Breast Cancer
Conditions
Keywords
Poziotinib, Metastatic Breast Cancer, HER2-positive, Pan-HER inhibitor
Brief summary
The purpose of this study is to establish the dose regimen and evaluate the preliminary efficacy and the safety/tolerability of poziotinib in participants with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer who have received at least two prior HER2-directed treatment regimens.
Detailed description
This is a phase 2, open-label, multicenter study to establish the dose regimen and evaluate the preliminary efficacy and the safety/tolerability of poziotinib in participants with HER2-positive metastatic breast cancer who have received at least two prior HER2-directed treatment regimens. Each treatment cycle will be 21 days in duration. During each 21-day cycle, participants who are eligible for participation will receive poziotinib orally once daily. All treated participants will be followed up until disease progression, death, intolerable adverse events or up to a maximum of 24 months whichever comes earlier.
Interventions
8 mg oral tablets, administered QD.
Sponsors
Study design
Eligibility
Inclusion criteria
1. Histopathologically confirmed primary breast cancer with metastatic lesions. 2. Confirmed HER2 overexpression or gene-amplified tumor 3. At least two prior HER2-directed therapy regimens for breast cancer, including trastuzumab and trastuzumab emtansine 4. Measurable disease per Response Evaluation Criteria for Solid Tumors version 1.1 (RECIST v1.1) 5. Participant is at least 18, and ≤90 years of age. 6. Adequate hematologic, hepatic, and renal function 7. Eastern Cooperative Oncology Group (ECOG) performance status \<= 2
Exclusion criteria
1. Previous treatment with poziotinib prior to study participation 2. Brain metastases that are symptomatic or require therapy to control symptoms, as well as any history of radiation, surgery, or other therapy, including steroids, to control symptoms from brain metastases within 15 days of enrollment. 3. Anticancer chemotherapy, biologics, immunotherapy, cure-intent radiotherapy, or investigational treatment within 15 days, except for hormone therapy, palliative therapy, or supportive therapy. 4. History of congestive heart failure Class III/IV according to the New York Heart Association (NYHA) Functional Classification or serious cardiac arrhythmias requiring treatment. 5. Cardiac ejection fraction \<50% 6. History of other malignancies within the last 5 years 7. Participant is pregnant or breast-feeding. 8. Unable to take drugs orally
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) | Up to 24 months | ORR was defined as the percentage of participants whose best overall response (BOR) was complete response (CR) or partial response (PR) among participants in the Evaluable Population assessed per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1). ORR was based on investigator assessed BOR. Per RECIST v1.1 for target lesions, CR was disappearance of all target tumor lesions (TLs) and all target lymph nodes (LNs) with short axis \<10mm. PR was ≥30% decrease in sum of diameters (SOD) from Baseline, and not progressive disease (PD) (≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disease Control Rate (DCR) | Up to 24 months | DCR was the percentage of participants whose best response was CR, PR or stable disease (SD) among participants in the Evaluable Population assessed per RECIST v1.1. DCR was based on investigator-assessed BOR. Per RECIST v1.1 for target lesions, CR was defined as disappearance of all target TLs and all target LNs with short axis \<10mm. PR was ≥30% decrease in sum of diameters (SOD) from Baseline, and not progressive disease (≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm). SD was SOD change neither sufficient for PR nor sufficient for PD. |
| Time to Progression (TTP) | Up to 24 months | TTP was defined as the time (in months) from first administration of study drug to tumor progression, which excluded death without tumor progression, by the end of study. TTP of participants who died without documented PD was censored at date of death. TTP of living participants without documented PD was censored at the same time as PFS, which was the last tumor assessment or the date of first treatment if there was no post-baseline tumor assessment. Per RECIST v1.1 for target lesions, PD was defined as ≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm. |
| Progression Free Survival (PFS) | Up to 24 Months | PFS was the duration of time (in months) from first administration of study treatment to date of first documented disease progression or death from any cause. PFS of living participants without documented PD was censored at the time of last tumor assessment or the date of first treatment if there was no post-baseline tumor assessment. Per RECIST v1.1 for target lesions, PD was defined as ≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm. |
| Number of Participants With One or More Treatment-Emergent Adverse Events (TEAEs) | From the first dose of study drug administration until 35 (± 5) days after the last dose of study drug administration (Up to approximately 25 months) | An AE was defined as any untoward medical occurrence in a participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. TEAEs were AEs that occurred or worsened from the first dose of study treatment until 35 (± 5) days after the last dose of study treatment. |
| Pharmacokinetic Analysis (Drug Concentration Measurements) | For Cohort 1: Pre-dose and 1 and 2 hours post-dose on Day 1 of Cycles 1, 2, and 3, and pre-dose on Day 14 of Cycle 1 For Cohort 2: Day 1 of Cycle 1 pre-dose and 30 minutes, 1,1.5,2,3, 4, 6, and 24 hours post-dose of Day 1 of Cycle 1 | — |
| Duration of Response (DoR) | Up to 24 months | DoR was evaluated only for participants whose BOR was CR or PR and was defined as the time (in months) from the date that response evaluation criteria were first met for CR or PR (whichever status was recorded first) until the first subsequent date that PD or death was documented. DoR of participants without documented PD or death was censored at the time of last tumor assessment. Per RECIST v1.1 for target lesions, CR was defined as disappearance of all target tumor lesions (TLs) and all target lymph nodes (LNs) with short axis \<10mm. PR was defined as ≥30% decrease in sum of diameters (SOD) from Baseline, and not PD. PD was defined as ≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm). |
Countries
United States
Participant flow
Recruitment details
A total of 67 participants were enrolled at 19 sites in the United States in the study which was conducted from 22 February 2016 to 11 March 2020.
