Clinical Trials /

BYL719 Plus Letrozole or Exemestane for Patients With Hormone-Receptor Positive Locally-Advanced Unresectable or Metastatic Breast Cancer

NCT01870505

Description:

The purpose of this study is to test the safety of a drug called BYL719 at different dose levels. The investigators want to find out what effects, good and/or bad, BYL719 has on the patient and breast cancer. BYL719 will be given with either letrozole or exemestane to patients with HR+ locally-advanced or metastatic breast cancer. When the recommended phase II dose of BYL719 in combination with letrozole or exemestane has been determined in the dose-finding phase, an additional 10 patients will be enrolled onto each arm in an expansion phase of the study. The purpose of the expansion phase is to further define the safety and feasibility of BYL719 in combination with letrozole or exemestane at the recommended phase II dose, and to estimate efficacy.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: BYL719 Plus Letrozole or Exemestane for Patients With Hormone-Receptor Positive Locally-Advanced Unresectable or Metastatic Breast Cancer
  • Official Title: A Phase I Trial of BYL719 Plus Letrozole or Exemestane for Patients With Hormone-Receptor Positive Locally-Advanced Unresectable or Metastatic Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: 13-027
  • NCT ID: NCT01870505

Conditions

  • Metastatic or Locally-advanced Unresectable Breast Cancer

Interventions

DrugSynonymsArms
BYL719Arm A: BYL719 plus Letrozole
LetrozoleArm A: BYL719 plus Letrozole
ExemestaneArm B: BYL719 plus Exemestane

Purpose

The purpose of this study is to test the safety of a drug called BYL719 at different dose levels. The investigators want to find out what effects, good and/or bad, BYL719 has on the patient and breast cancer. BYL719 will be given with either letrozole or exemestane to patients with HR+ locally-advanced or metastatic breast cancer. When the recommended phase II dose of BYL719 in combination with letrozole or exemestane has been determined in the dose-finding phase, an additional 10 patients will be enrolled onto each arm in an expansion phase of the study. The purpose of the expansion phase is to further define the safety and feasibility of BYL719 in combination with letrozole or exemestane at the recommended phase II dose, and to estimate efficacy.

Trial Arms

NameTypeDescriptionInterventions
Arm A: BYL719 plus LetrozoleExperimentalFor both the dose-finding phase and the expansion phase, patients may have stable or progressive disease on letrozole, and BYL719 will be added. A treatment cycle will consist of 28 days. Treatment doses for each AI will be fixed at the established dose. Patients will continue on treatment until progression of disease or unacceptable toxicity. The initial scan interval to assess disease status will be every two cycles (8 weeks) for the first four cycles (16 weeks), and then every 3rd cycle (12 weeks) thereafter.
  • BYL719
  • Letrozole
Arm B: BYL719 plus ExemestaneExperimentalFor both the dose-finding phase and the expansion phase, patients may have stable or progressive disease on Exemestane, and BYL719 will be added. A treatment cycle will consist of 28 days. Treatment doses for each AI will be fixed at the established dose. Patients will continue on treatment until progression of disease or unacceptable toxicity. The initial scan interval to assess disease status will be every two cycles (8 weeks) for the first four cycles (16 weeks), and then every 3rd cycle (12 weeks) thereafter.
  • BYL719
  • Exemestane
Arm C: BYL719 plus LetrozoleExperimentalFor both the dose-finding and expansion phases of Arms C and D, patients may have stable or progressive disease on letrozole or exemestane, and BYL719 will be added.Letrozole 2.5mg orally once daily with BYL719 given on days 1-7 and 15-21 of a 28 day cycle. The starting dose of BYL719 in Arms C will be 250mg daily. Patients who are on study under Amendment 13, the scan interval will become every 4th cycle (16 weeks ±4 weeks) from their last scan.
  • BYL719
  • Letrozole
Arm D: BYL719 plus ExemestaneExperimentalFor both the dose-finding and expansion phases of Arms C and D, patients may have stable or progressive disease on letrozole or exemestane, and BYL719 will be added. Exemestane 25mg orally once daily BYL719 Days 1-5, 8-12, 15-19, 22-26 of 28 day cycle. For Arm D, the established dose is 350mg for BYL719 we are currently enrolling 10 patients to the corresponding arm in the expansion phase of the study. Patients who are on study under Amendment 13, the scan interval will become every 4th cycle (16 weeks ±4 weeks) from their last scan.
  • BYL719
  • Exemestane

Eligibility Criteria

        Inclusion Criteria:

          -  Women age ≥ 18 years

          -  Willing and able to comply with scheduled visits, treatment plan and laboratory tests

          -  Willing and able to consent for biopsy of locally-advanced or metastatic breast cancer
             prior to treatment

          -  Metastatic or locally-advanced unresectable breast cancer (includes metastatic or
             locally-advanced unresectable breast cancer which is diagnosed while on adjuvant
             letrozole or exemestane)

          -  Histologically documented HR+ breast cancer in either the primary or metastatic
             setting, as defined by ER or PR ≥ 1%; results from the local lab are acceptable.
             Eligibility will not be affected by HER2 status.

