Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT1-02-02
E. Hamilton, N. Vidula, Cynthia X. Ma, P. LoRusso, J. Saeh, V. Reichert, Ziyang Yu, M. Annett, A. Weitzman, G. Hattersly, A. O'Neill, A. Weise
Background: Hormone receptor-positive (HR+) breast cancer accounts for about 75% of breast cancer cases. Despite initial response to ER-targeted therapies, subsequent tumor progression remains an important clinical problem, highlighting the need for new therapies with activity in endocrine-resistant tumors. The androgen receptor (AR) is expressed in up to 90% of ER+ breast cancers, and until the 1970s, breast cancer was commonly treated with androgens with single-agent response rates ranging from 20% to 25%. However, androgen-based therapy for breast cancer declined due to lack of tissue selectivity, potential for aromatization to estrogen, and the emergence of ER-targeted agents such as tamoxifen. RAD140 is an oral nonsteroidal selective androgen receptor modulator (SARM) that cannot be converted to estrogen by aromatase. RAD140 has high AR affinity and target selectivity, demonstrating marked tissue-selective AR agonist activity comparable to natural androgens in breast cancer cells, but lacking agonist activity in prostate cancer cells. Preclinical efficacy studies in multiple in vivo and in vitro models of AR+/ER+ breast cancer demonstrate potent anti-tumor activity of RAD140 as a single agent and in combination with a CDK4/6 inhibitor. This first-in-human study will evaluate the safety, tolerability, pharmacokinetics (PK) and clinical activity of RAD140 in patients with HR+ breast cancer. Trial Design and Specific Aims: This is a Phase I, open-label dose escalation and safety expansion study of RAD140 in postmenopausal patients (pts) with advanced HR+ breast cancer for whom no standard therapy is available. During dose escalation (Part A), pts are assigned sequentially to escalating doses of RAD140 using a standard 3+3 design to establish a maximum tolerated dose (MTD) and/or recommended dose (RD) based on safety, PK and preliminary clinical activity. The Safety Expansion (Part B) will further evaluate the safety, tolerability and clinical activity of the RD. Eligibility Criteria: Pts must be post-menopausal females ≥18 years old with locally advanced or metastatic ER+/HER2- (Part A) or ER+/AR+/HER2- (Part B) breast cancer and ECOG 0 or 1. Part A pts must not be eligible for standard therapy. Pts in Part B must have had at least 1 line of prior systemic therapy in the metastatic setting and at least 6 months of prior endocrine therapy in the metastatic setting and progressed on the most recent endocrine therapy. Measurable disease by RECIST 1.1 is also required for enrollment in Part B. Statistical Methods: Descriptive statistics (including mean, standard deviation, median for continuous variables; frequency counts and percentages for categorical variables) will be presented by dose. Plasma or serum PK parameters for RAD140 will be estimated using non-compartmental methods. Present Accrual and Target Accrual: The study will enroll up to 40 pts, including up to approximately 24 pts enrolled in cohorts of 3 to 6 in Part A, and another 15 pts e
背景:激素受体阳性(HR+)乳腺癌约占乳腺癌病例的75%。尽管对er靶向治疗有初步反应,但随后的肿瘤进展仍然是一个重要的临床问题,这突出了对具有内分泌抗性肿瘤活性的新疗法的需求。雄激素受体(AR)在高达90%的ER+乳腺癌中表达,直到20世纪70年代,乳腺癌通常用雄激素治疗,单药反应率在20%至25%之间。然而,由于缺乏组织选择性、雌激素芳构化的可能性以及er靶向药物(如他莫昔芬)的出现,基于雄激素的乳腺癌治疗有所下降。RAD140是一种口服非甾体选择性雄激素受体调节剂(SARM),不能通过芳香化酶转化为雌激素。RAD140具有高度的AR亲和力和靶标选择性,在乳腺癌细胞中显示出与天然雄激素相当的组织选择性AR激动剂活性,但在前列腺癌细胞中缺乏激动剂活性。在AR+/ER+乳腺癌的多种体内和体外模型中进行的临床前疗效研究表明,RAD140作为单一药物或与CDK4/6抑制剂联合使用时具有强大的抗肿瘤活性。这项首次人体研究将评估RAD140在HR+乳腺癌患者中的安全性、耐受性、药代动力学(PK)和临床活性。试验设计和特定目的:这是RAD140在绝经后晚期HR+乳腺癌患者(pts)中的I期开放标签剂量递增和安全性扩展研究,这些患者没有标准治疗方法。在剂量递增过程中(A部分),根据安全性、PK和初步临床活性,采用标准的3+3设计,将患者按顺序分配到RAD140的递增剂量,以确定最大耐受剂量(MTD)和/或推荐剂量(RD)。安全性扩展(B部分)将进一步评估RD的安全性、耐受性和临床活性。资格标准:患者必须是绝经后女性,年龄≥18岁,局部晚期或转移性ER+/HER2- (A部分)或ER+/AR+/HER2- (B部分)乳腺癌,ECOG为0或1。A部分患者不能接受标准治疗。B部分患者必须至少接受过1种转移性全身治疗,至少接受过6个月的转移性内分泌治疗,并在最近的内分泌治疗中取得进展。b部分的入组还需要RECIST 1.1可测量的疾病。统计方法:描述性统计(包括连续变量的平均值、标准差、中位数;频率计数和分类变量的百分比)将按剂量表示。RAD140的血浆或血清PK参数将使用非区室法估计。当前累积和目标累积:该研究将招募多达40名患者,其中约24名患者在A部分3至6人的队列中入组,另外15名患者在b部分入组。截至2018年6月,11名患者在5个地点入组。[摘要]引用本文:Hamilton E, Vidula N, Ma C, LoRusso P, Saeh J, Reichert V, Yu Z, Annett M, Weitzman A, Hattersly G, O9Neill A, Weise A。口服非甾体选择性雄激素受体调节剂RAD140在绝经后激素受体阳性乳腺癌患者中的临床研究[摘要]。2018年圣安东尼奥乳腺癌研讨会论文集;2018年12月4-8日;费城(PA): AACR;中国癌症杂志,2019;79(4增刊):01-02-02。
{"title":"Abstract OT1-02-02: A phase 1, first-in-human, multi-part study of RAD140, an oral nonsteroidal selective androgen receptor modulator, in postmenopausal women with hormone receptor positive breast cancer","authors":"E. Hamilton, N. Vidula, Cynthia X. Ma, P. LoRusso, J. Saeh, V. Reichert, Ziyang Yu, M. Annett, A. Weitzman, G. Hattersly, A. O'Neill, A. Weise","doi":"10.1158/1538-7445.SABCS18-OT1-02-02","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT1-02-02","url":null,"abstract":"Background: Hormone receptor-positive (HR+) breast cancer accounts for about 75% of breast cancer cases. Despite initial response to ER-targeted therapies, subsequent tumor progression remains an important clinical problem, highlighting the need for new therapies with activity in endocrine-resistant tumors. The androgen receptor (AR) is expressed in up to 90% of ER+ breast cancers, and until the 1970s, breast cancer was commonly treated with androgens with single-agent response rates ranging from 20% to 25%. However, androgen-based therapy for breast cancer declined due to lack of tissue selectivity, potential for aromatization to estrogen, and the emergence of ER-targeted agents such as tamoxifen. RAD140 is an oral nonsteroidal selective androgen receptor modulator (SARM) that cannot be converted to estrogen by aromatase. RAD140 has high AR affinity and target selectivity, demonstrating marked tissue-selective AR agonist activity comparable to natural androgens in breast cancer cells, but lacking agonist activity in prostate cancer cells. Preclinical efficacy studies in multiple in vivo and in vitro models of AR+/ER+ breast cancer demonstrate potent anti-tumor activity of RAD140 as a single agent and in combination with a CDK4/6 inhibitor. This first-in-human study will evaluate the safety, tolerability, pharmacokinetics (PK) and clinical activity of RAD140 in patients with HR+ breast cancer. Trial Design and Specific Aims: This is a Phase I, open-label dose escalation and safety expansion study of RAD140 in postmenopausal patients (pts) with advanced HR+ breast cancer for whom no standard therapy is available. During dose escalation (Part A), pts are assigned sequentially to escalating doses of RAD140 using a standard 3+3 design to establish a maximum tolerated dose (MTD) and/or recommended dose (RD) based on safety, PK and preliminary clinical activity. The Safety Expansion (Part B) will further evaluate the safety, tolerability and clinical activity of the RD. Eligibility Criteria: Pts must be post-menopausal females ≥18 years old with locally advanced or metastatic ER+/HER2- (Part A) or ER+/AR+/HER2- (Part B) breast cancer and ECOG 0 or 1. Part A pts must not be eligible for standard therapy. Pts in Part B must have had at least 1 line of prior systemic therapy in the metastatic setting and at least 6 months of prior endocrine therapy in the metastatic setting and progressed on the most recent endocrine therapy. Measurable disease by RECIST 1.1 is also required for enrollment in Part B. Statistical Methods: Descriptive statistics (including mean, standard deviation, median for continuous variables; frequency counts and percentages for categorical variables) will be presented by dose. Plasma or serum PK parameters for RAD140 will be estimated using non-compartmental methods. Present Accrual and Target Accrual: The study will enroll up to 40 pts, including up to approximately 24 pts enrolled in cohorts of 3 to 6 in Part A, and another 15 pts e","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"431 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77492539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT1-01-01
