Metastatic Breast Cancer
Conditions
Keywords
PARP, TMZ, Temodal, Carboplatin, veliparib, BRCA2 mutation carrier, Breast cancer, Metastatic breast cancer, temozolomide, BRCA1 mutation carrier, ABT-888, Paclitaxel, Recurrent breast cancer, Temodar, Locally recurrent
Brief summary
The primary objective of the study is to assess the progression-free survival (PFS) of oral veliparib in combination with TMZ or in combination with carboplatin and paclitaxel compared to placebo plus carboplatin and paclitaxel in subjects with BRCA1 or BRCA2 mutation and locally recurrent or metastatic breast cancer.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically or cytologically confirmed breast cancer that is either locally recurrent or metastatic. * Locally recurrent disease must not be amenable to surgical resection or radiation with curative intent. * Must have a documented deleterious Breast Cancer Gene BRCA1 or BRCA2 germline mutation. * If Human Epidermal Growth Factor Receptor (HER2) positive, subjects must have received and progressed on at least one prior standard HER2 directed therapy or the subject must be ineligible to receive anti-HER2 therapy. * Measurable or non-measurable (but radiologically evaluable) disease by RECIST (Response Evaluation Criteria in Solid Tumors) criteria 1.1. * Eastern Cooperative Oncology Group (ECOG) Performance Score of 0-2. * Subject must have adequate bone marrow, renal and hepatic function. * Subject must not be pregnant or plan to conceive a child.
Exclusion criteria
* Received anticancer agent(s) or an investigational agent within 21 days prior to C1D1, or radiotherapy within 28 days prior Cycle 1 Day 1. * More than 2 prior lines of cytotoxic chemotherapy. * Prior treatment of breast cancer with temozolomide, a platinum agent, or a Poly (ADP ribose) Polymerase (PARP) inhibitor. * Prior taxane therapy for metastatic breast cancer. * A history of or evidence of brain metastases or leptomeningeal disease. * A history of uncontrolled seizure disorder. * Pre-existing neuropathy from any cause in excess of Grade 1. * Known history of allergic reaction to cremophor/paclitaxel. * Clinical significant uncontrolled conditions, active infection, myocardial infarction, stroke, or transient ischemic attack, psychiatric illness/social situations that would limit compliance. * Pregnant or breastfeeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Radiographic evaluation every 9 weeks, clinical evaluation every cycle (data cutoff date: 04 March 2016); maximum duration of follow up for PFS was 34 months. | PFS is defined as the number of months from the date the participant was randomized to the date of radiographic progression as determined by the central imaging center, or to the date of all cause deaths within 63 days of last tumor assessment if disease progression was not reached. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | From Cycle 1 Day 1 until participant's death or 3 years post discontinuation (data cutoff date: 04 March 2016); maximum duration of follow up for OS was 72 months. | Time to death for a given participant was defined as the number of months from the day the participant is randomized to the date of the participant's death. All events of death were included, regardless of whether the event occurs while the participant was still taking study drug, or after the participant discontinued study drug. If a participant had not died, then the data will be censored at the date when the participant was last known to be alive. |
| Clinical Benefit Rate (CBR) at Week 18 | Week 18 | CBR: percentage of participants who were progression-free at 18 weeks, defined as complete response (CR), partial response (PR), stable disease (SD) or non-CR/non-disease progression (PD) per Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1. CR: The disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 0 mm. PR: \>= 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters (SOD). PD: \>= 20% increase in the SOD of target lesions, taking as reference the smallest SOD recorded since the treatment started (baseline or after) or the appearance of \>=1 new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest SOD since the treatment started (baseline or after). |
| Objective Response Rate (ORR) | Radiographic evaluation every 9 weeks, clinical evaluation every cycle (data cutoff date: 04 March 2016); maximum duration of follow up for ORR was 34 months. | The objective response rate, defined as percentage of participants with a confirmed CR or PR based on RECIST 1.1 criteria. CR: The disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 0 mm. PR: \>= 30% decrease in the sum of diameters of target lesions, taking as reference the baseline SODs. |
| Change From Baseline at Week 18 in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy Module (EORTC QLQ-CIPN20) Sensory Subscale Score | Baseline, Week 18 | EORTC QLQ-CIPN20 sensory subscale score was calculated following the standard scoring algorithm, transformed to a 0 (low quality of life) to 100 (best quality of life) scale. A positive change from baseline indicates improvement. |
Countries
Argentina, Australia, Belgium, Brazil, Canada, Czechia, Denmark, Finland, France, Hungary, Israel, Netherlands, Norway, Poland, Romania, Russia, Spain, Sweden, Ukraine, United States
Participant flow
Recruitment details
Under the original protocol, approximately 4 participants were randomized in a 1:1:1 ratio (Group 1) to 1 of the 3 treatment arms (1 participant in veliparib 40 mg twice daily (BID)+temozolomide (TMZ) arm and a total of 3 participants in either the veliparib 80 mg BID+carboplatin+paclitaxel or the placebo BID+carboplatin+paclitaxel arms) at approximately 3 research sites. Participants randomized under the original protocol were in Group 1, and were not included in the primary efficacy analyses.
