Breast Cancer
Conditions
Brief summary
The purpose of this study is to determine whether the combination of enzastaurin and capecitabine is more effective than the combination of placebo and capecitabine in treating participants with breast cancer who were previously treated with an anthracycline and a taxane.
Interventions
1125 milligrams (mg) loading dose then 500 mg, oral, daily, 21-day cycles until progressive disease
oral, daily, 21-day cycles until progressive disease
1250 mg/m\^2, BID, days 1-14 of each 21-day cycle until progressive disease
Sponsors
Study design
Eligibility
Inclusion criteria
* Have been diagnosed with metastatic or recurrent breast cancer. * Have been previously treated with both an anthracycline and a taxane. * Have not received more than two prior chemotherapy treatment programs. * Have stopped any antitumoral hormonal treatment before you enroll in this study. * Have a negative pregnancy blood test if menstruating or capable of becoming pregnant. You must use an approved birth control method during the study and for 3 months after stopping study treatment.
Exclusion criteria
* Cannot follow the study procedures (for example, you cannot swallow tablets). * Are receiving another treatment for your cancer. * Have received another experimental drug in the last 4 weeks. * Have had serious heart disease within last 6 months. * Are pregnant or breast-feeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | Randomization to measured progressive disease or death up to 14 months | PFS was defined as the time from randomization to the first observation of disease progression or death due to any cause. For participants not known to have died as of the data cut-off date and who did not have progressive disease, PFS was censored at the date of last visit with adequate assessment. For participants who received subsequent anticancer therapy (after discontinuation from the study treatment) prior to disease progression or death, PFS was censored at the date of last visit with adequate assessment prior to the initiation of post-discontinuation anticancer therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady State | From pre-dose to 24 hours post-dose on Day 1 of Cycle 2 | Area Under the Concentration versus time curve during 1 dosing interval at steady state (AUCτ,ss) for Cycle 2 Day 1 for Enzastaurin, its metabolite LY326020 and total analytes (enzastaurin + LY326020). AUCτ,ss was calculated using concentration versus time data by post hoc estimation of enzastaurin, its metabolite LY326020, and total analytes (enzastaurin + LY326020). |
| Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | Pre-dose to 6 hours post-dose on Day 1 of Cycle 2 | AUC0-tlast for Capecitabine, 5'-deoxy-5-fluorouridine (5'-DFUR) and 5-fluorouracil (5-FU) was calculated from the plasma concentration-time data for each analyte for Cycle 2, Day 1. |
| Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | From pre-dose to 6 hours post-dose on Day 1 of Cycle 2 | Cmax for Capecitabine, 5'-deoxy-5-fluorouridine (5'-DFUR) and its metabolites 5-fluorouracil (5-FU) was calculated from the plasma concentration-time data for each analyte for Day 1 of Cycle 2. |
| Expression of Tumor Markers in Tissue Samples (Tumor Markers and Genes Evaluation) | Randomization, Cycle 2, end of study | Protein expression was planned to be measured using an Immunohistochemistry (IHC) assay to determine membrane and cytoplasmic phosphorylated glycogen synthase kinase 3 beta (pGSK3B), nuclear phosphorylated adenosine 3'5'-cyclic monophosphate (cAMP) response-element binding protein (pCREB), cytoplasmic pCREB, protein kinase C beta 2 (PKCB2), cytoplasmic phospho S6 (pS6), and cytoplasmic phosphatase and tensin homolog (PTEN) IHC H-scores. Tumor tissue samples were to be scored using a 0 (negative, no staining) to 3+ (brightest staining) scoring system for cytoplasmic and nuclear staining, and H- scores calculated using formula: 1x(percentage of cells stained 1+) + 2x(percentage of cells stained 2+) + 3x(percentage of cells stained 3+) . |