N. Bahrami, T. Sauer, M. Loeng, B. Gravdehaug, S. Engebretsen, B. Aljabri, V. Bemanian, J. Lindstrøm, T. Lüders, V. Kristensen, J. Geisler
{"title":"Abstract OT1-01-01: The NEO-LET-EXE-trial: An intra-patient cross-over trial to explore the \"lack of cross-resistance\" between steroidal and non-steroidal aromatase inhibitors","authors":"N. Bahrami, T. Sauer, M. Loeng, B. Gravdehaug, S. Engebretsen, B. Aljabri, V. Bemanian, J. Lindstrøm, T. Lüders, V. Kristensen, J. Geisler","doi":"10.1158/1538-7445.SABCS18-OT1-01-01","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT1-01-01","url":null,"abstract":"","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79221257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT3-04-01
K. Khoury, C. Isaacs, M. Gatti-Mays, R. Donahue, J. Schlom, Hongkun Wang, C. Gallagher, D. Graham, R. Warren, A. Dilawari, S. Swain, P. Pohlmann, F. Lynce
Background: Long-term follow-up of neoadjuvant studies demonstrates poor clinical outcomes in patients with TNBC who do not achieve pathologic complete response, with only 35% remaining free of recurrence at 10 years. The addition of adjuvant capecitabine in the CREATE-X study prolonged disease free survival and overall survival (OS) in patients with HER2 negative breast cancer with residual invasive disease, with more striking benefit in patients with TNBC. Checkpoint inhibitors have not been approved in breast cancer yet, but recent studies suggest a benefit in combination with chemotherapy and low burden of disease. In the current study, we will evaluate the role of chemoimmunotherapy in the adjuvant setting for patients with TNBC with residual disease after neoadjuvant therapy. We will also investigate the role of the peripheral immunoscore (PIS) in predicting the benefit of immune checkpoint inhibition with or without chemotherapy. Trial design: OXEL is a pilot open-label three arm randomized study of nivolumab, capecitabine or the combination as adjuvant therapy for 45 patients with residual TNBC after adequate neoadjuvant chemotherapy. Patients enrolled will be randomly assigned to 1 of 3 treatment arms: nivolumab 360 mg iv q3weeks for x 6 cycles; capecitabine 1250mg/m2 po bid D1-D14 q3 weeks x 6 cycles; nivolumab 360mg iv q3weeks + capecitabine 1250mg/m2 po bid D1-D14 q3 weeks x 6 cycles. Main eligibility criteria: Patients ≥18 years of age with TNBC and ≥1cm of residual disease in the breast and/or node positive disease; receipt of neoadjuvant taxane +/- anthracycline, or platinum, and having completed definitive resection of primary tumor, with no prior use of capecitabine, fluorouracil or immunotherapy, and with no active autoimmune disease or chronic use of systemic steroids. Specific aims: The primary endpoint is assessing the immunologic effects of capecitabine, nivolumab or the combination in the adjuvant setting by PIS. Additional endpoints include toxicity assessment, distant recurrence free survival (DRFS) and OS at 3-years, association between changes in PIS and circulating tumor DNA at different timepoints with clinical outcome variables and characterization of the immune contexture in residual tumors. Statistical methods: The study is designed to assess the change in PIS at 6 weeks from baseline in each arm. The sample size of 15 per arm (45 total for 3 arms) will provide preliminary results. A sample size of 15 per arm will have 85% power to detect an effect size of 1 (the difference of the change in PIS from baseline to week 6 between two arms divided by the standard deviation) at 5% significance level. Present accrual and target accrual: The Institutional Review Board at Georgetown University Medical Center has approved the study. Clinicaltrials.gov NCT03487666. Enrollment of the first patient is expected in July 2018 with a total of 45 patients planned to be recruited. Recruitment sites are MedStar Georgetown University H
背景:新辅助研究的长期随访表明,未达到病理完全缓解的TNBC患者的临床结果较差,只有35%的患者在10年内没有复发。在CREATE-X研究中,辅助卡培他滨的加入延长了HER2阴性乳腺癌伴有残余浸润性疾病患者的无病生存期和总生存期(OS),在TNBC患者中获益更为显著。检查点抑制剂尚未被批准用于乳腺癌,但最近的研究表明,与化疗联合使用有好处,而且降低了疾病负担。在当前的研究中,我们将评估化疗免疫治疗在新辅助治疗后残留疾病的TNBC患者的辅助设置中的作用。我们还将研究外周免疫评分(PIS)在预测化疗或不化疗免疫检查点抑制的益处中的作用。试验设计:OXEL是一项试验性开放标签三组随机研究,将纳武单抗、卡培他滨或联合用药作为45例新辅助化疗后残余TNBC患者的辅助治疗。纳入的患者将被随机分配到3个治疗组中的1个:nivolumab 360 mg iv q3周,共x 6个周期;卡培他滨1250mg/m2 po bid D1-D14 q3周× 6个周期;纳武单抗360mg iv q3周+卡培他滨1250mg/m2 po bid D1-D14 q3周x 6个周期。主要入选标准:年龄≥18岁伴有TNBC且乳腺和/或淋巴结阳性疾病残留≥1cm的患者;接受新辅助紫杉烷+/-蒽环类药物或铂类药物,完成原发肿瘤的最终切除,既往未使用卡培他滨、氟尿嘧啶或免疫治疗,无活动性自身免疫性疾病或长期使用全身性类固醇。具体目的:主要终点是评估卡培他滨、纳武单抗或联合用药在PIS辅助治疗中的免疫效应。其他终点包括毒性评估、3年远期无复发生存期(DRFS)和OS、不同时间点PIS和循环肿瘤DNA变化与临床结果变量和残余肿瘤免疫环境表征之间的关系。统计学方法:该研究旨在评估每组患者在基线后6周PIS的变化。每组15个样本量(3组共45个)将提供初步结果。在5%的显著性水平上,每组15个样本量将有85%的能力检测到效应量为1(两组之间PIS从基线到第6周的变化之差除以标准差)。当前应计收益和目标应计收益:乔治城大学医学中心的机构审查委员会已经批准了这项研究。Clinicaltrials.gov NCT03487666。第一名患者预计将于2018年7月入组,计划共招募45名患者。招聘网站为:MedStar乔治敦大学医院、MedStar华盛顿医院中心、哈肯萨克大学医疗中心。该试验由Bristol-Meyers Squibb提供支持,P30CA051008-25来自NCI、Inivata和Nina Hyde乳腺癌研究中心。引用格式:Khoury K, Isaacs C, Gatti-Mays ME, Donahue RN, Schlom J, Wang H, Gallagher C, Graham D, Warren R, Dilawari A, Swain SM, Pohlmann PR, Lynce F. Nivolumab或capecitabine联合治疗新辅助化疗后残余病变的三阴性乳腺癌(TNBC): OXEL研究[摘要]。2018年圣安东尼奥乳腺癌研讨会论文集;2018年12月4-8日;费城(PA): AACR;中国癌症杂志2019;79(4增刊):OT3-04-01。
{"title":"Abstract OT3-04-01: Nivolumab or capecitabine or combination therapy as adjuvant therapy for triple negative breast cancer (TNBC) with residual disease following neoadjuvant chemotherapy: The OXEL study","authors":"K. Khoury, C. Isaacs, M. Gatti-Mays, R. Donahue, J. Schlom, Hongkun Wang, C. Gallagher, D. Graham, R. Warren, A. Dilawari, S. Swain, P. Pohlmann, F. Lynce","doi":"10.1158/1538-7445.SABCS18-OT3-04-01","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT3-04-01","url":null,"abstract":"Background: Long-term follow-up of neoadjuvant studies demonstrates poor clinical outcomes in patients with TNBC who do not achieve pathologic complete response, with only 35% remaining free of recurrence at 10 years. The addition of adjuvant capecitabine in the CREATE-X study prolonged disease free survival and overall survival (OS) in patients with HER2 negative breast cancer with residual invasive disease, with more striking benefit in patients with TNBC. Checkpoint inhibitors have not been approved in breast cancer yet, but recent studies suggest a benefit in combination with chemotherapy and low burden of disease. In the current study, we will evaluate the role of chemoimmunotherapy in the adjuvant setting for patients with TNBC with residual disease after neoadjuvant therapy. We will also investigate the role of the peripheral immunoscore (PIS) in predicting the benefit of immune checkpoint inhibition with or without chemotherapy. Trial design: OXEL is a pilot open-label three arm randomized study of nivolumab, capecitabine or the combination as adjuvant therapy for 45 patients with residual TNBC after adequate neoadjuvant chemotherapy. Patients enrolled will be randomly assigned to 1 of 3 treatment arms: nivolumab 360 mg iv q3weeks for x 6 cycles; capecitabine 1250mg/m2 po bid D1-D14 q3 weeks x 6 cycles; nivolumab 360mg iv q3weeks + capecitabine 1250mg/m2 po bid D1-D14 q3 weeks x 6 cycles. Main eligibility criteria: Patients ≥18 years of age with TNBC and ≥1cm of residual disease in the breast and/or node positive disease; receipt of neoadjuvant taxane +/- anthracycline, or platinum, and having completed definitive resection of primary tumor, with no prior use of capecitabine, fluorouracil or immunotherapy, and with no active autoimmune disease or chronic use of systemic steroids. Specific aims: The primary endpoint is assessing the immunologic effects of capecitabine, nivolumab or the combination in the adjuvant setting by PIS. Additional endpoints include toxicity assessment, distant recurrence free survival (DRFS) and OS at 3-years, association between changes in PIS and circulating tumor DNA at different timepoints with clinical outcome variables and characterization of the immune contexture in residual tumors. Statistical methods: The study is designed to assess the change in PIS at 6 weeks from baseline in each arm. The sample size of 15 per arm (45 total for 3 arms) will provide preliminary results. A sample size of 15 per arm will have 85% power to detect an effect size of 1 (the difference of the change in PIS from baseline to week 6 between two arms divided by the standard deviation) at 5% significance level. Present accrual and target accrual: The Institutional Review Board at Georgetown University Medical Center has approved the study. Clinicaltrials.gov NCT03487666. Enrollment of the first patient is expected in July 2018 with a total of 45 patients planned to be recruited. Recruitment sites are MedStar Georgetown University H","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82370560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT3-05-01
