Invasive Mammary Carcinoma, Metastatic Breast Cancer
Conditions
Brief summary
This is an open-label, multicenter, two-arm Phase II clinical trial that will evaluate the impact of 2nd line chemotherapy (i.e. capecitabine) on survival in patients with non-Luminal A hormone receptor-positive (HR+) metastatic breast cancer (MBC)
Detailed description
Primary Objective: \- Determine the impact of early chemotherapy (i.e., capecitabine) versus endocrine therapy-based regimen on anti-tumor effect in patients with non-Luminal A hormone receptor-positive (HR+) metastatic breast cancer Secondary Objectives: * Compare the safety and tolerability of capecitabine versus endocrine therapy in patients with non-Luminal A hormone receptor-positive (HR+) metastatic breast cancer * Determine the impact of early chemotherapy (i.e., capecitabine) versus endocrine therapy-based regimen on anti-tumor effect in patients with non-Luminal A hormone receptor-positive (HR+) metastatic breast cancer Correlatives: * Determine if the tumor mutations detected in cfDNA are early surrogates of response * Determine if the cfDNA results at disease progression show new genomic alterations potentially associated with resistance to therapy
Interventions
DRUGCapecitabine
2000 mg taken by mouth twice daily for 7 days on, 7 days off
OTHEREndocrine-therapy
Endocrine therapy administered
OTHERMammoPrint ® and BluePrint assays
Archival tissue will be analyzed using the MammoPrint ® and BluePrint assays
Sponsors
Sonya Reid
Agendia
Susan G. Komen Breast Cancer Foundation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Signed and dated written informed consent. * Subjects ≥ 18 years of age. * Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. * Clinical stage IV invasive mammary carcinoma or unresectable locoregional recurrence of invasive mammary carcinoma that is: * ER (\>/=1%) and/or PR (\>/= 1%) by IHC and HER2 negative (by IHC or FISH) * Previously exposed to an aromatase inhibitor (AI) or a selective estrogenreceptor modulator/ downregulator (SERM; SERD) + a CDK4/6 inhibitor. * Prior radiation permitted (if completed at least 2 weeks prior to study entry. Patients who have received prior radiotherapy must have recovered from toxicity (≤ grade 1) induced by this treatment (except for alopecia) * Patients with brain metastasis secondary to breast cancer and clinically stable for more than 4 weeks from completion of radiation treatment and off steroids * Evaluable disease (measurable or non-measurable) * Measurable disease, ie, at least 1 measurable lesion as per RECIST 1.1 (a lesion at a previously irradiated site may only be counted as a target lesion if there is clear sign of progression since the irradiation) * Patients with bone only disease allowed if possible to evaluate on radiological exams (eg.bone scan, PET/CT, CT, MRI) even if lesions are non-measurable according to RECIST1.1. * Adequate organ function including: * Absolute neutrophil count (ANC) ≥ 1.5 × 10\^9/L * Platelets ≥ 100 × 10\^9/L * Hemoglobin ≥ 8/g/dL (may have been transfused) * Total serum bilirubin ≤ 1.5 times upper limit of normal (ULN) * Aspartate aminotransferase (AST/SGOT) and alanine aminotransferase (ALT/SGPT) ≤ 2.5 × ULN (or ≤ 5 × ULN if liver metastases are present) * Serum creatinine ≤ 1.5 x ULN or estimated creatinine clearance ≥ 50mL/min as calculated using the Cockcroft-Gault (CG) equation * For randomized patients only: tumors must be diagnosed as non-Luminal A using the Blueprint® and Mammaprint® tests
Exclusion criteria
* Prior chemotherapy in the metastatic setting * Previous malignant disease other than breast cancer within the last 2 years with associated competing risk, with the exception of basal or squamous cell carcinoma of the skin, cervical carcinoma in situ, or low-risk cancers considered curatively treated (i.e. complete remission achieved at least 2 years prior to first dose of study drugs AND additional therapy not required while receiving study treatment). * Persisting symptoms related to prior therapy that has not reduced to Grade 1 \[National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE) version 5.0\]; however, menopausal symptoms, alopecia, and sensory neuropathy Grade ≤ 2 is acceptable * Pregnant or breastfeeding females.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Progression free survival | Up to 3 years |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival at 2 years | Up to 2 years | — |
| Overall survival at 5 years | Up to 5 years | — |
| Overall survival at 10 years | Up to 10 years | — |
| Clinical Benefit Rate | Approximately 6 months | Percentage of patients without disease progression at 6 months |
| Overall response rate | Up to 3 years | — |
| Incidence of adverse events | Up to 28 days post-treatment | — |
| Overall impact of treatment toxicity | Up to 3 years | Will be measured using Functional Assessment of Cancer Therapy (FACT)-G (5 point Likert-type scale from 1 ("none at all") to 5 ("very much") |
Countries
United States
Contacts
CONTACTVanderbilt-Ingram Services for Timely Access
PRINCIPAL_INVESTIGATORSonya Reid, MD
Vanderbilt University/Ingram Cancer Center
Outcome results
None listed