Participants by arm
| Arm | Count |
|---|---|
| Cohort 1: Poziotinib 24 mg Participants received poziotinib 24 mg, administered as three 8 mg tablets, orally, QD on an intermittent dosing schedule of 14 days on treatment followed by 7 days off treatment, in a 21-day cycle until disease progression, death, intolerable AEs or for up to a maximum of 24 months, whichever occurs first. | 33 |
| Cohort 2: Poziotinib 16 mg Participants received poziotinib 16 mg, administered as two 8 mg tablets, orally, QD, on a continuous dosing schedule in a 21-day cycle until disease progression, death, intolerable AEs or for up to a maximum of 24 months, whichever occurs first. | 34 |
| Total | 67 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 12 |
| Overall Study | Death | 6 | 1 |
| Overall Study | Disease Progression | 23 | 13 |
| Overall Study | Lost to Follow-up | 0 | 1 |
| Overall Study | Reason Unspecified | 0 | 3 |
| Overall Study | Withdrawal by Subject | 0 | 4 |
Baseline characteristics
| Characteristic | Total | Cohort 1: Poziotinib 24 mg | Cohort 2: Poziotinib 16 mg |
|---|---|---|---|
| Age, Continuous | 57.3 years STANDARD_DEVIATION 12.45 | 56.4 years STANDARD_DEVIATION 13.82 | 58.1 years STANDARD_DEVIATION 11.1 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 10 Participants | 5 Participants | 5 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 57 Participants | 28 Participants | 29 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 2 Participants | 2 Participants | 0 Participants |
| Race/Ethnicity, Customized Black or African American | 5 Participants | 1 Participants | 4 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 59 Participants | 30 Participants | 29 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 2 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants | 1 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 | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 59 Participants | 30 Participants | 29 Participants |
| Sex: Female, Male Female | 67 Participants | 33 Participants | 34 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 | 6 / 33 | 1 / 34 |
| other Total, other adverse events | 33 / 33 | 33 / 34 |
| serious Total, serious adverse events | 14 / 33 | 16 / 34 |
Outcome results
Objective Response Rate (ORR)
ORR was defined as the percentage of participants whose best overall response (BOR) was complete response (CR) or partial response (PR) among participants in the Evaluable Population assessed per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1). ORR was based on investigator assessed BOR. Per RECIST v1.1 for target lesions, CR was disappearance of all target tumor lesions (TLs) and all target lymph nodes (LNs) with short axis \<10mm. PR was ≥30% decrease in sum of diameters (SOD) from Baseline, and not progressive disease (PD) (≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm).
Time frame: Up to 24 months
Population: Evaluable Population included all enrolled participants who completed at least 1 cycle of poziotinib treatment and had at least 1 post-baseline tumor response evaluation using RECIST, v 1.1.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1: Poziotinib 24 mg | Objective Response Rate (ORR) | 30 percentage of participants |
| Cohort 2: Poziotinib 16 mg | Objective Response Rate (ORR) | 30 percentage of participants |
Disease Control Rate (DCR)
DCR was the percentage of participants whose best response was CR, PR or stable disease (SD) among participants in the Evaluable Population assessed per RECIST v1.1. DCR was based on investigator-assessed BOR. Per RECIST v1.1 for target lesions, CR was defined as disappearance of all target TLs and all target LNs with short axis \<10mm. PR was ≥30% decrease in sum of diameters (SOD) from Baseline, and not progressive disease (≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm). SD was SOD change neither sufficient for PR nor sufficient for PD.
