Clinical Trials /

Endoxifen in Adults With Hormone Receptor Positive Solid Tumors

NCT01273168

Description:

Background: - Some types of cancer cells that have hormone receptors on their surfaces need the hormone estrogen to grow. The drug tamoxifen blocks estrogen from binding to the tumor cells, which helps to slow or stop the growth of cancer. Tamoxifen has been approved for treatment of certain types of estrogen-linked cancers, such as breast and ovarian cancer. - The experimental drug Z-Endoxifen HCl (endoxifen) is related to tamoxifen, and has been shown to work against similar estrogen-linked cancers. In many cancer patients, tamoxifen is turned into endoxifen by enzymes in the liver; however, not all people have the liver enzymes that can turn tamoxifen into endoxifen, which means that the drug cannot work properly. Taking certain other drugs at the same time as tamoxifen can also keep it from turning into endoxifen. Researchers are interested in determining whether endoxifen tablets are effective in slowing or stopping tumor growth in individuals whose hormone-linked tumors have not responded to standard treatment. Objectives: - To test the safety and effectiveness of daily endoxifen in individuals with hormone receptor positive solid tumors that have not responded to standard treatment. Eligibility: - Individuals at least 18 years of age who have been diagnosed with hormone receptor positive solid tumors (breast or other tumors), desmoid tumors, or gynecologic tumors that have not responded to standard treatment. Individuals with breast cancer must have had at least one prior chemotherapy regimen and one prior hormonal regimen for metastatic disease. Design: - Participants will be screened with a full medical history (including prior hormone use) and physical examination, as well as blood and urine tests, tumor imaging studies, and an eye examination. - Participants will take endoxifen tablets daily for 28-day cycles of treatment, and will be asked to keep a medication diary to record any side effects. - Participants will have regular clinic visits with blood and urine samples and imaging studies to evaluate the cancer's response to treatment. - Participants will continue to take endoxifen for as long as the cancer responds to the treatment.

Related Conditions:
  • Breast Carcinoma
  • Desmoid-Type Fibromatosis
  • Endometrial Carcinoma
  • Fallopian Tube Carcinoma
  • Ovarian Carcinoma
  • Primary Peritoneal Carcinoma
  • Uterine Sarcoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Endoxifen in Adults With Hormone Receptor Positive Solid Tumors
  • Official Title: Phase I Trial of Z-Endoxifen in Adults With Refractory Hormone Receptor-Positive Breast Cancer, Desmoid Tumors, Gynecologic Tumors, or Other Hormone Receptor-Positive Solid Tumors

Clinical Trial IDs

  • ORG STUDY ID: 110061
  • SECONDARY ID: 11-C-0061
  • NCT ID: NCT01273168

Conditions

  • Hormone Receptor-Positive Breast
  • Gynecologic
  • Desmoid
  • Hormone Receptor-Positive Neoplasms

Interventions

DrugSynonymsArms
Z-Endoxifen0

Purpose

Background: - Some types of cancer cells that have hormone receptors on their surfaces need the hormone estrogen to grow. The drug tamoxifen blocks estrogen from binding to the tumor cells, which helps to slow or stop the growth of cancer. Tamoxifen has been approved for treatment of certain types of estrogen-linked cancers, such as breast and ovarian cancer. - The experimental drug Z-Endoxifen HCl (endoxifen) is related to tamoxifen, and has been shown to work against similar estrogen-linked cancers. In many cancer patients, tamoxifen is turned into endoxifen by enzymes in the liver; however, not all people have the liver enzymes that can turn tamoxifen into endoxifen, which means that the drug cannot work properly. Taking certain other drugs at the same time as tamoxifen can also keep it from turning into endoxifen. Researchers are interested in determining whether endoxifen tablets are effective in slowing or stopping tumor growth in individuals whose hormone-linked tumors have not responded to standard treatment. Objectives: - To test the safety and effectiveness of daily endoxifen in individuals with hormone receptor positive solid tumors that have not responded to standard treatment. Eligibility: - Individuals at least 18 years of age who have been diagnosed with hormone receptor positive solid tumors (breast or other tumors), desmoid tumors, or gynecologic tumors that have not responded to standard treatment. Individuals with breast cancer must have had at least one prior chemotherapy regimen and one prior hormonal regimen for metastatic disease. Design: - Participants will be screened with a full medical history (including prior hormone use) and physical examination, as well as blood and urine tests, tumor imaging studies, and an eye examination. - Participants will take endoxifen tablets daily for 28-day cycles of treatment, and will be asked to keep a medication diary to record any side effects. - Participants will have regular clinic visits with blood and urine samples and imaging studies to evaluate the cancer's response to treatment. - Participants will continue to take endoxifen for as long as the cancer responds to the treatment.

