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Enzastaurin in Combination of Capecitabine to Treat Breast Cancer

A Double-Blind, Randomized, Phase 2 Trial of Capecitabine Plus Enzastaurin Versus Capecitabine Plus Placebo in Patients With Metastatic or Recurrent Breast Cancer Previously Treated With an Anthracycline and a Taxane

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00437294
Enrollment
86
Registered
2007-02-19
Start date
2007-03-31
Completion date
2009-03-31
Last updated
2020-08-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Breast Cancer

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

DRUGenzastaurin

1125 milligrams (mg) loading dose then 500 mg, oral, daily, 21-day cycles until progressive disease

DRUGplacebo

oral, daily, 21-day cycles until progressive disease

DRUGcapecitabine

1250 mg/m\^2, BID, days 1-14 of each 21-day cycle until progressive disease

Sponsors

Eli Lilly and Company
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Progression Free Survival (PFS)Randomization to measured progressive disease or death up to 14 monthsPFS 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

MeasureTime frameDescription
Pharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady StateFrom pre-dose to 24 hours post-dose on Day 1 of Cycle 2Area 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 CapecitabinePre-dose to 6 hours post-dose on Day 1 of Cycle 2AUC0-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 CapecitabineFrom pre-dose to 6 hours post-dose on Day 1 of Cycle 2Cmax 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 studyProtein 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 monthsOS 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

ArmCount
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
Total85

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event54
Overall StudyDeath52
Overall StudyEntry criteria not met11
Overall StudyPhysician Decision03
Overall StudyProgressive Disease1923
Overall StudyProtocol Violation01
Overall StudySponsor Decision89
Overall StudyWithdrawal by Subject50

Baseline characteristics

CharacteristicCapecitabine + PlaceboTotalCapecitabine + Enzastaurin
Age, Continuous52.14 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 Participants5 Participants2 Participants
Disease Stage
Stage II
10 Participants15 Participants5 Participants
Disease Stage
Stage IIA
5 Participants10 Participants5 Participants
Disease Stage
Stage IIB
7 Participants13 Participants6 Participants
Disease Stage
Stage III
5 Participants7 Participants2 Participants
Disease Stage
Stage IIIA
1 Participants11 Participants10 Participants
Disease Stage
Stage IIIB
3 Participants10 Participants7 Participants
Disease Stage
Stage IIIC
7 Participants9 Participants2 Participants
Disease Stage
Stage IV
2 Participants4 Participants2 Participants
Disease Stage
Stage IVB
0 Participants1 Participants1 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
5 Participants11 Participants6 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
38 Participants74 Participants36 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race/Ethnicity, Customized
Asian
7 Participants9 Participants2 Participants
Race/Ethnicity, Customized
Black or African American
0 Participants3 Participants3 Participants
Race/Ethnicity, Customized
Hispanic
5 Participants11 Participants6 Participants
Race/Ethnicity, Customized
White
31 Participants62 Participants31 Participants
Region of Enrollment
Argentina
7 Participants16 Participants9 Participants
Region of Enrollment
Australia
11 Participants22 Participants11 Participants
Region of Enrollment
Canada
18 Participants34 Participants16 Participants
Region of Enrollment
Mexico
4 Participants7 Participants3 Participants
Region of Enrollment
South Africa
3 Participants6 Participants3 Participants
Sex: Female, Male
Female
43 Participants85 Participants42 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
38 / 4240 / 43
serious
Total, serious adverse events
12 / 4212 / 43

Outcome results

Primary

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.

ArmMeasureValue (MEDIAN)
Capecitabine + EnzastaurinProgression Free Survival (PFS)2.79 months
Capecitabine + PlaceboProgression Free Survival (PFS)4.27 months
p-value: 0.237Log Rank
Secondary

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.

ArmMeasureValue (MEDIAN)
Capecitabine + EnzastaurinDuration of Response (DOR)4.27 months
Capecitabine + PlaceboDuration of Response (DOR)3.47 months
p-value: 0.812Log Rank
Secondary

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.

Secondary

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.

ArmMeasureValue (MEDIAN)
Capecitabine + EnzastaurinOverall Survival (OS)9.86 months
Capecitabine + PlaceboOverall Survival (OS)14.88 months
p-value: 0.181Log Rank
Secondary

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.

ArmMeasureValue (NUMBER)
Capecitabine + EnzastaurinPercentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate)11.9 percentage of participants
Capecitabine + PlaceboPercentage of Participants With Complete Response (CR) or Partial Response (PR) (Objective Response Rate)11.6 percentage of participants
p-value: 1Fisher Exact
Secondary

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.