| Duration of Response (DOR) | Randomization to last visit (up to 9.66 months) | The DOR was defined as the time from first objective status assessment of complete response (CR) or partial response (PR) to the first time of progression or death as a result of any cause. According to the Response Evaluation Criteria in Solid Tumors (RECIST V1.0) criteria, CR was the disappearance of all tumor lesions. PR was at least a 30% decrease in the sum of the longest diameter (LD) of target lesions or complete disappearance of target lesions, with persistence (but not worsening) of 1 or more non-target lesions, with occurrence of no new lesions. For participants not known to have died as of the data cut-off date and who did not have progressive disease, DOR was censored at the date of last visit with adequate assessment. For participants who received subsequent anticancer therapy (after discontinuation from the study treatment) prior to disease progression or death, DOR was censored at the date of last visit with adequate assessment. |
| Overall Survival (OS) | Randomization to date of death from any cause up to 20.83 months | OS was defined as the time in months from the date of study enrollment to the date of death from any cause. For participants not known to have died as of the cut-off date, OS was censored at the last contact date. |
| Pharmacology Toxicity and Adverse Events (AEs) | Baseline to study completion [Cycle 19 (21 days/cycle) and 30-day safety follow-up] | Data presented are the number of participants who experienced serious AEs, AEs, death due to progressive disease (PD), death due to AEs while on treatment and death during the 30-day post-treatment. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module. |
| Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate) | Randomization to last visit (up to 9.66 months) | Response rate was defined as percent of participants with objective response \[CR or PR\] over randomized and treated participants using the Response Evaluation Criteria in Solid Tumors (RECIST v1.0) Guidelines. CR was defined as the disappearance of all tumor lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum of LDs or complete disappearance of target lesions, with persistence (but not worsening) of one or more non-target lesions. No new lesions may have appeared. |
Countries
Argentina, Australia, France, Mexico, South Africa
Participant flow
Pre-assignment details
Participant flow reports those participants who discontinued from study drug.
Participants by arm
| Arm | Count |
|---|---|
| Capecitabine + Enzastaurin Capecitabine: 1250 milligrams per square meter (mg/m\^2), twice daily (BID) on Days 1-14 followed by a 1-week rest period (Days 15-21) for each 21-day cycle until progressive disease.
Enzastaurin: 1125-milligram (mg) loading dose on Day 1 of Cycle 1, then 500 mg daily on subsequent days to complete 21-day cycles until progressive disease. | 42 |
| Capecitabine + Placebo Capecitabine: 1250 mg/m\^2, BID on Days 1-14 followed by a 1-week rest period (Days 15-21) for each 21-day cycles until progressive disease.
Placebo: taken as 4 tablets orally, tablets daily, to complete 21-day cycles until progressive disease. | 43 |
| Total | 85 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 5 | 4 |
| Overall Study | Death | 5 | 2 |
| Overall Study | Entry criteria not met | 1 | 1 |
| Overall Study | Physician Decision | 0 | 3 |
| Overall Study | Progressive Disease | 19 | 23 |
| Overall Study | Protocol Violation | 0 | 1 |
| Overall Study | Sponsor Decision | 8 | 9 |
| Overall Study | Withdrawal by Subject | 5 | 0 |
Baseline characteristics
| Characteristic | Capecitabine + Placebo | Total | Capecitabine + Enzastaurin |
|---|---|---|---|
| Age, Continuous | 52.14 years STANDARD_DEVIATION 9.78 | 53.91 years STANDARD_DEVIATION 10.02 | 55.73 years STANDARD_DEVIATION 10.06 |
| Body Mass Index (BMI) | 27.04 kilograms per square meter (kg/m^2) STANDARD_DEVIATION 4.95 | 27.14 kilograms per square meter (kg/m^2) STANDARD_DEVIATION 5.73 | 27.25 kilograms per square meter (kg/m^2) STANDARD_DEVIATION 6.48 |
| Body Surface Area (BSA) | 1.76 square meter (m^2) STANDARD_DEVIATION 0.2 | 1.75 square meter (m^2) STANDARD_DEVIATION 0.2 | 1.73 square meter (m^2) STANDARD_DEVIATION 0.2 |