C. Geyer, S. Loibl, P. Rastogi, S. Seiler, J. Costantino, V. Nekljudova, P. Cortazar, P. C. Lucas, C. Denkert, E. Mamounas, C. Jackisch, N. Wolmark
Background: TNBC is associated with higher percentages of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC), and women with a pCR have a favorable prognosis. However, Liedtke (2008) and Loibl (2017) found that women with residual disease have a substantially higher risk of recurrence than women with other subtypes of breast cancer. Additionally, Adams (2017) and Schmid (2017) found that therapeutic blockade of PD-L1 binding by atezolizumab has resulted in relevant anti-tumor efficacy. Methods: Design This is a phase III, double blind, placebo-control trial evaluating neoadjuvant atezolizumab with NAC followed by adjuvant atezolizumab in TNBC. Pts are stratified by region (North America; Europe), tumor size (1.1-3.0cm; >3.0cm), AC/EC schedule (q2w; q3w), and nodal status (positive; negative), then randomized 1:1 to receive atezolizumab/placebo 1200 mg IV every 3 wks concurrently with both sequential regimens of weekly paclitaxel 80 mg/m2 IV for 12 doses with every 3-wk carboplatin AUC of 5 IV for 4 doses followed by AC/EC every 2-3 wks (per investigator discretion) for 4 cycles. Following surgery, pts resume atezolizumab/placebo 1200 mg IV every 3 wks as adjuvant therapy for 6 months. Radiotherapy based on local standards is co-administered with atezolizumab/placebo. Eligibility criteria Centrally-confirmed ER-neg, PR-neg, HER2-neg invasive breast cancer by ASCO/CAP guidelines. Primary tumor must be stage T2 or T3 if cN0 or cN1 with negative biopsy or T1c, T2, or T3 if cN1 with positive biopsy or cN2 or cN3. LVEF >55% and no significant cardiac history. Statistical methods Co-primary endpoints are event-free survival (EFS) and pCR breast/nodes. Secondary endpoints include pCR breast, overall survival, distant disease-free survival, safety and toxicity. Trial is an academic collaboration between NSABP and GBG with support from Genentech/Roche. NCT03281954 Support: Genentech/Roche Citation Format: Geyer, Jr. CE, Loibl S, Rastogi P, Seiler S, Costantino JP, Nekljudova VN, Cortazar P, Lucas PC, Denkert C, Mamounas EP, Jackisch C, Wolmark N. A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-01.
{"title":"Abstract OT3-05-01: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze","authors":"C. Geyer, S. Loibl, P. Rastogi, S. Seiler, J. Costantino, V. Nekljudova, P. Cortazar, P. C. Lucas, C. Denkert, E. Mamounas, C. Jackisch, N. Wolmark","doi":"10.1158/1538-7445.SABCS18-OT3-05-01","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT3-05-01","url":null,"abstract":"Background: TNBC is associated with higher percentages of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC), and women with a pCR have a favorable prognosis. However, Liedtke (2008) and Loibl (2017) found that women with residual disease have a substantially higher risk of recurrence than women with other subtypes of breast cancer. Additionally, Adams (2017) and Schmid (2017) found that therapeutic blockade of PD-L1 binding by atezolizumab has resulted in relevant anti-tumor efficacy. Methods: Design This is a phase III, double blind, placebo-control trial evaluating neoadjuvant atezolizumab with NAC followed by adjuvant atezolizumab in TNBC. Pts are stratified by region (North America; Europe), tumor size (1.1-3.0cm; >3.0cm), AC/EC schedule (q2w; q3w), and nodal status (positive; negative), then randomized 1:1 to receive atezolizumab/placebo 1200 mg IV every 3 wks concurrently with both sequential regimens of weekly paclitaxel 80 mg/m2 IV for 12 doses with every 3-wk carboplatin AUC of 5 IV for 4 doses followed by AC/EC every 2-3 wks (per investigator discretion) for 4 cycles. Following surgery, pts resume atezolizumab/placebo 1200 mg IV every 3 wks as adjuvant therapy for 6 months. Radiotherapy based on local standards is co-administered with atezolizumab/placebo. Eligibility criteria Centrally-confirmed ER-neg, PR-neg, HER2-neg invasive breast cancer by ASCO/CAP guidelines. Primary tumor must be stage T2 or T3 if cN0 or cN1 with negative biopsy or T1c, T2, or T3 if cN1 with positive biopsy or cN2 or cN3. LVEF >55% and no significant cardiac history. Statistical methods Co-primary endpoints are event-free survival (EFS) and pCR breast/nodes. Secondary endpoints include pCR breast, overall survival, distant disease-free survival, safety and toxicity. Trial is an academic collaboration between NSABP and GBG with support from Genentech/Roche. NCT03281954 Support: Genentech/Roche Citation Format: Geyer, Jr. CE, Loibl S, Rastogi P, Seiler S, Costantino JP, Nekljudova VN, Cortazar P, Lucas PC, Denkert C, Mamounas EP, Jackisch C, Wolmark N. A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-01.","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84943053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT2-05-01
H. Yao, W. Wu, L. Ding, Y. Yu, Yongsheng Wang, Yi Zeng, J. Zhao, Qiao Li
Background: Metastatic breast cancer (MBC) is incurable. Although first-line endocrine therapy is preferred to hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) MBC, combination chemotherapy should be reserved as the initial treatment for patients with rapid clinical progression, life-threatening visceral metastases, and need for rapidly symptom control. Either prolonged chemotherapy or endocrine therapy may be used as maintenance after disease control. However, which maintenance strategy is superior in terms of delaying disease progression as well as maintaining quality of life (QOL) remains uncertain. This phase III trial aims to compare the efficacy and safety of fulvestrant or capecitabine as maintenance therapy after first-line combined chemotherapy in HR+/HER2- MBC. Trial Design: FAMILY is a multicenter, randomized, open-label phase III trial for HR+ and HER2- MBC. Eligible participants are randomized (1:1) to receive capecitabine (2000mg/m2 twice daily x 14 days followed by 7 days off) or fulvestrant (500mg Days 0, 14, 28, then every 28 days) until disease progression, unacceptable toxicity, or patient refusal. Stratification factor for randomization is sensitivity to adjuvant hormonal therapy (disease-free interval ≤24 months vs. >24 months). Eligibility Criteria: Eligible patients must have HR+ (ER and/or PR>1%, by IHC) and HER2- MBC; achieved a complete or partial response or stable disease (investigator assessed) after 4-8 cycles of first-line combination chemotherapy. Patients with central nervous system metastasis and/or prior use of endocrine therapy for advanced breast cancer are excluded. Specific Aims: The primary endpoint is progression free survival (PFS). Secondary endpoints include overall survival, overall response rate, disease control rate, safety and QOL. A prospective translational research is also planned to assess the correlations between biomarkers and response. Statistical Design: The planned sample size of 256 patients provides approximately 80% of power to detect a 6 months difference of PFS using a log-rank test with two-sided alpha of 0.05. Target Accrual: Recruitment is ongoing. Up to 256 evaluable subjects will be enrolled within 24 months. (ChiCTR-IIR-17014036). Citation Format: Yao H, Wu W, Ding L, Yu Y, Wang Y, Zeng Y, Zhao J, Li Q. FAMILY: A randomized, multicenter, open-label, phase III trial of fulvestrant versus capecitabine as maintenance therapy after first-line combination chemotherapy in patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-05-01.
