Eine klinische Studie zur Untersuchung eines neuen Behandlungsschemas ohne Chemotherapie nach der Operation für Patientinnen und Patienten mit Brustkrebs im Frühstadium, der „HER2-positiv“ und „Hormonrezeptor-negativ“ ist und auf eine vereinfachte Behandlung vor der Operation gut angesprochen hat

Drug: Pertuzumab and tratuzumab fixed dose combination;Drug: Trastuzumab emtansine

Gender: All
Maximum age: N/A
Minimum age: 18 Years
Inclusion Criteria:

1. Male or female.

2. Age =18 years old.

3. Eastern Cooperative Oncology Group (ECOG) performance status =1.

4. Subjects whose tumour measures =15 mm and =50 mm, according to clinical staging
performed with imaging exams (either mammography, ultrasound or breast magnetic
resonance imaging [MRI]).

5. Must have histologically confirmed diagnosis of HER2-positive and
ER-negative/PR-negative breast cancer (analysis performed by the local laboratory).

1. HER2-positive defined as a score of 3+ in IHC or a positive ISH (ratio of HER2
copy number/chromosome 17 =2 or average HER2 copy number =6 signals per cell).

2. ER-negative/PR-negative defined as estrogen receptor and progesterone receptor
nuclear staining <1% by IHC.

Note: patients with micro-invasive carcinoma or ductal carcinoma in situ (DCIS)
without invasive disease are not eligible.

6. Subjects with multifocal or multicentric invasive disease are eligible as long as
all the biopsiable lesions can be characterised and are confirmed to be
HER2-positive and ER and PR negative.

Note: In the case of multifocal or multicentric disease, only the biopsy from the
largest lesion should be provided.

7. Node-negative disease (N0): no axillary lymph nodes identifiable at ultrasound, or
in case of suspect axillary lymph nodes are identified, fine-needle aspiration or
core biopsy must be carried out to confirm that axillary status is negative.
Axillary micrometastases (i.e., if the greatest diameter of the nodal metastasis in
a sentinel node is 0.2 mm or less) are not allowed.

8. Serum pregnancy test (for women of childbearing potential) negative within 7 days
prior to treatment start.

9. Women of childbearing potential must agree to use 1 highly effective non-hormonal
contraceptive method with a failure rate of less than 1% per year from the signing
of the ICF until at least 7 months after last dose of study drugs; or they must
totally abstain from any form of sexual intercourse. Men with a partner of
childbearing potential must agree to use condom in combination with a spermicidal
foam, gel, film, cream, or suppository, and agreement to refrain from donating
sperm, during the course of this study and for at least 7 months after the last
administration of study treatment.

10. Adequate bone marrow and coagulation functions as defined below:

- Absolute neutrophil count =1500 /?L or 1.5x109/L

- Haemoglobin =9 g/dL (blood transfusions to reach these levels of haemoglobin
are allowed)

- Platelets =100,000/?L or 100x109/L

- International normalized ratio (INR) and activated partial thromboplastin time
(aPTT) = 1.5 ?ULN

11. Adequate liver function as defined below:

- Serum total bilirubin =1.5 x ULN. In case of known Gilbert's syndrome =3xUNL is
allowed

- AST (SGOT) and ALT (SGPT) =2.5 x ULN

- Alkaline phosphatase =2.5 x ULN

12. Adequate renal function as defined below:

? Creatinine =1.5 x UNL or creatinine clearance >60 mL/min/1.73 m2

13. Completion of all necessary screening procedures within 28 days prior to enrolment.

14. Adequate cardiac function, defined as a left ventricular ejection fraction =55%
estimated by echocardiogram (ECHO) or multiple-gated acquisition scintigraphy
(MUGA).

15. Availability of a pre-treatment tumour biopsy sample as specified below:

- At least one FFPE tumour block must be available for central evaluation.
Whenever possible, two FFPE tumour blocks should be available (preferred).

- If a block cannot be provided, 25 unstained FFPE slides of 4 ?m thickness from
the pre-treatment tumour biopsy must be provided as an alternative. These
slides must be freshly cut prior the shipment to the sponsor.

- In either case, the local pathologist must evaluate an H&E stained slide to
ensure that the tumour surface is at least 4 mm? and that tumour cellularity is
=10%.

Note 1: Tumour biopsy must be sent to the central research laboratory as soon as the
patient is confirmed by the local investigator to be eligible for the study.

Note 2: the inclusion of the subject is only based on local assessments. A central
review of HER2, ER, and PR status will be performed at posteriori for quality
control purposes.

16. Signed Informed Consent form (ICF) obtained prior to any study related procedure.

17. Subject is willing and able to comply with the protocol for the duration of the
study including treatment and scheduled visits and examinations.

Inclusion criterion applicable to FRANCE only:

18. Affiliated to the French Social Security System.

Exclusion Criteria:

1. Pregnant and/or lactating women.

2. Bilateral invasive breast cancer.

3. Evidence of metastatic breast cancer: all subjects must have had a CT/MRI scan of
the thorax/abdomen/pelvis to rule out metastatic breast cancer prior to enrolment.
FDG/PET-CT can be used as an alternative to replace all the exams above. A screening
bone scan must have been done if ALP and/or corrected calcium levels were above the
institutional upper limits at screening (if PET/CT was used as an alternative
imaging exam, a bone scan and/or CT/MRI is not required).

4. Subject with a significant medical, neuro-psychiatric, or surgical condition,
currently uncontrolled by treatment, which, in the investigator's opinion, may
interfere with completion of the study.

5. Previous exposure to any anti-HER2 treatment.

6. Concomitant exposure to any investigational products as part of a clinical trial
within 30 days prior to enrolment.

7. Subject with second primary malignancies diagnosed = 5 years before enrolment in the
study. Exceptions are: adequately treated non-melanoma skin cancer, in situ cancer
of the cervix, ductal carcinoma in situ of the breast, and any other solid or
haematological tumour diagnosed > 5 years before enrolment and for which no
chemotherapy and no systemic treatment were necessary, with no evidence of disease
recurrence.

8. Resting electrocardiogram (ECG) with QTc >470 msec detected on at 2 or more time
points within a 24-hour period, or family history of long QT syndrome.

9. Serious cardiac illness or medical conditions including, but not confined to, the
following:

- History of NCI CTCAE (v4) Grade = 3 symptomatic congestive heart failure (CHF)
or New York Heart Association (NYHA) Class = II

- High-risk uncontrolled arrhythmias (i.e., atrial tachycardia with a heart rate
= or > 100/min at rest, significant ventricular arrhythmia [ventricular
tachycardia], or higher-grade atrioventricular [AV]-block, such as second
degree AV-block Type 2 [Mobitz 2] or third-degree AV-block) - Serious cardiac
arrhythmia not controlled by adequate medication, severe conduction abnormality

- Angina pectoris requiring anti-anginal medication

- Clinically significant valvular heart disease

- Evidence of transmural infarction on ECG

-