Clinical Trials /

Reversing Hormone Resistance in Advanced Breast Cancer With Pazopanib

NCT01466972

Description:

The purpose of this study is to evaluate the clinical benefit rate at 12 weeks from the addition of pazopanib to a non-steroidal aromatase inhibitor (NSAI) (letrozole or anastrozole) in patients with hormone receptor positive advanced breast cancer progressing on the same NSAI hormone therapy.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Reversing Hormone Resistance in Advanced Breast Cancer With Pazopanib
  • Official Title: Reversing Hormone Resistance in Advanced Breast Cancer With Pazopanib

Clinical Trial IDs

  • ORG STUDY ID: 117513
  • NCT ID: NCT01466972

Conditions

  • Breast Cancer
  • Breast Neoplasm

Interventions

DrugSynonymsArms
PazopanibVotrientPazopanib in combination with a NSAI

Purpose

The purpose of this study is to evaluate the clinical benefit rate at 12 weeks from the addition of pazopanib to a non-steroidal aromatase inhibitor (NSAI) (letrozole or anastrozole) in patients with hormone receptor positive advanced breast cancer progressing on the same NSAI hormone therapy.

Detailed Description

      In this trial, the investigators propose to evaluate the role of VEGFR blockade with the
      tyrosine kinase inhibitor pazopanib in combination with nonsteroidal aromatase inhibitors
      (NSAI) in patients who are progressing or have relapsed on the same NSAI hormone therapy
      given for advanced or early stage breast cancer. If this trial demonstrates clinical benefit,
      this all oral combination could be tested in both the neoadjuvant and metastatic settings in
      a randomized phase II design.

      In order to investigate potential factors predicting response or resistance to pazopanib and
      NSAIs, several translational studies have been incorporated into this trial.

      The prognostic value of circulating tumor cells (CTC) has been demonstrated in several
      studies in breast cancer, especially in advanced stage [35-38]. At UCSF in the laboratory of
      Dr. John Park, the investigators have demonstrated expertise in the measurement of CTC in
      patients with advanced stage breast cancer by IC/FC assay. CTC are first enriched with
      immunomagnetic beads coated with EpCAM, then EpCAM+, CD45-, nucleic acid+ cells are detected
      by flow cytometry. This technique is highly sensitive and reproducable, and allows sorting of
      cells for molecular analysis as well as analysis of cell surface markers[39]. In this trial,
      the investigators will collect patient's peripheral blood samples every 4 weeks while on
      treatment and follow any reduction of CTC.

      The mechanisms of hormonal resistance includes intrinsic and acquired pathways: decreased ER
      expression accounts for intrinsic resistance and the increased receptor tyrosine kinase
      pathway relates to acquired resistance [40-42]. The investigators plan to analyze the
      mutation of PI3K/Akt and deletion of PTEN by sequencing in CTC (depending on numbers of
      cells, which in turn determines feasibility), in order to make a preliminary assessment of
      potential markers of response to pazopanib.

      The tumor microenvironment plays an important role in cancer development and progression.
      Clinical studies have revealed that the increased T regulatory cells (Treg), high ratios of
      CD4/CD8 T lymphocytes, and extra follicular B cells in primary tumors correlated with worse
      overall survival [43-45]. Recently, studies from preclinical models have shown that tumor
      associated macrophages (TAM) can promote pulmonary metastases in breast cancer animal models,
      and in both the preclinical and clinical settings are associated with worse clinical outcome
      [46-48]. TGFβ has been linked to hormonal resistance in breast cancer. The activation of TGFβ
      leads to increased regulatory CD4+ T cells and decreased cytotoxic CD8+ T cells in the tumor
      microenvironment [49]. A recent study in non-small cell lung cancer suggests that baseline
      and post-treatment levels of cytokines, particularly IL-4 and IL-12 correlated with response
      to pazopanib[50]. In this study, the investigators will collect patient's serum to monitor
      the level of cytokines at baseline and during treatment, the investigators will compare the
      change of cytokine level with pazopanib in each patient, and also compare between responders
      and non-responders. This information may help us to identify biomarkers that would predict
      response to antiangiogenic therapy and to identify possible mechanisms of resistance.
    

