Clinical Trials /

PAKT: AZD5363 in Combination With Paclitaxel in Triple-Negative Advanced or Metastatic Breast Cancer



PAKT was an investigator-led, placebo-controlled, randomized phase II trial performed in 42 academic medical centers in the United Kindom, South Korea, France, Hungary, Romania, and Georgia. Patients were randomly assigned (1:1) to receive paclitaxel plus capivasertib or paclitaxel plus placebo. Stratification was by number of metastatic sites (< 3 v ≥ 3) and interval from the end of prior adjuvant or neoadjuvant chemotherapy (≤ 12 v > 12 months v no prior chemotherapy). Paclitaxel was administered as a once-per-week intravenous infusion of 90 mg/m2 over approximately 1 hour on days 1, 8, and 15 of each 28-day treatment cycle. Capivasertib 400 mg or placebo was administered orally twice per day on an intermittent weekly dosing schedule, with treatment on days 2 to 5 of weeks 1, 2, and 3 within each 28-day cycle. All treatments were continued until disease progression, development of unacceptable toxicity, or withdrawal of consent. If paclitaxel treatment was discontinued before disease progression, patients could continue to receive capivasertib or placebo alone. In case of adverse events (AEs), capivasertib or placebo could be reduced to 320 mg twice per day and subsequently to 240 mg twice per day. Capivasertib or placebo could be interrupted for up to 4 weeks for toxicity. Tumor assessments included computed tomography scanning or magnetic resonance imaging of the chest, abdomen, and pelvis at baseline, every 8 weeks during treatment, and at progression. Patients who discontinued treatment for any reason other than progression were required to follow the same schedule of assessments until progression, initiation of another treatment, death, or withdrawal of consent.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting


Phase 2

Trial Eligibility



  • Brief Title: PAKT: AZD5363 in Combination With Paclitaxel in Triple-Negative Advanced or Metastatic Breast Cancer
  • Official Title: A Phase II, Double-blind, Randomised, Placebo-controlled Study of the AKT Inhibitor AZD5363 in Combination With Paclitaxel in Triple-Negative Advanced or Metastatic Breast Cancer (PAKT).

Clinical Trial IDs

  • ORG STUDY ID: 009246QM
  • SECONDARY ID: 2013-001521-43
  • NCT ID: NCT02423603


  • Metastatic Breast Cancer


PaclitaxelTaxolPaclitaxel + AZD5363
AZD5363Paclitaxel + AZD5363
PlaceboPaclitaxel + Placebo


Normally, cells in human body divide in an orderly way. However in cancer cells, some important proteins, which help control cell growth, start to behave abnormally resulting in faster growth and multiplication. In this study, we are looking at a protein called AKT that helps the cancer cells to develop. Blocking the action of AKT with a drug like AZD5363 may slow down or stop the cancer growing. The development of AZD5363 is intended to provide a new treatment option for patients with cancer. The standard chemotherapy agent, Paclitaxel, is given to destroy cancer cells. AZD5363 may also make the cancer more sensitive to Paclitaxel and so make this agent more effective. A gene called PIK3CA has an important relationship with AKT. In tumours where this gene has been altered, or said to have 'mutated', the response to AZD5363 may be better. PIK3CA mutations are found commonly in breast cancers, and we will test for the presence of these mutations in both blood and tumour tissue samples that we ask you to provide. This study will also look at the relationship between tumours with PIK3CA mutations and the effect of the treatment.

Detailed Description

      The term triple-negative breast cancer (TNBC) is generally used to define tumours that do not
      express oestrogen receptors (ER), progesterone receptors (PR) and HER2 receptors. This
      subtype comprises 10-15% of all breast cancers.

      TNBC has an aggressive clinical course, shares features with basal-like tumours, and has a
      poorer outcome compared with other subtypes. Clinically, TNBC's are a challenge to treat
      because there is no role for endocrine or HER2-directed therapy. Chemotherapy is effective,
      but neo-adjuvant studies have shown that despite initial chemo-sensitivity, TNBC's still had
      a worse outcome, particularly in women in whom a pathologically confirmed complete response
      was not achieved. Consequently, there is a clear need to develop specific treatment
      strategies for the subgroup of TNBC's both in the early and advanced disease setting.

      AZD5363 is a potent, selective inhibitor of the kinase activity of the serine/threonine
      AKT/PKB (protein kinase B) that is being developed as a potential treatment for solid and
      haematological malignancies. AKT is part of the AGC family of kinases. Mammalian cells
      express three closely related AKT isoforms: AKT1 (PKBa), AKT2 (PKBß) and AKT3 (PKBgamma), all
      encoded by different genes.

      This is a placebo-controlled, multi-centre, 2-arm randomised phase II trial of Paclitaxel +
      AZD5363 versus Paclitaxel + placebo in patients with triple-negative (ER-negative,
      PR-negative/unknown, HER2-negative) advanced or metastatic breast cancer.

      Patients will be randomised into either of the Arms Paclitaxel + Placebo OR Paclitaxel +

      Randomisation will be stratified by the following criteria:

        -  Number of metastatic sites (<3, =3)

        -  (Neo)Adjuvant chemotherapy (end of (neo)adjuvant chemotherapy =12 months ago, end of
           (neo)adjuvant chemotherapy >12 months or no prior (neo)adjuvant chemotherapy).

