Clinical Trials /

A Study of Abemaciclib (LY2835219) Combined With Fulvestrant in Women With Hormone Receptor Positive HER2 Negative Breast Cancer

NCT02107703

Description:

The main purpose of this study is to compare progression-free survival for women with hormone receptor positive (HR+), human epidermal growth factor receptor (HER2) negative advanced breast cancer receiving either abemaciclib + fulvestrant or fulvestrant alone. Participants will be randomized to abemaciclib or placebo in a 2:1 ratio. The study will last about 9 months for each participant. For the endocrine naïve cohort, all participants will received abemaciclib + fulvestrant.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: A Study of Abemaciclib (LY2835219) Combined With Fulvestrant in Women With Hormone Receptor Positive HER2 Negative Breast Cancer
  • Official Title: MONARCH 2: A Randomized, Double-Blind, Placebo-Controlled, Phase 3 Study of Fulvestrant With or Without Abemaciclib, a CDK4/6 Inhibitor, for Women With Hormone Receptor Positive, HER2 Negative Locally Advanced or Metastatic Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: 15362
  • SECONDARY ID: I3Y-MC-JPBL
  • SECONDARY ID: 2013-004728-13
  • NCT ID: NCT02107703

Conditions

  • Breast Neoplasms

Interventions

DrugSynonymsArms
AbemaciclibLY2835219Abemaciclib + Fulvestrant
FulvestrantAbemaciclib + Fulvestrant
PlaceboPlacebo + Fulvestrant

Purpose

The main purpose of this study is to compare progression-free survival for women with hormone receptor positive (HR+), human epidermal growth factor receptor (HER2) negative advanced breast cancer receiving either abemaciclib + fulvestrant or fulvestrant alone. Participants will be randomized to abemaciclib or placebo in a 2:1 ratio. The study will last about 9 months for each participant. For the endocrine naïve cohort, all participants will received abemaciclib + fulvestrant.

Trial Arms

NameTypeDescriptionInterventions
Abemaciclib + FulvestrantExperimental150 milligrams (mg) Abemaciclib given orally once every 12 hours in 28 day cycles. 500 mg fulvestrant administered as two 250-mg injections intramuscularly (IM) on Days 1 and 15 of Cycle 1, then on Day 1 of Cycle 2 and beyond. Participants may continue to receive treatment until discontinuation criteria are met.
  • Abemaciclib
  • Fulvestrant
Placebo + FulvestrantPlacebo ComparatorPlacebo will be supplied as capsules administered orally every 12 hours in 28 day cycles. 500 mg fulvestrant administered as two 250-mg injections IM on Days 1 and 15 of Cycle 1, then on Day 1 of Cycle 2 and beyond. Participants may continue to receive treatment until discontinuation criteria are met.
  • Fulvestrant
  • Placebo
Abemaciclib + Fulvestrant (Endocrine Naïve Cohort)Experimental150 milligrams mg Abemaciclib given orally once every 12 hours in 28 day cycles. 500 mg fulvestrant administered as two 250-mg injections intramuscularly (IM) on Days 1 and 15 of Cycle 1, then on Day 1 of Cycle 2 and beyond. Participants may continue to receive treatment until discontinuation criteria are met.
  • Abemaciclib
  • Fulvestrant

Eligibility Criteria

        Inclusion Criteria

          -  Have a diagnosis of HR+, HER2- breast cancer

          -  Have locally advanced disease not amenable to curative treatment by surgery or
             metastatic disease. In addition, participants must fulfill 1 of the following
             criteria:

               -  relapsed with radiologic evidence of progression while receiving neoadjuvant or
                  adjuvant endocrine therapy, with no subsequent endocrine therapy received
                  following progression

               -  relapsed with radiologic evidence of progression within 1 year from completion of
                  adjuvant endocrine therapy, with no subsequent endocrine therapy received
                  following progression

               -  relapsed with radiologic evidence of progression more than 1 year from completion
                  of adjuvant endocrine therapy and then subsequently relapsed with radiologic
                  evidence of progression after receiving treatment with either an antiestrogen or
                  an aromatase inhibitor as first-line endocrine therapy for metastatic disease.
                  Participants may not have received more than 1 line of endocrine therapy or any
                  prior chemotherapy for metastatic disease

               -  presented de novo with metastatic disease and then relapsed with radiologic
                  evidence of progression after receiving treatment with either an antiestrogen or
                  an aromatase inhibitor as first line endocrine therapy for metastatic disease.
                  Participants may not have received more than 1 line of endocrine therapy or any
                  prior chemotherapy for metastatic disease

               -  for the endocrine naïve cohort: Must not have received prior endocrine therapy in
                  current or prior disease setting

          -  Have postmenopausal status due to either surgical/natural menopause or ovarian
             suppression (initiated at least 28 days prior to Day 1 of Cycle 1) with a
             gonadotropin-releasing hormone (GnRH) agonist such as goserelin

          -  Have a negative serum pregnancy test at baseline (within 14 days prior to
             randomization) and agree to use medically approved precautions to prevent pregnancy
             during the study and for 12 weeks following the last dose of abemaciclib if
             postmenopausal status is due to ovarian suppression with a GnRH agonist

