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Entinostat Versus Placebo Combined With Endocrine Therapy in Chinese Patients With Advanced Breast Cancer in Chinese Patients With Hormone Receptor-Positive Advanced Breast Cancer

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ClinicalTrials.gov Identifier: NCT03538171
Recruitment Status : Recruiting
First Posted : May 28, 2018
Last Update Posted : June 5, 2018
Sponsor:
Information provided by (Responsible Party):
EddingPharm Oncology Co., LTD.

Brief Summary:
The purpose of this randomized phase III trial is to evaluate the clinical benefit of the addition of Entinostat to endocrine therapy (Exemestane) in Chinese patients with HR-positive, ER2-negative locally advanced or metastatic breast cancer who have previously progressed on a non-steroidal aromatase inhibitor (AI). In addition,the safety, tolerance and PK profile are evaluated.

Condition or disease Intervention/treatment Phase
Advanced Breast Cancer Drug: Entinostat Drug: Placebo Drug: Exemestane Phase 3

Detailed Description:

This randomized phase III trial studies Exemestane and Entinostat to see how well they work compared to Exemestane alone in treating Chinese patients with hormone receptor-positive breast cancer that has spread to nearby tissue or lymph nodes or another place in the body.

Estrogen can cause the growth of breast cancer cells. Endocrine therapy using Exemestane may fight breast cancer by lowering the amount of estrogen the body makes. Entinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Previous Phase I trial in US breast cancer patients demonstrated a significant anti-tumor effect of combined therapy when compared to Exemestane alone.

It is not yet known whether Exemestane is more effective with or without Entinostat in Chinese patients with advanced breast cancer.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 512 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized Phase III Clinical Study of Entinostat Versus Placebo Combined With Endocrine Therapy in Chinese Patients With Hormone Receptor-positive Advanced Breast Cancer
Actual Study Start Date : May 15, 2018
Estimated Primary Completion Date : October 2020
Estimated Study Completion Date : April 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Exemestane

Arm Intervention/treatment
Active Comparator: ARM Entinostat+Exemestane
Patients receive Exemestane orally (PO) once daily (QD) on days 1-28 and Entinostat PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: Entinostat
Entinostat will be repeatedly administered PO on days 1, 8, 15 and 22 of each treatment cycle. Exemestane PO once daily on day 1-28.

Drug: Exemestane
Exemestane PO once daily on day 1-28.

Placebo Comparator: ARM Placebo+Exemestane
Patients receive Exemestane as in Arm A and placebo PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: Placebo
Patients receive Exemestane as in Arm A and placebo PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Drug: Exemestane
Exemestane PO once daily on day 1-28.




Primary Outcome Measures :
  1. Cmax (The Open-label Part) [ Time Frame: Run-in Period Day 1, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h; Run-in Period Day 2, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h. ]
    Maximum Plasma Concentration

  2. Tmax (The Open-label Part) [ Time Frame: Run-in Period Day 1, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h; Run-in Period Day 2, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h. ]
    Time at which maximum plasma concentration was observed.

  3. AUC 0-168h(The Open-label Part) [ Time Frame: Run-in Period Day 1, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h; Run-in Period Day 2, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h. ]
    area under the plasma concentration-time curve from time zero to 168h

  4. AUC 0-inf(The Open-label Part) [ Time Frame: Run-in Period Day 1, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h; Run-in Period Day 2, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h. ]
    Area under the plasma concentration-time curve from time zero to infinity.

  5. T1/2(The Open-label Part) [ Time Frame: Run-in Period Day 1, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h; Run-in Period Day 2, -5min, 0.25、0.5、0.75、1、2、4、8、12、24h. ]
    Elimination Half-life

  6. PFS (The Randomized Double-blinded Part) [ Time Frame: From the day of randomization, assessment will be made every 8 weeks (±3 days) to the earliest of documented disease progression (PD) or death caused by any reason (whichever happens first), assessed up to 40 months. ]
    Progression Free Survival, defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 (v1.1). The distribution of PFS will be estimated using the Kaplan- Meier method, with 95% confidence intervals calculated using Greenwood's formula. In the primary analysis of PFS, differences in treatment effect will be tested using stratified log rank tests, stratifying on the randomization stratification factors. Stratified univariate and multivariable Cox proportional-hazard models will be built to estimate the hazard ratios (HRs) for treatment effect for PFS as a supportive analysis. In all analyses, P-values will be two-sided.

