Breast Cancer
Conditions
Keywords
Breast Cancer
Brief summary
A single centre, single arm phase II study of alternating eribulin and hormonal therapy in 12 patients with locally advanced or metastatic breast cancer who have received at least one hormonal therapy and at least one chemotherapy in the metastatic setting.
Detailed description
12 patients with locally advanced or metastatic breast cancer who have received at least one hormonal therapy and at least one chemotherapy in the metastatic setting will be enrolled to receive treatment. Once patients are consented and have completed on study screening, eribulin and Aromatase Inhibitor (AI) treatment will be alternated for up to 9 months, until disease progression or unacceptable toxicities, whichever is sooner. Patients will then attend a safety follow-up visit 4 weeks after completing treatment. Eribulin (Halaven®) is a non-taxane microtubule dynamics inhibitor. Eribulin inhibits the growth phase of microtubules without affecting the shortening phase and sequesters tubulin into non-productive aggregates. Eribulin exerts its effects via a tubulin-based antimitotic mechanism leading to G2/M cell-cycle block, disruption of mitotic spindles, and, ultimately, apoptotic cell death after prolonged mitotic blockage. Eribulin is licenced for the treatment of patients with locally advanced or metastatic breast cancer who have previously received at least one chemotherapeutic regimen for the treatment of advanced disease. Prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting unless patients were not suitable for these treatments. The aim of this study is to alternate eribulin and aromatase inhibitors, examining whether there may be breakthrough relapse during the AI therapy or on the other hand we can extend the duration that eribulin may be used for. Importantly, blood based biomarkers, the tumour derived fraction of circulating free DNA (cfDNA) termed circulating tumor DNA (ctDNA), and circulating tumour cells will be measured. A major aim of this study is to test whether biomarkers fluctuate between chemotherapy and AI treatment in the setting of advanced breast cancer.
Interventions
DRUGEribulin
Sponsors
Imperial College London
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 1\. Written informed consent prior to admission to this study * 2\. Aged 18≥over * 3\. Histologically confirmed ER+ve metastatic breast cancer according to local criteria * 4\. Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2 * 5\. Have progressed after at least one hormonal therapy regime and at least one chemotherapy regime for advanced disease * 6\. Patients must have had prior treatment with an anthracycline and a taxane (either sequential or in combination) unless patients were not suitable for these treatments. This treatment can be in the adjuvant setting * 7\. Measurable sites of locally advanced and/or metastatic disease that can be accurately assessed by CT/MRI scan at baseline (RECIST v1.1)¹ * 8\. Life expectancy of ≥6 months * 9\. Adequate organ function, as defined by: * Haemoglobin (Hb) ≥ 9 g/dL * Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L * Platelet count (Plts) ≥ 100 x 109/L * White Blood Cell (WBC) ≥ 3.0 x 109/L * Serum albumin ≤ 1.5 Upper Limit of Normal (ULN) * Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 3 x ULN if no demonstrable liver metastases or ≤ 5 x ULN in the presence of liver metastases. * Alkaline Phosphatase Level (ALP) ≤ 5 x ULN * Total bilirubin ≤ 1.5 x ULN if no demonstrable liver metastases or ≤ 3 x ULN in the presence of liver metastases * Creatinine ≤ 1.5 x ULN or creatinine clearance \>50ml/min * 10\. Postmenopausal as defined by age \>50, no menstruation for \>2 years, previous oophorectomy or lab results confirming this status * 11\. Premenopausal if has been subject to ovarian ablation/ suppression at least 3 weeks prior to commencing AI therapy * RECIST v1.1 updated and now considers bone metastasis with an identifiable soft tissue mass to be measurable disease. Therefore, patients with bone metastasis are eligible, provided they have evaluable disease.