Time frame: Up to 24 months
Population: Evaluable Population included all enrolled participants who completed at least 1 cycle of poziotinib treatment and had at least 1 post-baseline tumor response evaluation using RECIST, v 1.1.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1: Poziotinib 24 mg | Disease Control Rate (DCR) | 60 percentage of participants |
| Cohort 2: Poziotinib 16 mg | Disease Control Rate (DCR) | 78 percentage of participants |
Duration of Response (DoR)
DoR was evaluated only for participants whose BOR was CR or PR and was defined as the time (in months) from the date that response evaluation criteria were first met for CR or PR (whichever status was recorded first) until the first subsequent date that PD or death was documented. DoR of participants without documented PD or death was censored at the time of last tumor assessment. Per RECIST v1.1 for target lesions, CR was defined as disappearance of all target tumor lesions (TLs) and all target lymph nodes (LNs) with short axis \<10mm. PR was defined as ≥30% decrease in sum of diameters (SOD) from Baseline, and not PD. PD was defined as ≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm).
Time frame: Up to 24 months
Population: Evaluable Population included all participants who had received at least one cycle of poziotinib and had at least one evaluable post-baseline tumor response evaluation using response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST, v1.1). Overall number of participants analyzed is the number of participants with best overall response of CR or PR.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Poziotinib 24 mg | Duration of Response (DoR) | 5.7 months |
| Cohort 2: Poziotinib 16 mg | Duration of Response (DoR) | 13.0 months |
Number of Participants With One or More Treatment-Emergent Adverse Events (TEAEs)
An AE was defined as any untoward medical occurrence in a participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. TEAEs were AEs that occurred or worsened from the first dose of study treatment until 35 (± 5) days after the last dose of study treatment.
Time frame: From the first dose of study drug administration until 35 (± 5) days after the last dose of study drug administration (Up to approximately 25 months)
Population: Safety Population included all participants who received at least 1 dose of poziotinib.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1: Poziotinib 24 mg | Number of Participants With One or More Treatment-Emergent Adverse Events (TEAEs) | 33 participants |
| Cohort 2: Poziotinib 16 mg | Number of Participants With One or More Treatment-Emergent Adverse Events (TEAEs) | 33 participants |
Pharmacokinetic Analysis (Drug Concentration Measurements)
Time frame: For Cohort 1: Pre-dose and 1 and 2 hours post-dose on Day 1 of Cycles 1, 2, and 3, and pre-dose on Day 14 of Cycle 1 For Cohort 2: Day 1 of Cycle 1 pre-dose and 30 minutes, 1,1.5,2,3, 4, 6, and 24 hours post-dose of Day 1 of Cycle 1
Population: Pharmacokinetic analyses specified in the protocol were not performed as the samples were no longer stable at the time of the analysis.
Progression Free Survival (PFS)
PFS was the duration of time (in months) from first administration of study treatment to date of first documented disease progression or death from any cause. PFS of living participants without documented PD was censored at the time of last tumor assessment or the date of first treatment if there was no post-baseline tumor assessment. Per RECIST v1.1 for target lesions, PD was defined as ≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm.
Time frame: Up to 24 Months
Population: Evaluable Population included all enrolled participants who completed at least 1 cycle of poziotinib treatment and had at least 1 post-baseline tumor response evaluation using RECIST, v 1.1.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Poziotinib 24 mg | Progression Free Survival (PFS) | 4.1 months |
| Cohort 2: Poziotinib 16 mg | Progression Free Survival (PFS) | 4.9 months |
Time to Progression (TTP)
TTP was defined as the time (in months) from first administration of study drug to tumor progression, which excluded death without tumor progression, by the end of study. TTP of participants who died without documented PD was censored at date of death. TTP of living participants without documented PD was censored at the same time as PFS, which was the last tumor assessment or the date of first treatment if there was no post-baseline tumor assessment. Per RECIST v1.1 for target lesions, PD was defined as ≥20% increase in SOD from previous smallest SOD on study, and an absolute increase of ≥5mm.
Time frame: Up to 24 months
Population: Evaluable Population included all enrolled participants who completed at least 1 cycle of poziotinib treatment and had at least 1 post-baseline tumor response evaluation using RECIST, v 1.1.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cohort 1: Poziotinib 24 mg | Time to Progression (TTP) | 4.1 months |
| Cohort 2: Poziotinib 16 mg | Time to Progression (TTP) | 4.9 months |