  7. OS (The Randomized Double-blinded Part) [ Time Frame: From the day of randomization to the date of death from any cause,assessed up to 54 months. ]
    Overall Survival


Secondary Outcome Measures :
  1. Safety and tolerability (both the Open-label and Randomized Double-blinded parts) [ Time Frame: From the first administration of the investigational product to 30 days after the last administration.The Open-label part: assessed up to 4.5 months The Randomized Double-blinded: assessed up to 54months ]
    Incidence of toxicity graded according to National Cancer Institute CTCAE version 4.0. All treatment-emergent, baseline adverse events and hematological/biochemical toxicities based on laboratory measurements, as well as drug related AEs, will be summarized by both groups. The incidence of deaths and treatment-emergent serious AEs (defined as number of patients experiencing the AE divided by all treated patients) will be summarized and compared between Arm Entinostat+Exemestane and Arm Placebo+Exemestane using Fisher's exact test. Also, the incidence of adverse events leading to discontinuation of investigational product and/or patient's withdrawal from the study will be summarized and listed.

  2. Preliminary efficacy (PFS) (The Open-label Part) [ Time Frame: From the first administration, evaluation will be made every 8 weeks (±3 days), to the earliest of documented disease progression (PD) or death caused by any reason(whichever happens first),assessed up to 12 months. ]
    PFS defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 (v1.1).

  3. ORR (both the Open-label and Randomized Double-blinded parts) [ Time Frame: From the first administration on Day 1 Run-in Period or randomization day, evaluation will be made every 8 weeks (±3 days), until the earliest of documented PD or death caused by any reason (whichever happens first), assessed up to 54 months. ]
    Objective Response Rate, defined as the proportion of patients with complete response (CR) or partial response (PR) among all patients assessed per RESIST v1.1. Objective response in the two arms will be evaluated by comparing objective response rate (ORR, PR+CR) using a Fisher's exact test on the intention-to-treat patients with one-sided type I error of 2.5%. ORR will be summarized along with the exact binomial 95% confidence interval. In all analyses, P-values will be two-sided.

  4. TTD (both the Open-label and Randomized Double-blinded parts) [ Time Frame: Estimated per 8 weeks (±3 days) from the first administration of the investigational product on Day 1 Run-in Period or randomization day, to the earliest of documented PD or death caused by any reason(whichever happens first),assessed up to 54 months. ]
    Time to treatment deterioration, defined as time from randomization to disease progression or death or worsening of symptoms, assessed per RECIST v1.1.

  5. CBR (both the Open-label and Randomized Double-blinded parts) [ Time Frame: Estimated per 8 weeks (±3 days) from the first administration of the investigational product on Day 1 Run-in Period or randomization day, to the earliest of documented PD or death caused by any reason(whichever happens first),assessed up to 54 months. ]
    Clinical Benefit Rate, defined as CR+PR+SD≥ 24 weeks

  6. Cmax (The Randomized Double-blinded Part) [ Time Frame: Cycle 1 Day 1, 3 and 5h after the administration; Cycle 1 Day 15,1h after the administration; Cycle 2 Day 1, -72h before the administration. ]
    Maximum Plasma Concentration

  7. Tmax (The Randomized Double-blinded Part) [ Time Frame: Cycle 1 Day 1, 3 and 5h after the administration; Cycle 1 Day 15,1h after the administration; Cycle 2 Day 1, -72h before the administration. ]
    Time at which maximum plasma concentration was observed.

  8. AUC 0-168h (The Randomized Double-blinded Part) [ Time Frame: Cycle 1 Day 1, 3 and 5h after the administration; Cycle 1 Day 15,1h after the administration; Cycle 2 Day 1, -72h before the administration. ]
    Area under the plasma concentration-time curve from time zero to 168h.

  9. AUC 0-inf (The Randomized Double-blinded Part) [ Time Frame: Cycle 1 Day 1, 3 and 5h after the administration; Cycle 1 Day 15,1h after the administration; Cycle 2 Day 1, -72h before the administration. ]
    Area under the plasma concentration-time curve from time zero to infinity.

  10. T1/2 (The Randomized Double-blinded Part) [ Time Frame: Cycle 1 Day 1, 3 and 5h after the administration; Cycle 1 Day 15,1h after the administration; Cycle 2 Day 1, -72h before the administration. ]
    Elimination Half-life

  11. Preliminary efficacy (OS) (The Open-label Part) [ Time Frame: From the day of first administration to the date of death from any cause, assessed up to 54 months. ]
    Overall Survival



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Signed informed consent.
  2. Female, age≥18 years and ≤75 years (For the Open-label study, only the patients with natural menopause or surgical ovariectomy are enrolled).

    Note: surgical ovariectomy is defined as bilateral oophorectomy.

  3. The ECOG score is 0-1.
  4. Life expectancy duration ≥12 weeks.
  5. Estrogen receptor (ER) and/or progesterone receptor (PR) positive, human epidermal growth factor receptor 2 (HER-2) negative.