Trial Arms

Paclitaxel + AZD5363Active ComparatorPatients receive Paclitaxel on Day 1, Day 8 and Day 15 plus AZD5363/Placebo on Days 2-5, Days 9-12, and Days 16-19. Upon Paclitaxel withdrawal, Patient receive AZD5363/Placebo on Days 2-5, Days 9-12, Days 16-19 and Days 23-27.
  • Paclitaxel
  • AZD5363
Paclitaxel + PlaceboPlacebo ComparatorPatients receive Paclitaxel on Day 1, Day 8 and Day 15. plus AZD5363/Placebo on Days 2-5, Days 9-12, and Days 16-19. Upon Paclitaxel withdrawal, Patient receive AZD5363/Placebo on Days 2-5, Days 9-12, Days 16-19 and Days 23-27.
  • Paclitaxel
  • Placebo

Eligibility Criteria

        Inclusion Criteria:

          1. Written informed consent prior to admission to this study

          2. Women, age > 18 years

          3. Histologically confirmed breast cancer

          4. Metastatic or locally recurrent disease; locally recurrent disease must not be
             amenable to resection with curative intent (patients who are considered suitable for
             surgical or ablative techniques following potential down-staging with study treatment
             are not eligible)

          5. Patient must have

               -  At least one lesion, not previously irradiated, that can be measured accurately
                  at baseline as ≥ 10mm in the longest diameter (except lymph nodes which must have
                  short axis ≥15mm) with CT, or magnetic resonance imaging (MRI) which is suitable
                  for accurate repeated measurements, OR

               -  lytic or mixed bone lesions in the absence of measurable disease as defined
                  above; patients with sclerotic/osteoblastic bone lesions only in the absence of
                  measurable disease are not eligible.

          6. Radiological or clinical evidence of recurrence or progression

          7. Triple-negative disease, defined as tumour cells being

               -  Negative for ER with <1% of tumour cells positive for ER on IHC or IHC score of

               -  Negative for PR with <1% of tumour cells positive for PR on IHC or IHC score of
                  ≥2 or PR unknown

               -  Negative for HER2 with 0, 1+ or 2+ intensity on IHC and no evidence of
                  amplification on ISH

          8. Formalin fixed paraffin embedded tumour sample from the primary or recurrent cancer
             must be available for central testing

          9. Patients must be able to swallow and retain oral medication

         10. Haematologic and biochemical indices within protocol specified ranges

         11. ECOG performance status 0-2

         12. Non-childbearing potential. If patient is of childbearing potential, she must have a
             negative serum pregnancy test and agree to use adequate contraception

         13. Willing and able to provide written informed consent

        Exclusion Criteria:

          1. Patients with confirm brain metastases or a history of primary central nervous system
             tumours or who have signs/symptoms attributable to brain metastases and have not been
             assessed with radiologic imaging to rule out the presence of brain metastases.

          2. Prior chemotherapy for metastatic breast cancer

          3. Radiotherapy with a wide field of radiation within 4 weeks before the first dose of
             study medication

          4. Prior treatment with PI3K inhibitors, AKT inhibitors or mTOR inhibitors

          5. Prior treatment with paclitaxel or docetaxel in the (neo)adjuvant setting within 12
             months from inclusion into this study

          6. Pre-existing sensory or motor polyneuropathy ≥ Grade 2 according to CTCAE

          7. Malabsorption syndrome or other condition that would interfere with enteral absorption

          8. Clinically significant pulmonary dysfunction

          9. Prolongation defined as a QTc interval >470msecs or other significant abnormalities in
             rhythm, conduction or morphology of resting ECG including 2nd degree (Type II) or 3rd
             degree AV block or bradycardia (ventricular rate <50 beats/min)

         10. Any factors that increase risk of QTc prolongation or risk of arrythmic events

         11. Experience of any of the following procedures or conditions in the preceding 6 months:
             coronary artery bypass graft, angioplasty, vascular stent, myocardial infarction,
             angina pectoris, congestive heart failure NYHA Grade ≥2, or cardiac ejection fraction
             outside institutional range of normal or <50%

         12. Clinically significant abnormalities of glucose metabolism

         13. Patients with proteinuria or creatine >1.5xULN concurrent with creatinine clearance

         14. Exposure to potent inhibitors or inducers or substrates of CYP3A4 or substrates of
             CYP2D6 within 2 weeks before the first dose of study treatment

         15. Concurrent treatment with other experimental drugs or participation in another
             clinical trial with any investigational drug within 30 days prior to study entry

         16. Psychological, familial, sociological or geographical conditions that do not permit
             compliance with the study protocol.

         17. Detained persons or prisoners

         18. Pregnant or nursing women
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:Date of randomisation to date of first tumour progression or death (this can range on average between 3 weeks and 32 weeks).
Safety Issue:
Description:Progression-free survival, defined as the time from the date of randomisation to the date of first documented tumour progression (using RECIST 1.1) or death from any cause, whichever occurs first.


Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Queen Mary University of London

Trial Keywords

  • Triple Negative Breast Cancer
  • Metastatic
  • AKT Inhibitor
  • Advanced
  • AZD5363
  • Paclitaxel
  • PAKT

Last Updated

August 29, 2017