          -  Have either measurable disease or nonmeasurable bone only disease

          -  Have a performance status ≤1 on the ECOG scale

          -  Have discontinued previous therapies for cancer (including specifically, aromatase
             inhibitors, anti-estrogens, chemotherapy, radiotherapy, and immunotherapy) for at
             least 21 days for myelosuppressive agents or 14 days for nonmyelosuppressive agents
             prior to receiving study drug, and recovered from the acute effects of therapy (until
             the toxicity resolves to either baseline or at least Grade 1) except for residual
             alopecia or peripheral neuropathy

        Exclusion Criteria

          -  Are currently receiving an investigational drug in a clinical trial or participating
             in any other type of medical research judged not to be scientifically or medically
             compatible with this study

          -  Have visceral crisis, lymphangitic spread, or leptomeningeal carcinomatosis visceral
             crisis is not the mere presence of visceral metastases but implies severe organ
             dysfunction as assessed by symptoms and signs, laboratory studies, and rapid
             progression of the disease

          -  Have clinical evidence or history of central nervous system metastasis

          -  Have received prior treatment with chemotherapy (except for neoadjuvant/ adjuvant
             chemotherapy), fulvestrant, everolimus, or any CDK4/6 inhibitor. For the endocrine
             naïve cohort: In addition, have received treatment with any prior endocrine therapy

          -  Have received treatment with a drug that has not received regulatory approval for any
             indication within 14 or 21 days prior to randomization of study drug for a
             nonmyelosuppressive or myelosuppressive agent, respectively

          -  Have received recent (within 28 days prior to randomization) yellow fever vaccination

          -  Have had major surgery within 14 days prior to randomization of study drug to allow
             for post-operative healing of the surgical wound and site(s)

          -  Have a personal history within the last 12 months of any of the following conditions:
             syncope of cardiovascular etiology, ventricular tachycardia, ventricular fibrillation,
             or sudden cardiac arrest

          -  Have inflammatory breast cancer or a history of any other cancer (except nonmelanoma
             skin cancer or carcinoma in-situ of the cervix), unless in complete remission with no
             therapy for a minimum of 3 years

          -  Have received an autologous or allogeneic stem-cell transplant

          -  Have active bacterial or fungal infection, or detectable viral infection

          -  Have initiated bisphosphonates or approved Receptor activator of nuclear factor
             kappa-B (RANK) ligand targeted agents <7 days prior to randomization
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression-Free Survival (PFS)
Time Frame:From Date of Randomization until Disease Progression or Death Due to Any Cause (Up To 31 Months)
Safety Issue:
Description:PFS defined as the time from the date of randomization to the first evidence of disease progression as defined by response evaluation criteria in solid tumors (RECIST) v1.1 or death from any cause. Progressive Disease (PD) was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions. If a participant does not have a complete baseline disease assessment, then the PFS time was censored at the date of randomization, regardless of whether or not objectively determined disease progression or death has been observed for the participant. If a participant was not known to have died or have objective progression as of the data inclusion cutoff date for the analysis, the PFS time was censored at the last adequate tumor assessment date.