| Disease Stage Stage I | 3 Participants | 5 Participants | 2 Participants |
| Disease Stage Stage II | 10 Participants | 15 Participants | 5 Participants |
| Disease Stage Stage IIA | 5 Participants | 10 Participants | 5 Participants |
| Disease Stage Stage IIB | 7 Participants | 13 Participants | 6 Participants |
| Disease Stage Stage III | 5 Participants | 7 Participants | 2 Participants |
| Disease Stage Stage IIIA | 1 Participants | 11 Participants | 10 Participants |
| Disease Stage Stage IIIB | 3 Participants | 10 Participants | 7 Participants |
| Disease Stage Stage IIIC | 7 Participants | 9 Participants | 2 Participants |
| Disease Stage Stage IV | 2 Participants | 4 Participants | 2 Participants |
| Disease Stage Stage IVB | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 5 Participants | 11 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 38 Participants | 74 Participants | 36 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 7 Participants | 9 Participants | 2 Participants |
| Race/Ethnicity, Customized Black or African American | 0 Participants | 3 Participants | 3 Participants |
| Race/Ethnicity, Customized Hispanic | 5 Participants | 11 Participants | 6 Participants |
| Race/Ethnicity, Customized White | 31 Participants | 62 Participants | 31 Participants |
| Region of Enrollment Argentina | 7 Participants | 16 Participants | 9 Participants |
| Region of Enrollment Australia | 11 Participants | 22 Participants | 11 Participants |
| Region of Enrollment Canada | 18 Participants | 34 Participants | 16 Participants |
| Region of Enrollment Mexico | 4 Participants | 7 Participants | 3 Participants |
| Region of Enrollment South Africa | 3 Participants | 6 Participants | 3 Participants |
| Sex: Female, Male Female | 43 Participants | 85 Participants | 42 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 38 / 42 | 40 / 43 |
| serious Total, serious adverse events | 12 / 42 | 12 / 43 |
Outcome results
Progression Free Survival (PFS)
PFS was defined as the time from randomization to the first observation of disease progression or death due to any cause. For participants not known to have died as of the data cut-off date and who did not have progressive disease, PFS was censored at the date of last visit with adequate assessment. For participants who received subsequent anticancer therapy (after discontinuation from the study treatment) prior to disease progression or death, PFS was censored at the date of last visit with adequate assessment prior to the initiation of post-discontinuation anticancer therapy.
Time frame: Randomization to measured progressive disease or death up to 14 months
Population: Intent-to-treat (ITT) population: All randomized participants who received at least 1 dose of study drug.~Participants censored: Capecitabine + Enzastaurin = 13; Capecitabine + Placebo = 14.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Capecitabine + Enzastaurin | Progression Free Survival (PFS) | 2.79 months |
| Capecitabine + Placebo | Progression Free Survival (PFS) | 4.27 months |
Duration of Response (DOR)
The DOR was defined as the time from first objective status assessment of complete response (CR) or partial response (PR) to the first time of progression or death as a result of any cause. According to the Response Evaluation Criteria in Solid Tumors (RECIST V1.0) criteria, CR was the disappearance of all tumor lesions. PR was at least a 30% decrease in the sum of the longest diameter (LD) of target lesions or complete disappearance of target lesions, with persistence (but not worsening) of 1 or more non-target lesions, with occurrence of no new lesions. For participants not known to have died as of the data cut-off date and who did not have progressive disease, DOR was censored at the date of last visit with adequate assessment. For participants who received subsequent anticancer therapy (after discontinuation from the study treatment) prior to disease progression or death, DOR was censored at the date of last visit with adequate assessment.