{"title":"Abstract OT2-05-01: FAMILY: A randomized, multicenter, open-label, phase III trial of fulvestrant versus capecitabine as maintenance therapy after first-line combination chemotherapy in patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cance","authors":"H. Yao, W. Wu, L. Ding, Y. Yu, Yongsheng Wang, Yi Zeng, J. Zhao, Qiao Li","doi":"10.1158/1538-7445.SABCS18-OT2-05-01","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT2-05-01","url":null,"abstract":"Background: Metastatic breast cancer (MBC) is incurable. Although first-line endocrine therapy is preferred to hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) MBC, combination chemotherapy should be reserved as the initial treatment for patients with rapid clinical progression, life-threatening visceral metastases, and need for rapidly symptom control. Either prolonged chemotherapy or endocrine therapy may be used as maintenance after disease control. However, which maintenance strategy is superior in terms of delaying disease progression as well as maintaining quality of life (QOL) remains uncertain. This phase III trial aims to compare the efficacy and safety of fulvestrant or capecitabine as maintenance therapy after first-line combined chemotherapy in HR+/HER2- MBC. Trial Design: FAMILY is a multicenter, randomized, open-label phase III trial for HR+ and HER2- MBC. Eligible participants are randomized (1:1) to receive capecitabine (2000mg/m2 twice daily x 14 days followed by 7 days off) or fulvestrant (500mg Days 0, 14, 28, then every 28 days) until disease progression, unacceptable toxicity, or patient refusal. Stratification factor for randomization is sensitivity to adjuvant hormonal therapy (disease-free interval ≤24 months vs. >24 months). Eligibility Criteria: Eligible patients must have HR+ (ER and/or PR>1%, by IHC) and HER2- MBC; achieved a complete or partial response or stable disease (investigator assessed) after 4-8 cycles of first-line combination chemotherapy. Patients with central nervous system metastasis and/or prior use of endocrine therapy for advanced breast cancer are excluded. Specific Aims: The primary endpoint is progression free survival (PFS). Secondary endpoints include overall survival, overall response rate, disease control rate, safety and QOL. A prospective translational research is also planned to assess the correlations between biomarkers and response. Statistical Design: The planned sample size of 256 patients provides approximately 80% of power to detect a 6 months difference of PFS using a log-rank test with two-sided alpha of 0.05. Target Accrual: Recruitment is ongoing. Up to 256 evaluable subjects will be enrolled within 24 months. (ChiCTR-IIR-17014036). Citation Format: Yao H, Wu W, Ding L, Yu Y, Wang Y, Zeng Y, Zhao J, Li Q. FAMILY: A randomized, multicenter, open-label, phase III trial of fulvestrant versus capecitabine as maintenance therapy after first-line combination chemotherapy in patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-05-01.","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85224056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.sabcs18-ot3-02-02
E. Noguchi, T. Hata, Kenichi Nakamura, A. Kuchiba, M. Hayashi, A. Hamada, K. Yonemori, J. Sohn, Y. Lu, Y. Yap, Y. Fujiwara, K. Tamura
BACKGROUND: The incidence rates of breast cancer (BC) in Asian counties have been rising rapidly. The age-specific female BC incidence rates peak before menopause (around 40-50 years of age) in Asia, however treatment options for pre/perimenopausal patients are limited. Palbociclib (P) is an oral novel cyclin-dependent kinase 4/6 (CDK4/6) inhibitor. The addition of P to endocrine therapy (ET) such as aromatase inhibitor or fulvestrant has been demonstrated improved progression-free survival (PFS) in phase 3 studies PALOMA-2 and PALOMA-3. This study is designed to evaluate efficacy and safety of P plus tamoxifen (TAM) in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic BC regardless of menopausal status. This study is conducted as a Clinical Research Collaboration by National Cancer Center Hospital with research funding from Pfizer. TRIAL DESIGN: PATHWAY/NCCH1607 is a double-blind, placebo-controlled, randomized, phase 3 study. Patients will be randomized 1:1 to receive either P (125 mg once daily, days1-21 of a 28-day cycle) or placebo in combination with TAM (20 mg once daily, continuously). Pre/perimenopausal women should receive concurrent ovarian function suppression with goserelin. Randomization will be stratified by prior ET for advanced/metastatic BC (1st line ET vs. 2nd line ET) and menopausal status (pre/perimenopausal vs. postmenopausal). KEY ELIGIBILITY CRITERIA: Eligible patients include women of any menopausal status with HR-positive, HER2-negative advanced or metastatic BC; candidates to receive TAM as 1st line or 2nd line ET for advanced/metastatic disease; ≥18 years of age; measurable or non-measurable disease (RECIST v.1.1); ECOG performance status 0-1; adequate organ function; have not received treatment with TAM (except for patients who have had more than 12 months from completion of adjuvant therapy with TAM); and have not received any CDK4/6 or phosphoinositide 3-kinase (PI3K) - mammalian target of rapamycin (mTOR) inhibitors. SPECIFIC AIMS: The primary endpoint is PFS as assessed by the investigator. Secondary endpoints include overall survival (OS), 1, 2, and 3-year survival probabilities, objective response (OR), duration of response, clinical benefit rate (CBR), pharmacokinetics, safety, and patient-reported outcomes. STATISTICAL METHODS: The sample size was determined to detect a 38% reduction in the hazard of disease progression or death in P plus TAM arm with a 1-sided significance level of 2.5% and power of 80%. A stratified log rank test will be used to compare PFS between the 2 treatment arms. PRESENT ACCRUAL AND TARGET ACCRUAL: Target accrual of 180 patients will be enrolled within 23 sites among Japan, Korea, Taiwan, and Singapore. As of June 2018, 46 patients have been enrolled. CONTACT INFORMATION: This trial is registered at ClinicalTrials.gov NCT03423199 and UMIN000030816. For more information, email NCCH1607_office@ml.res.ncc.go.jp C
背景:乳腺癌(BC)在亚洲国家的发病率一直在迅速上升。在亚洲,特定年龄的女性BC发病率在绝经前(约40-50岁)达到高峰,然而绝经前/围绝经期患者的治疗选择有限。Palbociclib (P)是一种口服的新型细胞周期蛋白依赖性激酶4/6 (CDK4/6)抑制剂。在3期研究PALOMA-2和PALOMA-3中,在内分泌治疗(ET)(如芳香化酶抑制剂或氟维司汀)中添加P已被证明可改善无进展生存期(PFS)。本研究旨在评估P +他莫昔芬(TAM)治疗激素受体(HR)阳性、人表皮生长因子受体2 (HER2)阴性的晚期或转移性BC患者的疗效和安全性,无论是否绝经。本研究由美国国家癌症中心医院作为临床研究合作项目进行,研究经费由辉瑞公司提供。试验设计:PATHWAY/NCCH1607是一项双盲、安慰剂对照、随机、3期研究。患者将以1:1的比例随机分配,接受P (125 mg,每日一次,28天周期,第1-21天)或安慰剂与TAM联合治疗(20 mg,每日一次,连续)。绝经前/围绝经期妇女应同时接受戈舍林卵巢功能抑制。随机分组将根据晚期/转移性BC的既往ET(一线ET vs二线ET)和绝经状态(绝经前/围绝经期vs绝经后)进行分层。关键资格标准:符合条件的患者包括任何绝经期hr2阳性、her2阴性的晚期或转移性BC的妇女;接受TAM作为一线或二线ET治疗晚期/转移性疾病的候选人;年龄≥18岁;可测量或不可测量的疾病(RECIST v.1.1);ECOG性能状态0-1;器官功能正常;未接受过TAM治疗(TAM辅助治疗完成后超过12个月的患者除外);并且未接受任何CDK4/6或磷酸肌肽3激酶(PI3K) -哺乳动物雷帕霉素靶点(mTOR)抑制剂。具体目的:主要终点是研究者评估的PFS。次要终点包括总生存期(OS)、1年、2年和3年生存率、客观反应(OR)、反应持续时间、临床获益率(CBR)、药代动力学、安全性和患者报告的结果。统计学方法:确定样本量,以检测P + TAM组疾病进展或死亡风险降低38%,单侧显著性水平为2.5%,功率为80%。分层对数秩检验将用于比较两个治疗组之间的PFS。当前累积和目标累积:目标累积将在日本、韩国、台湾和新加坡的23个地点纳入180名患者。截至2018年6月,已有46名患者入组。联系信息:本试验注册在ClinicalTrials.gov NCT03423199和UMIN000030816。引用格式:Noguchi E, Hata T, Nakamura K, Kuchiba, Hayashi M, Hamada A, Yonemori K, Sohn J, Lu Y- s, Yap Y- s, Fujiwara Y, Tamura K途径:亚洲多中心,他莫昔芬联合或不联合palbociclib±goserelin治疗激素受体阳性,her2阴性的晚期或转移性乳腺癌[摘要]。2018年圣安东尼奥乳腺癌研讨会论文集;2018年12月4-8日;费城(PA): AACR;中国癌症杂志,2019;79(4增刊):OT3-02-02。
