the cervix or colorectal.
- Have history of allergic reactions to trastuzumab, vinorelbine, or tucatinib (or compounds chemically or biologically similar), except for Grade 1 or 2 infusion related reactions to trastuzumab or vinorelbine that were successfully managed.
- Have difficulties to swallow tablets, malabsorption syndrome, disease significantly affecting gastrointestinal function, resection of the stomach or small bowel, or active inflammatory bowel disease (e.g., ulcerative diseases).
- Have positive serology for Human Immunodeficiency Virus (HIV), or active infection for hepatitis B, hepatitis C or have other known chronic liver disease.
- Other severe acute or chronic medical (such as neuropathy grade 3-4) or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
- Are pregnant, breastfeeding, or planning a pregnancy. Women of child-bearing potential or partners of women of child-bearing potential, unless agreement to remain abstinent or use of single or combined non-hormonal contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 7 months after the last dose of study treatment.
- Abstinence is only acceptable if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or post-ovulation methods) and withdrawal are not acceptable methods of contraception.
- Examples of non-hormonal contraceptive methods with a failure rate of < 1% per year include tubal ligation, male sterilization (only if he is the sole partner and have been performed at least 6 months prior to screening), and certain intrauterine devices.
- Alternatively, two methods (e.g., two barrier methods such as a condom and a cervical cap) may be combined to achieve a failure rate of < 1% per year. Barrier methods must always be supplemented with the use of a spermicide.
- Male participants must not donate sperm during study and up to the time period specified above.
Trial locations and contacts
18 sites in 1 country.
18 sites in 1 country
Spain18 sites
Hospital San Juan de Alicante
Alicante, Valencia, 03550
Hospital Nuestra Señora de Sonsoles
Ávila, Castille and León, 05004
Hospital Universitario de Bádajoz
Bádajoz, Extremadura, 06080
ICO Badalona
Barcelona, Catalonia, 08916
Hospital Universitario de Jeréz De La Frontera
Cadiz, Andalusia, 11407
Hospital Universitario Reina Sofía
Córdoba, Andalusia, 14004
Hospital Universitario Donostia
Donostia / San Sebastian, Basque Country, 20014
Hospital Universitario de Jaén
Jaén, Andalusia, 23007
Complejo hospitalario Universitario Insular-Materno Infantil
Las Palmas de Gran Canaria, Las Palmas, 35016
Hospital General Universitario Gregorio Marañón
Madrid, 28009
Hospital Universitario Quironsalud Madrid
Madrid, 28223
Hospital Costa del Sol
Málaga, Andalusia, 29603
Hospital Universitario Central de Asturias
Oviedo, Principality of Asturias, 33011
Hospital Universitario Virgen de Valme
Seville, Andalusia, 41014
Hospital Clínico Universitario de Valladolid
Valladolid, Castille and León, 47003
Hospital Álvaro Cunqueiro
Vigo, Galicia, 36213
Hospital Universitario de Araba
Vitoria-Gasteiz, Álava, 01009
Hospital Clínico Universitario Lozano Blesa
Zaragoza, Aragon, 50009
About this study
Official title: Single Arm Phase II Study of the Efficacy and Safety of the Combination of Trastuzumab Plus TUCAtinib Plus viNorelbine in Patients With HER2-positive Non-resectable Locally Advanced or Metastatic Breast Cancer "TrasTUCAN Study"
Breast cancer (BC) is the most common neoplasm in the world. In Spain, one in 8 women is diagnosed with BC. The human epidermal growth factor receptor 2 (HER2)-positive BC subtype (that represents around 20% of all BC) was associated with poor prognosis however, new therapeutic advances have significantly increased the cure rate of patients in early stages.
In the metastatic setting, anti-HER2 targeted therapies have significantly improved overall survival (OS) with good quality of life, however there is still a substantial group of patients who die, and therefore additional drugs need to be investigated.
