Clinical Trials /

Clinical Study for the Treatment of Breast Cancer: the Patient Will Receive Afatinib Plus Letrozole or Letrozole Alone

NCT02115048

Description:

The purpose of the study is to compare the efficacy of treatment with afatinib plus letrozole to treatment with letrozole alone in women diagnosed with a specific type of breast cancer.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Completed

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Clinical Study for the Treatment of Breast Cancer: the Patient Will Receive Afatinib Plus Letrozole or Letrozole Alone
  • Official Title: A Randomized Open-label Phase II Study of Letrozole Plus Afatinib (BIBW2992) Versus Letrozole Alone in First Line Treatment of Advanced ER+, HER2- Post-menopausal Breast Cancer With Low ER Expression

Clinical Trial IDs

  • ORG STUDY ID: TRIO 020
  • NCT ID: NCT02115048

Conditions

  • Breast Neoplasms

Interventions

DrugSynonymsArms
LetrozoleArm A
AfatinibArm B

Purpose

The purpose of the study is to compare the efficacy of treatment with afatinib plus letrozole to treatment with letrozole alone in women diagnosed with a specific type of breast cancer.

Detailed Description

      This is an open-label, multicenter, international, randomized, Phase II clinical trial that
      will assess the efficacy and safety of letrozole in combination with afatinib(oral epidermal
      growth factor receptor (EGFR ) inhibitor) versus letrozole monotherapy for the first-line
      treatment of postmenopausal women with ER+, Human Epidermal Growth Factor Receptor 2 (HER2)
      negative advanced breast cancer with low ER expression.

      In order to assess the level of estrogen receptor (ER) expression we will use a
      semi-quantitative scoring system (McClelland, 1990) defined as :

      H-score = (% of cells stained at intensity category 1x1) + (% of cells stained at intensity
      category 2x2) + (% of cells stained at intensity category 3x3).

      This formula results in an H-score in the range of 0-300 where 300 equals 100% of tumor cells
      stained strongly (i.e., 3+). Low ER expression will be defined as tumor sample with H-score
      below 160 (Finn, 2009).

      All subjects who consented for the study must submit a tumor sample to the designated central
      laboratory for central confirmation of ER / Progesterone receptor (PR) and HER2 statuses and
      determination of the H-score. This will be assessed prior to randomization.

      Subjects with HER2 negative, ER+ advanced breast cancer with low ER expression defined as
      H-score between 1 and 159 will enter screening phase and perform the required screening
      assessments.

      Eligible subjects will be randomly assigned in a 1:1 ratio and stratified according to sites
      of disease (bone only disease vs. other) and prior administration of hormonal therapy in
      neo/adjuvant setting (Yes vs. No) to either:

      Arm A : Continuous regimen of oral letrozole 2.5 mg until progression of disease or any other
      study treatment discontinuation criteria.

      or Arm B : Continuous regimen of oral letrozole 2.5 mg daily plus oral afatinib 30 mg daily
      until progression of disease or any other study treatment discontinuation criteria.

      Once the subject is discontinued from study treatment and has undergone the End of Treatment
      visit, the subject will enter in the follow-up phase.

      A total of 150 subjects, 75 per arm, will be randomized over an estimated period of 18
      months.
    

Trial Arms

NameTypeDescriptionInterventions
Arm AActive ComparatorContinuous regimen of oral Letrozole 2.5 mg daily
  • Letrozole
Arm BExperimentalContinuous regimen of oral Letrozole 2.5 mg daily plus oral Afatinib 30 mg daily
  • Letrozole
  • Afatinib

Eligibility Criteria

        Inclusion Criteria:

          -  Signed and dated informed consent.

          -  Postmenopausal females, 18 years of age or older.

          -  Histologically or cytologically proven diagnosis of adenocarcinoma of the breast with
             evidence of locally recurrent disease not amenable to resection or radiation therapy
             with curative intent, or metastatic disease.

          -  HER2 negative breast cancer. Central testing (required for all subjects) must
             demonstrate that the tumor is HER2 negative by FISH or Immunohistochemistry (IHC).

          -  ER positive breast cancer. Central testing (required for all subjects) must
             demonstrate that the tumor is ER+ with low expression (H-score [1-159]).

          -  Paraffin-embedded tumor block(s) or 15 to 20 unstained slides available for
             centralized assessment of ER, PR, and HER2.