Exclusion criteria
* 1.Triple negative or Human Epidermal Growth Factor Receptor 2 (HER2) positive cancer * 2\. Hypersensitivity to the active substance or to any of its excipients * 3\. History of another primary malignancy within 5 years prior to starting study treatment, except adequately treated basal or squamous cell carcinoma of the skin, carcinoma in site and the disease under study * 4\. Evidence of uncontrolled active infection * 5\. Severe hepatic impairment (Child-Pugh C) * 6\. Evidence of significant medical condition or laboratory finding which, in the opinion of the Investigator, makes it undesirable for the patient to participate in the trial * 7\. Concurrent therapy with any other investigational agent or everolimus * 8\. Concomitant use within 14 days prior to commencement of study treatment of any investigational agent * 9\. Uncontrolled abnormalities of serum potassium, sodium, calcium (corrected) phosphate or magnesium levels * 10\. Pregnant or lactating women. Effective non-hormonal contraception is mandatory for all patients of reproductive potential * 11\. Evidence of ovarian activity * 12\. Prior eribulin therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Estimated Kaplan-Meier Progression Free Survival as Assessed by RECIST v1.1 | Fixed timepoints - 3, 6 and 9 months | Estimated Kaplan-Meier Progression free survival (PFS) to be defined as time from study entry to first evidence of disease progression or death due to any cause, as assessed by RECIST v1.0. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Benefit Rate as Assessed by RECIST v1.1 | To be assessed at 3, 6 and 9 months. | Clinical benefit rate (CBR), defined as the proportion of patients whose best overall response according to Response Evaluation Criteria in Solid Tumours (RECIST), v1.0 is either a complete response, partial response or stable disease for a least 6 months. |
| Safety and Tolerability | Collected form consent to follow-up | Safety and Tolerability were assessed by adverse events (AEs) and serious adverse events (SAEs) according the Common Terminology Criteria for Adverse Event (NCI-CTCAE) v4.03. |
Countries
United Kingdom
Participant flow
Recruitment details
This was a pilot of proof study recruiting 8 breast cancer patients over a 2 year period from the Charing Cross Hospital, London. The last patient completed in July 2018.
Pre-assignment details
Of the 58 patients screened, during the period between February 2016 and July 2018, 13 patients were consented to the study; and upon screening, 8 were recruited to receive study treatment, eribulin1.23mg/m2 on day 1 and day 8 of 21 day cycles, alternated with an aromatase inhibitor (AI), orally once daily for 9 weeks.
Participants by arm
| Arm | Count |
|---|---|
| Single Arm Study 3 x 3 weekly cycles at the recommended dose of eribulin as the ready to use solution, 1.23 mg/m2, administered intravenously over 2-5 minutes on days 1 and 8 of every 21 day cycle. This will then be followed by 9 weeks of AI treatment, to be followed again by 3 x 3 weekly cycles of eribulin and 9 weeks AI treatment. Patients will remain on treatment for up to 9 months, or until disease progression or unacceptable toxicities, whichever is sooner. | 8 |
| Total | 8 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Patient Non-compliance | 1 |
Baseline characteristics
| Characteristic | Single Arm Study |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants |
| Age, Continuous | 50 years |
| Body Mass Index | 26.5 kg/m^2 |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG Performamce Status 0 | 4 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG Performamce Status 1 | 4 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG Performamce Status 2 | 0 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG Performamce Status 3 | 0 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG Performamce Status 4 | 0 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status ECOG Performamce Status 5 | 0 Participants |
| Human Epidermal Growth Factor Receptor 2 (HER2) Status 1+ | 1 Participants |
| Human Epidermal Growth Factor Receptor 2 (HER2) Status 2+ | 0 Participants |
| Human Epidermal Growth Factor Receptor 2 (HER2) Status 3+ | 0 Participants |
| Human Epidermal Growth Factor Receptor 2 (HER2) Status Not measured | 2 Participants |
| Human Epidermal Growth Factor Receptor 2 (HER2) Status Zero | 5 Participants |
| Oestrogen Receptor (ER) Status Assessment Method Allred | 3 Participants |
| Oestrogen Receptor (ER) Status Assessment Method Other | 5 Participants |
| Primary Tumour Grade Grade 1 | 1 Participants |
