Breast Cancer, Breast Tumors, Metastatic Cancer
Conditions
Keywords
postmenopausal, hormone receptor positive, locally advanced, metastatic
Brief summary
This is a randomized, double-blind, placebo-controlled, phase 2 study. Subjects will include postmenopausal women with confirmed HR-positive, locally advanced or metastatic breast cancer, who have disease progression during or within 12 months after completing prior adjuvant endocrine therapy or during the first prior endocrine therapy for metastatic disease.
Interventions
AMG 479 administered with exemestane or fulvestrant
Placebo administered with either exemestane or fulvestrant
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically or cytologically confirmed carcinoma of the breast with locally advanced or metastatic disease * Confirmation of hormone receptor (HR) positive disease status * Amenable to receive endocrine therapy * Disease progression while receiving prior endocrine therapy for locally advanced or metastatic breast cancer * Postmenopausal woman ≥ 18 years old
Exclusion criteria
* HR-unknown or HR-negative disease * Not amenable to endocrine therapy * Central nervous system metastasis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months. | PFS was defined as the time from randomization to the first observation of disease progression (as classified by modified RECIST), symptomatic deterioration or death due to any cause, whichever occurs first. Disease progression per RECIST is defined as at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study and an absolute increase of at least 5 mm; the appearance of any new lesions is also considered progression. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cmax of AMG 479 | Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months. | Serum AMG 479 Concentrations After IV Administration of 12 mg/kg AMG 479 in combination with Exemestane, and in combination with Fulvestrant (Cmax). |
| Clinical Benefit and Objective Response Rate | Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months. | Clinical benefit was defined as complete/partial response, or stable disease≥24 weeks per modified RECIST/local review. Objective response rate was defined as complete/partial response per modified RECIST/local review. Per Response Evaluation Criteria in Solid Tumors \[RECIST\]: a complete response is the disappearance of all target lesions; a partial response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Stable disease is disease that is not complete, partial or progressive (PD = at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study) |
| Number of Participants With Adverse Events | 30 days after the last dose of study treatment, up to 109 weeks | Graded Using the National Cancer Institute(NCI) Common Terminology Criteria for Adverse Events(CTCAE) Version 3.0 |
| Time To Progression, Time-to-treatment Failure, Overall Survival | Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months. | Time to progression was defined as the time from date of randomization to the date of first occurrence of disease progression or death due to disease progression Time to treatment failure was defined as the time from date of randomization to the earliest date of disease progression, death, or end of cycle \[last dose date + 1 cycle time: 14 days\] for the last dose of ganitumab or placebo regardless of the reason of discontinuation Overall survival was defined as the time from randomization to death. Progressive disease is at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study. |
| Global Health Status Time-Adjusted AUC | From start of study, on Day 1 of cycles 2, 3, and 4 and Day 1 every 3rd cycle thereafter, up to cycle 25 (Cycle = 28 days), approximately 700 days. | Based on the European Organization Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ C-30) v3, a 30-item questionnaire comprised of 5 functional scales, 3 symptom scales, and 6 single item scales, all with scores ranging from 1=not at all to 4=very much, along with the Health-Related Quality of Life scale with scores ranging from 1=very poor to 7=excellent; and 2 questions from the Dermatology Life Quality Index (DLQI; scores ranged from 1=not at all to 4=very much). Summing of all these questions and standardizing yielded a total score ranging from 0-100; higher total scores = better quality of life. AUC of the change from baseline of the mean total score over time were calculated using the linear trapezoidal rule. The time-adjusted AUC was calculated by dividing the AUC by the time interval between baseline and the last scheduled assessment, the difference was analyzed using analysis of covariance with baseline score and stratification factors as covariates. |
| Duration of Response and Time-to-response | Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months. | Duration of response was defined as time from the date of first confirmed response to the date of first disease progression or death due to any cause in a subset of subjects with confirmed response. Time to response was defined as the interval in days from randomization to the first assessment of objective response (CR or PR). A complete response is the disappearance of all target lesions; a partial response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Progressive disease is at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study. |
