Trastuzumab Deruxtecan for Cancer

(DPT02 Trial)

Recruiting at 54 trial locations

Overseen By AstraZeneca Clinical Study Information Center

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: AstraZeneca

Disqualifiers: Pneumonitis, Severe lung illness, Infection, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 4 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 6-8 months

468 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores the effectiveness and safety of trastuzumab deruxtecan, an antibody-drug conjugate, for various cancers expressing the HER2 protein. It examines several cancer types, including bladder, biliary tract, cervical, endometrial, ovarian, pancreatic, and some rare tumors. People with advanced cancer showing HER2 protein might be suitable candidates, especially if other treatments have failed. The trial aims to determine if trastuzumab deruxtecan can improve outcomes compared to current options. As a Phase 2 trial, the research focuses on assessing the treatment's effectiveness in an initial, smaller group of participants.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the study team or your doctor.

Is there any evidence suggesting that this trial's treatment is likely to be safe?

Research has shown that trastuzumab deruxtecan is safe, as demonstrated in various studies. One study with 371 patients who had HER2-low breast cancer found the treatment to be generally well-tolerated. Most patients experienced side effects like nausea and tiredness, but these were usually manageable, while serious side effects were less common.

The FDA has already approved this treatment for other types of cancer, indicating it has undergone thorough testing and is safe for some patients. However, individual experiences may vary, so discussing expectations with a healthcare provider is important. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatment?

Trastuzumab deruxtecan is unique because it combines an antibody with a chemotherapy drug, creating a powerful approach against cancer cells with high HER2 protein levels. Unlike traditional treatments that often target a wide range of cells, this drug specifically seeks out and binds to HER2-positive cancer cells, delivering its chemotherapy payload directly to the tumor. This targeted action not only intensifies the attack on cancer cells but also aims to reduce side effects by sparing healthy cells, making researchers hopeful for more effective and less toxic cancer treatment options.

What evidence suggests that trastuzumab deruxtecan could be an effective treatment for HER2-expressing tumors?

Research shows that trastuzumab deruxtecan (T-DXd) holds promise for treating various tumors expressing HER2. In this trial, participants will join different cohorts based on cancer type and HER2 expression levels. For tumors with high HER2 levels (IHC 3+), studies indicate that T-DXd significantly improves survival rates and reduces the risk of recurrence. In tumors with moderate HER2 levels (IHC 2+/ISH+), the treatment has demonstrated meaningful improvements in survival and disease progression. For endometrial and cervical cancers, real-world evidence suggests it works effectively, with notable patient responses. In biliary tract and pancreatic cancers, T-DXd has shown a 37.1% success rate in shrinking or eliminating tumors. Overall, T-DXd offers a potentially effective treatment option for these HER2-expressing tumors. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for people with certain HER2-expressing tumors, including ovarian, endometrial, biliary tract, and pancreatic cancers. Participants must have advanced or metastatic disease that has worsened after prior treatment or lack other treatment options. They should not have breast, colon, stomach cancer or non-small cell lung cancer and must be free of severe infections and conditions that could affect study participation.

Inclusion Criteria

My heart, kidneys, and liver are functioning well.

My cancer's HER2 status was confirmed by a test.

My cancer is one of the specified types and may express HER2.

Exclusion Criteria

I need treatment for fluid buildup in my chest, abdomen, or around my heart.

I have severe lung-related health issues.

I have had lung inflammation that needed steroids or currently have lung disease.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive trastuzumab deruxtecan (T-DXd) for the treatment of selected HER2-expressing tumors across multiple cohorts

6-8 months

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Long-term follow-up

Participants are monitored for overall survival and progression-free survival

Up to 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Trastuzumab deruxtecan

Trial Overview

The trial tests Trastuzumab deruxtecan (T-DXd) in patients with selected HER2-positive tumors to assess its effectiveness and safety. It's an open-label Phase 2 study involving multiple cohorts based on tumor type to see if T-DXd can provide clinical benefits.

How Is the Trial Designed?