Read more
Trastuzumab, an anti HER2 antibody has demonstrated, in combination with chemotherapy, an improvement of OS in early and metastatic stages.
Tucatinib is an oral selective inhibitor of the HER2 receptor tyrosine kinase subunit. Its high affinity for this subunit causes fewer toxicities, such as rash and diarrhea, which are common with other anti-HER tyrosine kinase inhibitors (TKIs).
Vinorelbine has been evaluated previously in combination with trastuzumab showing interesting results.
This is a single country, multicenter, single arm phase II clinical trial with a safety run-in phase, to study the efficacy, safety and tolerability of the administration of tucatinib in combination with trastuzumab and vinorelbine in HER2-positive non-resectable locally advanced or metastatic breast cancer (MBC) with measurable disease.
Read the detailed description
Patients with brain metastasis are allowed (but up to maximum of 50% of included patients).
Forty-nine patients will be enrolled in the study:
- The first 3 patients included in the study will receive trastuzumab plus tucatinib plus oral vinorelbine at a dose of 50 mg/m2 in the first cycle. If not dose limiting toxicity (DLT) is observed, these patients will receive oral vinorelbine at a dose of 60 mg/m2 for the following cycles.
- If 1/3 patients experience DLT in the first cycle, 3 additional patients will be included to receive trastuzumab plus tucatinib plus oral vinorelbine at a dose of 50 mg/m2 in the first cycle and then 60 mg/m2.
- If 0/3 or <2/6 patients experience DLT in the first cycle the vinorelbine dose will be 60 mg/m2 for all the following patients included in the study.
- If ≥2 out of 3 or 6 patients experienced DLT in the first cycle, all the following included patients will receive oral vinorelbine at a dose of 50 mg/m2.
DLTs are defined according to the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0 as any of the following events considered by the investigator to be related to investigational treatment:
- Grade 4 neutropenia lasting more than 7 consecutive days or associated with fever.
- Grade 4 thrombocytopenia lasting more than 7 consecutive days.
- Grade 3 thrombocytopenia associated with clinically significant bleeding.
- Platelet count <10,000/mm3.
- Delay of more than 7 days in the initiation of a subsequent cycle due to treatment-related adverse events.
- Any grade 3 or higher non-hematologic toxicity (except grade 3 or higher nausea/emesis or diarrhea in the absence of optimal symptomatic treatment for these conditions, grade 3 or higher fatigue lasting less than 1 week and other grade 3 or higher non-hematologic toxicity that could be controlled to grade 2 or less with appropriate treatment).
Justification of Sample size determination:
The A'Hern one stage design will be used for this study. Taking into account the HERCLIMB study, we assume a null hypothesis (H0) of an Objective response rate (ORR) of 23% and alternative hypothesis (H1) of an ORR of 40%. With an alpha error of 0.05 and a statistical power of 80%, we will need to include 46 evaluable patients. Assuming a 5% dropout rate, 49 patients will be included in this study.
Patients included in the run-in phase will be considered for the efficacy analysis of the phase II.
Study Duration:
The start date of the study is the date of the first site activation. Recruitment period will occur during approximately 18 months from the first patient in.
The end date of the study is the date of the last visit of the last patient (LPLV), including follow-up. The duration of the study will be approximately 40 months from the first patient in.
Performing exploratory objectives will be independent of the date of the end of the study.
- Being tested
- Tucatinib, Trastuzumab, Vinorelbine
- Keywords
- tucatinib, Non-resectable locally advanced or metastatic breast cancer, HER2-positive
- Medical subject headings
- Breast Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TucatinibDrug
Also called Tukysa
Run-in Phase:
- Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg intravenous (IV) or 600 mg subcutaneous (SC) every 3 weeks.
- Oral vinorelbine: 50 mg/m2 (in the first cycle) and 60 mg/m2 (in the following cycles if no dose limiting toxicity [DLT] is seen) on days 1 and 8, every 3 weeks.
- Oral tucatinib 300 mg twice a day (BID) on a continuous dosing schedule.