{"title":"Abstract OT3-02-02: PATHWAY: Asian, multicenter, phase 3 trial of tamoxifen with or without palbociclib ± goserelin in women with hormone receptor-positive, HER2-negative advanced or metastatic breast cancer","authors":"E. Noguchi, T. Hata, Kenichi Nakamura, A. Kuchiba, M. Hayashi, A. Hamada, K. Yonemori, J. Sohn, Y. Lu, Y. Yap, Y. Fujiwara, K. Tamura","doi":"10.1158/1538-7445.sabcs18-ot3-02-02","DOIUrl":"https://doi.org/10.1158/1538-7445.sabcs18-ot3-02-02","url":null,"abstract":"BACKGROUND: The incidence rates of breast cancer (BC) in Asian counties have been rising rapidly. The age-specific female BC incidence rates peak before menopause (around 40-50 years of age) in Asia, however treatment options for pre/perimenopausal patients are limited. Palbociclib (P) is an oral novel cyclin-dependent kinase 4/6 (CDK4/6) inhibitor. The addition of P to endocrine therapy (ET) such as aromatase inhibitor or fulvestrant has been demonstrated improved progression-free survival (PFS) in phase 3 studies PALOMA-2 and PALOMA-3. This study is designed to evaluate efficacy and safety of P plus tamoxifen (TAM) in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic BC regardless of menopausal status. This study is conducted as a Clinical Research Collaboration by National Cancer Center Hospital with research funding from Pfizer. TRIAL DESIGN: PATHWAY/NCCH1607 is a double-blind, placebo-controlled, randomized, phase 3 study. Patients will be randomized 1:1 to receive either P (125 mg once daily, days1-21 of a 28-day cycle) or placebo in combination with TAM (20 mg once daily, continuously). Pre/perimenopausal women should receive concurrent ovarian function suppression with goserelin. Randomization will be stratified by prior ET for advanced/metastatic BC (1st line ET vs. 2nd line ET) and menopausal status (pre/perimenopausal vs. postmenopausal). KEY ELIGIBILITY CRITERIA: Eligible patients include women of any menopausal status with HR-positive, HER2-negative advanced or metastatic BC; candidates to receive TAM as 1st line or 2nd line ET for advanced/metastatic disease; ≥18 years of age; measurable or non-measurable disease (RECIST v.1.1); ECOG performance status 0-1; adequate organ function; have not received treatment with TAM (except for patients who have had more than 12 months from completion of adjuvant therapy with TAM); and have not received any CDK4/6 or phosphoinositide 3-kinase (PI3K) - mammalian target of rapamycin (mTOR) inhibitors. SPECIFIC AIMS: The primary endpoint is PFS as assessed by the investigator. Secondary endpoints include overall survival (OS), 1, 2, and 3-year survival probabilities, objective response (OR), duration of response, clinical benefit rate (CBR), pharmacokinetics, safety, and patient-reported outcomes. STATISTICAL METHODS: The sample size was determined to detect a 38% reduction in the hazard of disease progression or death in P plus TAM arm with a 1-sided significance level of 2.5% and power of 80%. A stratified log rank test will be used to compare PFS between the 2 treatment arms. PRESENT ACCRUAL AND TARGET ACCRUAL: Target accrual of 180 patients will be enrolled within 23 sites among Japan, Korea, Taiwan, and Singapore. As of June 2018, 46 patients have been enrolled. CONTACT INFORMATION: This trial is registered at ClinicalTrials.gov NCT03423199 and UMIN000030816. For more information, email NCCH1607_office@ml.res.ncc.go.jp C","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83562505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT1-04-01
Kelly Benante, Yanfei Xu, M. B. Tull, A. J. Segura, Katrina M. Alber, Kiril Kalinichenko, Lifang Hou, B. Jovanovic, M. Perloff, B. Heckman-Stoddard, E. Dimond, S. Khan
Background Ductal carcinoma in situ (DCIS) is diagnosed in 60,000 women annually in the US. TAM is proven to reduce risk of local recurrence and new primary breast cancer in women with estrogen receptor (ER) positive DCIS. However, acceptance of TAM has been low, primarily because of toxicity related to systemic exposure. Local delivery to the breast is an attractive alternative since low systemic levels could minimize toxicity. 4-OHT is an active metabolite of TAM. When formulated as a gel and applied to the breast skin, it is well tolerated, and results in 4-OHT breast tissue drug levels comparable oral TAM. In small pilot studies, its anti-proliferative effects on invasive breast tumors and DCIS are also similar to oral TAM [Lee O, et al. PMID 25028506]. The goal of our study is to validate these results in preparation for a Phase III trial of 4-OHT gel in comparison to oral TAM. Methods We are conducting a randomized, double-blinded, placebo-controlled, Phase IIB pre-surgical trial to demonstrate that daily application of 4-OHT gel will result in a reduction in the Ki-67 labeling index of DCIS lesions that is not inferior to that seen in women receiving daily oral TAM 20 mg daily. Ki-67 of the base-line diagnostic core needle biopsy will be compared to that of the therapeutic surgical excision sample after oral TAM or 4-OHT gel for 8 ± 2 weeks. Secondary endpoints include changes in Oncotype DCIS-Score, IHC markers (CD68, COX2, p16), hormone levels, coagulation markers, drug concentration in the plasma and breast tissue, the fraction of women with no residual DCIS in the surgical sample, and experienced symptoms. 100 women (assuming 20% non-evaluable samples or compliance issues) with DCIS (10% ER-positive) will be enrolled across six institutions into two intervention arms: oral TAM 20 mg daily, placebo gel and 4-OHT gel 4mg daily (2mg/breast), placebo capsule. All participants will be evaluable for toxicity from their first dose. All samples from all participants who receive drug will be evaluated and included in the primary analysis, which will be based on intent to treat principle. To date 15 of 100 participants have been enrolled across six institutions including: Northwestern University in Chicago, IL, St. Elizabeth Healthcare in Edgewood, KY, Duke University Medical Center in Durham, NC, Cleveland Clinic in Cleveland, OH, Memorial Sloan Kettering Cancer Center in New York, NY, and Mayo Clinic in Rochester, MN. Since study open, 69 potential participants have been contacted, 52 did not consent for screening, 17consented for screening, 2 are pending consent, and 15 have started study intervention. The most common reasons potential participants chose not to consent are wanting to schedule surgery as soon as possible, attitudes toward medical research, and current use of a prohibited concomitant medication such as a potent inhibitor of tamoxifen metabolism or exogenous sex steroid. Funding Source: NCI Contract # HHSN2612201200035I. Citatio