Time frame: Randomization to last visit (up to 9.66 months)
Population: Intent to treat (ITT) population: All randomized participants who received at least 1 dose of study drug with a CR or PR. Participants censored: Capecitabine + Enzastaurin = 3; Capecitabine + Placebo = 2.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Capecitabine + Enzastaurin | Duration of Response (DOR) | 4.27 months |
| Capecitabine + Placebo | Duration of Response (DOR) | 3.47 months |
Expression of Tumor Markers in Tissue Samples (Tumor Markers and Genes Evaluation)
Protein expression was planned to be measured using an Immunohistochemistry (IHC) assay to determine membrane and cytoplasmic phosphorylated glycogen synthase kinase 3 beta (pGSK3B), nuclear phosphorylated adenosine 3'5'-cyclic monophosphate (cAMP) response-element binding protein (pCREB), cytoplasmic pCREB, protein kinase C beta 2 (PKCB2), cytoplasmic phospho S6 (pS6), and cytoplasmic phosphatase and tensin homolog (PTEN) IHC H-scores. Tumor tissue samples were to be scored using a 0 (negative, no staining) to 3+ (brightest staining) scoring system for cytoplasmic and nuclear staining, and H- scores calculated using formula: 1x(percentage of cells stained 1+) + 2x(percentage of cells stained 2+) + 3x(percentage of cells stained 3+) .
Time frame: Randomization, Cycle 2, end of study
Population: Zero participants were analyzed. The study was terminated and no data was collected.
Overall Survival (OS)
OS was defined as the time in months from the date of study enrollment to the date of death from any cause. For participants not known to have died as of the cut-off date, OS was censored at the last contact date.
Time frame: Randomization to date of death from any cause up to 20.83 months
Population: Intent-to-treat (ITT) population: All randomized participants who received at least 1 dose of study drug. Participants censored: Capecitabine + Enzastaurin = 23; Capecitabine + Placebo = 28.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Capecitabine + Enzastaurin | Overall Survival (OS) | 9.86 months |
| Capecitabine + Placebo | Overall Survival (OS) | 14.88 months |
Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate)
Response rate was defined as percent of participants with objective response \[CR or PR\] over randomized and treated participants using the Response Evaluation Criteria in Solid Tumors (RECIST v1.0) Guidelines. CR was defined as the disappearance of all tumor lesions. PR was defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum of LDs or complete disappearance of target lesions, with persistence (but not worsening) of one or more non-target lesions. No new lesions may have appeared.
Time frame: Randomization to last visit (up to 9.66 months)
Population: Intent-to-treat (ITT) population: All randomized participants who received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Capecitabine + Enzastaurin | Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate) | 11.9 percentage of participants |
| Capecitabine + Placebo | Percentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate) | 11.6 percentage of participants |
Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine
AUC0-tlast for Capecitabine, 5'-deoxy-5-fluorouridine (5'-DFUR) and 5-fluorouracil (5-FU) was calculated from the plasma concentration-time data for each analyte for Cycle 2, Day 1.
Time frame: Pre-dose to 6 hours post-dose on Day 1 of Cycle 2
Population: All randomized participants who received at least 1 dose of capecitabine and had data for AUC 0-tlast analysis.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Capecitabine + Enzastaurin | Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | Capecitabine | 6.09 micrograms*hour/milliliter (ug*hr/mL) | Geometric Coefficient of Variation 57 |
| Capecitabine + Enzastaurin | Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | 5'-deoxy-5-fluorouridine (5'-DFUR) | 11.6 micrograms*hour/milliliter (ug*hr/mL) | Geometric Coefficient of Variation 44 |
| Capecitabine + Enzastaurin | Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | 5-fluorouracil (5-FU) | 0.683 micrograms*hour/milliliter (ug*hr/mL) | Geometric Coefficient of Variation 60 |
| Capecitabine + Placebo | Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | Capecitabine | 4.18 micrograms*hour/milliliter (ug*hr/mL) | Geometric Coefficient of Variation 70 |
| Capecitabine + Placebo | Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | 5'-deoxy-5-fluorouridine (5'-DFUR) | 11.0 micrograms*hour/milliliter (ug*hr/mL) | Geometric Coefficient of Variation 31 |
| Capecitabine + Placebo | Pharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine | 5-fluorouracil (5-FU) | 0.358 micrograms*hour/milliliter (ug*hr/mL) | Geometric Coefficient of Variation 42 |
Pharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady State
Area Under the Concentration versus time curve during 1 dosing interval at steady state (AUCτ,ss) for Cycle 2 Day 1 for Enzastaurin, its metabolite LY326020 and total analytes (enzastaurin + LY326020). AUCτ,ss was calculated using concentration versus time data by post hoc estimation of enzastaurin, its metabolite LY326020, and total analytes (enzastaurin + LY326020).