Pre-assignment details
Following approval of Amendment 1, the veliparib dose in combination with carboplatin and paclitaxel was increased to 120 mg BID. Participants were randomized 1:1:1 ratio (Group 2) to 1 of the 3 treatment arms (veliparib 40 mg BID+TMZ, veliparib 120 mg BID+carboplatin+paclitaxel, placebo BID+carboplatin+paclitaxel) at approximately 120 research sites. Participants randomized following approval of Amendment 1 were in Group 2 and were included in the primary efficacy analyses.
Participants by arm
| Arm | Count |
|---|---|
| Group 1 Placebo + Carboplatin/Paclitaxel Placebo BID Days 1 through 7 plus carboplatin target AUC 6 administered on Day 3 of each 21-day cycle and paclitaxel 175 mg/m\^2 administered on Day 3 of each 21-day cycle. | 2 |
| Group 1 Veliparib + Carboplatin/Paclitaxel Veliparib 80 mg BID Days 1 through 7 plus carboplatin target AUC 6 administered on Day 3 of each 21-day cycle and paclitaxel 175 mg/m\^2 administered on Day 3 of each 21-day cycle. | 1 |
| Group 1 Veliparib + TMZ Veliparib 40 mg BID Days 1 through 7 plus TMZ 150 to 200 mg/m\^2 QD Days 1 through 5 in each 28-day cycle. | 1 |
| Group 2 Placebo + Carboplatin/Paclitaxel Placebo BID Days 1 through 7 plus carboplatin target AUC 6 administered on Day 3 of each 21-day cycle and paclitaxel 175 mg/m\^2 administered on Day 3 of each 21-day cycle. | 99 |
| Group 2 Veliparib + Carboplatin/Paclitaxel Veliparib 120 mg BID Days 1 through 7 plus carboplatin target AUC 6 administered on Day 3 of each 21-day cycle and paclitaxel 175 mg/m\^2 administered on Day 3 of each 21-day cycle. | 97 |
| Group 2 Veliparib + TMZ Veliparib 40 mg BID Days 1 through 7 plus TMZ 150 to 200 mg/m\^2 QD Days 1 through 5 in each 28-day cycle. | 94 |
| Total | 294 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Overall Study | Adverse Event Not Related to Progression | 0 | 1 | 0 | 6 | 10 | 5 |
| Overall Study | Adverse Event Related to Progression | 0 | 0 | 0 | 3 | 7 | 3 |
| Overall Study | Lost to Follow-up | 0 | 0 | 0 | 1 | 2 | 0 |
| Overall Study | Missing / Unknown Reason | 1 | 0 | 1 | 4 | 4 | 2 |
| Overall Study | Other, Not Specified | 0 | 0 | 0 | 10 | 7 | 3 |
| Overall Study | Progressive Disease per Protocol | 1 | 0 | 0 | 64 | 57 | 74 |
| Overall Study | Sponsor Discontinued Study | 0 | 0 | 0 | 2 | 2 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 0 | 0 | 9 | 7 | 7 |
Baseline characteristics
| Characteristic | Total | Group 1 Placebo + Carboplatin/Paclitaxel | Group 1 Veliparib + Carboplatin/Paclitaxel | Group 1 Veliparib + TMZ | Group 2 Placebo + Carboplatin/Paclitaxel | Group 2 Veliparib + Carboplatin/Paclitaxel | Group 2 Veliparib + TMZ |
|---|---|---|---|---|---|---|---|
| Age, Customized 45 to 64 years | 143 Participants | 0 Participants | 0 Participants | 1 Participants | 49 Participants | 47 Participants | 46 Participants |
| Age, Customized < 45 years | 140 Participants | 2 Participants | 1 Participants | 0 Participants | 47 Participants | 49 Participants | 41 Participants |
| Age, Customized >= 65 years | 11 Participants | 0 Participants | 0 Participants | 0 Participants | 3 Participants | 1 Participants | 7 Participants |
| Race/Ethnicity, Customized Asian | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Black | 17 Participants | 0 Participants | 0 Participants | 0 Participants | 4 Participants | 3 Participants | 10 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 18 Participants | 0 Participants | 0 Participants | 0 Participants | 6 Participants | 7 Participants | 5 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized No Ethnicity | 276 Participants | 2 Participants | 1 Participants | 1 Participants | 93 Participants | 90 Participants | 89 Participants |
| Race/Ethnicity, Customized Other, Not Specified | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 272 Participants | 2 Participants | 1 Participants | 1 Participants | 93 Participants | 92 Participants | 83 Participants |
| Sex: Female, Male Female | 288 Participants | 2 Participants | 1 Participants | 1 Participants | 97 Participants | 95 Participants | 92 Participants |
| Sex: Female, Male Male | 6 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants | 2 Participants | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 2 / 2 | 1 / 1 | 1 / 1 | 65 / 96 | 59 / 93 | 76 / 93 |
| other Total, other adverse events | 2 / 2 | 1 / 1 | 1 / 1 | 93 / 96 | 93 / 93 | 91 / 93 |
| serious Total, serious adverse events | 0 / 2 | 0 / 1 | 0 / 1 | 26 / 96 | 32 / 93 | 16 / 93 |
Outcome results
Progression-Free Survival (PFS)
PFS is defined as the number of months from the date the participant was randomized to the date of radiographic progression as determined by the central imaging center, or to the date of all cause deaths within 63 days of last tumor assessment if disease progression was not reached.