Group I: Part 2 Cohort E Experimental Treatment 1 Intervention

HER2 IHC 2+ or 1+ cervical cancer

Group II: Part 2 Cohort D Experimental Treatment 1 Intervention

HER2 IHC 2+ or 1+ ovarian cancer

Group III: Part 2 Cohort C Experimental Treatment 1 Intervention

HER2 IHC 2+ or 1+ endometrial cancer

Group IV: Part 2 Cohort B Experimental Treatment 1 Intervention

Any tumor type that is HER2 IHC 2+/ISH+ (excluding breast, gastric cancer, and colorectal cancer)

Group V: Part 2 Cohort A Experimental Treatment 1 Intervention

Any tumor type that is HER2 IHC 3+ (excluding breast, gastric cancer, and colorectal cancer)

Group VI: Part 1 Cohort 7 Experimental Treatment 1 Intervention

Rare tumors

Group VII: Part 1 Cohort 6 Experimental Treatment 1 Intervention

Pancreatic cancer

Group VIII: Part 1 Cohort 5 Experimental Treatment 1 Intervention

Ovarian cancer

Group IX: Part 1 Cohort 4 Experimental Treatment 1 Intervention

Endometrial cancer

Group X: Part 1 Cohort 3 Experimental Treatment 1 Intervention

Cervical cancer

Group XI: Part 1 Cohort 2 Experimental Treatment 1 Intervention

Bladder cancer

Group XII: Part 1 Cohort 1 Experimental Treatment 1 Intervention

Biliary tract cancer

Trastuzumab deruxtecan is already approved in United States, European Union, Japan for the following indications:

Approved in United States as Enhertu for:

• Unresectable or metastatic HER2-positive breast cancer
• Locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma
• Unresectable or metastatic HER2-low breast cancer
• Unresectable or metastatic HER2-positive solid tumors

Approved in European Union as Enhertu for:

• Unresectable or metastatic HER2-positive breast cancer
• Locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma

Approved in Japan as Enhertu for:

• Unresectable or metastatic HER2-positive breast cancer
• Locally advanced or metastatic HER2-positive gastric or gastroesophageal junction adenocarcinoma

Who Is Running the Clinical Trial?

AstraZeneca

Lead Sponsor

Trials

4,491

Recruited

290,540,000+

Sir Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Dr. Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Pascal Soriot

AstraZeneca

Chief Executive Officer since 2012

Veterinary Medicine from École nationale vétérinaire d'Alfort, MBA from HEC Paris

Cristian Massacesi

AstraZeneca

Chief Medical Officer since 2021

MD from Marche Polytechnic University, Medical Oncology training at Royal Marsden Hospital, Kaplan Comprehensive Cancer Center, and European Institute of Oncology

Daiichi Sankyo Co., Ltd.

Industry Sponsor

Trials

116

Recruited

49,200+

Published Research Related to This Trial

Fam-trastuzumab deruxtecan-nxki (T-DXd) has been approved for treating HER2-low metastatic breast cancer, showing significant improvements in progression-free survival (PFS) and overall survival (OS) in a phase III trial with 557 patients.

The study demonstrated a 50% reduction in the risk of disease progression and a 36% reduction in the risk of death compared to standard chemotherapy, with a safety profile consistent with previous uses of T-DXd and no new safety concerns identified.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

US Food and Drug Administration Approval Summary: Fam-Trastuzumab Deruxtecan-nxki for Human Epidermal Growth Factor Receptor 2-Low Unresectable or Metastatic Breast Cancer. Narayan, P., Dilawari, A., Osgood, C., et al.[2023]

In a phase 2 study involving 184 patients with HER2-positive metastatic breast cancer who had previously been treated with trastuzumab emtansine, trastuzumab deruxtecan demonstrated a significant response rate of 60.9%, with a median response duration of 14.8 months.