Following patients in the phase II:
- Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg IV or 600 mg SC every 3 weeks.
- Oral vinorelbine: 50 mg/m2 or 60 mg/m2 (based on the run-in phase results) on days 1 and 8, every 3 weeks.
- Oral tucatinib 300 mg BID on a continuous dosing schedule.
TrastuzumabDrug
Also called Herceptin
Run-in Phase:
- Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg intravenous (IV) or 600 mg subcutaneous (SC) every 3 weeks.
- Oral vinorelbine: 50 mg/m2 (in the first cycle) and 60 mg/m2 (in the following cycles if no dose limiting toxicity [DLT] is seen) on days 1 and 8, every 3 weeks.
- Oral tucatinib 300 mg twice a day (BID) on a continuous dosing schedule.
Following patients in the phase II:
- Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg IV or 600 mg SC every 3 weeks.
- Oral vinorelbine: 50 mg/m2 or 60 mg/m2 (based on the run-in phase results) on days 1 and 8, every 3 weeks.
- Oral tucatinib 300 mg BID on a continuous dosing schedule.
VinorelbineDrug
Also called Navelbine
Run-in Phase:
- Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg intravenous (IV) or 600 mg subcutaneous (SC) every 3 weeks.
- Oral vinorelbine: 50 mg/m2 (in the first cycle) and 60 mg/m2 (in the following cycles if no dose limiting toxicity [DLT] is seen) on days 1 and 8, every 3 weeks.
- Oral tucatinib 300 mg twice a day (BID) on a continuous dosing schedule.
Following patients in the phase II:
- Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg IV or 600 mg SC every 3 weeks.
- Oral vinorelbine: 50 mg/m2 or 60 mg/m2 (based on the run-in phase results) on days 1 and 8, every 3 weeks.
- Oral tucatinib 300 mg BID on a continuous dosing schedule.
| Study group | Role | What they receive |
|---|---|---|
| Trastuzumab-Vinorelbine-Tucatinib | Experimental | Trastuzumab-Vinorelbine-Tucatinib Receives: Drug: Tucatinib; Drug: Trastuzumab; Drug: Vinorelbine |
What is being measured
The primary outcome is the main question the study is designed to answer.
Objective Response Rate (ORR)
Objective response rate (ORR) defined as the rate of complete response (CR) plus partial response (PR) based on the investigator's assessment using the response evaluation criteria for solid tumors (RECIST) version 1.1., out of the patients who received at least 1 dose of treatment.
Measured: Approximately 26 months from the inclusion of the first patient
Secondary outcomes (9)
ORR in patients with brain metastasis at baseline
ORR defined as the rate of complete response (CR) plus partial response (PR) based on the investigator's assessment using the response evaluation criteria for solid tumors (RECIST) version 1.1., out of the patients who received at least 1 dose of treatment in patients with brain metastasis at baseline.
Measured: Approximately 26 months from the inclusion of the first patient
Progression-free survival (PFS)
Progression-free survival (PFS) defined as the time from the date of enrollment to the date of disease progression, based on the investigator's assessment using RECIST version 1.1., or death from any cause, whichever occurs first.
Measured: Approximately 26 months from the inclusion of the first patient
Duration of response (DOR)
Duration of response (DOR) defined as the time from the date of first documentation of objective tumor response (CR or PR) to the date of first documented progressive disease based on the investigator's assessment using RECIST version 1.1, or death from any cause, whichever occurs first.
Measured: Approximately 26 months from the inclusion of the first patient
Disease control rate (DCR)
Disease control rate (DCR): is defined as the rate of CR plus PR plus stable disease (SD) of any duration, based on the investigator's assessment using RECIST version 1.1 out of all enrolled patients/patients with brain metastasis.
Measured: Approximately 26 months from the inclusion of the first patient
Clinical benefit rate (CBR)
Clinical benefit rate (CBR) defined as the rate of CR plus PR plus SD lasting more than 24 weeks, based on the investigator's assessment using RECIST version 1.1 out of all enrolled patients/patients with brain metastasis.