背景:在美国,每年有6万名女性被诊断为导管原位癌(DCIS)。经证实,TAM可降低雌激素受体(ER)阳性DCIS患者局部复发和新发原发性乳腺癌的风险。然而,TAM的接受度一直很低,主要是因为与全身接触有关的毒性。局部给药到乳房是一个有吸引力的选择,因为低的全身水平可以减少毒性。4-OHT是TAM的活性代谢物。当配制成凝胶并应用于乳房皮肤时,它具有良好的耐受性,并且导致4-OHT乳房组织药物水平与口服TAM相当。在小规模的试点研究中,其对浸润性乳腺肿瘤和DCIS的抗增殖作用也与口服TAM相似[Lee O,等]。PMID 25028506]。我们研究的目的是在准备4-OHT凝胶与口服TAM的III期试验时验证这些结果。方法:我们正在进行一项随机、双盲、安慰剂对照的IIB期术前试验,以证明每天应用4-OHT凝胶会导致DCIS病变Ki-67标记指数的降低,其效果并不低于每天口服TAM 20毫克的女性。在口服TAM或4-OHT凝胶8±2周后,将基线诊断核心针活检的Ki-67与治疗性手术切除样本进行比较。次要终点包括癌型DCIS评分、免疫组化标志物(CD68、COX2、p16)、激素水平、凝血标志物、血浆和乳腺组织药物浓度、手术样本中无DCIS残留的女性比例以及出现症状的变化。100名患有DCIS的女性(假设20%的样本不可评估或存在依从性问题)(10% er阳性)将在6个机构入组,分为两个干预组:口服TAM每天20毫克,安慰剂凝胶和4-OHT凝胶每天4毫克(每乳房2毫克),安慰剂胶囊。所有参与者将评估他们的毒性从他们的第一次剂量。所有接受药物治疗的参与者的所有样本将被评估并纳入初级分析,这将基于治疗意图原则。迄今为止,100名参与者中有15名已经在6个机构注册,包括:伊利诺伊州芝加哥的西北大学,肯塔基州埃奇伍德的圣伊丽莎白医疗中心,北卡罗来纳州达勒姆的杜克大学医学中心,俄亥俄州克利夫兰的克利夫兰诊所,纽约州纽约的纪念斯隆凯特琳癌症中心和明尼苏达州罗切斯特的梅奥诊所。自研究开始以来,已经联系了69名潜在参与者,52人不同意筛查,17人同意筛查,2人等待同意,15人已经开始研究干预。潜在参与者选择不同意的最常见原因是希望尽快安排手术,对医学研究的态度,以及目前使用禁用的伴随药物,如有效的他莫昔芬代谢抑制剂或外源性性类固醇。资金来源:NCI合同# HHSN2612201200035I。引用格式:Benante KA, Xu Y, Tull MB, Segura AJ, Alber KM, Kalinichenko K, Hou L, Jovanovic B, Perloff M, Heckman-Stoddard B, Dimond E, Khan SA。口服他莫昔芬(TAM)与透皮4-羟基他莫昔芬(4-OHT)治疗乳腺DCIS女性的IIB期术前试验[摘要]。2018年圣安东尼奥乳腺癌研讨会论文集;2018年12月4-8日;费城(PA): AACR;中国癌症杂志,2019;79(4增刊):OT1-04-01。
{"title":"Abstract OT1-04-01: A phase IIB pre-surgical trial of oral tamoxifen (TAM) versus transdermal 4-hydroxytamoxifen (4-OHT) in women with DCIS of the breast","authors":"Kelly Benante, Yanfei Xu, M. B. Tull, A. J. Segura, Katrina M. Alber, Kiril Kalinichenko, Lifang Hou, B. Jovanovic, M. Perloff, B. Heckman-Stoddard, E. Dimond, S. Khan","doi":"10.1158/1538-7445.SABCS18-OT1-04-01","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT1-04-01","url":null,"abstract":"Background Ductal carcinoma in situ (DCIS) is diagnosed in 60,000 women annually in the US. TAM is proven to reduce risk of local recurrence and new primary breast cancer in women with estrogen receptor (ER) positive DCIS. However, acceptance of TAM has been low, primarily because of toxicity related to systemic exposure. Local delivery to the breast is an attractive alternative since low systemic levels could minimize toxicity. 4-OHT is an active metabolite of TAM. When formulated as a gel and applied to the breast skin, it is well tolerated, and results in 4-OHT breast tissue drug levels comparable oral TAM. In small pilot studies, its anti-proliferative effects on invasive breast tumors and DCIS are also similar to oral TAM [Lee O, et al. PMID 25028506]. The goal of our study is to validate these results in preparation for a Phase III trial of 4-OHT gel in comparison to oral TAM. Methods We are conducting a randomized, double-blinded, placebo-controlled, Phase IIB pre-surgical trial to demonstrate that daily application of 4-OHT gel will result in a reduction in the Ki-67 labeling index of DCIS lesions that is not inferior to that seen in women receiving daily oral TAM 20 mg daily. Ki-67 of the base-line diagnostic core needle biopsy will be compared to that of the therapeutic surgical excision sample after oral TAM or 4-OHT gel for 8 ± 2 weeks. Secondary endpoints include changes in Oncotype DCIS-Score, IHC markers (CD68, COX2, p16), hormone levels, coagulation markers, drug concentration in the plasma and breast tissue, the fraction of women with no residual DCIS in the surgical sample, and experienced symptoms. 100 women (assuming 20% non-evaluable samples or compliance issues) with DCIS (10% ER-positive) will be enrolled across six institutions into two intervention arms: oral TAM 20 mg daily, placebo gel and 4-OHT gel 4mg daily (2mg/breast), placebo capsule. All participants will be evaluable for toxicity from their first dose. All samples from all participants who receive drug will be evaluated and included in the primary analysis, which will be based on intent to treat principle. To date 15 of 100 participants have been enrolled across six institutions including: Northwestern University in Chicago, IL, St. Elizabeth Healthcare in Edgewood, KY, Duke University Medical Center in Durham, NC, Cleveland Clinic in Cleveland, OH, Memorial Sloan Kettering Cancer Center in New York, NY, and Mayo Clinic in Rochester, MN. Since study open, 69 potential participants have been contacted, 52 did not consent for screening, 17consented for screening, 2 are pending consent, and 15 have started study intervention. The most common reasons potential participants chose not to consent are wanting to schedule surgery as soon as possible, attitudes toward medical research, and current use of a prohibited concomitant medication such as a potent inhibitor of tamoxifen metabolism or exogenous sex steroid. Funding Source: NCI Contract # HHSN2612201200035I. Citatio","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81403444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.sabcs18-ot2-03-01
T. Kinosita, M. Takahashi, T. Fujisawa, N. Yamamoto, H. Doihara, S. Ohtani, M. Futamura, K. Aogi, T. Hojo, M. Yoshida, S. Shiino, H. Tsuda
{"title":"Abstract OT2-03-01: Multicenter study to standardize and evaluate the efficacy of radiofrequency ablation therapy for early breast cancer (RAFAELO study)","authors":"T. Kinosita, M. Takahashi, T. Fujisawa, N. Yamamoto, H. Doihara, S. Ohtani, M. Futamura, K. Aogi, T. Hojo, M. Yoshida, S. Shiino, H. Tsuda","doi":"10.1158/1538-7445.sabcs18-ot2-03-01","DOIUrl":"https://doi.org/10.1158/1538-7445.sabcs18-ot2-03-01","url":null,"abstract":"","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75498452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT1-03-02
V. Massard, L. Uwer, J. Salleron, M. Deblock, A. Kieffer, M. Ríos, P. Gilson, A. Lesur, A. Harlé, J. Merlin
Activating ESR1 mutations have recently been reported as a key mechanism leading to Aromatase Inhibitor (AI) resistance. ESR1 mutations occur rarely in primary breast cancers. However, in large retrospective studies, ESR1 mutations occurred in up to 39% of Estrogen-Receptor(ER)-positive metastatic breast cancer resistant to AI. Numerous hotspot mutations have been identified, most of them affecting the ligand-binding domain (LBD) and leading to ligand-independent activation of the ER and to resistance to AI. Phosphatidylinositol 3-kinase (PI3K)/AKT pathway is involved in key Cellular Mechanisms and mutations in PIK3CA and AKT1 are frequently reported in breast cancer. In this study, we propose to use a capture-based Next Generation Sequencing (NGS) assay and to use the barcoding and polishing features in our analysis pipeline. This assay will be able to detect all mutations on AKT1 , PIK3CA , ESR1 and other genes on circulating tumor DNA (ctDNA) extracted from blood samples of patients with breast cancer. We consider that this exon-screening strategy is relevant according to the recent knowledge. We plan to prospectively include women with advanced breast cancer about to begin standard-of-care first line endocrine therapy (ET). Patients will be required to have histologically confirmed ER-positive, HER2-negative breast cancer and documented loco-regionally advanced or metastatic disease, not amenable to surgery or radiation with curative intent. Patients with endocrine