Countries
Australia, Canada, France, Germany, Ireland, Spain, Switzerland, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy AMG 479: AMG 479 administered with exemestane or fulvestrant | 106 |
| Arm B: Placebo IV Q2W + Endocrine Therapy Placebo: Placebo administered with either exemestane or fulvestrant | 50 |
| Total | 156 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 64 | 19 |
| Overall Study | Lost to Follow-up | 1 | 4 |
| Overall Study | Withdrawal by Subject | 2 | 1 |
Baseline characteristics
| Characteristic | Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Arm B: Placebo IV Q2W + Endocrine Therapy | Total |
|---|---|---|---|
| Age, Continuous | 62.6 years STANDARD_DEVIATION 10.4 | 61.7 years STANDARD_DEVIATION 10.2 | 62.3 years STANDARD_DEVIATION 10.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 106 Participants | 49 Participants | 155 Participants |
| Postmenopausal Women with Hormone Receptor Positive Locally Advanced or Metastatic Breast Cancer | 106 Participants | 50 Participants | 156 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) White | 100 Participants | 47 Participants | 147 Participants |
| Sex: Female, Male Female | 106 Participants | 50 Participants | 156 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 | 64 / 106 | 19 / 50 |
| other Total, other adverse events | 105 / 106 | 47 / 49 |
| serious Total, serious adverse events | 27 / 106 | 9 / 49 |
Outcome results
Progression Free Survival (PFS)
PFS was defined as the time from randomization to the first observation of disease progression (as classified by modified RECIST), symptomatic deterioration or death due to any cause, whichever occurs first. Disease progression per RECIST is defined as at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study and an absolute increase of at least 5 mm; the appearance of any new lesions is also considered progression.
Time frame: Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Progression Free Survival (PFS) | 3.9 Months |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Progression Free Survival (PFS) | 5.7 Months |
Clinical Benefit and Objective Response Rate
Clinical benefit was defined as complete/partial response, or stable disease≥24 weeks per modified RECIST/local review. Objective response rate was defined as complete/partial response per modified RECIST/local review. Per Response Evaluation Criteria in Solid Tumors \[RECIST\]: a complete response is the disappearance of all target lesions; a partial response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Stable disease is disease that is not complete, partial or progressive (PD = at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study)
Time frame: Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months.
Population: All Randomized Subjects with Baseline Tumor Assessment
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Clinical Benefit and Objective Response Rate | Objective Response Rate | 5 Participants |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Clinical Benefit and Objective Response Rate | Clinical Benefit Rate | 22 Participants |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Clinical Benefit and Objective Response Rate | Objective Response Rate | 4 Participants |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Clinical Benefit and Objective Response Rate | Clinical Benefit Rate | 10 Participants |
Cmax of AMG 479
Serum AMG 479 Concentrations After IV Administration of 12 mg/kg AMG 479 in combination with Exemestane, and in combination with Fulvestrant (Cmax).
Time frame: Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months.
Population: PK population, included only subjects who received the specified combination.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Cmax of AMG 479 | AMG 479 in combination with Exemestane, Cycle 1 Day 1 | 231 μg/mL | Standard Deviation 61.8 |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Cmax of AMG 479 | AMG 479 in combination with Exemestane, Cycle 2 Day 1 | 257 μg/mL | Standard Deviation 66.9 |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Cmax of AMG 479 | AMG 479 in combination with Exemestane, Cycle 3 Day 1 | 289 μg/mL | Standard Deviation 52.7 |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Cmax of AMG 479 | AMG 479 in combination with Fulvestrant, Cycle 1 Day 1 | 225 μg/mL | Standard Deviation 46.3 |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Cmax of AMG 479 | AMG 479 in combination with Fulvestrant, Cycle 2 Day 1 | 267 μg/mL | Standard Deviation 79.3 |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Cmax of AMG 479 | AMG 479 in combination with Fulvestrant, Cycle 3 Day 1 | 268 μg/mL | Standard Deviation 66.7 |
Duration of Response and Time-to-response
Duration of response was defined as time from the date of first confirmed response to the date of first disease progression or death due to any cause in a subset of subjects with confirmed response. Time to response was defined as the interval in days from randomization to the first assessment of objective response (CR or PR). A complete response is the disappearance of all target lesions; a partial response is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Progressive disease is at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study.