Time frame: Radiographic evaluation every 9 weeks, clinical evaluation every cycle (data cutoff date: 04 March 2016); maximum duration of follow up for PFS was 34 months.
Population: Group 2: All randomized participants with suspected deleterious or deleterious breast cancer gene (BRCA)1 or BRCA2 mutation determined by sponsor core lab.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group 2 Placebo + Carboplatin/Paclitaxel | Progression-Free Survival (PFS) | 12.3 months |
| Group 2 Veliparib + Carboplatin/Paclitaxel | Progression-Free Survival (PFS) | 14.1 months |
| Group 2 Veliparib + TMZ | Progression-Free Survival (PFS) | 7.4 months |
Change From Baseline at Week 18 in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy Module (EORTC QLQ-CIPN20) Sensory Subscale Score
EORTC QLQ-CIPN20 sensory subscale score was calculated following the standard scoring algorithm, transformed to a 0 (low quality of life) to 100 (best quality of life) scale. A positive change from baseline indicates improvement.
Time frame: Baseline, Week 18
Population: Group 2: All randomized participants with suspected deleterious or deleterious BRCA1 or BRCA2 mutation determined by sponsor core lab. Participants with a baseline and post baseline value. Per protocol, this outcome measure was not planned for the Veliparib + TMZ arm.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group 2 Placebo + Carboplatin/Paclitaxel | Change From Baseline at Week 18 in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy Module (EORTC QLQ-CIPN20) Sensory Subscale Score | 13.94 score on a scale | Standard Deviation 14.123 |
| Group 2 Veliparib + Carboplatin/Paclitaxel | Change From Baseline at Week 18 in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy Module (EORTC QLQ-CIPN20) Sensory Subscale Score | 11.24 score on a scale | Standard Deviation 13.954 |
Clinical Benefit Rate (CBR) at Week 18
CBR: percentage of participants who were progression-free at 18 weeks, defined as complete response (CR), partial response (PR), stable disease (SD) or non-CR/non-disease progression (PD) per Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1. CR: The disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 0 mm. PR: \>= 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters (SOD). PD: \>= 20% increase in the SOD of target lesions, taking as reference the smallest SOD recorded since the treatment started (baseline or after) or the appearance of \>=1 new lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest SOD since the treatment started (baseline or after).
Time frame: Week 18
Population: Group 2: All randomized participants with suspected deleterious or deleterious BRCA1 or BRCA2 mutation determined by sponsor core lab.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 2 Placebo + Carboplatin/Paclitaxel | Clinical Benefit Rate (CBR) at Week 18 | 87.0 percentage of participants |
| Group 2 Veliparib + Carboplatin/Paclitaxel | Clinical Benefit Rate (CBR) at Week 18 | 90.7 percentage of participants |
| Group 2 Veliparib + TMZ | Clinical Benefit Rate (CBR) at Week 18 | 73.0 percentage of participants |
Objective Response Rate (ORR)
The objective response rate, defined as percentage of participants with a confirmed CR or PR based on RECIST 1.1 criteria. CR: The disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 0 mm. PR: \>= 30% decrease in the sum of diameters of target lesions, taking as reference the baseline SODs.
Time frame: Radiographic evaluation every 9 weeks, clinical evaluation every cycle (data cutoff date: 04 March 2016); maximum duration of follow up for ORR was 34 months.
Population: Group 2: All randomized participants with suspected deleterious or deleterious BRCA1 or BRCA2 mutation determined by sponsor core lab. Participants with at least 1 measurable lesion at baseline.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 2 Placebo + Carboplatin/Paclitaxel | Objective Response Rate (ORR) | 61.3 percentage of participants |
| Group 2 Veliparib + Carboplatin/Paclitaxel | Objective Response Rate (ORR) | 77.8 percentage of participants |
| Group 2 Veliparib + TMZ | Objective Response Rate (ORR) | 28.6 percentage of participants |
Overall Survival (OS)
Time to death for a given participant was defined as the number of months from the day the participant is randomized to the date of the participant's death. All events of death were included, regardless of whether the event occurs while the participant was still taking study drug, or after the participant discontinued study drug. If a participant had not died, then the data will be censored at the date when the participant was last known to be alive.
Time frame: From Cycle 1 Day 1 until participant's death or 3 years post discontinuation (data cutoff date: 04 March 2016); maximum duration of follow up for OS was 72 months.
Population: Group 2: All randomized participants with suspected deleterious or deleterious BRCA1 or BRCA2 mutation determined by sponsor core lab.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Group 2 Placebo + Carboplatin/Paclitaxel | Overall Survival (OS) | 25.4 months |
| Group 2 Veliparib + Carboplatin/Paclitaxel | Overall Survival (OS) | 28.3 months |
| Group 2 Veliparib + TMZ | Overall Survival (OS) | 19.1 months |