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Alpelisib (BYL719) in Combination With Continued Endocrine Therapy Following Progression on Endocrine Therapy in Hormone Receptor Positive, HER2 Negative, PIK3CA Mutant Metastatic Breast Cancer

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ClinicalTrials.gov Identifier: NCT04762979
Recruitment Status : Recruiting
First Posted : February 21, 2021
Last Update Posted : September 2, 2021
Sponsor:
Collaborators:
Novartis
University of Wisconsin, Madison
Information provided by (Responsible Party):
Amanda Parkes, Big Ten Cancer Research Consortium

Brief Summary:
Patients who have histologically confirmed metastatic or unresectable (not amenable to curative therapy) breast cancer may be screened for eligibility. All patients must have HER2 negative breast cancer with the identified PIK3CA mutation and received at least one line of endocrine therapy. The study will consist of a screening phase, a treatment phase, and a post-treatment phase which includes safety, efficacy, and follow-up. The treatment phase will include taking alpelisib daily in combination with continued use of either Fulvestrant or Aromatase Inhibitor per standard of care until disease progression or unacceptable toxicity.

Condition or disease Intervention/treatment Phase
Hormone Receptor Positive Breast Carcinoma HER2-negative Breast Cancer PIK3CA Mutant Metastatic Breast Cancer Drug: Alpelisib Drug: Fulvestrant Drug: Aromatase inhibitor Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 44 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: Apelisib 300mg PO, Daily AND Aromatices Inhibitor(AI) or Fulvestrant 500mg IM per Standard of Care
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II, Single Arm, Non-randomized Study of Alpelisib (BYL719) in Combination With Continued Endocrine Therapy Following Progression on Endocrine Therapy in Hormone Receptor Positive, HER2 Negative, PIK3CA Mutant Metastatic Breast Cancer
Actual Study Start Date : February 12, 2021
Estimated Primary Completion Date : January 2024
Estimated Study Completion Date : January 2025

Resource links provided by the National Library of Medicine

Drug Information available for: Fulvestrant

Arm Intervention/treatment
Experimental: Alpelisib + Aromatase Inhibitor or Fulvestrant
Subjects will be treated with Alpelisib in combination with either an Aromatase Inhibitor or Fulvestrant per Standard of Care
Drug: Alpelisib
Alpelisib 300mg, PO, days 1-28 of each cycle.

Drug: Fulvestrant
Fulvestrant 500mg, IM, once monthly

Drug: Aromatase inhibitor
Aromatase Inhibitor, administered per standard of care




Primary Outcome Measures :
  1. Progression-Free Survival (PFS) [ Time Frame: From enrollment until the time of disease progression, up to 60 months ]
    To estimate the progression-free survival (PFS) of alpelisib with continued endocrine therapy (aromatase inhibitor or fulvestrant) following progression in patients with hormone receptor positive, HER2 negative, PIK3CA mutant metastatic breast cancer.


Secondary Outcome Measures :
  1. Objective Response Rate (ORR) [ Time Frame: From enrollment until the time of disease progression, up to 60 months ]
    To estimate the objective response rate (ORR) of alpelisib with continued endocrine therapy (aromatase inhibitor or fulvestrant) following progression in patients with hormone receptor positive, HER2 negative, PIK3CA mutant metastatic breast cancer.

  2. Clinical Benefit Rate (CBR) [ Time Frame: From enrollment until the time of disease progression, up to 60 months ]
    To estimate the clinical benefit rate (CBR) of alpelisib with continued endocrine therapy (aromatase inhibitor or fulvestrant) following progression in patients with hormone receptor positive, HER2 negative, PIK3CA mutant metastatic breast cancer.

  3. Duration of Response (DOR) [ Time Frame: From enrollment until the time of disease progression, up to 60 months ]
    To estimate the duration of response (DoR) of alpelisib with continued endocrine therapy (aromatase inhibitor or fulvestrant) following progression in patients with hormone receptor positive, HER2 negative, PIK3CA mutant metastatic breast cancer.

  4. Overall Survival (OS) [ Time Frame: From enrollment until the time of death, up to 60 months ]
    To estimate the overall survival (OS) of alpelisib with continued endocrine therapy (aromatase inhibitor or fulvestrant) following progression in patients with hormone receptor positive, HER2 negative, PIK3CA mutant metastatic breast cancer.