Time frame: Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months.
Population: Subjects with Baseline Measureable Disease and Confirmed Response
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Duration of Response and Time-to-response | Time to Response | 22.1 Weeks | Standard Deviation 13.1 |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Duration of Response and Time-to-response | Duration of Response | 26.5 Weeks | Standard Deviation 10.6 |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Duration of Response and Time-to-response | Time to Response | 19.5 Weeks | Standard Deviation 13.6 |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Duration of Response and Time-to-response | Duration of Response | 31.7 Weeks | Standard Deviation 19 |
Global Health Status Time-Adjusted AUC
Based on the European Organization Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ C-30) v3, a 30-item questionnaire comprised of 5 functional scales, 3 symptom scales, and 6 single item scales, all with scores ranging from 1=not at all to 4=very much, along with the Health-Related Quality of Life scale with scores ranging from 1=very poor to 7=excellent; and 2 questions from the Dermatology Life Quality Index (DLQI; scores ranged from 1=not at all to 4=very much). Summing of all these questions and standardizing yielded a total score ranging from 0-100; higher total scores = better quality of life. AUC of the change from baseline of the mean total score over time were calculated using the linear trapezoidal rule. The time-adjusted AUC was calculated by dividing the AUC by the time interval between baseline and the last scheduled assessment, the difference was analyzed using analysis of covariance with baseline score and stratification factors as covariates.
Time frame: From start of study, on Day 1 of cycles 2, 3, and 4 and Day 1 every 3rd cycle thereafter, up to cycle 25 (Cycle = 28 days), approximately 700 days.
Population: The European Organization for Research and Treatment of Cancer (EORTC) analysis set consisted of all subjects in the full analysis set who had a baseline and at least~1 postbaseline non-missing measurable score of the EORTC QLQ-C30 questionnaire for descriptive comparisons between treatment groups.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Global Health Status Time-Adjusted AUC | 1.56 scores*day |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Global Health Status Time-Adjusted AUC | 1.59 scores*day |
Number of Participants With Adverse Events
Graded Using the National Cancer Institute(NCI) Common Terminology Criteria for Adverse Events(CTCAE) Version 3.0
Time frame: 30 days after the last dose of study treatment, up to 109 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Number of Participants With Adverse Events | 105 Participants |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Number of Participants With Adverse Events | 47 Participants |
Time To Progression, Time-to-treatment Failure, Overall Survival
Time to progression was defined as the time from date of randomization to the date of first occurrence of disease progression or death due to disease progression Time to treatment failure was defined as the time from date of randomization to the earliest date of disease progression, death, or end of cycle \[last dose date + 1 cycle time: 14 days\] for the last dose of ganitumab or placebo regardless of the reason of discontinuation Overall survival was defined as the time from randomization to death. Progressive disease is at least a 20% increase in the sum of diameters of target lesions in reference to the smallest sum on study.
Time frame: Subject completing study will be contacted by the study staff by telephone or at routine clinic visits approximately every 3 months, up to approximately 3 years and 6 months.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Time To Progression, Time-to-treatment Failure, Overall Survival | Time-to-treatment failure | 15.8 Weeks |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Time To Progression, Time-to-treatment Failure, Overall Survival | Time To Progression | 17.0 Weeks |
| Arm A: AMG 479 12 mg/kg IV Q2W + Endocrine Therapy | Time To Progression, Time-to-treatment Failure, Overall Survival | Overall Survival | 96.6 Weeks |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Time To Progression, Time-to-treatment Failure, Overall Survival | Time-to-treatment failure | 21.6 Weeks |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Time To Progression, Time-to-treatment Failure, Overall Survival | Time To Progression | 24.6 Weeks |
| Arm B: Placebo IV Q2W + Endocrine Therapy | Time To Progression, Time-to-treatment Failure, Overall Survival | Overall Survival | NA Weeks |