Trial Arms

NameTypeDescriptionInterventions
Pazopanib in combination with a NSAIExperimentalNon-randomized, open label
  • Pazopanib

Eligibility Criteria

        Inclusion Criteria:

          1. Subjects must provide written informed consent prior to performance of study specific
             procedures or assessments, and must be willing to comply with treatment and follow up.

             - Procedures conducted as a part of routine clinical management of the subject (e.g.,
             blood count, imaging study) and obtained prior to signed informed consent may be
             utilized for Screening or Baseline purposes provided these tests are obtained as
             specified in the protocol).

          2. Subjects must have measurable or evaluable disease. Disease sites that are evaluable
             for progression but not measurable per RECIST guidelines include:

               -  Bone lesions

               -  Previously irradiated lesions

               -  Cutaneous manifestations (non-discreet lesions only)

          3. Age ≥ 18 years.

          4. Postmenopausal women defined by one of the criteria:

               -  No spontaneous menses for at least 12 months if the subject is ≥ 50 years old;

               -  Amenorrheic for at least 12 months if the subject is < 50 years old, with serum
                  estradiol within the institutional postmenopausal range;

               -  Bilateral oophorectomy;

               -  If prior hysterectomy but intact ovaries, must be ≥ 55 years old, or have serum
                  estradiol within the postmenopausal range;

               -  If premenopausal, must be on a GnRH agonist (leuprolide or goserelin) with serum
                  estradiol levels within the institutional postmenopausal range.

          5. Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 2.

          6. Histologically or cytologically confirmed estrogen receptor (ER) and/or progesterone
             receptor (PgR) positive carcinoma of the breast with unresectable, locally advanced
             and/or metastatic (AJCC Stage IV) disease.

          7. Subjects must have received prior hormonal therapy for the treatment of breast cancer
             as follows:

               -  Progression must be documented while taking a nonsteroidal aromatase inhibitor
                  including anastrozole or letrozole.

               -  No more than 2 prior hormonal therapies for metastatic disease.

               -  If hormonal therapy was administered in the adjuvant setting, subjects must have
                  received therapy for at least 6 months prior to developing metastatic disease.

             Note: A regimen of sequential tamoxifen/AI in the adjuvant setting is considered to be
             one therapy

             - If hormonal therapy was administered in the metastatic setting, subjects must have
             received therapy for at least 3 months prior to progression

          8. Subjects whose tumors overexpress ErbB2 are eligible provided that they have
             progressed following therapy which included trastuzumab and/or lapatinib.

             Note for prior lapatinib: Subjects must have completed therapy with lapatinib at least
             7 days prior to the first dose of study drug.

             Note for prior trastuzumab: Subjects who received Q3 weekly, Q2 weekly or Q1 weekly
             must have completed therapy with trastuzumab at least 3 weeks, 2 weeks or 1 week,
             respectively, prior to the first dose of study drug.

          9. Adequate hematologic and hepatic function as defined in Protocol Table 1

         10. Subjects must have discontinued hormone replacement therapy (HRT) (e.g., conjugated
             estrogens tablets, USP or premarin), at least 28 days prior to receiving the first
             dose of randomized therapy.

         11. Radiotherapy prior to initiation of therapy is allowed to a limited area (e.g.,
             palliative treatment for painful bone metastases), if it is not the sole site of
             disease. Subjects must have completed treatment at least one week prior to starting
             study drugs, and must have recovered from all treatment-related toxicities.

         12. Bisphosphonate or RANK ligand inhibitor therapy for bone metastases is allowed.
             Prophylactic use of bisphosphonates in subjects without bone disease, except for the
             treatment of osteoporosis, is not permitted;

         13. Ability to swallow and retain oral medication.

        Exclusion Criteria:

          1. Prior use of pazopanib

          2. Premenopausal levels of estradiol, or ongoing menses (see definitions of menopause
             above).

          3. Known central nervous system (CNS) metastases or leptomeningeal carcinomatosis.
             Screening with CNS imaging studies (computed tomography [CT] or magnetic resonance
             imaging [MRI]) is required only if the subject has clinical findings suggestive of CNS
             metastasis.

