Description:
This is a single-centre study comprising two phases: a lead-in phase Ib and a phase II
randomized portion.
Lead-in Phase Ib study A lead-in phase I study will be built into this protocol to confirm
the dose of lenvatinib that can safely be combined with letrozole.
We expect that the optimal phase II dose level will be determined after recruiting 12-18
subjects into phase Ib. This dose level will be the one to be tested in the phase II portion
of the study.
Phase II open label study In this part of the study, eligible patients will be treated with
single agent lenvatinib at the phase II recommended dose for 2 weeks, followed by lenvatinib
combined with letrozole 2.5mg daily for 12 weeks.
A total of 30 patients with ER positive breast cancer and measurable primary tumor will be
enrolled over a period of 24-30 months
Title
- Brief Title: Neoadjuvant Lenvatinib Combined With Letrozole in Hormone Receptor Positive Breast Cancer
- Official Title: Phase Ib Followed by Phase II Study of Pre-operative Treatment With Lenvatinib Combined With Letrozole in Post-menopausal Women With Newly Diagnosed Hormone Receptor Positive Breast Cancer With Measurable Primary Breast Tumor
Clinical Trial IDs
- ORG STUDY ID:
BR01/04/15
- SECONDARY ID:
2015/00411
- NCT ID:
NCT02562118
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Lenvatinib + Letrozole | | Lenvatinib + Letrozole |
Purpose
This is a single-centre study comprising two phases: a lead-in phase Ib and a phase II
randomized portion.
Lead-in Phase Ib study A lead-in phase I study will be built into this protocol to confirm
the dose of lenvatinib that can safely be combined with letrozole.
We expect that the optimal phase II dose level will be determined after recruiting 12-18
subjects into phase Ib. This dose level will be the one to be tested in the phase II portion
of the study.
Phase II open label study In this part of the study, eligible patients will be treated with
single agent lenvatinib at the phase II recommended dose for 2 weeks, followed by lenvatinib
combined with letrozole 2.5mg daily for 12 weeks.
A total of 30 patients with ER positive breast cancer and measurable primary tumor will be
enrolled over a period of 24-30 months
Detailed Description
Hypothesis:
We hypothesize that combining a RET inhibitor such as lenvatinib with endocrine therapy may
potentiate anti-tumor effects in ER+ breast cancers in the clinic. Given that RET inhibition
is the primary mechanism of action of lenvatinib, we further hypothesize that RET expression
in the breast tumor may be a biomarker that predicts for better response to the combination
of a RET inhibitor and endocrine therapy in both a neoadjuvant (Part A) and a metastatic
(Part B) setting.
Primary Objectives
1. To confirm the dose of lenvatinib that can be safely combined with letrozole in the
lead-in Phase Ib part of the study.
2. Part A (For patients with non-metastatic breast cancer undergoing neoadjuvant treatment)
: To determine the overall clinical response (measured by ultrasound) and pathological
complete response rate after 2 weeks of neoadjuvant single agent lenvatinib followed by
12 weeks of letrozole combined with lenvatinib and compare with historical controls
treated with single agent letrozole.
3. Part B (For patients with metastatic breast cancer and who have tumor lesion that can be
serially biopsied safely): to determine the clinical response (measured by RECIST
criteria) after 2 weeks of single agent lenvatinib followed by continuous dual therapy
of lenvatinib and letrozole, until time of progression or intolerability.
Secondary Objectives
1. To evaluate the overall biological effects (Ki67 changes, histological response,
apoptosis, RET and downstream targets such as AKT and ERK) of 2 weeks of single agent
lenvatinib, and of letrozole + lenvatinib, in ER positive breast cancer, respectively.
2. To identify biological predictors for treatment response to letrozole + lenvatinib in ER
positive breast cancer using pharmacokinetics, pharmacogenetics, genomics and proteomics
strategies.
3. To compare the following parameters between RET positive versus RET negative, ER
positive breast cancer:
- Part A :
i. Clinical response (measured by ultrasound) and biological effects of 2 weeks of single
agent lenvatinib, ii. Clinical response (measured by ultrasound) and biological effects after
2 weeks of single agent lenvatinib followed by 12 weeks of letrozole combined with lenvatinib
-Part B : i. Clinical response measured by RECIST criteria after 2 weeks of single agent
lenvatinib followed by letrozole combined with lenvatinib ii. Progression-free and overall
survival with letrozole combined with lenvatinib
Trial Arms
Name | Type | Description | Interventions |
---|
Lenvatinib + Letrozole | Experimental | Single agent lenvatinib daily continuously x 2 weeks, followed by Letrozole 2.5mg daily + lenvatinib x 12 weeks (for Part A) or continuous till progression or intolerability (Part B) | |
Eligibility Criteria
Inclusion Criteria:
- Female, age ≥ 18 years.