Measured: Approximately 26 months from the inclusion of the first patient
Overall survival (OS)
Overall survival (OS) defined as the time from the date of enrollment to the date of death from any cause.
Measured: Approximately 26 months from the inclusion of the first patient
The Number of Participants Who Experienced Adverse Events (AE) Related to Study Treatment
Safety: Incidence and severity of AEs and clinical lab abnormalities. AE grades will be defined by the NCI-CTCAE v. 5.0. AE terms will be coded according to the MedDRA dictionary.
Measured: Through study treatment, and average of 26 months
Change from baseline (CFB) Between Treatment Comparison in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) Functional Scale Scores
The EORTC-QLQ-C30 is a 30-item questionnaire composed of 5multi-item functional subscales (physical, role, cognitive emotional, and social functioning), 3 multi-item symptom scales (fatigue, nausea/vomiting, and pain), a global health/QoL subscale, and 6 single items assessing other cancer-related symptoms (dyspnea, sleep disturbance, appetite, diarrhea, constipation, and the financial impact of cancer). The questionnaire employs 28 4-point Likert scales with responses from "not at all" to "very much" and two 7-point Likert scales for global health and overall QoL. For functional and global QOL scales, higher scores represent a better level of functioning and are converted to a 0 to 100 scale. For symptom-oriented scales, a higher score represents more severe symptoms.
Patients will complete EORTC QLQ-C30 at baseline, at cycle 2 and 3 and then every 2 cycles until end of treatment, and at the post-treatment visit (30 (±5) days after finishing the last dose of study drug).
Measured: Baseline, cycle 2 and 3, and then at every 2 cycles (each cycle is 21 days) and at the post-treatment visit, 30 days after last dose of study drug
Time to Deterioration (TTD) in EORTC QLQ-C30 Functional Scale
TTD is defined as the time from the date of enrollment to the date of first detection of a deterioration event (increase of ≥ minimally important difference (MID) from baseline for the EORTC QLQ-C30 symptom scales and a decrease of ≥ MID from baseline for the EORTC QLQ-C30 functional and global health status score scales.
The EORTC-QLQ-C30 is a 30-item questionnaire composed of 5multi-item functional subscales, 3 multi-item symptom scales, a global health/QoL subscale, and 6 single items assessing other cancer-related symptoms. The questionnaire employs 28 4-point Likert scales with responses from "not at all" to "very much" and two 7-point Likert scales for global health and overall QoL. For functional and global QOL scales, higher scores represent a better level of functioning and are converted to a 0 to 100 scale. For symptom-oriented scales, a higher score represents more severe symptoms.
Measured: Baseline, cycle 2 and 3, and then at every 2 cycles (each cycle is 21 days) and at the post-treatment visit, 30 days after last dose of study drug
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Oct 2022
- Study start8 Mar 2023
- Primary completion30 May 2025
- Study completion30 May 2025
Why it stopped: The study was closed early due to safety concerns and an unfavorable benefit-risk balance. Unexpected high neutropenia rates required a costly sub-study, which was not feasible, forcing the sponsor to terminate the trial prematurely.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for HER2-positive Metastatic Breast CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 13 participants (actual)
Sponsor and investigators
- Lead sponsor
- Spanish Breast Cancer Research Group
- Sponsor type
- University, hospital or other
- Collaborators
- Seagen Inc.