sensitive disease (no prior ET or relapse more than 12 months after completing adjuvant ET) as well as patients with endocrine resistant disease (relapse while on adjuvant ET or within 12 months of completing adjuvant ET) will be enrolled. ET can be prescribed alone or in combination with a targeted therapy. Nevertheless, we will recruit at least 25% of patients with exclusive ET in the endocrine sensitive group. Peripheral-blood samples, for analysis of ctDNA, will be obtained from participating patients at pre-specified time points: at start of ET to determine the baseline mutational status of ESR1 , PIK3CA , AKT1 and other genes included in a panel of genes of interest in solid tumors, and then, at evaluation of response to therapy until disease progression or end of study. Patients will be followed for 36 months or until disease progression. Determination of progression will be done per local investigator. The primary objective is to describe the prevalence of activating ESR1 mutations affecting the LBD, using NGS, from the start of ET to progression or end of study. Secondary objectives include to describe the prevalence of ESR1 mutations affecting other domains, the prevalence of ESR1 mutations in patients with and without endocrine resistance at enrolment and the prevalence of PIK3CA and AKT1 mutations, to demonstrate that ESR1 , PIK3CA and AKT1 mutations whatever their times of onset are predictors of progression free survival. As of June 2018, 8 sites were opened to recrui
最近有报道称,激活ESR1突变是导致芳香酶抑制剂(AI)耐药的关键机制。ESR1突变在原发性乳腺癌中很少发生。然而,在大型回顾性研究中,ESR1突变发生在高达39%的雌激素受体(ER)阳性转移性乳腺癌中。已经发现了许多热点突变,其中大多数影响配体结合域(LBD),导致内质网不依赖于配体的激活和对AI的抗性。磷脂酰肌醇3-激酶(PI3K)/AKT通路参与关键的细胞机制,PIK3CA和AKT1突变在乳腺癌中经常被报道。在这项研究中,我们建议使用基于捕获的下一代测序(NGS)分析,并在我们的分析管道中使用条形码和抛光功能。该检测将能够检测从乳腺癌患者血液样本中提取的循环肿瘤DNA (ctDNA)上的AKT1、PIK3CA、ESR1和其他基因的所有突变。根据最近的知识,我们认为这种外显子筛选策略是相关的。我们计划前瞻性地纳入即将开始标准护理一线内分泌治疗(ET)的晚期乳腺癌妇女。患者需要组织学证实为er阳性,her2阴性的乳腺癌,并有局部区域晚期或转移性疾病,不适合手术或放疗治疗。内分泌敏感性疾病患者(既往无ET或完成辅助ET后12个月以上复发)以及内分泌抵抗性疾病患者(在辅助ET治疗期间或完成辅助ET治疗后12个月内复发)将被纳入研究对象。ET可以单独使用,也可以与靶向治疗联合使用。然而,我们将在内分泌敏感组中招募至少25%的排他性ET患者。用于ctDNA分析的外周血样本将在预先指定的时间点从参与研究的患者中获得:在ET开始时确定ESR1、PIK3CA、AKT1和实体瘤感兴趣基因组中其他基因的基线突变状态,然后在评估治疗反应时,直到疾病进展或研究结束。患者将被随访36个月或直到疾病进展。进展的确定将由当地调查员完成。主要目的是描述从ET开始到研究进展或研究结束,使用NGS来激活影响LBD的ESR1突变的患病率。次要目标包括描述影响其他结构域的ESR1突变的患病率,入组时有无内分泌抵抗的患者中ESR1突变的患病率以及PIK3CA和AKT1突变的患病率,以证明ESR1, PIK3CA和AKT1突变无论其发病时间如何都是无进展生存的预测因子。截至2018年6月,共有8个站点开放招聘,其中包括18名员工;目标入学人数为146人。该试验得到了阿斯利康公司的支持。引用格式:Massard V, Uwer L, Salleron J, Deblock M, Kieffer A, Rios M, Gilson P, Lesur A, Harle A, Merlin JL。CICLADES:在接受内分泌治疗的晚期乳腺癌患者的现实随访中监测ESR1、PIK3CA和AKT1 ctDNA突变[摘要]。2018年圣安东尼奥乳腺癌研讨会论文集;2018年12月4-8日;费城(PA): AACR;中国癌症杂志,2019;79(4增刊):01-03-02。
{"title":"Abstract OT1-03-02: CICLADES: Monitoring ofESR1,PIK3CAandAKT1ctDNA mutations during real-life follow-up of patients with advanced breast cancer treated with endocrine therapy","authors":"V. Massard, L. Uwer, J. Salleron, M. Deblock, A. Kieffer, M. Ríos, P. Gilson, A. Lesur, A. Harlé, J. Merlin","doi":"10.1158/1538-7445.SABCS18-OT1-03-02","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT1-03-02","url":null,"abstract":"Activating ESR1 mutations have recently been reported as a key mechanism leading to Aromatase Inhibitor (AI) resistance. ESR1 mutations occur rarely in primary breast cancers. However, in large retrospective studies, ESR1 mutations occurred in up to 39% of Estrogen-Receptor(ER)-positive metastatic breast cancer resistant to AI. Numerous hotspot mutations have been identified, most of them affecting the ligand-binding domain (LBD) and leading to ligand-independent activation of the ER and to resistance to AI. Phosphatidylinositol 3-kinase (PI3K)/AKT pathway is involved in key Cellular Mechanisms and mutations in PIK3CA and AKT1 are frequently reported in breast cancer. In this study, we propose to use a capture-based Next Generation Sequencing (NGS) assay and to use the barcoding and polishing features in our analysis pipeline. This assay will be able to detect all mutations on AKT1 , PIK3CA , ESR1 and other genes on circulating tumor DNA (ctDNA) extracted from blood samples of patients with breast cancer. We consider that this exon-screening strategy is relevant according to the recent knowledge. We plan to prospectively include women with advanced breast cancer about to begin standard-of-care first line endocrine therapy (ET). Patients will be required to have histologically confirmed ER-positive, HER2-negative breast cancer and documented loco-regionally advanced or metastatic disease, not amenable to surgery or radiation with curative intent. Patients with endocrine sensitive disease (no prior ET or relapse more than 12 months after completing adjuvant ET) as well as patients with endocrine resistant disease (relapse while on adjuvant ET or within 12 months of completing adjuvant ET) will be enrolled. ET can be prescribed alone or in combination with a targeted therapy. Nevertheless, we will recruit at least 25% of patients with exclusive ET in the endocrine sensitive group. Peripheral-blood samples, for analysis of ctDNA, will be obtained from participating patients at pre-specified time points: at start of ET to determine the baseline mutational status of ESR1 , PIK3CA , AKT1 and other genes included in a panel of genes of interest in solid tumors, and then, at evaluation of response to therapy until disease progression or end of study. Patients will be followed for 36 months or until disease progression. Determination of progression will be done per local investigator. The primary objective is to describe the prevalence of activating ESR1 mutations affecting the LBD, using NGS, from the start of ET to progression or end of study. Secondary objectives include to describe the prevalence of ESR1 mutations affecting other domains, the prevalence of ESR1 mutations in patients with and without endocrine resistance at enrolment and the prevalence of PIK3CA and AKT1 mutations, to demonstrate that ESR1 , PIK3CA and AKT1 mutations whatever their times of onset are predictors of progression free survival. As of June 2018, 8 sites were opened to recrui","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85210185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-15DOI: 10.1158/1538-7445.SABCS18-OT2-07-04
G. Bhat, D. Potter, J. Bharadwaj, N. Khan, L. Shabazz, J. Tache, Zandong Yang