Detailed Description

      BACKGROUND:

        -  Genetic polymorphisms in CYP2D6 and concomitant medications alter tamoxifen metabolism,
           limiting exposure to the active metabolite endoxifen. These factors are associated with
           a higher rate of recurrence and shorter disease-free survival in breast cancer patients
           receiving tamoxifen.

        -  Administration of endoxifen directly to patients is anticipated to bypass the effects of
           CYP2D6 polymorphisms and concomitant medications and provide adequate active drug levels
           in all treated patients, resulting in clinical benefit.

        -  16 alpha-[(18)F]-fluoro-17 beta estradiol (FES) is an investigational radiolabeled
           imaging agent used with positron emission tomography (PET) to investigate tumor estrogen
           receptor activity

      OBJECTIVES:

      Primary:

        -  Establish the safety and tolerability of oral endoxifen (Z-Endoxifen HCl) administered
           on a daily schedule to patients with refractory hormone receptor positive solid tumors
           (breast or other tumors), desmoid tumors, or gynecologic tumors.

        -  Establish the maximum tolerated dose (MTD) of oral Z-endoxifen HCl administered on a
           daily schedule.

      Secondary:

      -Determine the pharmacokinetics of oral Z-endoxifen (HCl form).

      Exploratory:

      -Evaluate the change in [(18)F]FES uptake using PET/CT in hormone receptor-positive tumors
      before and after treatment with oral Z-endoxifen-HCI.

      ELIGIBILITY:

        -  Adults with histologically documented hormone receptor positive solid tumors (breast or
           other tumors), desmoid tumors, or gynecologic tumors.

        -  Patients with breast cancer must have had at least one prior chemotherapy regimen and
           one prior hormonal regimen for metastatic disease. All other patients must have disease
           that has progressed following at least one line of standard therapy.

        -  No major surgery, radiation, hormonal, or chemotherapy within 4 weeks prior to study
           enrollment, and recovered from toxicities of prior therapies to at least eligibility
           levels.

        -  Patients in the 6-patient expansion cohort at the MTD will be asked to undergo optional
           tumor biopsies for research purposes.

      STUDY DESIGN:

        -  Z-endoxifen will be administered orally once a day in 28-day cycles.

        -  Dose escalation will proceed until the MTD is established or targeted maximum dose (DL8)
           reached. Six additional patients will then be entered in an expansion cohort to assess
           pharmacodynamics and pharmacokinetics

        -  When imaging agent is available, optional FES PET/CT scans will be performed at baseline
           and 1-3 hours after Z-endoxifen treatment once during week 1 of cycle 1.

        -  As a relative bioavailability study, 6 patients in the expansion cohort will be given a
           single dose of the free base form of Z-endoxifen on day 1 and will then continue on
           study taking Z-endoxifen HCl; blood and urine will be collected for PK at baseline, on
           cycle 1 days 1 and 2, and on cycle 2 day 1. Please note: As of Febuary 2017, we will no
           longer evaluate the free base form of Z-endoxifen in the expansion cohort due to drug
           supply issues.
    

Trial Arms

NameTypeDescriptionInterventions
0ExperimentalZ-endoxifen will be administered orally once a day in 28-day cycles
  • Z-Endoxifen

Eligibility Criteria

        -  INCLUSION CRITERIA:

        Patients with the following types of histologically documented solid tumors:

          -  ER +/PR+, ER+/PR-, or ER-/PR+ breast cancer

          -  Gynecologic tumors (endometrial, ovarian, uterine, fallopian tube, peritoneal, etc.)

          -  Desmoid tumors

          -  Tumors that are ER+ or PR+ by immunohistochemistry (including low-level expression)
             such as non-small cell lung, colorectal, and prostate

        Patients with breast cancer must have had at least one prior chemotherapy regimen for
        metastatic disease. Additionally, patients with breast cancer must have received prior
        tamoxifen and/or aromatase inhibitor therapy (if postmenopausal) with at least one hormonal
        regimen in the metastatic setting. Patients with HER2+ breast cancer must have progressed
        after at least one prior HER2-directed regimen (trastuzumab, lapatinib) for metastatic
        disease.