  5. Safety Profile of alpelisib with continued endocrine therapy(aromatse inhibitor or fulvestrant) [ Time Frame: From enrollment until 30 days after completion of study therapy or subject withdrawal, up to seven months ]
    To estimate grade 3-4 adverse events or events of any grade leading to dose adjustments of alpelisib with continued endocrine therapy (aromatase inhibitor or fulvestrant) following progression in patients with hormone receptor positive, HER2 negative, PIK3CA mutant metastatic breast cancer.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Eligibility Criteria Inclusion Criteria

  • Written informed consent and HIPAA authorization for release of personal health information. NOTE: HIPAA authorization may be included in the informed consent or obtained separately.
  • Age ≥ 18 years at the time of consent.
  • ECOG Performance Status of 0-2 within 28 days prior to registration.
  • Men and postmenopausal female patients. Premenopausal patients (age 18 or older) who have been rendered postmenopausal will also be included. Postmenopausal is defined as:

    • Age >= 55 years and one year or more of amenorrhea.
    • Age < 55 years and one year or more of amenorrhea, with estradiol < 20 pg/ml
    • Age < 55 years with prior hysterectomy but intact ovaries, with estradiol < 20 pg/ml
    • Prior bilateral oophorectomy

NOTE: Women who do not fit the criteria for being postmenopausal as above are deemed premenopausal. Premenopausal patients (age 18 or older) who can be rendered postmenopausal will also be eligible. Methods eligible for rending premenopausal patients postmenopausal include:

  • Ongoing treatment with luteinizing hormone-releasing hormone (LHRH) agonist, with treatment starting at least 4 weeks prior to randomization and with estradiol < 20 pg/ml. LHRH agonist must be administered within 7 days of scheduled administration date during the length of the clinical trial.
  • Histologically confirmed metastatic or unresectable (not amenable to curative therapy) breast cancer.
  • Has confirmed hormone receptor positivity with ER >=1% and/or PR >=1%. Preferred receptor testing is obtained from a metastatic site, but can be from the primary breast or axilla biopsy as long as this is most recent biopsy.
  • Has confirmed HER2 negative breast cancer. HER2 negative or non-amplified is determined by the current ASCO-CAP criteria which are as follows: HER2 testing by IHC as 0 or 1+. Or negative by in situ hybridization (FISH/CISH/SISH) defined as Her2/CEP17 ratio <2 and for single probe assessment a HER2 copy number <6). Preferred receptor testing is obtained from a metastatic site, but can be from the primary breast or axilla biopsy as long as this is most recent biopsy.
  • PIK3CA mutation identified via local testing from tumor tissue or blood.
  • Has either measurable disease, i.e. at least one measurable lesion as per RECIST 1.1 criteria OR if no measurable disease is present, then at least one predominantly lytic bone lesion must be present, within 28 days prior to registration. Patients with no measurable disease and only one predominantly lytic bone lesion that has been previously irradiated are eligible if there is documented evidence of disease progression of the bone lesion after irradiation.
  • Has received at least one line of therapy with an endocrine therapy or endocrine therapy combination with other agents in the metastatic setting.
  • Must have received endocrine therapy (aromatase inhibitor or fulvestrant as single agent or in combination with other agents) as last line of therapy with progressive disease, as determined by treating physician.
  • No more than two prior lines of endocrine therapy or endocrine therapy combinations in the metastatic setting. Transition from one nonsteroidal aromatase inhibitor to a second nonsteroidal aromatase inhibitor due to tolerance will only count as one line of endocrine therapy. Combination therapy will be considered one line even if one of the agents is discontinued and the other continued.
  • Patient must have received treatment with a CDK4/6 inhibitor for breast cancer in the metastatic setting. CDK4/6 inhibitor discontinuation due to intolerance or reasons other than progression is allowed.
  • Demonstrate adequate organ function as defined in the protocol; all screening labs to be obtained within 28 days prior to registration.
  • Men who are not surgically or medically sterile must agree to use an acceptable method of contraception. Acceptable forms of contraception include castration, vasectomy, and condom/occlusive cap with spermicidal foam/gel/film/cream/suppository. Male patients with female sexual partners who are pregnant, possibly pregnant, or who could become pregnant during the study must agree to use condoms at least one month after the last dose of study drug. Total abstinence for the same study period is an acceptable alternative.
  • Premenopausal females must agree to use an acceptable method of contraception or to abstain from sexual intercourse for the duration of their participation in the study and for 3 months after discontinuation of therapy. Adequate forms of contraception include: total abstinence, surgery intended to prevent pregnancy (defined as hysterectomy, bilateral oophorectomy or bilateral tubal ligation), non-hormonal IUD, or condom/occlusive cap with spermicidal foam/gel/film/cream/suppository).
  • As determined by the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study
  • HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of registration are eligible for this trial.