Time frame: From pre-dose to 24 hours post-dose on Day 1 of Cycle 2
Population: All randomized participants who received at least 1 dose of enzastaurin and had data for AUCτ,ss analysis.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Capecitabine + Enzastaurin | Pharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady State | Enzastaurin | 90000 nanomoles*hour per liter (nmol*hr/L) | Geometric Coefficient of Variation 99 |
| Capecitabine + Enzastaurin | Pharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady State | Enzastaurin Metabolite LY326020 | 40700 nanomoles*hour per liter (nmol*hr/L) | Geometric Coefficient of Variation 31 |
| Capecitabine + Enzastaurin | Pharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady State | Total Analytes (enzastaurin + LY326020) | 137000 nanomoles*hour per liter (nmol*hr/L) | Geometric Coefficient of Variation 66 |
Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine
Cmax for Capecitabine, 5'-deoxy-5-fluorouridine (5'-DFUR) and its metabolites 5-fluorouracil (5-FU) was calculated from the plasma concentration-time data for each analyte for Day 1 of Cycle 2.
Time frame: From pre-dose to 6 hours post-dose on Day 1 of Cycle 2
Population: All randomized participants who received at least 1 dose of capecitabine and had data for Cmax analysis.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Capecitabine + Enzastaurin | Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | Capecitabine | 4.42 micrograms/milliliter(ug/mL) | Geometric Coefficient of Variation 88 |
| Capecitabine + Enzastaurin | Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | 5-DFUR | 6.09 micrograms/milliliter(ug/mL) | Geometric Coefficient of Variation 80 |
| Capecitabine + Enzastaurin | Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | 5-FU | 0.374 micrograms/milliliter(ug/mL) | Geometric Coefficient of Variation 113 |
| Capecitabine + Placebo | Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | Capecitabine | 2.75 micrograms/milliliter(ug/mL) | Geometric Coefficient of Variation 114 |
| Capecitabine + Placebo | Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | 5-DFUR | 6.05 micrograms/milliliter(ug/mL) | Geometric Coefficient of Variation 69 |
| Capecitabine + Placebo | Pharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine | 5-FU | 0.206 micrograms/milliliter(ug/mL) | Geometric Coefficient of Variation 73 |
Pharmacology Toxicity and Adverse Events (AEs)
Data presented are the number of participants who experienced serious AEs, AEs, death due to progressive disease (PD), death due to AEs while on treatment and death during the 30-day post-treatment. A summary of SAEs and other non-serious AEs, regardless of causality, is located in the Reported Adverse Events module.
Time frame: Baseline to study completion [Cycle 19 (21 days/cycle) and 30-day safety follow-up]
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Capecitabine + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Other non-serious AEs | 38 Participants |
| Capecitabine + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to AEs | 4 Participants |
| Capecitabine + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to PD | 13 Participants |
| Capecitabine + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Deaths in 30-day follow-up | 6 Participants |
| Capecitabine + Enzastaurin | Pharmacology Toxicity and Adverse Events (AEs) | Serious AEs | 12 Participants |
| Capecitabine + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Deaths in 30-day follow-up | 1 Participants |
| Capecitabine + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Serious AEs | 12 Participants |
| Capecitabine + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Other non-serious AEs | 40 Participants |
| Capecitabine + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to PD | 12 Participants |
| Capecitabine + Placebo | Pharmacology Toxicity and Adverse Events (AEs) | Deaths Due to AEs | 2 Participants |