          -  Measurable disease according to Response Evaluation Criteria In Solid Tumors (RECIST)
             1.1 or bone-only non measurable disease.

          -  Eastern Cooperative Oncology Group (ECOG) Performance status 0 or 1.

          -  Adequate hematological, hepatic and renal functions.

          -  Baseline left ventricular ejection fraction (LVEF) 50%.

          -  Willingness and ability to comply with scheduled visits, treatment plan, laboratory
             tests, and other trial procedures.

        Exclusion Criteria:

          -  Brain metastases, spinal cord compression, carcinomatous meningitis, or leptomeningeal
             disease.

          -  Prior treatment with any type of systemic therapy for advanced disease.

          -  Prior treatment with letrozole in (neo)adjuvant setting with disease-free interval ≤
             12 months from completion of treatment until randomization.

          -  Prior treatment with any anti HER-family targeted therapy in (neo)adjuvant setting.

          -  Any concurrent or previous malignancy within 5 years prior to randomization, except
             for adequately and radically treated basal or squamous skin cancer, or carcinoma in
             situ of the cervix, or other non-invasive/in-situ neoplasm.

          -  Non-measurable disease according to RECIST 1.1, with the exception of bone-only
             non-measurable disease.

          -  Known pre-existing interstitial lung disease.

          -  Significant or recent acute gastrointestinal disorders with diarrhea as a major
             symptom.

          -  History or presence of clinically relevant cardiovascular abnormalities as per
             investigator assessment.

          -  Any other concomitant serious illness or organ system dysfunction as per investigator
             assessment

          -  Any contraindication to oral agents.

          -  Active hepatitis B infection, active hepatitis C infection or known HIV carrier.

          -  Known or suspected active drug or alcohol abuse.

          -  Known hypersensitivity to afatinib or letrozole or the excipients of any of the trial
             drugs.

          -  Concomitant treatment with strong inhibitor of P-gp.

          -  Any ongoing acute clinically significant toxic effect of prior anticancer therapy or
             any persisting complication of prior surgery.

          -  Subjects with known history of keratitis, ulcerative keratitis or severe dry eye.

          -  Participation in the active phase of other clinical trials of investigational agents
             in which last study treatment was administered within 2 weeks 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
Time Frame:Every 12 weeks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm
Safety Issue:
Description:Progression Free Survival is defined as the time from randomization until date of progression (assessed by RECIST) or death due to any cause, whichever occurs first.

Secondary Outcome Measures

Measure:Overall Survival (OS)
Time Frame:Under treatment: every 4 wks up to 9 months (average) for subject in the control arm or up to 14 months (average) for subjects in the experimental arm. After documentation of disease progression up to the end of the study: every 6 months up to 42 months
Safety Issue:
Description:Overall Survival is defined as the time from randomization until death to any cause. For subjects in which treatment is discontinued for reasons different than Progression Disease: after treatment and up to documentation of disease progression: Overall Survival is assessed every 12 weeks
Measure:Objective Response Rate (OR)
Time Frame:Every 12 weeks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm
Safety Issue:
Description:As per RECIST
Measure:Time to tumor progression (TTP)
Time Frame:Every 12 weeks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm
Safety Issue:
Description:As per RECIST
Measure:Incidence of Adverse Events
Time Frame:Under treatment: every 4 wks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm. After documentation of disease progression up to the end of the study: every 6 months up to 42 months
Safety Issue:
Description:Subject's incidence of adverse events will be tabulated by system organ class, preferred term and toxicity grade by treatment arm. Adverse events leading to death or drug discontinuation, drug related and serious adverse events will also be summarized by treatment arm. For subjects in which treatment is discontinued for reasons different than Progression Disease, after treatment and up to documentation of disease progression, the assessment of incidence of adverse events will be assessed every 12 weeks.
Measure:Laboratory Parameters
Time Frame:every 4 weeks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm
Safety Issue:
Description:Laboratory parameters, graded according to the NCI CTCAE v4.0, will be summarized at baseline, along visits and at the end of study treatment by treatment arm. Tables of shifts in toxicity will also be provided.
Measure:ECOG Performance Status
Time Frame:Every 4 weeks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm
Safety Issue:
Description:
Measure:Left Ventricular Ejection Fraction (LVEF)
Time Frame:Every 12 weeks up to 9 months (average) for subjects in the control arm or up to 14 months (average) for subjects in the experimental arm
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Translational Research in Oncology

Last Updated

October 10, 2017