Exclusion Criteria

  • Patients with prior chemotherapy for metastatic or advanced disease.
  • Active infection requiring systemic therapy.
  • Patients with a prior or concurrent malignancy whose natural history or treatment has the potential to interfere with the safety or efficacy assessment of the investigational regimen are not eligible for this trial.
  • Uncontrolled, active CNS metastases causing clinical symptoms or metastases that require therapeutic intervention, including leptomeningeal disease.

NOTE: Subjects who are symptomatic and have not undergone prior brain imaging must undergo a head computed tomography (CT) scan or brain magnetic resonance imaging (MRI) within 28 days prior to registration to exclude brain metastases.

  • Treatment with any investigational drug within 14 days prior to registration.
  • Radiotherapy to index lesion <= 4 weeks or limited field radiation to index lesion for palliation <= 2 weeks prior to randomization.
  • Established diagnosis of diabetes mellitus type I or persistent poorly controlled diabetes mellitus, with an uninterrupted hemoglobin A1c > 8.0% for 1 year or greater despite standard care. For patients with newly diagnosed diabetes mellitus without 1 year of hemoglobin A1c values, available hemoglobin A1c values cannot all be > 8.0%.
  • Symptomatic visceral disease or any disease burden that makes the patient ineligible for endocrine therapy per the investigator's best judgment.
  • As determined by the enrolling physician or protocol designee, impairment of gastrointestinal function or disease that may significantly alter the absorption of the study drugs.
  • Currently documented clinically active pneumonitis. Patients could have received prior treatment for pneumonitis but pneumonitis must have clinically resolved and treatments for pneumonitis (e.g. steroids) must be completed prior to randomization.
  • Active cardiac disease, defined as any of the following within 6 months prior to the start of study treatment:

    • History of angina pectoris, coronary artery bypass graft, symptomatic pericarditis, or myocardial infarction.
    • History of documented congestive heart failure (New York Heart Association functional classification III-IV).
    • History of any cardiac arrhythmias, (e.g., ventricular tachycardia), complete left bundle branch block, high grade AV block (e.g., bifascicular block, Mobitz type II and third degree AV block), supraventricular, nodal arrhythmias, or conduction abnormality.
    • Systolic blood pressure (SBP) >180 mmHg and/or Diastolic Blood Pressure (DBP) ≥ 100 mm Hg at screening. Initiation or adjustment of antihypertensive medication(s) is allowed prior to screening.
  • History of acute pancreatitis within 1 year of screening or a past medical history of chronic pancreatitis.
  • Prior treatment with PI3K, mTOR or AKT inhibitor in the metastatic setting.
  • History of chronic steroid use (defined as daily steroid use > 14 days) and requirement for continued chronic steroid use.

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): NCT04762979


Contacts
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Contact: Julia Beck 317-634-5842 ext 62 jbeck@hoosiercancer.org
Contact: LeaEtta Hyer 317-634-5842 ext 26 lhyer@hoosiercancer.org

Locations
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United States, Illinois
University of Illinois Cancer Center Recruiting
Chicago, Illinois, United States, 60612
Contact: Roxana Toh    312-996-2088    rtoh@uic.edu   
Principal Investigator: Oana Danciu, MD         
United States, Pennsylvania
Penn State Cancer Institute Recruiting
Hershey, Pennsylvania, United States, 17033
Contact: CI-CTO REG Penn State       PSCI_CTO_REG@pennstatehealth.psu.edu   
Principal Investigator: Cristina Truica, MD         
United States, Wisconsin
University of Wisconsin Recruiting
Madison, Wisconsin, United States, 53705
Contact: UWCCC Cancer Cennect    800-622-8922    cancerconnect@uwcarbone.wisc.edu   
Principal Investigator: Amanda Parkes, MD         
Sponsors and Collaborators
Amanda Parkes
Novartis
University of Wisconsin, Madison
Investigators
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Principal Investigator: Amanda Parkes, MD University of Wisconsin, Madison
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Responsible Party: Amanda Parkes, Principal Investigator, Big Ten Cancer Research Consortium
ClinicalTrials.gov Identifier: NCT04762979    
Other Study ID Numbers: BTCRC-BRE19-409
First Posted: February 21, 2021    Key Record Dates
Last Update Posted: September 2, 2021
Last Verified: September 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Fulvestrant
Aromatase Inhibitors
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Estrogen Receptor Antagonists
Estrogen Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action