          4. History of another active malignancy. Note: Subjects who have had another malignancy
             and have been disease-free for 5 years, or subjects with a history of completely
             resected non-melanomatous skin carcinoma or successfully treated in situ carcinoma are
             eligible.

          5. Clinically significant gastrointestinal abnormalities which might interfere with oral
             dosing, including, but not limited to:

               -  Malabsorption syndrome

               -  Major resection of the stomach or small bowel that could affect the absorption of
                  study drug

               -  Inflammatory bowel disease

               -  Ulcerative colitis, or other gastrointestinal conditions with increased risk of
                  perforation

               -  History of abdominal fistula, gastrointestinal perforation, or intra abdominal
                  abscess within 28 days prior to beginning study treatment

          6. Presence of uncontrolled infection.

          7. Prolongation of corrected QT interval (QTc) >480msecs.

          8. History of any one or more of the following cardiovascular conditions within the past
             6 months:

               -  Angioplasty or stenting

               -  Myocardial infarction

               -  Unstable angina

               -  Coronary artery by-pass graft surgery

               -  Symptomatic peripheral vascular disease

          9. Class II, III or IV congestive heart failure, as defined by the New York Heart
             Association (NYHA).

         10. Use of an investigational agent, including an investigational anti-cancer agent,
             within 14 days prior to the first dose of study drug.

         11. Prior use of an investigational drug that targets VEGF or VEGF receptors.

         12. Any ongoing toxicity from prior anti-cancer therapy that is > Grade 1 and/or that is
             progressing in severity.

         13. Poorly controlled hypertension (defined as systolic blood pressure (SBP) of ≥140mmHg
             or diastolic blood pressure (DBP) of ≥ 90mmHg).

             Note: Initiation or adjustment of antihypertensive medication(s) is permitted prior to
             study entry. Blood pressure must be re-assessed prior to start of study therapy. The
             mean SBP/DBP values must be <140/90mmHg (OR 150/90mmHg, if this criterion is approved
             by Safety Review Team) in order for a subject to be eligible for the study.

         14. History of cerebrovascular accident (CVA), pulmonary embolism or untreated deep venous
             thrombosis (DVT) within the past 6 months.

             Note: Subjects with recent DVT who have been treated with therapeutic anti-coagulant
             agents for at least 6 weeks are eligible.

         15. Major surgery or trauma within 28 days prior to first dose of study drug and/or
             presence of any non-healing wound, fracture, or ulcer not related to cancer
             (procedures such as catheter placement not considered to be major).

         16. Evidence of active bleeding or bleeding diathesis.

         17. Any serious and/or unstable pre-existing medical, psychiatric, or other condition that
             could interfere with subject's safety, provision of informed consent, or compliance to
             study procedures
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Clinical benefit rate
Time Frame:Ongoing evaluation at 12 week intervals until progression or up to 2 years, whichever is first.
Safety Issue:
Description:The clinical benefit rate from the addition of pazopanib to a non-steroidal aromatase inhibitor (NSAI) (letrozole or anastrozole) in patients with hormone receptor positive advanced breast cancer progressing on the same NSAI hormone therapy.

Secondary Outcome Measures

Measure:Time to tumor progression
Time Frame:Ongoing evaluation at 12 week intervals until progression or up to 2 years, whichever is first.
Safety Issue:
Description:
Measure:Number of participants with Adverse Events and SAEs.
Time Frame:Ongoing evaluations at 4 week intervals until progression or up to 2 years, whichever is first.
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Hope Rugo, MD

Trial Keywords

  • Advanced
  • Breast
  • Cancer
  • Hormone Resistance
  • Pazopanib
  • anastrozole
  • arimidex
  • letrozole
  • femara

Last Updated

November 27, 2017