Recruiting
Phase 3

HER2-targeted Therapy

Sponsor:

SWOG Cancer Research Network

Code:

NCT07578116

Conditions

Anatomic Stage IV Breast Cancer AJCC v8

Metastatic HER2-Positive Breast Carcinoma

Oligometastatic Breast Carcinoma

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Interventions

Biopsy Procedure

Biospecimen Collection

Breast Conservation Treatment

Computed Tomography

Cyclin-Dependent Kinase 4 Inhibitor

Study Details

Brief summary:

This phase III trial evaluates the effect of adding locoregional therapy (surgery and radiation) and metastasis-directed stereotactic body radiation therapy (SBRT) to standard systemic therapy following standard HER2-targeted systemic therapy, compared to standard systemic therapy alone, in treating patients with HER2-positive stage IV breast cancer that has spread from where it first started (primary site) to other places in the body (metastatic) or to a limited number of sites (oligometastatic). The usual approach for patients with (oligo)metastatic HER2-positive breast cancer is systemic drug treatment, which means medicines that travel through the whole body to treat both the breast and any areas where the cancer has spread. There are a number of approved HER2-targeted systemic therapy regimens available to patients. These typically include immunotherapy and/or chemotherapy. Immunotherapy drugs may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Unlike systemic therapy, locoregional therapies like surgery and radiation are focused treatments at the site of disease, delivered with the intent of sparing healthy tissues. Breast surgeries such as breast conserving therapy or total mastectomy are procedures in which the cancerous breast tissue (and healthy breast tissue in the case of total mastectomy) are surgically removed from the body. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. SBRT is a type of external radiation therapy that uses special equipment to position a patient and precisely deliver radiation to tumors in the body (except the brain). The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps spare normal tissue. Adding locoregional therapy, as well as metastasis-directed SBRT, to standard systemic therapy may help patients with (oligo)metastatic, HER2-positive stage IV breast cancer live longer overall or before their cancer progresses, and may help more patients achieve no evidence of disease, when compared to standard systemic therapy alone.

Conditions

Anatomic Stage IV Breast Cancer AJCC v8

Metastatic HER2-Positive Breast Carcinoma

Oligometastatic Breast Carcinoma

Study ID

NCT07578116

Start date

Mar 9, 2027

Status verified date

Oct, 2026

Completion date

May 31, 2033

Anticipated

Primary completion date

May 31, 2032

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • REGISTRATION STEP 1 - SCREENING \& INITIAL TREATMENT:
  • Participants must have histologically confirmed de novo metastatic (i.e. American Joint Committee on Cancer \[AJCC\] stage IV, no prior history of breast cancer) HER2+ breast cancer with 1 to 5 distant metastatic lesions (oligometastatic). Metastatic breast cancer must be histologically confirmed through biopsy of a distant metastatic lesion unless it is not feasible or safe to biopsy a metastatic lesion, then there must be unequivocal evidence of metastasis on imaging and laboratory studies. HER2+ status must be confirmed in the breast tumor and distant metastatic site as defined per NCCN guidelines version 4.2025

  • NOTE: If HER2 positivity at metastatic site is equivocal due to limitations in HER2 analysis in bone, or it is not feasible or safe to biopsy the metastatic lesion, then HER2 positivity based on breast tumor only is acceptable. If there is no breast lesion, HER2+ must be confirmed in at least one metastatic site
  • Participants with brain metastases are eligible if they meet all of the following criteria at baseline:

  • There are 5 or fewer intracranial lesions
  • Each intracranial lesions is no larger than 2cm in longest dimension
  • NOTE: The brain is counted as 1 distant site towards the oligometastatic definition. Brain imaging is not required for participants who have no neurological signs or symptoms suggestive of central nervous system (CNS) involvement; however, assessment of neurological symptoms and brain MRI is strongly encouraged to rule out CNS disease
  • Participants must have no known leptomeningeal disease
  • Participants must meet one of the following criteria prior to Step 1 registration:

  • Treatment naïve and planning to initiate standard of care systemic HER2+ targeted treatment OR
  • Have already initiated standard of care systemic HER2+ targeted treatment and have completed at least one (≥ 1) but no more than three (≤ 3) cycles prior to enrollment, without progression