- Responsible party
- Sponsor
- Investigators
- Study Director, Study director, Hospital General Universitario Gregorio Marañón, Madrid, SpainStudy Director, Study director, Hospital Universitario Donostia, San Sebastián, Spain.Study Director, Study director, Hospital Universitario Reina Sofía, Córdoba, Spain
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05583110
- Sponsor's protocol ID
- GEICAM/2020-08
- Other IDs
- 2021-002561-18
- Acronym
- TrasTUCAN
- Status last verified
- Dec 2025
- First submitted
- 11 Oct 2022
- Last updated
- 10 Dec 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 10 Dec 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Single Arm Phase II Study of the Efficacy and Safety of the Combination of Trastuzumab Plus TUCAtinib Plus viNorelbine in Patients With HER2-positive Non-resectable Locally Advanced or Metastatic Breast Cancer "TrasTUCAN Study"
- ClinicalTrials.gov ID
- NCT05583110
- Acronym / sponsor ID
- TrasTUCAN / GEICAM/2020-08
- Keywords
- tucatinib, Non-resectable locally advanced or metastatic breast cancer, HER2-positive
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: The study was closed early due to safety concerns and an unfavorable benefit-risk balance. Unexpected high neutropenia rates required a costly sub-study, which was not feasible, forcing the sponsor to terminate the trial prematurely.
- Enrolment
- 13 participants (actual)
- Lead sponsor
- Spanish Breast Cancer Research GroupUniversity, hospital or other
- Collaborators
- Seagen Inc.
- Study start
- 8 Mar 2023 (actual)
- Primary completion
- 30 May 2025 (actual)
- Study completion
- 30 May 2025 (actual)
- First posted
- 17 Oct 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Breast cancer (BC) is the most common neoplasm in the world. In Spain, one in 8 women is diagnosed with BC. The human epidermal growth factor receptor 2 (HER2)-positive BC subtype (that represents around 20% of all BC) was associated with poor prognosis however, new therapeutic advances have significantly increased the cure rate of patients in early stages.
In the metastatic setting, anti-HER2 targeted therapies have significantly improved overall survival (OS) with good quality of life, however there is still a substantial group of patients who die, and therefore additional drugs need to be investigated.
Trastuzumab, an anti HER2 antibody has demonstrated, in combination with chemotherapy, an improvement of OS in early and metastatic stages.
Tucatinib is an oral selective inhibitor of the HER2 receptor tyrosine kinase subunit. Its high affinity for this subunit causes fewer toxicities, such as rash and diarrhea, which are common with other anti-HER tyrosine kinase inhibitors (TKIs).
Vinorelbine has been evaluated previously in combination with trastuzumab showing interesting results.
This is a single country, multicenter, single arm phase II clinical trial with a safety run-in phase, to study the efficacy, safety and tolerability of the administration of tucatinib in combination with trastuzumab and vinorelbine in HER2-positive non-resectable locally advanced or metastatic breast cancer (MBC) with measurable disease.
Detailed description
Patients with brain metastasis are allowed (but up to maximum of 50% of included patients).
Forty-nine patients will be enrolled in the study:
- The first 3 patients included in the study will receive trastuzumab plus tucatinib plus oral vinorelbine at a dose of 50 mg/m2 in the first cycle. If not dose limiting toxicity (DLT) is observed, these patients will receive oral vinorelbine at a dose of 60 mg/m2 for the following cycles.
- If 1/3 patients experience DLT in the first cycle, 3 additional patients will be included to receive trastuzumab plus tucatinib plus oral vinorelbine at a dose of 50 mg/m2 in the first cycle and then 60 mg/m2.
- If 0/3 or <2/6 patients experience DLT in the first cycle the vinorelbine dose will be 60 mg/m2 for all the following patients included in the study.
- If ≥2 out of 3 or 6 patients experienced DLT in the first cycle, all the following included patients will receive oral vinorelbine at a dose of 50 mg/m2.
DLTs are defined according to the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0 as any of the following events considered by the investigator to be related to investigational treatment:
- Grade 4 neutropenia lasting more than 7 consecutive days or associated with fever.
- Grade 4 thrombocytopenia lasting more than 7 consecutive days.
- Grade 3 thrombocytopenia associated with clinically significant bleeding.
- Platelet count <10,000/mm3.
- Delay of more than 7 days in the initiation of a subsequent cycle due to treatment-related adverse events.