Background:Poziotinib represents a new class of irreversible quinazoline inhibitors of ErbB receptor tyrosine kinases that inhibit the proliferation of tumor cells in culture and in vivo by inhibiting HER-1 (EGFR), HER-2, HER-4. ErbB signaling plays important roles in the progression of HER2+ breast cancer. Poziotinib has promising clinical activity in breast cancer, and other solid tumors including lung, gastric, and colorectal cancers. Study SPI-POZ-101, is being conducted to evaluate the safety and efficacy of the combination of daily poziotinib and T-DM1, HER2 antibody-drug-conjugate every three weeks in patients with HER2+ advanced or metastatic breast cancer. Trial Objectives and Design: The primary objectives of the study are to determine the maximum tolerated dose (MTD) or maximum administered dose (MAD) of daily poziotinib plus T-DM1 (every 3 weeks) in women with advanced or metastatic HER2 positive breast cancer; and to evaluate the Objective Response Rate (ORR) in these patients. The secondary objectives include disease control rate (DCR), progression-free-survival (PFS), safety and pharmacokinetics at the MTD/MAD dose level of poziotinib plus T-DM1. In Part 1, the dose of poziotinib plus standard dose of T-DM1 (3.6 mg/kg IV) on Day 1 of each cycle will be determined using a “3+3” design with up to 3 escalating dose levels, 8, 10 and 12 mg with no DLT or to de-escalate to 6 mg with DLT observed in Cycle 1. Patients in current dose cohort, if not discontinued, will continue treatment until discontinuation of therapy. In Part 2 of the study, approximately 10 patients will be treated at the MTD/MAD to confirm dose for safety of the combination and to evaluate preliminary efficacy. Eligibility Criteria: The study will enroll female patients between 18 and 90 years with confirmed HER2 overexpression or gene-amplified tumor via immunohistochemistry [IHC] with IHC 3+ or IHC 2+ with confirmatory fluorescence in situ hybridization [FISH]+ or [ISH]+ and must have had at least 2 lines of anti-HER2 directed therapies either in the metastatic or early-stage disease setting. Patients must have adequate hematologic, hepatic, cardiac and renal functions and have at least one measurable lesion per RECIST 1.1 criteria. Exclusion criteria includes unstable CNS metastases or seizure disorder; anticancer chemotherapy, TKIs, biologics, immunotherapy, radiotherapy, or investigational treatment within 15 days; ≥ Grade 2 adverse events; known hypersensitivity to receptor tyrosine kinase inhibitors or any of the components of poziotinib tablets or T-DM1 IV solution. Statistical Methods: Part 1 of the study will enroll 3 to 6 patients at each dose using 3+3 design. Part 2 will enroll 10 patients at the MTD/MAD. The efficacy analysis will be conducted using the Evaluable Population based on RECIST 1.1. The Clopper-Pearson 95% confidence interval will be estimated using exact method based on binomial distribution. Target Accrual:Part 1: 6-18 patients Part 2: 10 pa
背景:Poziotinib是一类新的ErbB受体酪氨酸激酶不可逆喹唑啉类抑制剂,通过抑制HER-1 (EGFR)、HER-2、HER-4,在培养和体内抑制肿瘤细胞的增殖。ErbB信号在HER2+乳腺癌的进展中起重要作用。Poziotinib在乳腺癌和其他实体肿瘤(包括肺癌、胃癌和结直肠癌)中具有良好的临床活性。SPI-POZ-101研究正在进行中,目的是评估每日poziotinib和T-DM1 (HER2抗体-药物偶联物)联合治疗HER2阳性晚期或转移性乳腺癌患者的安全性和有效性。试验目标和设计:该研究的主要目标是确定晚期或转移性HER2阳性乳腺癌妇女每日poziotinib加T-DM1(每3周)的最大耐受剂量(MTD)或最大给药剂量(MAD);评估患者的客观缓解率(ORR)。次要目标包括poziotinib + T-DM1在MTD/MAD剂量水平下的疾病控制率(DCR)、无进展生存期(PFS)、安全性和药代动力学。在第1部分中,每个周期第1天,poziotinib加标准剂量T-DM1 (3.6 mg/kg IV)的剂量将使用“3+3”设计确定,最多有3个递增剂量水平,8,10和12mg无DLT或在第1周期中观察到的DLT降至6mg。当前剂量组的患者,如果未停药,将继续治疗直至停药。在研究的第2部分中,大约10名患者将接受MTD/MAD治疗,以确认联合用药的剂量和安全性,并评估初步疗效。资格标准:该研究将招募年龄在18至90岁之间的女性患者,通过免疫组化(IHC)证实HER2过表达或基因扩增肿瘤,IHC 3+或IHC 2+,验证性荧光原位杂交(FISH) +或[ISH]+,并且必须在转移性或早期疾病环境中接受至少2种抗HER2定向治疗。患者必须具有足够的血液学、肝脏、心脏和肾脏功能,并且根据RECIST 1.1标准至少有一个可测量的病变。排除标准包括不稳定的中枢神经系统转移或癫痫发作障碍;15天内接受抗癌化疗、TKIs、生物制剂、免疫治疗、放疗或研究性治疗;≥2级不良事件;已知对受体酪氨酸激酶抑制剂或任何波齐替尼片或T-DM1 IV溶液的成分过敏。统计学方法:第1部分采用3+3设计,每个剂量入组3 - 6例患者。第2部分将在MTD/MAD招募10名患者。使用基于RECIST 1.1的可评估人群进行疗效分析。采用基于二项分布的精确方法估计Clopper-Pearson 95%置信区间。目标应计:第一部分:6-18名患者第二部分:10名患者ClinicalTrials.gov标识码:NCT03429101联系信息:Spectrum Pharmaceuticals。SPI-POZ-101@sppirx.com Poziotinib目前处于临床研究阶段,尚未被批准用于乳腺癌。引用本文:Bhat G, Potter D, Bharadwaj J, Khan N, Shabazz L, Tache J, Yang Z. poziotinib联合T-DM1治疗晚期或转移性her2阳性乳腺癌的1b期研究[摘要]。2018年圣安东尼奥乳腺癌研讨会论文集;2018年12月4-8日;费城(PA): AACR;中国癌症杂志,2019;79(4增刊):OT2-07-04。
{"title":"Abstract OT2-07-04: A phase 1b study of poziotinib in combination with T-DM1 in women with advanced or metastatic HER2-positive breast cancer","authors":"G. Bhat, D. Potter, J. Bharadwaj, N. Khan, L. Shabazz, J. Tache, Zandong Yang","doi":"10.1158/1538-7445.SABCS18-OT2-07-04","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-OT2-07-04","url":null,"abstract":"Background:Poziotinib represents a new class of irreversible quinazoline inhibitors of ErbB receptor tyrosine kinases that inhibit the proliferation of tumor cells in culture and in vivo by inhibiting HER-1 (EGFR), HER-2, HER-4. ErbB signaling plays important roles in the progression of HER2+ breast cancer. Poziotinib has promising clinical activity in breast cancer, and other solid tumors including lung, gastric, and colorectal cancers. Study SPI-POZ-101, is being conducted to evaluate the safety and efficacy of the combination of daily poziotinib and T-DM1, HER2 antibody-drug-conjugate every three weeks in patients with HER2+ advanced or metastatic breast cancer. Trial Objectives and Design: The primary objectives of the study are to determine the maximum tolerated dose (MTD) or maximum administered dose (MAD) of daily poziotinib plus T-DM1 (every 3 weeks) in women with advanced or metastatic HER2 positive breast cancer; and to evaluate the Objective Response Rate (ORR) in these patients. The secondary objectives include disease control rate (DCR), progression-free-survival (PFS), safety and pharmacokinetics at the MTD/MAD dose level of poziotinib plus T-DM1. In Part 1, the dose of poziotinib plus standard dose of T-DM1 (3.6 mg/kg IV) on Day 1 of each cycle will be determined using a “3+3” design with up to 3 escalating dose levels, 8, 10 and 12 mg with no DLT or to de-escalate to 6 mg with DLT observed in Cycle 1. Patients in current dose cohort, if not discontinued, will continue treatment until discontinuation of therapy. In Part 2 of the study, approximately 10 patients will be treated at the MTD/MAD to confirm dose for safety of the combination and to evaluate preliminary efficacy. Eligibility Criteria: The study will enroll female patients between 18 and 90 years with confirmed HER2 overexpression or gene-amplified tumor via immunohistochemistry [IHC] with IHC 3+ or IHC 2+ with confirmatory fluorescence in situ hybridization [FISH]+ or [ISH]+ and must have had at least 2 lines of anti-HER2 directed therapies either in the metastatic or early-stage disease setting. Patients must have adequate hematologic, hepatic, cardiac and renal functions and have at least one measurable lesion per RECIST 1.1 criteria. Exclusion criteria includes unstable CNS metastases or seizure disorder; anticancer chemotherapy, TKIs, biologics, immunotherapy, radiotherapy, or investigational treatment within 15 days; ≥ Grade 2 adverse events; known hypersensitivity to receptor tyrosine kinase inhibitors or any of the components of poziotinib tablets or T-DM1 IV solution. Statistical Methods: Part 1 of the study will enroll 3 to 6 patients at each dose using 3+3 design. Part 2 will enroll 10 patients at the MTD/MAD. The efficacy analysis will be conducted using the Evaluable Population based on RECIST 1.1. The Clopper-Pearson 95% confidence interval will be estimated using exact method based on binomial distribution. Target Accrual:Part 1: 6-18 patients Part 2: 10 pa","PeriodicalId":19476,"journal":{"name":"Ongoing Clinical Trials","volume":"401 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85229419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}