| Primary Tumour Grade Grade 2 | 5 Participants |
| Primary Tumour Grade Grade 3 | 2 Participants |
| Primary Tumour Size | 28 millimeteres (mm) |
| Primary Tumour Stage No information | 4 Participants |
| Primary Tumour Stage Stage I | 1 Participants |
| Primary Tumour Stage Stage IIA | 1 Participants |
| Primary Tumour Stage Stage IIIA | 1 Participants |
| Primary Tumour Stage Stage IIIC | 1 Participants |
| Prior Chemotherapy No | 0 Participants |
| Prior Chemotherapy Yes | 8 Participants |
| Prior Endocrine Therapy Anastrozole | 5 participants |
| Prior Endocrine Therapy Exemestane | 5 participants |
| Prior Endocrine Therapy Letrozole | 3 participants |
| Prior Endocrine Therapy Tamoxifen | 8 participants |
| Prior Radiotherapy No | 0 Participants |
| Prior Radiotherapy Yes | 8 Participants |
| Prior Surgery No | 0 Participants |
| Prior Surgery Yes | 8 Participants |
| Progesterone Receptors (PgR) Status Negative | 0 Participants |
| Progesterone Receptors (PgR) Status Positive | 7 Participants |
| Progesterone Receptors (PgR) Status Unknown | 1 Participants |
| Race/Ethnicity, Customized Ethnicity Asian | 0 Participants |
| Race/Ethnicity, Customized Ethnicity Black | 0 Participants |
| Race/Ethnicity, Customized Ethnicity Middle Eastern | 1 Participants |
| Race/Ethnicity, Customized Ethnicity Mixed | 0 Participants |
| Race/Ethnicity, Customized Ethnicity Turkish | 1 Participants |
| Race/Ethnicity, Customized Ethnicity White | 6 Participants |
| Region of Enrollment United Kingdom | 8 participants |
| Sex: Female, Male Female | 8 Participants |
| Sex: Female, Male Male | 0 Participants |
| Smoking Status Current | 1 Participants |
| Smoking Status Former | 3 Participants |
| Smoking Status Never | 3 Participants |
| Smoking Status No Information | 1 Participants |
| Tumour Type Invasive Ducal Carcinoma | 8 Participants |
| Tumour Type Other Tumour type | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 8 |
| other Total, other adverse events | 8 / 8 |
| serious Total, serious adverse events | 5 / 8 |
Outcome results
Primary
Estimated Kaplan-Meier Progression Free Survival as Assessed by RECIST v1.1
Estimated Kaplan-Meier Progression free survival (PFS) to be defined as time from study entry to first evidence of disease progression or death due to any cause, as assessed by RECIST v1.0.
Time frame: Fixed timepoints - 3, 6 and 9 months
Population: PFS was measured at fixed time points of 3, 6 and 9 months, as estimated by the Kaplan-Meier curve. The median PFS at the end of the study was 235 days. PFS could not be calculated at 3 months, as no patient experienced disease progression at follow-up.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Single Arm Study | Estimated Kaplan-Meier Progression Free Survival as Assessed by RECIST v1.1 | 3 months | NA Days |
| Single Arm Study | Estimated Kaplan-Meier Progression Free Survival as Assessed by RECIST v1.1 | 6 months | 202 Days |
| Single Arm Study | Estimated Kaplan-Meier Progression Free Survival as Assessed by RECIST v1.1 | 9 months | 235 Days |
Secondary
Clinical Benefit Rate as Assessed by RECIST v1.1
Clinical benefit rate (CBR), defined as the proportion of patients whose best overall response according to Response Evaluation Criteria in Solid Tumours (RECIST), v1.0 is either a complete response, partial response or stable disease for a least 6 months.
Time frame: To be assessed at 3, 6 and 9 months.
Population: Only 6 patients had at least one tumour assessment during the study period.
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Single Arm Study | Clinical Benefit Rate as Assessed by RECIST v1.1 | Complete Response | 0 Participants |
| Single Arm Study | Clinical Benefit Rate as Assessed by RECIST v1.1 | Partial response | 3 Participants |
| Single Arm Study | Clinical Benefit Rate as Assessed by RECIST v1.1 | Stable Disease | 3 Participants |
Secondary
Safety and Tolerability
Safety and Tolerability were assessed by adverse events (AEs) and serious adverse events (SAEs) according the Common Terminology Criteria for Adverse Event (NCI-CTCAE) v4.03.
Time frame: Collected form consent to follow-up
Population: AEs and SAEs were collected for all 8 subjects who received at least one dose of study treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Single Arm Study | Safety and Tolerability | Mild | 71 Events |
| Single Arm Study | Safety and Tolerability | Moderate | 39 Events |
| Single Arm Study | Safety and Tolerability | Severe | 17 Events |
| Single Arm Study | Safety and Tolerability | Life Threatening or disabling | 2 Events |
| Single Arm Study | Safety and Tolerability | Death | 0 Events |