          -  The most recent treatment prior to enrollment must be one of the following (duration
             of treatment ≥2 weeks), and must have been adequately tolerated according the treating
             physician's judgment:

          -  Letrozole

          -  Exemestane

          -  Exemestane + everolimus (everolimus must be discontinued for ≥ 3 weeks prior to
             starting study treatment)

          -  Letrozole or exemestane in combination with an experimental agent(s) on a clinical
             trial, provided that the experimental agent(s) is not a PI3K inhibitor or AKT
             inhibitor (experimental agent(s) must be discontinued for ≥ 3 weeks prior to starting
             study treatment)

          -  Any number of prior endocrine therapies (including tamoxifen, fulvestrant and/or
             aromatase inhibitors in either the adjuvant or metastatic setting) and any number of
             prior chemotherapy regimens. Anti-cancer systemic therapy, such as chemotherapy or
             biologics or endocrine therapy, other than the AI, must be discontinued for ≥ 3 weeks
             prior to starting study treatment.

          -  For the dose-finding phase, patients must also have stable disease OR progression of
             disease on the most recent treatment. For the expansion phase, patients must have
             progression of disease on the most recent treatment. Progression of disease is defined
             as new or worsening disease on objective imaging. Progression of disease includes
             recurrence diagnosed while on adjuvant letrozole or exemestane.

          -  Postmenopausal women, as defined by one of the following (estradiol assay cutoff takes
             into account that the patient is on aromatase inhibitor therapy):

          -  Age ≥ 55 years and one year or more of amenorrhea

          -  Age < 55 years and one year or more of amenorrhea, with an estradiol assay within the
             post-menopausal range

          -  Age < 55 years with prior hysterectomy but intact ovaries, with an estradiol assay
             within the post-menopausal range

          -  Surgical menopause with bilateral oophorectomy

          -  Ovarian suppression with a LH-RH agonist, with an estradiol assay within the
             post-menopausal range at baseline and periodically on-study Measurable or
             non-measurable disease per RECIST criteria v1.1

          -  ECOG performance status 0-1

          -  Adequate organ function, as defined by all of the following:

        Hematologic parameters:

          -  Absolute neutrophil count (ANC) ≥ 1500/μl (without growth factor support)

          -  Platelets ≥ 100,000/μl (no transfusion allowed within 2 weeks)

          -  Hemoglobin ≥ 9.0 g/dl (may be reached by transfusion)

          -  Liver function:

          -  Serum bilirubin ≤ 1.5 x upper limit of normal (ULN) unless attributable to Gilbert's
             syndrome

          -  AST ≤ 2.5 x ULN, or ≤ 5 x ULN if liver metastases are present

          -  ALT ≤ 2.5 x ULN, or ≤ 5 x ULN if liver metastases are present

        Kidney function:

          -  Creatinine ≤ 1.5 ULN

          -  Endocrine function:

          -  Fasting plasma glucose <140 mg/dl (may be on antiglycemic agents other than insulin).
             Fasting glucose measurement must be obtained at least 8 hours after the most recent
             caloric intake.

          -  Ability to swallow oral medication

          -  Willing to discontinue all herbal preparations / medications at least 7 days prior to
             the first dose of study drug and throughout the study. These include, but not limited
             to,St. John's wort, Kava, ephedra (ma huang), gingko biloba, dehydroepiandrosterone
             (DHEA), yohimbe, saw palmetto, and ginseng.

        Exclusion Criteria:

          -  Pregnant patients or women who are breast-feeding (patients must be postmenopausal,
             see Section 6.1.9)

        Patients with central nervous system (CNS) involvement may participate if:

          -  Clinically stable with respect to the CNS tumor at the time of screening and >4 weeks
             from prior therapy completion (including radiation and/or surgery) to the start of
             study treatment

          -  Not receiving steroid therapy

          -  Not receiving enzyme inducing anti-epileptic medications that were started for brain
             metastases (these include carbamazepine, phenytoin, phenobarbital, primidone,
             oxcarbazepine, topiramate, and vigabatrin) Prior PI3K inhibitor or AKT inhibitor
             (patients previously treated with everolimus are eligible, see rationale in Section
             3.6)

          -  History of toxicity to the most recent AI (letrozole or exemestane) that warrants
             cessation of the AI

          -  Patients who have received radiotherapy ≤ 2 weeks prior to starting study treatment

          -  Patients who have undergone major surgery ≤ 4 weeks prior to starting study treatment,
             who have not recovered from side effects of such procedure

          -  Uncontrolled diabetes (as defined by fasting glucose ≥ 140mg/dL) and/or
             insulin-dependent diabetes. Fasting glucose measurement must be obtained at least 8
             hours after the most recent caloric intake. Patients currently requiring the use of
             antiglycemic agents (other than insulin) may be enrolled if fasting glucose <140mg/dL.