Secondary Outcome Measures

Measure:Overall Survival (OS)
Time Frame:From Date of Randomization until Death Due to Any Cause (Up To 80 Months)
Safety Issue:
Description:OS defined as the time from the date of randomization to the date of death due to any cause. For each participant who is not known to have died as of the data-inclusion cutoff date for overall survival analysis, OS time was censored on the last date the participant is known to be alive.
Measure:Percentage of Participants Achieving Complete Response (CR) or Partial Response (PR) (Objective Response Rate [ORR])
Time Frame:From Date of First Dose until Disease Progression or Death Due to Any Cause (Up To 31 Months)
Safety Issue:
Description:ORR was the percentage of participants achieving a best overall response (BOR) of complete response (CR) or partial response (PR) as per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. CR defined as the disappearance of all target and non-target lesions and no appearance of new lesions. PR defined as at least a 30% decrease in the sum of the longest diameters (LD) of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, and no appearance of new lesions. PD was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions.
Measure:Duration of Response (DOR)
Time Frame:From Date of CR, PR until Disease Progression or Death Due to Any Cause (Up To 31 Months)
Safety Issue:
Description:DOR was the time from the date of first evidence of complete response or partial response to the date of objective progression or the date of death due to any cause, whichever is earlier. CR and PR were defined using the RECIST v1.1. CR defined as the disappearance of all target and non-target lesions and no appearance of new lesions. PR defined as at least a 30% decrease in the sum of the LD of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, and no appearance of new lesions. If a responder was not known to have died or have objective progression as of the data inclusion cutoff date, duration of response was censored at the last adequate tumor assessment date. PD was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions.
Measure:Percentage of Participants Achieving CR, PR or Stable Disease (SD) (Disease Control Rate [DCR])
Time Frame:From Date of First Dose until Disease Progression or Death Due to Any Cause (Up To 31 Months)
Safety Issue:
Description:Disease Control Rate (DCR) was the percentage of participants with a best overall response of CR, PR, or Stable Disease (SD) as per Response using RECIST v1.1 criteria. CR defined as the disappearance of all target and non-target lesions and no appearance of new lesions. PR defined as at least a 30% decrease in the sum of the LD of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, and no appearance of new lesions. SD was neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD for target lesions, no progression of non-target lesions, and no appearance of new lesions. PD was at least a 20% increase in the sum of the diameters of target lesions, with reference being the smallest sum on study and an absolute increase of at least 5 mm, or unequivocal progression of non-target lesions, or 1 or more new lesions.
Measure:Percentage of Participants With CR, PR or SD With a Duration of At Least 6 Months (Clinical Benefit Rate [CBR])
Time Frame:From Date of First Dose until Disease Progression or Death Due to Any Cause (Up To 31 Months)
Safety Issue:
Description:Clinical benefit rate defined as percentage of participants with best overall response of CR, PR, or SD with a duration of at least 6 months.CR defined as the disappearance of all target and non-target lesions and no appearance of new lesions.PR defined as at least a 30% decrease in the sum of the LD of target lesions (taking as reference the baseline sum LD), no progression of non-target lesions, and no appearance of new lesions.SD was neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD for target lesions, no progression of non-target lesions, and no appearance of new lesions. Percentage of participants=(participants with CR+PR+SD with a duration of at least 6 months /number of participants enrolled) *100.PD was at least a 20% increase in sum of the diameters of target lesions,with reference being the smallest sum on study and an absolute increase of at least 5 mm or unequivocal progression of non-target lesions,or 1 or more new lesions.
Measure:Change From Baseline in Pain and Symptom Burden Assessment Using the Modified Brief Pain Inventory-Short Form (mBPI-sf)
Time Frame:Baseline, End of Study (Up To 31 Months)
Safety Issue:
Description:A self-reported scale that measures the severity of pain based on the average pain experienced over the past 24 hours. The severity scores range from 0 (no pain) to 10 (pain as severe as you can imagine). The overall change is based on the estimated main treatment effect. Least square (LS) Mean value was controlled for Treatment, visit, Treatment*Visit and baseline.
Measure:Pharmacokinetics (PK): Area Under the Concentration Curve (AUC) of Abemaciclib, Its Metabolites M2 and M20
Time Frame:Cycle 1 Day 1 2-4 hours (h) post dose, Cycle 1 Day 15 4 and 7h post dose, Cycle 2 Day 1 pre dose and 3h post dose, Cycle 3 Day1 pre dose
Safety Issue:
Description:Area Under the Plasma Concentration versus Time Curve from Time Zero to Infinity (AUC[0-∞]) was evaluated for Abemaciclib and Metabolites M2 and M20.
Measure:Change From Baseline in Health Status Using the EuroQol 5-Dimension 5 Level (EQ-5D 5L)
Time Frame:Baseline, End of Study (Up To 31 Months)
Safety Issue:
Description:European Quality of Life-5 Dimensions-5 Level (EQ-5D-5L) is a standardized measure of health status of the participant. The EQ-5D-5L is assessed using a visual analog scale (VAS) that ranged from 0 to 100mm, where 0 is the worst health you can imagine and 100 is the best health you can imagine. A higher score indicates better health state. LS Mean value was controlled for Treatment, visit, Treatment*Visit and baseline.
Measure:Change From Baseline to Short Term Follow up in Quality of Life Using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30)
Time Frame:Baseline, Short Term Follow Up (Up To 31 Months)
Safety Issue:
Description:EORTC QLQ-C30 v3.0 was a self-administered questionnaire with multidimensional scales that measures 5 functional domains (physical, role, cognitive, emotional, and social), global health status, and symptom scales of fatigue, pain, nausea and vomiting, dyspnea, loss of appetite, insomnia, constipation and diarrhea, and financial difficulties. A linear transformation is applied to standardize the raw scores to range between 0 and 100 per developer guidelines. For functional domains and global health status, scores range from 0 to 110 with higher scores representing a better level of functioning. For symptoms scales, scores range from 0 to 100 with higher scores representing a greater degree of symptoms. LS Mean value of changing from baseline to short follow up was estimated from the mixed model that was controlled for Treatment, visit, Treatment*Visit and baseline.
Measure:Change From Baseline to Short Term Follow up in Quality of Life Using the EORTC QLQ-BR23 (Breast) Questionnaire
Time Frame:Baseline, Short Term Follow Up (Up To 31 Months)
Safety Issue:
Description:EORTC-QLQ-BR23 measured multi-item functional scales for body image, sexual functioning and future perspective and measured single item symptoms scales which assessed systemic therapy side effects, breast symptoms and arm symptoms. For functional scales, scores ranged from 0 to 100 where higher scores represented a better level of functioning. For symptoms scales, scores ranged from 0 to 100 where higher scores represented a greater degree of symptoms. LS Mean value of changing from baseline to short follow up was estimated from the mixed model that was controlled for Treatment, visit, Treatment*Visit and baseline.

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Eli Lilly and Company

Trial Keywords

  • MONARCH 2

Last Updated

September 23, 2020