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Trial of Ra-223 Dichloride in Combination With Hormonal Therapy and Denosumab in the Treatment of Patients With Hormone-Positive Bone-Dominant Metastatic Breast Cancer

NCT02366130

Description:

The goal of this clinical research study is to learn if Xofigo® (also called Ra-223 dichloride) combined with hormone therapy and denosumab can help to control breast cancer that has spread to the bones and/or bone marrow. The safety of this study drug combination will also be studied. This is an investigational study. Denosumab and the hormone therapies used in this study are FDA-approved and commercially available for the treatment of metastatic breast cancer. Ra-223 dichloride is FDA-approved and commercially available for the treatment of bone metastases. It is considered investigational to use the combination of Ra-223 dichloride, hormone therapy and denosumab to treat patients with bone cancer that has spread to the bones. The study doctor can explain how the study drugs are designed to work. Up to 36 participants will be enrolled in this study. All will take part at MD Anderson.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Completed

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Trial of Ra-223 Dichloride in Combination With Hormonal Therapy and Denosumab in the Treatment of Patients With Hormone-Positive Bone-Dominant Metastatic Breast Cancer
  • Official Title: Phase II Trial of Ra-223 Dichloride in Combination With Hormonal Therapy and Denosumab in the Treatment of Patients With Hormone-Positive Bone-Dominant Metastatic Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: 2014-0508
  • SECONDARY ID: NCI-2015-00508
  • NCT ID: NCT02366130

Conditions

  • Breast Cancer

Interventions

DrugSynonymsArms
Ra-223 dichlorideXofigo, Radium-223 chloride, Radium-223 dichloride, AlpharadinRa-223 dichloride + Denosumab
DenosumabAMG 162, ProliaRa-223 dichloride + Denosumab
Hormone TherapyRa-223 dichloride + Denosumab

Purpose

The goal of this clinical research study is to learn if Xofigo® (also called Ra-223 dichloride) combined with hormone therapy and denosumab can help to control breast cancer that has spread to the bones and/or bone marrow. The safety of this study drug combination will also be studied. This is an investigational study. Denosumab and the hormone therapies used in this study are FDA-approved and commercially available for the treatment of metastatic breast cancer. Ra-223 dichloride is FDA-approved and commercially available for the treatment of bone metastases. It is considered investigational to use the combination of Ra-223 dichloride, hormone therapy and denosumab to treat patients with bone cancer that has spread to the bones. The study doctor can explain how the study drugs are designed to work. Up to 36 participants will be enrolled in this study. All will take part at MD Anderson.

Detailed Description

      Study Drug Administration:

      If you are found to be eligible to take part in this study, you will receive Ra-223
      dichloride by vein over no more than 1 minute on Day 1 of each 28-day study cycle.

      You will also receive denosumab as an injection under the skin on Day 1 of Cycles 1- 6.

      You will also receive hormone therapy while on study. Your doctor will discuss with you what
      type of hormone therapy you will have, how it will be given, and its risks.

      Study Visits:

      On Day 1 of Cycle 1, blood (about 2 teaspoons) will be drawn for routine tests.

      On Day 1 of Cycles 2-5:

        -  You will have a physical exam.

        -  Blood (about 2 teaspoons) will be drawn for routine tests.

      On Day 1 of Cycle 6:

        -  Blood (about 2 teaspoons) and urine will be collected for routine tests.

        -  Blood (about 3 tablespoons) will be drawn for biomarker testing, including genetic
           biomarkers.

        -  Blood (about 5 teaspoons) will be drawn to test for CTCs, tumor markers, and genetic
           testing.

        -  You will have a PET-CT scan and a bone scan to check the status of the disease. If the
           doctor thinks it is needed, you will also have an MRI.

      Length of Study Participation:

      You may continue taking the study drugs for up to 6 cycles. You will no longer be able to
      take the study drug if the disease gets worse, if intolerable side effects occur, or if you
      are unable to follow study directions.

      Your participation will be over after the end-of-study visit.

      End-of-Study Visit:

      After your last dose of study drug:

        -  You will have a physical exam.

        -  Blood (about 2 teaspoons) and urine will be collected for routine tests.

        -  Blood (about 3 tablespoons) will be drawn for biomarker testing, including genetic
           biomarkers.

        -  Blood (about 5 teaspoons) will be drawn to test for CTCs, tumor markers, and genetic
           testing.

        -  You will have a PET-CT scan and either a bone scan or a CT scan to check the status of
           the disease. If the doctor thinks it is needed, you will also have an MRI.

        -  If the doctor thinks it is needed, you will have a bone marrow aspiration/biopsy to
           check the status of the disease.
    

Trial Arms

NameTypeDescriptionInterventions
Ra-223 dichloride + DenosumabExperimentalRa-223 dichloride 55 kBq/kg administered as a bolus intravenous (IV) injection (over 1 minute) through a secure in-dwelling catheter on day 1 of the study and then every four weeks thereafter for 6 cycles. Denosumab 120 mg by subcutaneous (SC) injections on Day 1 of Cycles 2-5. A single hormonal agent (ie, Tamoxifen or Aromatase Inhibitor or Fulvestrant) administered daily while on study. Physician to decide what type of hormone therapy participant will receive.
  • Ra-223 dichloride
  • Denosumab
  • Hormone Therapy

Eligibility Criteria

        Inclusion Criteria:

          1. Stage IV breast cancer with metastases to the bone and/or bone marrow.

          2. Pathological or radiographically confirmation of metastases to the bone and/or bone
             marrow. (The definition of radiologic diagnosis of bone metastasis is based on typical
             and highly reliable imaging findings in studies such as bone scan (new or multiple
             TC99m positive lesions), PET/CT (new or multiple FRG positive lesions), and MRI
             (typical T1w replacement, T2w positive and T1 plus contrast media positive) for bone
             metastasis with 2 or more lesions. If the bone metastasis is highly suspected or not
             well defined by imaging, bone biopsy is necessary for confirmation.)