        All other patients must have disease that has progressed following at least one line of
        standard therapy. Prior therapy with tamoxifen is allowed.

        Patients enrolled based on tumor ER/PR status must have ER/PR status confirmed by the
        Laboratory of Pathology, NIH. ER/PR status will be determined on a metastatic site, if
        possible; otherwise, the original site or available tissue will be acceptable.

        Patients must have recovered to at least eligibility levels following any display of
        adverse events and/or toxicity due to prior chemotherapy or biologic therapy. They must not
        have had hormonal therapy, chemotherapy or biologic therapy within 4 weeks prior to
        entering the study (6 weeks for nitrosoureas or mitomycin C, or UCN-01). Patients must be
        greater than or equal 2 weeks since any prior administration of study drug in a Phase 0
        study (also referred to as an "early Phase I study" or "pre-Phase I study" where a
        sub-therapeutic dose of drug is administered) at the PI's discretion. Patients must be
        greater than or equal to 4 weeks since any prior radiation or major surgery. However,
        patients receiving bisphosphonates or therapeutic anticoagulation are eligible for this
        trial.

        Age greater than or equal 18 years

        The Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2

        Life expectancy > 3 months

        Patients must have normal or adequate organ and marrow function as defined below:

        Absolute neutrophil count greater than or equal to 1,500/microL

        Platelets greater than or equal to 100,000/micorL

        Total bilirubin within less than or equal to 1.5 times institutional upper limit of normal

        AST (SGOT)/ALT (SGPT) less than or equal to 2.5 times institutional upper limit of normal

        Creatinine < 1.5 times upper limit of normal

        OR

        Creatinine clearance greater than or equal to 60 mL/min/1.73 m(2) for patients with
        creatinine levels greater than or equal to 1.5 times upper limit of normal.

        The effects of Z-endoxifen on the developing human fetus are unknown. For this reason,
        women of childbearing potential and men must agree to use adequate nonhormonal
        contraception (barrier method of birth control or abstinence) prior to study entry, for the
        duration of study participation, and for 2 months after discontinuation from the study.
        Women of childbearing potential must have a negative pregnancy test in order to be
        eligible. Should a woman become pregnant or suspect she is pregnant while participating in
        this study, she should inform her treating physician immediately. Because there is an
        unknown but potential risk for adverse events in nursing infants secondary to treatment of
        the mother with Z-endoxifen, breastfeeding should be discontinued if the mother is treated
        with Z-endoxifen.

        Ability to understand and the willingness to sign a written informed consent document.

        EXCLUSION CRITERIA:

        Patients receiving any other investigational agents.

        Patients with known brain metastases are excluded from this clinical trial, with the
        exception of patients whose brain metastatic disease status has remained stable for greater
        than or equal to 3 months after treatment of the brain metastases, without steroids or
        anti-seizure medications. These patients may be enrolled at the discretion of the principal
        investigator.

        Patients with clinically significant illnesses which could compromise participation in the
        study, including, but not limited to, uncontrolled infection, uncontrolled diabetes,
        uncontrolled hypertension, symptomatic congestive heart failure, unstable angina pectoris,
        myocardial infarction within the past 6 months, uncontrolled cardiac arrhythmia,
        stroke/cerebrovascular accident within the past 6 months, or psychiatric illness/social
        situations that in the investigator s opinion would make it undesirable for the patient to
        participate in the trial, or which would jeopardize compliance with the protocol.

        Patients with untreated spinal cord metastases or metastases close to vital organs (as
        determined by the principal investigator) are excluded because of the risk of hormonal
        flare.

        Patients with a history of deep vein thrombosis must be on anti-coagulation therapy prior
        to enrollment. Patients requiring prophylactic anti-coagulation are eligible.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Establish safety and MTD of Z-endoxifen
Time Frame:28 days (1 cycle)
Safety Issue:
Description:Adverse events will be graded as described in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

Secondary Outcome Measures

Measure:Determine the pharmacokinetics of Zendoxifen (free base and HClforms)
Time Frame:28 days (1 cycle)
Safety Issue:
Description:

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Pharmacokinetics
  • Advanced Cancer
  • Cytochrome P 450
  • Selective Estrogen Receptor Modulator
  • Tamoxifen Metabolite
  • Gynecologic Cancer
  • Breast Cancer
  • Desmoid Tumor
  • Endometrial Cancer
  • Ovarian Cancer
  • Uterine Cancer
  • Fallopian Tube Cancer
  • Peritoneal Cancer

Last Updated

August 11, 2021