Inclusion Criteria:
1. Voluntary written informed consent before performance of any study-related procedure
not part of normal medical care
2. Patients must have MBC that is measurable or evaluable as defined by Response
Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria. Patients with metastases
limited to the bones are eligible.
3. Patients with breast tumors that are AR+ (≥10% staining by immunohisto-chemistry).
Archived tumor tissue from a primary biopsy or metastatic lesion for centralized
determination of AR expression is mandatory. If tissue is limited, the additional
correlative testing is optional. If tissue is not available, a patient will not be
eligible for enrollment into the study. Patients may enroll based on local laboratory
AR assessment, but will need to submit tissue for confirmation at the central
laboratory.
4. In addition to having AR+ tumors, patients must fit into 1 of the 2 following
categories:
- Triple negative (ER-/PR-/HER2-) (Note: This group of patients must have received
at least 1 and up to 3 prior chemotherapy regimens in the advanced setting.)
- ER+ and/or PR+ (Note: This group of patients must have received at least 1 and up
to 3 prior hormonal therapies and at least one prior chemotherapy treatment in
the advanced setting. HER2+ patients in this group must have received a minimum
of 2 lines of HER2-directed therapy in the advanced setting.) This group of
patients may be pre-menopausal with ovarian suppression or post-menopausal. LHRH
agonists maybe used to render ovarian suppression with post-menopausal ranges of
estradiol or FSH per institutional guidelines.
5. Female or male patients ≥18 years-of-age
6. Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2
7. Patient has recovered (to Grade ≤1) from all clinically significant toxicities related
to prior antineoplastic therapies (with the exception of alopecia)
8. Adequate hematological function, defined as:
- Absolute neutrophil count (ANC) ≥1.25 x 109/L
- Platelets ≥75 x 109/L
- Hemoglobin ≥9 g/dL
9. Adequate liver function, defined as:
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 x the
upper limit of normal (ULN), if no liver involvement or ≤5 x ULN with liver
involvement
- Total bilirubin ≤1.5 times the upper limit of normal (ULN) (in patients with
known Gilbert Syndrome, a total bilirubin ≤3.0 x ULN, with direct bilirubin ≤1.5
x ULN)
10. Adequate renal function, defined as:
- Creatinine ≤1.5 x ULN or creatinine clearance ≥40 mL/min as calculated by the
Cockcroft-Gault method
11. Screening calculated LVEF of ≥50% by echocardiogram (ECHO) or multiple-gated
acquisition (MUGA) scan
12. Ability to swallow and retain oral medication
13. Male patients (even those post vasectomy) who are willing to use adequate
contraceptive measures or abstain from heterosexual intercourse during the entire
study treatment period and for 4 months after the last dose of study drug
14. Female patients who are not of child-bearing potential and female patients of
child-bearing potential who agree to use adequate contraceptive measures or abstain
from heterosexual intercourse during the entire study treatment period and for 4
months after the last dose of study drug, who are not breastfeeding, and who have had
a negative serum/urine pregnancy test ≤7 days prior to dosing
15. Life expectancy of ≥3 months
16. Willingness and ability to understand the nature of this study and to comply with the
study and follow-up procedures.
Exclusion Criteria:
1. Known hypersensitivity to orteronel or to orteronel excipients, which are listed by
formulation in the Investigator Brochure
2. Patients receiving other treatment for breast cancer (includes standard hormonal
therapy, chemotherapy, biologic therapy, immunotherapy, or radiation therapy).
Patients receiving chronic bisphosphonate or denosumab therapy are eligible.
3. Female patients who are both lactating and breastfeeding or have a positive serum
pregnancy test during the screening period.
4. Prior anti-androgen therapy
5. Use of an investigational drug ≤21 days or 5 half-lives (whichever is shorter) prior
to the first dose of orteronel, or concurrent treatment. For investigational drugs for
which 5 half-lives is less than 21 days, a minimum of 10 days between termination of
the investigational drug and administration of orteronel is required.
6. Active brain metastases or leptomeningeal disease. Previously treated brain metastases
are allowed provided lesions are stable for at least 3 months as documented by head CT
scan or magnetic resonance imaging (MRI) of the brain. Patients must be off steroids,
but anti-convulsants are allowed.
7. Patients with known adrenal insufficiency, or patients receiving treatment with
ketoconazole, abiraterone, or aminoglutethimide.
8. Wide field radiotherapy (including therapeutic radioisotopes such as strontium 89)
administered ≤28 days or limited field radiation for palliation ≤7 days prior to
starting study drug or has not recovered from side effects of such therapy.
9. Major surgical procedures ≤28 days of beginning study treatment or minor surgical
procedures ≤7 days. No waiting is required following port-a-cath placement.
10. Presence of active gastrointestinal (GI) disease or other condition that will
interfere significantly with the absorption, distribution, metabolism, or excretion of
oral therapy (eg, ulcerative disease, uncontrolled nausea, vomiting, diarrhea ≥ Grade
2, and malabsorption syndrome).
11. History of myocardial infarction, unstable symptomatic ischemic heart disease, ongoing
arrhythmias > Grade 2 (National Cancer Institute [NCI] Common Terminology Criteria for
Adverse Events [CTCAE], Version 4.0), thromboembolic events (eg, deep vein thrombosis,
pulmonary embolism, or symptomatic cerebrovascular events), or any other cardiac
condition (eg, pericardial effusion restrictive cardiomyopathy) within 6 months prior
to first dose of study drug. Chronic stable atrial fibrillation on stable
anticoagulant therapy is allowed.
12. New York Heart Association (NYHA) Class III or IV heart failure
13. Electrocardiogram (ECG) abnormalities of Q-wave infarction, unless identified 6 or
more months prior to screening or QTc Fridericia (F) interval >460 msec
14. Inadequately controlled hypertension (ie, systolic blood pressure [SBP] >160 mmHg or
diastolic BP [DBP] >90 mmHg) at 2 separate measurements no more than 60 minutes apart
during the Screening visit. Note: patients may be rescreened after adjustment of
antihypertensive medications.
15. Known diagnosis of human immunodeficiency virus, active chronic hepatitis B, or C,
life-threatening illness unrelated to cancer, or any serious medical or psychiatric
illness that could, in the investigator's opinion, potentially interfere with
participation in this study
16. Uncontrolled diabetes mellitus. Patients with Type II diabetes are eligible if they
require only oral hypoglycemic agents and fasting blood glucose level is ≤120.
Patients with Type I diabetes are eligible if their glycosylated hemoglobin (HbAlc) is
≤7.
17. Diagnosis or treatment for another malignancy within 2 years of enrollment, with the
exception of adequately treated in-situ carcinoma of the cervix, uteri, basal or
squamous cell carcinoma or non-melanomatous skin cancer
18. Inability or unwillingness (including psychological, familial, sociological, or
geographical conditions) to comply with study and/or follow-up procedures as outlined
in the protocol.
19. Use of a prohibited concomitant medication that cannot be safely discontinued or
substituted.