  • NOTE: Standard of care scans for baseline disease assessment must have been performed within 28 days prior to initiation of treatment
  • Participants must not be receiving or planning to receive any investigational systemic therapy during study before disease progression
  • Participants must not have received whole brain irradiation

  • NOTE: Participants with up to five brain metastases may have received SRS/SRT either before or after initiation of systemic therapy. If lesions are small and asymptomatic and the participant is receiving CNS penetration they may be managed with observation
  • Participants must be ≥ 18 years old at the time of registration
  • Participants must have Zubrod performance status of 0-2
  • Participants with known human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy and have undetectable viral load test on the most recent test results obtained within 6 months prior to registration
  • Participants must be able to safely receive the physician's choice of standard of care systemic HER2+ targeted treatment per the current Food and Drug Administration (FDA)-approved package insert(s), treating physician's discretion, and institutional guidelines
  • Participants must be candidates for definitive surgical and radiotherapeutic management of locoregional disease opinion per the discretion of the treating physician
  • Participants must be able to receive ablative dose stereotactic body radiation therapy (SBRT) to all metastatic lesions identified at baseline, in the opinion of the treating physician
  • Participants must be offered the opportunity to participate in specimen banking
  • 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 CIRB regulations
  • REGISTRATION STEP 2 - COHORT ASSIGNMENT AND RANDOMIZATION:
  • COHORT A: Participants must be registered to Step 2 within 14 days of staging scans performed after completing Step 1 systemic therapy
  • COHORT A: Participants must have standard of care (SOC) staging scans and breast imaging performed following 12-24 weeks (minimum of 4 cycles) of initial systemic therapy and within 14 days prior to Step 2 registration
  • COHORT A: Participants must have experienced partial or complete response in the breast (in the opinion of the treating physician) following 12-24 weeks of initial systemic therapy based on staging scans performed within 14 days prior to Step 2 registration

  • Participants with breast lesion(s) at diagnosis must have a clinical response on breast imaging per the treating physician
  • Metastatic lesions, as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) and bone response criteria, must have at least stable disease
  • Brain metastases treated with SRS/SRT must have at least stable disease as per Response Assessment in Neuro-Oncology Brain Metastases (RANO BM) and must not require steroid treatment
  • Participants with no known breast lesions at diagnosis must have at least partial response in the metastatic sites as assessed by RECIST and bone response criteria
  • NOTE: The same imaging modality must be used as in Step 1
  • COHORT A: Participants must be eligible for definitive surgical and radiotherapeutic management of locoregional disease per the discretion of the treating physician
  • COHORT A: Participants must not have metastatic lesions that are not amenable to ablative dose stereotactic body radiation therapy (SBRT)

  • Lung lesions that completely resolve after systemic therapy will not be targeted with SBRT, as it is not possible to achieve dose build-up
  • The development of new sclerotic bone lesions after systemic therapy is not to be interpreted as disease progression, and all such lesions should be targeted with SBRT
  • COHORT B: Participants must be registered to Step 2 within 14 days of staging scans performed after completing Step 1 systemic therapy
  • COHORT B: Participants must have standard of care (SOC) staging and breast imaging performed following 12-24 weeks (minimum of 4 cycles) of initial systemic therapy and within 14 days prior to Step 2 registration
  • COHORT B: Participants must experience clinically stable disease or progression following 12-24 weeks (minimum of 4 cycles) of initial systemic therapy and within 14 days prior to Step 2 registration

  • Participants must have progression in metastatic lesions as assessed by RECIST and bone response criteria or may have stable disease in metastatic lesions by RECIST and bone response criteria if there is progression or no clinical response in the breast
  • Participants with known breast lesion must have progression or no clinical response on breast imaging as per the treating physician
  • NOTE: The same modality must be used as in Step 1

Study Design

Enrollment

562 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Step 1 (HER2-targeted systemic therapy, STS/SRT)