          3. Visible uptake in at least one lesion on bone scanning prior to radium therapy.

          4. No limit in number of prior hormonal agents in metastatic breast cancer; only one
             prior chemotherapy is allowed in metastatic setting. Anti-HER2 targeting therapy,
             CDK4/6 inhibitor, other targeted therapy (e.g., mTOR or PI3K inhibitor) in combination
             with hormonal treatment will be counted as one hormonal agent. Any anti-HER2 targeting
             therapy in combination with chemotherapy will not be counted as one additional
             treatment.

          5. Breast tumors with hormone receptor positive disease (ER+/PR+, ER+/PR- regardless of
             HER2 status).

          6. ECOG performance score of 0, 1.

          7. Age =/> 18 years.

          8. All acute toxic effects of any prior treatment have resolved to NCI-CTCAE v4.0 Grade 1
             or less at the time of signing the Informed Consent Form (ICF).

          9. Subjects (men and women) of childbearing potential must agree to use adequate
             contraception beginning at the signing of the ICF until at least 6 months after the
             last dose of study drug. The definition of adequate contraception will be based on the
             judgment of the principal investigator or a designated associate.

         10. Acceptable hematology and serum biochemistry screening values: White Blood Cell Count
             (WBC) =/> 3,000/mm3 Absolute Neutrophil Count (ANC) =/> 1,500/mm3 Platelet (PLT) count
             =/> 100,000/mm3 Hemoglobin (HGB) =/> 10 g/dl Total bilirubin level </=2.0 x
             institutional upper limit of normal (ULN) Aspartate aminotransferase (AST) and alanine
             aminotransferase (ALT) </= 3.0 x ULN Creatinine </= 1.5 x ULN

         11. Subjects must be able to understand and be willing to sign the written informed
             consent form. A signed informed consent form must be appropriately obtained prior to
             the conduct of any trial-specific procedure.

        Exclusion Criteria:

          1. Following breast cancer disease conditions are not eligible: A) Single Bone Lesion.
             B)Two or more visceral metastasis C) Single visceral lesion < 2cm without any
             laboratory changes or clinical symptoms due to the metastatic lesion is permitted.
             D)Presence of brain metastases E) Imminent spinal cord compression based on clinical
             findings and/or magnetic resonance imaging (MRI). T F) Impending fracture, spinal cord
             compression, and/or potentially unstable compression fracture of vertebral body with
             possibility of cord compression. G) Life expectancy severely limited by concomitant
             illness (less than 12 months). H) Concurrent external beam radiation therapy to non
             target lesion is permitted.

          2. Following prior treatments are not eligible. A) Use of any investigational agent
             within 30 days preceding enrollment. B) Treatment with cytotoxic chemotherapy within
             previous 4 weeks C) Failure to achieve </= Grade 2 AE resolution from cytotoxic
             chemotherapy administered more than 4 weeks previous (however, ongoing neuropathy is
             permitted). D) Received systemic therapy with radionuclides (e.g., strontium-89,
             samarium-153, rhenium-186, or rhenium-188, or Ra-223 dichloride) for the treatment of
             bony metastases.

          3. Following medical conditions are not eligible. A) Other malignancy treated within the
             last 3 years (except non melanoma skin cancer or low-grade superficial bladder cancer
             or cervical dysplasia) B) Any other serious illness or medical condition, such as but
             not limited to: Any infection =/> National Cancer Institute Common Terminology
             Criteria for Adverse Events (NCI-CTCAE) version 4.03 Grade 2. C) Cardiac failure New
             York Heart Association (NYHA) III or IV. D) Crohn's disease or ulcerative colitis-Bone
             marrow dysplasia or Myelodysplastic syndrome.

          4. Women who are pregnant or breast-feeding. Women of childbearing potential must have a
             negative serum pregnancy test performed within 7 days prior to the start of study
             drug. Post-menopausal women (defined as no menses for at least 1 year) and surgically
             sterilized women are not required to undergo a pregnancy test.

          5. Any condition which, in the investigator's opinion, makes the subject unsuitable for
             trial participation.

          6. Major surgery within 30 days prior to start of study drug.

          7. Excluded therapies and medications, previous and concomitant: A) Concurrent
             anti-cancer therapy (chemotherapy, surgery, immunotherapy, biologic therapy, anti-HER
             2 targeting therapies, or tumor embolization) other than Ra 223 dichloride. Concurrent
             external beam radiation therapy is permitted.B) Prior use of Ra-223 dichloride. C)
             Concurrent use of another investigational drug or device therapy (i.e., outside of
             study treatment) during, or within 4 weeks of trial entry (signing of the informed
             consent form).
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Disease Control Rate
Time Frame:9 months
Safety Issue:
Description:Efficacy evaluation done by bone scan and PET-CT. PERCIST criteria used for assessment of efficacy.

Secondary Outcome Measures

Measure:Tumor Response Rate
Time Frame:6 months
Safety Issue:
Description:PERICST criteria used to determine tumor response rate.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:M.D. Anderson Cancer Center

Trial Keywords

  • Breast cancer
  • Hormone-positive bone-dominant metastatic breast cancer
  • Ra-223 dichloride
  • Xofigo
  • Radium-223 chloride
  • Radium-223 dichloride
  • Alpharadin
  • Denosumab
  • AMG 162
  • Prolia
  • Hormone therapy

Last Updated

December 17, 2020