- Histologic or cytologic diagnosis of breast carcinoma.
- Part A: T1-4 breast cancer with measurable primary breast tumor, defined as palpable
tumor with both diameters 2.0cm or greater as measured by caliper. Newly diagnosed
metastatic patients with measurable primary breast tumor ≥2cm are eligible provided
that there are plans for toilet mastectomy after completing 14 weeks of pre-operative
drug therapy. Patients must not have received prior chemotherapy or hormonal therapy
for the treatment of the current breast cancer.
- Part B: Patients with metastatic breast cancer with measurable tumor by RECIST
criteria.Patients previously treated with letrozole are eligible if they progressed on
letrozole ≥1 year after adjuvant treatment, or ≥ 6 months in the metastatic setting.
- ECOG 0-1.
- Estimated life expectancy of at least 12 weeks.
- Adequate organ function including the following:
- Bone marrow:
- Absolute neutrophil (segmented and bands) count (ANC) ≥ 1.5 x 109/L
- Platelets ≥ 100 x 109/L
- Hepatic:
- Bilirubin ≤ 1.5 x upper limit of normal (ULN),
- ALT or AST ≤ 2.5x ULN, (or ≤5 X with liver metastases)
- Renal:
Creatinine ≤ 1.5x ULN
• Post-menopausal women. Post-menopausal status is defined either by
- Age ≥ 60 years and one year or more of amenorrhea
- Age < 60 years and one year or more of amenorrhea (in the absence of ovarian
suppression) and with estradiol and FSH levels consistent with menopause, *Treatment
with a luteinizing hormone-releasing hormone (LHRH) agonist (goserelin acetate or
leuprolide acetate) is not permitted for induction of ovarian suppression for Part A
(patients with non-metastatic disease receiving the study treatment as neoadjuvant
therapy).
However, in Part B (patients with metastatic disease), pre-menopausal women who are treated
with medical ovarian suppression with post-menopausal levels of estradiol (institutional
limits) at time of study entry and who will continue to be suppressed with 4-weekly LHRH
agonist during study treatment may be enrolled. If these patients were previously on
12-weekly long-acting LHRH agonist, this has to be switched to 4-weekly LHRH agonist while
the patient is on study treatment.
• Signed informed consent from patient or legal representative.
Exclusion Criteria:
- Treatment within the last 30 days with any investigational drug.
- Concurrent administration of any other tumor therapy, including cytotoxic
chemotherapy, hormonal therapy, and immunotherapy.
- Major surgery within 28 days of study drug administration.
- Active infection that in the opinion of the investigator would compromise the
patient's ability to tolerate therapy.
- Pregnancy.
- Breast feeding.
- Serious concomitant disorders that would compromise the safety of the patient or
compromise the patient's ability to complete the study, at the discretion of the
investigator.
- Active bleeding disorder or bleeding site.
- Non-healing wound.
- Poorly controlled diabetes mellitus.
- Second primary malignancy that is clinically detectable at the time of consideration
for study enrollment.
- Symptomatic brain metastasis.
- History of significant neurological or mental disorder, including seizures or
dementia.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Rates of clinical response |
Time Frame: | 2-3 weeks |
Safety Issue: | |
Description: | Complete and partial clinical response, including confidence intervals. |
Secondary Outcome Measures
Measure: | Rates of pathological complete responses. |
Time Frame: | 4-6 weeks |
Safety Issue: | |
Description: | A pathological complete responder is defined as any patient who demonstrates no histological evidence of invasive tumor in the primary breast site as well as in resected axillary lymph nodes |
Measure: | Progression-free survival |
Time Frame: | 2 - 5 year |
Safety Issue: | |
Description: | Time to documented disease progression is defined as the time from the date of study enrollment to the first date of documented disease progression. Time to documented disease progression will be censored at the date of death for patients who have not had documented disease progression. For patients who are still alive at the time of analysis and who have not had documented disease progression, time to documented disease progression will be censored at the date of the last follow-up visit. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | National University Hospital, Singapore |
Trial Keywords
Last Updated
October 5, 2020