Patients receive physician's choice of HER2-targeted systemic therapy according to NCCN/ASCO guidelines until completion of at least 12 weeks (4 cycles) or up to 24 weeks (8 cycles) of HER2-targeted therapy prior to Step 2 registration. Patients with brain metastases may also undergo SRS/SRT at the discretion of the treating physician. All patients also undergo ECHO, MRI, mammography, ultrasound, CT, and/or PET/CT throughout the trial. Patients may undergo optional biopsy and/or collection of blood samples throughout the trial.

experimental: Step 2 Cohort A, Arm 1 (locoregional, SBRT, systemic therapy)

See Detailed Description.

experimental: Step 2 Cohort A, Arm 2 (systemic therapy)

Patients continue systemic therapy (T-DXd, or T-DM1, or T-DXd with or without pertuzumab, or taxane with trastuzumab and pertuzumab, or trastuzumab with pertuzumab) according to NCCN/ASCO guidelines for at least 1 year in the absence of disease progression or unacceptable toxicity. Patients may receive locoregional therapy and/or SBRT according to standard of care only if required for palliative purposes. All patients also undergo ECHO, MRI, mammography, ultrasound, CT, and/or PET/CT throughout the trial. Patients may undergo optional biopsy and/or collection of blood samples throughout the trial.

experimental: Step 2 Cohort B (systemic therapy)

Patients continue systemic therapy (T-DXd, or T-DM1, or T-DXd with or without pertuzumab, or taxane with trastuzumab and pertuzumab, or trastuzumab with pertuzumab) according to NCCN/ASCO guidelines in the absence of disease progression or unacceptable toxicity. All patients also undergo ECHO, MRI, mammography, ultrasound, CT, and/or PET/CT throughout the trial. Patients may undergo optional biopsy and/or collection of blood samples throughout the trial.

Interventions

Biopsy Procedure

Undergo biopsy

Biospecimen Collection

Undergo collection of blood samples

Breast Conservation Treatment

Undergo breast conserving therapy

Computed Tomography

Undergo CT and/or PET/CT

Cyclin-Dependent Kinase 4 Inhibitor

Given CDK4/6 inhibitor

Cyclin-Dependent Kinase 6 Inhibitor

Given CDK4/6 inhibitor

Echocardiography Test

Undergo ECHO

HER2-targeted Therapy

Receive HER2-targeted systemic therapy

Hormone Therapy

Given endocrine therapy

Magnetic Resonance Imaging

Undergo MRI

Mammography

Undergo mammography

Pertuzumab

Given pertuzumab

Positron Emission Tomography

Undergo PET/CT

Radiation Boost

Undergo RT boost

Radiation Therapy

Undergo RT

Stereotactic Body Radiation Therapy

Undergo SBRT

Stereotactic Radiosurgery

Undergo SRS/SRT

Taxane Compound

Given taxane therapy

Total Mastectomy

Undergo total mastectomy

Trastuzumab

Given trastuzumab

Trastuzumab Deruxtecan

Given T-DXd

Trastuzumab Emtansine

Given T-DM1

Ultrasound Imaging

Undergo ultrasound

Primary outcome measure

  • Overall survival (OS) (Cohort A) [ Time Frame: From date of Step 2 registration to date of death, assessed up to 10 years ]
  • Progression-free survival (PFS) (Observational Cohort B) [ Time Frame: From date of Step 2 registration to date of first documentation of progression or recurrence or death, assessed at 3 and 5 years ]
  • Overall survival (Observational Cohort B) [ Time Frame: From date of Step 2 registration to date of death, assessed at 3 and 5 years ]

Central Contacts and Locations

Locations

NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro

Recruiting

Jonesboro, Arkansas, United States, 72401

Contacts

Principal Investigator:

Philip E. Lammers

Smilow Cancer Hospital-Derby Care Center

Recruiting

Derby, Connecticut, United States, 06418

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital Care Center-Fairfield

Recruiting

Fairfield, Connecticut, United States, 06824

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital Care Center at Greenwich

Recruiting

Greenwich, Connecticut, United States, 06830

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital Care Center - Guilford

Recruiting

Guilford, Connecticut, United States, 06437

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital-Hamden Care Center

Recruiting

Hamden, Connecticut, United States, 06518

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Center/Yale-New Haven Hospital