- Any grade 3 or higher non-hematologic toxicity (except grade 3 or higher nausea/emesis or diarrhea in the absence of optimal symptomatic treatment for these conditions, grade 3 or higher fatigue lasting less than 1 week and other grade 3 or higher non-hematologic toxicity that could be controlled to grade 2 or less with appropriate treatment).
Justification of Sample size determination:
The A'Hern one stage design will be used for this study. Taking into account the HERCLIMB study, we assume a null hypothesis (H0) of an Objective response rate (ORR) of 23% and alternative hypothesis (H1) of an ORR of 40%. With an alpha error of 0.05 and a statistical power of 80%, we will need to include 46 evaluable patients. Assuming a 5% dropout rate, 49 patients will be included in this study.
Patients included in the run-in phase will be considered for the efficacy analysis of the phase II.
Study Duration:
The start date of the study is the date of the first site activation. Recruitment period will occur during approximately 18 months from the first patient in.
The end date of the study is the date of the last visit of the last patient (LPLV), including follow-up. The duration of the study will be approximately 40 months from the first patient in.
Performing exploratory objectives will be independent of the date of the end of the study.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Trastuzumab-Vinorelbine-Tucatinib | Experimental | Drug: Tucatinib, Drug: Trastuzumab, Drug: VinorelbineTrastuzumab-Vinorelbine-Tucatinib |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (28 listed)
- Patients are eligible to be enrolled in the study only if they meet all of the following criteria:
- Written and signed informed consent obtained prior to any study-specific procedure.
- Male or female patients at least 18 years of age.
- Availability of pre-treatment archival Formalin-Fixed Paraffin-Embedded (FFPE) tumor tissue (preferably the most recent available), otherwise possibility to perform a biopsy, to carry out exploratory biomarker analyses.
- Documented HER2-positive status by local laboratory determination, preferably on the most recent available FFPE tumor sample, according to the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) international guidelines valid at the time of the assay.
Key exclusion criteria (36 listed)
- Have received more than 4 lines of systemic therapy for locally advanced or MBC.
- Have received prior treatment with tucatinib, vinorelbine for locally advanced or MBC or anti-HER2 TKI agents if administered less than 12 months prior to study entry.
- Have used a strong CYP3A4 or CYP2C8 inhibitor or CYP3A substrate within 2 weeks, or a strong CYP3A4 or CYP2C8 inducer within 5 days prior to the first dose of study treatment (see Protocol Attachment 2 for more information).
- Require therapy with warfarin or other coumarin derivatives (non-coumarin anticoagulants are allowed).
- Patients who received before inclusion:
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| TucatinibAlso: TukysaRun-in Phase: * Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg intravenous (IV) or 600 mg subcutaneous (SC) every 3 weeks. * Oral vinorelbine: 50 mg/m2 (in the first cycle) and 60 mg/m2 (in the following cycles if no dose limiting toxicity [DLT] is seen) on days 1 and 8, every 3 weeks. * Oral tucatinib 300 mg twice a day (BID) on a continuous dosing schedule. Following patients in the phase II: * Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg IV or 600 mg SC every 3 weeks. * Oral vinorelbine: 50 mg/m2 or 60 mg/m2 (based on the run-in phase results) on days 1 and 8, every 3 weeks. * Oral tucatinib 300 mg BID on a continuous dosing schedule. | Drug | Trastuzumab-Vinorelbine-Tucatinib |
| TrastuzumabAlso: HerceptinRun-in Phase: * Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg intravenous (IV) or 600 mg subcutaneous (SC) every 3 weeks. * Oral vinorelbine: 50 mg/m2 (in the first cycle) and 60 mg/m2 (in the following cycles if no dose limiting toxicity [DLT] is seen) on days 1 and 8, every 3 weeks. * Oral tucatinib 300 mg twice a day (BID) on a continuous dosing schedule. Following patients in the phase II: * Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg IV or 600 mg SC every 3 weeks. * Oral vinorelbine: 50 mg/m2 or 60 mg/m2 (based on the run-in phase results) on days 1 and 8, every 3 weeks. * Oral tucatinib 300 mg BID on a continuous dosing schedule. | Drug | Trastuzumab-Vinorelbine-Tucatinib |