ArmMeasureGroupValue (GEOMETRIC_MEAN)Dispersion
Capecitabine + EnzastaurinPharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of CapecitabineCapecitabine6.09 micrograms*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 57
Capecitabine + EnzastaurinPharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine5'-deoxy-5-fluorouridine (5'-DFUR)11.6 micrograms*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 44
Capecitabine + EnzastaurinPharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine5-fluorouracil (5-FU)0.683 micrograms*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 60
Capecitabine + PlaceboPharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of CapecitabineCapecitabine4.18 micrograms*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 70
Capecitabine + PlaceboPharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine5'-deoxy-5-fluorouridine (5'-DFUR)11.0 micrograms*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 31
Capecitabine + PlaceboPharmacokinetics: Area Under the Concentration Curve Versus Time From Time 0 to Last Quantifiable Value (AUC0-tlast) of Capecitabine5-fluorouracil (5-FU)0.358 micrograms*hour/milliliter (ug*hr/mL)Geometric Coefficient of Variation 42
Secondary

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.

ArmMeasureGroupValue (GEOMETRIC_MEAN)Dispersion
Capecitabine + EnzastaurinPharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady StateEnzastaurin90000 nanomoles*hour per liter (nmol*hr/L)Geometric Coefficient of Variation 99
Capecitabine + EnzastaurinPharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady StateEnzastaurin Metabolite LY32602040700 nanomoles*hour per liter (nmol*hr/L)Geometric Coefficient of Variation 31
Capecitabine + EnzastaurinPharmacokinetics: Area Under the Concentration Versus Time Curve During One Dosing Interval at Steady StateTotal Analytes (enzastaurin + LY326020)137000 nanomoles*hour per liter (nmol*hr/L)Geometric Coefficient of Variation 66
Secondary

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.

ArmMeasureGroupValue (GEOMETRIC_MEAN)Dispersion
Capecitabine + EnzastaurinPharmacokinetics: Maximum Observed Concentration (Cmax) of CapecitabineCapecitabine4.42 micrograms/milliliter(ug/mL)Geometric Coefficient of Variation 88
Capecitabine + EnzastaurinPharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine5-DFUR6.09 micrograms/milliliter(ug/mL)Geometric Coefficient of Variation 80
Capecitabine + EnzastaurinPharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine5-FU0.374 micrograms/milliliter(ug/mL)Geometric Coefficient of Variation 113
Capecitabine + PlaceboPharmacokinetics: Maximum Observed Concentration (Cmax) of CapecitabineCapecitabine2.75 micrograms/milliliter(ug/mL)Geometric Coefficient of Variation 114
Capecitabine + PlaceboPharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine5-DFUR6.05 micrograms/milliliter(ug/mL)Geometric Coefficient of Variation 69
Capecitabine + PlaceboPharmacokinetics: Maximum Observed Concentration (Cmax) of Capecitabine5-FU0.206 micrograms/milliliter(ug/mL)Geometric Coefficient of Variation 73
Secondary

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]

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Capecitabine + EnzastaurinPharmacology Toxicity and Adverse Events (AEs)Other non-serious AEs38 Participants
Capecitabine + EnzastaurinPharmacology Toxicity and Adverse Events (AEs)Deaths Due to AEs4 Participants
Capecitabine + EnzastaurinPharmacology Toxicity and Adverse Events (AEs)Deaths Due to PD13 Participants
Capecitabine + EnzastaurinPharmacology Toxicity and Adverse Events (AEs)Deaths in 30-day follow-up6 Participants
Capecitabine + EnzastaurinPharmacology Toxicity and Adverse Events (AEs)Serious AEs12 Participants
Capecitabine + PlaceboPharmacology Toxicity and Adverse Events (AEs)Deaths in 30-day follow-up1 Participants
Capecitabine + PlaceboPharmacology Toxicity and Adverse Events (AEs)Serious AEs12 Participants
Capecitabine + PlaceboPharmacology Toxicity and Adverse Events (AEs)Other non-serious AEs40 Participants
Capecitabine + PlaceboPharmacology Toxicity and Adverse Events (AEs)Deaths Due to PD12 Participants
Capecitabine + PlaceboPharmacology Toxicity and Adverse Events (AEs)Deaths Due to AEs2 Participants

Source: ClinicalTrials.gov · Data processed: Mar 30, 2026