    1. ER and PR status should be histologically confirmed with staining of ≥ 1% cells.
    2. Positive human epidermal growth factor receptor 2 (HER-2) should be defined as positive ISH test or immunohistochemical test +++ or ++ with positive ISH amplification test.
    3. Receptor status may be based on any time during treatment prior to study randomization, and from any site (i.e. primary, recurrent, or metastatic).
  6. The patient must have measurable or non-measurable but can only be bone metastasis Stage III /locally advanced or metastatic breast cancer (in accordance with the general evaluation criteria, RECIST Version 1.1).

    For Part 2 the Randomized, double-blind study: the ratio of patients with non-measurable lesion (simple bone metastasis) should be ≤ 20%; not required for Part 1-the Open-label study.

    Notes:

    1. Evaluation of lesions must be performed within 4 weeks prior to the randomization. The radiological examination includes cranial MRI (magnetic resonance imaging), thoracic and abdominal contrast-enhanced CT (computed tomography, the lower limit of abdominal scan must reach anterior superior iliac spine). MRI is optional in patients who are allergic to the contrast substance. It needs to ensure that the lesions should be scanned and evaluated in accordance with the requirement in the general evaluation criteria RECIST version 1.1.
    2. Non-measurable lesion is defined as all the other lesions, including small foci (the maximum diameter<10 mm or minor axis of pathological lymph node ≥10 mm but <15 mm) and unmeasurable foci (meningeal foci, ascites, hydrothorax, pericardial effusion, pelvic effusion, inflammatory breast cancer, carcinomatous lymphangitis of skin or lung, abdominal mass that can't be diagnosed or followed up by radiology, and cystic lesion).
  7. In terms of the treatment of aromatase inhibitors (AI) other than Exemestane, the patients must meet at least one of the following conditions:

    1. Advanced tumor, progression of disease at any time point after previous treatment of nonsteroidal aromatase inhibitors (AI).
    2. Adjuvant therapy of nonsteroidal aromatase inhibitors (AI) for advanced tumor (regardless of other endocrine therapy previously), tumor recurrence at or within 12 months after the end of treatment.

    Notes:

    In the above two circumstances, any other therapy other than Exemestane (including but not limited to fulvestrant, everolimus, palbociclib, ribociclib, abemaciclib and other CDK inhibitors) must be competed two weeks prior to the start date of the dose of investigational product, i.e., Day 1 (D1) in the Run-in period in open-lable study and Day 1 in the 1st cycle (C1D1, Cycle 1 Day 1) in the randomized, double-blind study.

  8. Exemestane is allowed to be used in the following two circumstances:

    1. Within 4 weeks prior to C1D1;
    2. If the disease-free interval is >12 months after discontinuation of Exemestane, Exemestane as previous adjuvant therapy is allowed.
  9. For the patients with metastatic breast cancer who have already received at most one chemotherapeutic regimen,the end of chemotherapy should be at least 4 weeks before the randomization.
  10. The end of previous radiotherapy should be at least 2 weeks before the randomization, and the patient must have recovered from the toxicity of radiotherapy (grade 1 or below).
  11. The patient is allowed to receive the medications to regulatebone metabolism, for example, bisphosphonates and RANK-L (nuclear factor κB ligand receptor activator, e.g., denosumab); the bone metabolism-regulating therapy needs to be initiated 1 week prior to the first administration of treatment in the clinical trial, the same drug must be used throughout the clinical trial, except that actual clinical situation that requires amendment to the therapeutic regimen;
  12. Patients must have adequate hematological, hepatic and renal function one week (7 days) prior to the Run-in period in open-label study and prior to randomization in randomized, double-blind study, which are defined as below:

    1. Haemoglobin (Hgb) ≥ 90 g/L;
    2. platelet count ≥ 100×109/L
    3. Absolute neutrophil count ≥ 1.5×109/L
    4. Serum creatinine ≤ 2.0 mg/dL
    5. Total bilirubin < 1.5 ×ULN (upper limit of normal) (≤3 mg/dL in case of Gilbert syndrome);
    6. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5×ULN; ALT and AST ≤5×ULN for liver metastasis.
  13. Open-label study only enroll the patients with natural menopause or surgical ovariectomy. Postmenopausal, premenopausal/perimenopausal and menopausal female patients can be enrolled in the randomized, double-blind study; patients with childbearing potential must agree to use recognized effective methods for contraception (including condom containing sperm inactivation, vaginal septum, oral or injectable contraceptives, etc.) or abstain from sex life during participation in the study and within three months after discontinuation of the treatment.