While trastuzumab deruxtecan showed promising efficacy, it was associated with notable adverse effects, including interstitial lung disease in 13.6% of patients, highlighting the need for careful monitoring of pulmonary symptoms during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer. Modi, S., Saura, C., Yamashita, T., et al.[2021]

Fam-trastuzumab deruxtecan-nxki (ENHERTU) received accelerated FDA approval for treating HER2-positive breast cancer in patients who have already undergone two or more anti-HER2 therapies, based on a study involving 184 patients that showed a confirmed overall response rate of 60.3%.

While ENHERTU is effective, it carries significant risks, including severe interstitial lung disease and neutropenia, highlighting the importance of monitoring for serious side effects during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

FDA Approval Summary: Fam-Trastuzumab Deruxtecan-Nxki for the Treatment of Unresectable or Metastatic HER2-Positive Breast Cancer. Narayan, P., Osgood, CL., Singh, H., et al.[2022]

In a phase 1 trial involving 44 patients with HER2-positive gastric or gastro-oesophageal junction cancer, trastuzumab deruxtecan demonstrated a manageable safety profile, with the most common serious side effects being anemia and decreases in blood cell counts, but no drug-related deaths were reported.

The treatment showed promising preliminary activity, with 43.2% of patients achieving a confirmed objective response, indicating its potential effectiveness in patients who had previously been treated with trastuzumab.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trastuzumab deruxtecan (DS-8201a) in patients with advanced HER2-positive gastric cancer: a dose-expansion, phase 1 study. Shitara, K., Iwata, H., Takahashi, S., et al.[2020]

In a phase 1 trial involving 115 patients with HER2-positive breast cancer previously treated with trastuzumab emtansine, trastuzumab deruxtecan demonstrated a manageable safety profile, with 59.5% of patients achieving a confirmed objective response.

Despite some serious treatment-emergent adverse events, including cases of interstitial lung disease and pneumonitis, the preliminary efficacy results suggest that trastuzumab deruxtecan is a promising treatment option, warranting further investigation in larger clinical trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trastuzumab deruxtecan (DS-8201a) in patients with advanced HER2-positive breast cancer previously treated with trastuzumab emtansine: a dose-expansion, phase 1 study. Tamura, K., Tsurutani, J., Takahashi, S., et al.[2020]

Trastuzumab deruxtecan (ENHERTU®) is an innovative treatment that combines an antibody targeting HER2 with a DNA topoisomerase I inhibitor, specifically designed for HER2-expressing solid tumors, including various types of cancer.

It received accelerated approval in the USA based on the promising results from the phase 2 DESTINY-Breast01 trial, which focused on patients with advanced HER2-positive breast cancer who had already undergone multiple treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trastuzumab Deruxtecan: First Approval. Keam, SJ.[2020]

Trastuzumab deruxtecan (Enhertu®) has been shown to significantly improve progression-free survival in adults with unresectable or metastatic HER2-positive breast cancer compared to the previous standard treatment, trastuzumab emtansine, in a pivotal phase 3 trial.

The treatment has a generally manageable safety profile, although it is associated with common adverse events like hematological and gastrointestinal disorders, and requires careful monitoring for interstitial lung disease (ILD)/pneumonitis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trastuzumab Deruxtecan: A Review in Unresectable or Metastatic HER2-Positive Breast Cancer. Nie, T., Blair, HA.[2023]

Fam-trastuzumab deruxtecan-nxki is an effective treatment for advanced HER2-positive breast cancer, showing a response rate of 60.9% in major clinical trials, making it a viable option for patients who have not responded to standard therapies.

While the drug is effective, it comes with potential side effects, including serious risks like interstitial lung disease and left ventricular dysfunction, highlighting the need for careful monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Review of Fam-Trastuzumab Deruxtecan-nxki in HER2-Positive Breast Cancer. Nguyen, X., Hooper, M., Borlagdan, JP., et al.[2021]

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FDA APPROVED IN MULTIPLE INDICATIONS · HER2-Positive, HER2-Low, and HER2-Ultralow Metastatic Breast Cancer, HER2-Mutant NSCLC, and Solid Tumors (Including IHC 3 ...