| VinorelbineAlso: NavelbineRun-in Phase: * Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg intravenous (IV) or 600 mg subcutaneous (SC) every 3 weeks. * Oral vinorelbine: 50 mg/m2 (in the first cycle) and 60 mg/m2 (in the following cycles if no dose limiting toxicity [DLT] is seen) on days 1 and 8, every 3 weeks. * Oral tucatinib 300 mg twice a day (BID) on a continuous dosing schedule. Following patients in the phase II: * Trastuzumab either IV or SC: 8 mg/kg IV loading dose (if necessary), followed by 6 mg/kg IV or 600 mg SC every 3 weeks. * Oral vinorelbine: 50 mg/m2 or 60 mg/m2 (based on the run-in phase results) on days 1 and 8, every 3 weeks. * Oral tucatinib 300 mg BID on a continuous dosing schedule. | Drug | Trastuzumab-Vinorelbine-Tucatinib |
Primary outcome
Objective Response Rate (ORR)
Time frame: Approximately 26 months from the inclusion of the first patient
Objective response rate (ORR) defined as the rate of complete response (CR) plus partial response (PR) based on the investigator's assessment using the response evaluation criteria for solid tumors (RECIST) version 1.1., out of the patients who received at least 1 dose of treatment.
9 secondary outcomes
ORR in patients with brain metastasis at baseline
Time frame: Approximately 26 months from the inclusion of the first patient
Progression-free survival (PFS)
Time frame: Approximately 26 months from the inclusion of the first patient
Duration of response (DOR)
Time frame: Approximately 26 months from the inclusion of the first patient
Disease control rate (DCR)
Time frame: Approximately 26 months from the inclusion of the first patient
Clinical benefit rate (CBR)
Time frame: Approximately 26 months from the inclusion of the first patient
Overall survival (OS)
Time frame: Approximately 26 months from the inclusion of the first patient
The Number of Participants Who Experienced Adverse Events (AE) Related to Study Treatment
Time frame: Through study treatment, and average of 26 months
Change from baseline (CFB) Between Treatment Comparison in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) Functional Scale Scores
Time frame: Baseline, cycle 2 and 3, and then at every 2 cycles (each cycle is 21 days) and at the post-treatment visit, 30 days after last dose of study drug
Time to Deterioration (TTD) in EORTC QLQ-C30 Functional Scale
Time frame: Baseline, cycle 2 and 3, and then at every 2 cycles (each cycle is 21 days) and at the post-treatment visit, 30 days after last dose of study drug
Results and safety
The study was stopped early (reason given: The study was closed early due to safety concerns and an unfavorable benefit-risk balance. Unexpected high neutropenia rates required a costly sub-study, which was not feasible, forcing the sponsor to terminate the trial prematurely.). Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Dec 2025.
- GEICAM is a Spanish Breast Cancer Research GroupLink provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Study Director study director
Hospital General Universitario Gregorio Marañón, Madrid, Spain
Study Director study director
Hospital Universitario Donostia, San Sebastián, Spain.
Study Director study director
Hospital Universitario Reina Sofía, Córdoba, Spain
18 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Tucatinib, Trastuzumab and Vinorelbine in people with HER2-positive Metastatic Breast Cancer and Locally Advanced HER2 Positive Breast Carcinoma, run by Spanish Breast Cancer Research Group at 18 sites in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 28 inclusion and 36 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 10 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 18 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study was stopped early (reason given: The study was closed early due to safety concerns and an unfavorable benefit-risk balance. Unexpected high neutropenia rates required a costly sub-study, which was not feasible, forcing the sponsor to terminate the trial prematurely.). Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Objective Response Rate (ORR) (time frame: Approximately 26 months from the inclusion of the first patient). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Dec 2025.