          -  Current need for chronic corticosteroid therapy (≥10mg of prednisone daily or an
             equivalent dose of other corticosteroid), or patients who have received systemic
             corticosteroids ≤ 2 weeks prior to starting study drug

          -  Current therapeutic anticoagulation with warfarin (or coumarin derivatives) Active
             infection or serious underlying medical condition that would impair the patient's
             ability to receive protocol treatment

          -  Clinically significant cardiac disease or impaired cardiac function, such as:

          -  Congestive heart failure requiring treatment (e.g., New York Heart Association Class
             II, III or IV) Acute coronary syndromes < 3 months prior to screening (including
             myocardial infarction, unstable angina, coronary artery bypass graft, coronary
             angioplasty, or stenting)

          -  Uncontrolled arterial hypertension defined by blood pressure > 140/100 mm Hg at rest
             (average of 3 consecutive readings)

          -  History or current evidence of unstable, clinically significant cardiac arrhythmias or
             patients that require medications with a narrow therapeutic window, atrial
             fibrillation and/or conduction abnormality, e.g. congenital long QT syndrome,
             high-Grade/complete AV-blockage

          -  Corrected QT interval (QTc) > 480 msec on screening ECG Patients who are currently
             receiving medication with a known risk of prolonging the QT interval or inducing
             Torsades de Pointes (TdP) and the treatment cannot either be discontinued or switched
             to a different medication prior to starting study drug treatment (see Section 9.6.3
             and Appendix F)

          -  Impaired gastrointestinal function or poorly controlled gastrointestinal disease that
             may significantly alter the absorption of oral BYL719 (e.g. Crohn's disease,
             ulcerative colitis, malabsorption syndrome, small bowel resection, uncontrolled nausea
             or vomiting, or grade ≥ 3 diarrhea of any etiology) based on treating physician
             assessment

          -  Patients may not have a "currently active" second malignancy other than non-melanoma
             skin cancers. Patients are not considered to have a "currently active" malignancy if
             they have completed therapy and are considered by their physician to be at less than
             30% risk of relapse.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:phase II dose of BYL719 (Arm A and Arm B)
Time Frame:2 years
Safety Issue:
Description:Three patients will be enrolled onto Cohort 0 at the starting BYL719 dose of 300mg daily. All patients within a cohort will be observed for toxicity for one cycle (28 days) prior to entering additional patients.

Secondary Outcome Measures

Measure:safety and tolerability of BYL719 (Arm A, B, C and D)
Time Frame:2 years
Safety Issue:
Description:Toxicity will be tabulated using the NCI Common Toxicity Criteria (CTCAE), version 4.0. A dose-limiting toxicity (DLT) is defined as an adverse event or abnormal laboratory value assessed as at least possibly related to the study medication, meeting any of the criteria listed in the table below, and occurring during Cycle 1 (≤ 28 days following the first dose of BYL719, including those in which the event started in Cycle 1 and the confirmation of the DLT occurs in a subsequent cycle).
Measure:efficacy of BYL719 (Arm A and Arm B)
Time Frame:2 years
Safety Issue:
Description:Progression-free survival Overall response rate (complete response + partial response) Clinical benefit rate at 16 weeks (complete response + partial response + stable disease) Time to treatment failure
Measure:efficacy of BYL719 (Arm C and Arm D)
Time Frame:2 years
Safety Issue:
Description:in two distinct schedules, plus letrozole or exemestane, in patients with HR+ locally-advanced or metastatic breast cancer, by calculation of the following in an expansion cohort:. Progression-free survival Overall response rate (complete response + partial response) Clinical benefit rate at 16 weeks (complete response + partial response + stable disease) Time to treatment failure
Measure:evaluate mechanisms of acquired resistance (Arms A, B, C and D)
Time Frame:2 years
Safety Issue:
Description:with correlative studies of on-treatment and optional post-progression tumor biopsies

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Memorial Sloan Kettering Cancer Center

Trial Keywords

  • BYL719
  • Letrozole
  • Exemestane
  • 13-027

Last Updated

July 27, 2017