Postmenopause is defined as:

  1. Underwent irreversible surgical sterilization such as amputation of uterus, bilateral oophorectomy, but not tubal ligation;
  2. Age≥60 years;
  3. Age<60 years, natural menopause≥12 months, blood follicle stimulating hormone (FSH) and estradiol (E2) levels within the postmenopausal range (FSH>40 IU/L and E2<30 pg/mL) in case of no use of chemotherapy, Tamoxifen, Toremifene or ovariectomy in recent one year;
  4. Age <60 years, currently using Tamoxifen or Toremifene, blood follicle stimulating hormone (FSH) and estradiol (E2) levels within the postmenopausal range (FSH>40 IU/L and E2<30 pg/mL).

Notes:

  1. It will be considered as the premenopausal or perimenopausal state if the above criteria on menopause are not met;
  2. The premenopausal/perimenopausal female patients can be enrolled only when they agree to use the concomitant drug LHRH agonist Goserelin, and need to start the dose of LHRH agonist at least 4 weeks prior to randomization;
  3. If the patient has received other LHRH agonist prior to entry in the study, he/she must switch to Goserelin during the study.

Exclusion Criteria:

  1. Previous or current metastatic foci in central nervous system, or leptomeningeal disease;
  2. Current or previous history of other malignant tumor (except for cured basal cell carcinoma or squamous cell carcinoma of skin, carcinoma in situ of cervix), unless taking radical therapy and no evidence of recurrence or metastasis in recent 5 years;
  3. Uncontrolled or serious cardiovascular disease, for example, refractory angina pectoris, congestive heart failure within half a year prior to the screening; myocardial infarction within 12 months prior to screening; any history of clinically significant ventricular arrhythmia, prolonged QT interval; history of cerebrovascular accident, symptomatic coronary heart disease requiring drug therapy;
  4. The 3rd space effusion (e.g., hydrothorax and ascites) which can not be controlled with drainage or other therapeutic method;
  5. Patients with a history of immune deficiency, including HIV-positive;
  6. Clinically significant abnormality in gastrointestinal function that may affect intake, transportation or absorption of oral administration of drugs (e.g., inability to swallow, chronic diarrhea, intestinal obstruction, etc.);
  7. Unrecovered toxicity resulted from previous medication or toxicity, evaluation score is still > grade 1 or baseline (except alopecia);
  8. Use of HDAC inhibitor (e.g., valproic acid, Entinostat, Vorinostat, chidamide, etc.) prior to enrollment or intended use of HDAC inhibitor during the study;
  9. Known allergic to Exemestane, Entinostat or other drugs containing benzamide structure (e.g., Tiapride, Remoxipride, clebopride, etc.); allergic to Goserelin in premenopausal/perimenopausal female patients;
  10. Any cognitive disorder resulted from mental or neurological disease, including epilepsy and dementia;
  11. Clinically uncontrolled active infection, for example, acute pneumonia, active phase of hepatitis B (positive Hepatitis B surface antigen, and copy of DNA > upper limit of normal) two weeks (14 days) prior to the dose in the Open-label study and prior to randomization in the double-blind study;
  12. Major surgery (judged by investigators in accordance with the previous history), major trauma or fracture 4 weeks (28 days) prior to the first dose in the Open-label study and prior to randomization in the double-blind study;
  13. Organ transplant recipient;
  14. Women who are pregnant or breastfeeding;
  15. Patients who plan to receive other anticancer therapy or other investigational product during the study;
  16. Participation in any other drug clinical trial 4 weeks (28 days) prior to the screening or currently receiving treatment in other clinical trials (except those who are participating in the follow-up of overall survival in one study);
  17. Patients who are considered by investigators as inappropriate to participate in this clinical trial.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03538171


Contacts
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Contact: Min Dong, Ph D +86-021-3175 7830 min.dong@eocpharma.com
Contact: Song Lu +86-021-31757888 song.lu@eocpharma.com

Locations
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China, Beijing
Cancer Hospital Chinese Academy Medical Sciences Recruiting
Beijing, Beijing, China, 10021
Contact: Binghe Xu, Ph D         
Sponsors and Collaborators
EddingPharm Oncology Co., LTD.

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Responsible Party: EddingPharm Oncology Co., LTD.
ClinicalTrials.gov Identifier: NCT03538171     History of Changes
Other Study ID Numbers: EOC103A3101
First Posted: May 28, 2018    Key Record Dates
Last Update Posted: June 5, 2018
Last Verified: June 2018

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
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Entinostat
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Hormones
Exemestane
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents
Aromatase Inhibitors
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Estrogen Antagonists
Hormone Antagonists
Histone Deacetylase Inhibitors