Recruiting

New Haven, Connecticut, United States, 06510

Contacts

Principal Investigator:

Mariya Rozenblit

Yale University

Recruiting

New Haven, Connecticut, United States, 06520

Contacts

Principal Investigator:

Mariya Rozenblit

Yale-New Haven Hospital North Haven Medical Center

Recruiting

North Haven, Connecticut, United States, 06473

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital Care Center at Long Ridge

Recruiting

Stamford, Connecticut, United States, 06902

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital-Torrington Care Center

Recruiting

Torrington, Connecticut, United States, 06790

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital Care Center-Trumbull

Recruiting

Trumbull, Connecticut, United States, 06611

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital-Waterbury Care Center

Recruiting

Waterbury, Connecticut, United States, 06708

Contacts

Principal Investigator:

Mariya Rozenblit

Smilow Cancer Hospital Care Center - Waterford

Recruiting

Waterford, Connecticut, United States, 06385

Contacts

Principal Investigator:

Mariya Rozenblit

Orlando Health Cancer Institute

Recruiting

Orlando, Florida, United States, 32806

Contacts

Principal Investigator:

Shane R. Stecklein

OSF Saint Joseph Medical Center

Recruiting

Bloomington, Illinois, United States, 61701

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Bloomington

Recruiting

Bloomington, Illinois, United States, 61704

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Canton

Recruiting

Canton, Illinois, United States, 61520

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Carthage

Recruiting

Carthage, Illinois, United States, 62321

Contacts

Principal Investigator:

Bryan A. Faller

Cancer Care Specialists of Illinois - Decatur

Recruiting

Decatur, Illinois, United States, 62526

Contacts

Principal Investigator:

Bryan A. Faller

Decatur Memorial Hospital

Recruiting

Decatur, Illinois, United States, 62526

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Eureka

Recruiting

Eureka, Illinois, United States, 61530

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Galesburg

Recruiting

Galesburg, Illinois, United States, 61401

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Kewanee Clinic

Recruiting

Kewanee, Illinois, United States, 61443

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Macomb

Recruiting

Macomb, Illinois, United States, 61455

Contacts

Principal Investigator:

Bryan A. Faller

Cancer Care Center of O'Fallon

Recruiting

O'Fallon, Illinois, United States, 62269

Contacts

Principal Investigator:

Bryan A. Faller

HSHS Saint Elizabeth's Hospital

Recruiting

O'Fallon, Illinois, United States, 62269

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Ottawa Clinic

Recruiting

Ottawa, Illinois, United States, 61350

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Pekin

Recruiting

Pekin, Illinois, United States, 61554

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Peoria

Recruiting

Peoria, Illinois, United States, 61615

Contacts

Principal Investigator:

Bryan A. Faller

OSF Saint Francis Radiation Oncology at Peoria Cancer Center

Recruiting

Peoria, Illinois, United States, 61615

Contacts

Principal Investigator:

Bryan A. Faller

OSF Saint Francis Medical Center

Recruiting

Peoria, Illinois, United States, 61637

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Peru

Recruiting

Peru, Illinois, United States, 61354

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare-Princeton

Recruiting

Princeton, Illinois, United States, 61356

Contacts

Principal Investigator:

Bryan A. Faller

Southern Illinois University School of Medicine

Recruiting

Springfield, Illinois, United States, 62702

Contacts

Site Public Contact

217-545-7929

Principal Investigator:

Bryan A. Faller

Springfield Clinic

Recruiting

Springfield, Illinois, United States, 62702

Contacts

Site Public Contact

800-444-7541

Principal Investigator:

Bryan A. Faller

Springfield Memorial Hospital

Recruiting

Springfield, Illinois, United States, 62781

Contacts

Principal Investigator:

Bryan A. Faller

Illinois CancerCare - Washington

Recruiting

Washington, Illinois, United States, 61571

Contacts

Principal Investigator:

Bryan A. Faller

Mercy Cancer Center-West Lakes

Recruiting

Clive, Iowa, United States, 50325

Contacts

Site Public Contact

515-241-3305

Principal Investigator:

Richard L. Deming

Iowa Methodist Medical Center

Recruiting

Des Moines, Iowa, United States, 50309

Contacts

Site Public Contact

515-241-6727

Principal Investigator:

Seema Harichand-Herdt

Broadlawns Medical Center

Recruiting

Des Moines, Iowa, United States, 50314

Contacts

Site Public Contact

515-282-2200

Principal Investigator:

Seema Harichand-Herdt

Mercy Medical Center - Des Moines

Recruiting

Des Moines, Iowa, United States, 50314

Contacts

Site Public Contact

515-241-3305

Principal Investigator:

Richard L. Deming

Mercy Medical Center-West Lakes

Recruiting

West Des Moines, Iowa, United States, 50266

Contacts

Site Public Contact

515-241-3305

Principal Investigator:

Richard L. Deming

Ascension Via Christi Hospitals Wichita

Recruiting

Wichita, Kansas, United States, 67214

Contacts

Principal Investigator:

Dennis F. Moore

Baptist Memorial Hospital and Cancer Center-Golden Triangle

Recruiting

Columbus, Mississippi, United States, 39705

Contacts

Principal Investigator:

Philip E. Lammers

Baptist Cancer Center-Grenada

Recruiting

Grenada, Mississippi, United States, 38901

Contacts

Principal Investigator:

Philip E. Lammers

Baptist Memorial Hospital and Cancer Center-Union County

Recruiting

New Albany, Mississippi, United States, 38652

Contacts

Principal Investigator:

Philip E. Lammers

Baptist Memorial Hospital and Cancer Center-Oxford

Recruiting

Oxford, Mississippi, United States, 38655

Contacts

Principal Investigator:

Philip E. Lammers

Saint Francis Medical Center

Recruiting

Cape Girardeau, Missouri, United States, 63703

Contacts

Site Public Contact

573-334-2230sfmc@sfmc.net

Principal Investigator:

Bryan A. Faller

Thomas Jefferson University Hospital

Recruiting

Philadelphia, Pennsylvania, United States, 19107

Contacts

Principal Investigator:

Elena Shagisultanova

Asplundh Cancer Pavilion

Recruiting

Willow Grove, Pennsylvania, United States, 19090

Contacts

Principal Investigator:

Elena Shagisultanova

Smilow Cancer Hospital Care Center - Westerly

Recruiting

Westerly, Rhode Island, United States, 02891

Contacts

Principal Investigator:

Mariya Rozenblit

Lexington Health

Recruiting

West Columbia, South Carolina, United States, 29169

Contacts

Principal Investigator:

Steven A. Madden

Baptist Memorial Hospital and Cancer Center-Collierville

Recruiting

Collierville, Tennessee, United States, 38017

Contacts

Principal Investigator:

Philip E. Lammers

Baptist Memorial Hospital and Cancer Center-Memphis

Recruiting

Memphis, Tennessee, United States, 38120

Contacts

Principal Investigator:

Philip E. Lammers

Bon Secours Memorial Regional Medical Center

Recruiting

Mechanicsville, Virginia, United States, 23116

Contacts

Principal Investigator:

William J. Irvin

Bon Secours Saint Francis Medical Center

Recruiting

Midlothian, Virginia, United States, 23114

Contacts

Principal Investigator:

William J. Irvin

Bon Secours Saint Mary's Hospital

Recruiting

Richmond, Virginia, United States, 23226

Contacts

Principal Investigator:

William J. Irvin

Bon Secours Cancer Institute at Reynolds Crossing

Recruiting

Richmond, Virginia, United States, 23230

Contacts

Principal Investigator:

William J. Irvin

More Information

Sponsor

SWOG Cancer Research Network

Last update posted

Oct 13, 2026

Last verified

Oct, 2026

Trial information was received from ClinicalTrials.gov and was last updated on 2026-10-14. This information was provided to ClinicalTrials.gov by SWOG Cancer Research Network on 2026-10-13. Recruitment status is synced daily from ClinicalTrials.gov and may not reflect the sponsor's current status. Confirm during your call.