Description:
This phase IIB trial studies how well enzalutamide and paclitaxel before surgery works in
treating patients with stage I-III androgen receptor-positive triple-negative breast cancer.
Androgens can cause the growth of triple-negative breast cancer. Anti-hormone therapy, such
as enzalutamide, prevent androgen from binding to the androgen receptor, thereby decreasing
cell growth and causing tumor cell death. Drugs used in chemotherapy, such as paclitaxel,
work in different ways to stop the growth of tumor cells, either by killing the cells, by
stopping them from dividing, or by stopping them from spreading. Giving enzalutamide and
paclitaxel before surgery may make the tumor smaller and reduce the amount of normal tissue
that needs to be removed. This treatment study is part of the MD Anderson Moonshot
initiative.
Title
- Brief Title: Enzalutamide and Paclitaxel Before Surgery in Treating Patients With Stage I-III Androgen Receptor-Positive Triple-Negative Breast Cancer
- Official Title: A Phase IIB Study of Neoadjuvant ZT Regimen (Enzalutamide) Therapy in Combination With Weekly Paclitaxel) for Androgen Receptor (AR)-Positive Triple-Negative Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
2015-0488
- SECONDARY ID:
NCI-2016-00367
- SECONDARY ID:
2015-0488
- SECONDARY ID:
P30CA016672
- NCT ID:
NCT02689427
Conditions
- Androgen Receptor Positive
- Estrogen Receptor Negative
- HER2/Neu Negative
- Invasive Breast Carcinoma
- Progesterone Receptor Negative
- Stage I Breast Cancer AJCC v7
- Stage IA Breast Cancer AJCC v7
- Stage IB Breast Cancer AJCC v7
- Stage II Breast Cancer AJCC v6 and v7
- Stage IIA Breast Cancer AJCC v6 and v7
- Stage IIB Breast Cancer AJCC v6 and v7
- Stage III Breast Cancer AJCC v7
- Stage IIIA Breast Cancer AJCC v7
- Stage IIIB Breast Cancer AJCC v7
- Stage IIIC Breast Cancer AJCC v7
- Triple-Negative Breast Carcinoma
Interventions
Drug | Synonyms | Arms |
---|
Enzalutamide | ASP9785, MDV3100, Xtandi | Treatment (enzalutamide, paclitaxel) |
Paclitaxel | Anzatax, Asotax, Bristaxol, Praxel, Taxol, Taxol Konzentrat | Treatment (enzalutamide, paclitaxel) |
Purpose
This phase IIB trial studies how well enzalutamide and paclitaxel before surgery works in
treating patients with stage I-III androgen receptor-positive triple-negative breast cancer.
Androgens can cause the growth of triple-negative breast cancer. Anti-hormone therapy, such
as enzalutamide, prevent androgen from binding to the androgen receptor, thereby decreasing
cell growth and causing tumor cell death. Drugs used in chemotherapy, such as paclitaxel,
work in different ways to stop the growth of tumor cells, either by killing the cells, by
stopping them from dividing, or by stopping them from spreading. Giving enzalutamide and
paclitaxel before surgery may make the tumor smaller and reduce the amount of normal tissue
that needs to be removed. This treatment study is part of the MD Anderson Moonshot
initiative.
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the pathologic complete response (pCR) and residual cancer burden-index
(RCB-I) rates of patients with triple-negative breast cancer (TNBC) who were non-responders
to initial anthracycline and cyclophosphamide chemotherapy and who were treated with
enzalutamide in combination with weekly paclitaxel in the neoadjuvant setting.
SECONDARY OBJECTIVES:
I. To estimate progression free survival (PFS) distribution of androgen receptor
(AR)-positive TNBC patients who were nonresponders to initial anthracycline and
cyclophosphamide chemotherapy, treated with enzalutamide in combination with weekly
paclitaxel in the neoadjuvant setting.
II. To determine the safety of administering enzalutamide in combination with weekly
paclitaxel.
EXPLORATORY OBJECTIVES:
I. To investigate the association between biomarkers in the peripheral blood and tumor tissue
with safety and efficacy for TNBC patients who were treated with enzalutamide and treatment
in combination with weekly paclitaxel in the neoadjuvant setting.
II. To investigate the correlation between circulating tumor cells (CTC) characteristics
and/or gene profiles and treatment response of enzalutamide and taxane.
OUTLINE:
Patients receive enzalutamide orally (PO) daily on days 1-7 and paclitaxel intravenously (IV)
over 2 hours on day 1. Cycles repeat every 7 days for up to 12 cycles in the absence of
disease progression or unacceptable toxicity.
SURGERY: After 12 cycles of therapy, patients undergo surgical resection of primary tumor
with or without lymph node biopsy or complete axillary dissection.
After completion of study treatment, patients are followed up within 30 days after surgery.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (enzalutamide, paclitaxel) | Experimental | Patients receive enzalutamide PO daily on days 1-7 and paclitaxel IV over 2 hours on day 1. Cycles repeat every 7 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
SURGERY: After 12 cycles of therapy, patients undergo surgical resection of primary tumor with or without lymph node biopsy or complete axillary dissection. | |
Eligibility Criteria
Inclusion Criteria:
- Patients must be willing to sign the protocol-specific written informed consent
- Patients with histologically confirmed intact primary cancer that is confirmed
invasive carcinoma of the breast, with at least 1.0 cm residual disease as measured by
mammography, ultrasound, or breast magnetic resonance imaging (MRI) after neoadjuvant
anthracycline based chemotherapy
- Patients must have triple-negative breast cancer defined as estrogen receptor (ER) <
10%; progesterone receptor (PR) < 10% by immunohistochemistry (IHC) and human
epidermal growth factor receptor 2 (HER2) 0-1+ by IHC or 2+, fluorescence in situ
hybridization (FISH) non-amplified
- Androgen receptor will be quantified using a Clinical Laboratory Improvement Act
(CLIA)-compliant assay for AR on a biopsy specimen obtained prior to the start of
treatment; AR-positivity is defined as >= 10% of nuclear staining
- Patient's disease state must be American Joint Committee on Cancer (AJCC) 7th edition
stage I-III
- Patients must have a performance status of 0 - 1 on the Eastern Cooperative Oncology
Group (ECOG) performance scale
- A negative serum or urine pregnancy test must be done within 72 hours before the first
dose of the study medication for women of childbearing potential as per institutional
guidelines; post-menopausal women (defines as no menses for at least 1 year) and
surgically sterilized women are not required to undergo pregnancy test
- Men on study must use a condom if having sex with a pregnant woman
- Male patients and his female partner who is of childbearing potential must use 2
acceptable methods of birth control (one of which must include a condom as a barrier
method of contraception) starting at screening and continuing throughout the study
period and for 3 months after final study drug administration
- Absolute neutrophil count >= to 1,500 /uL
- Platelets >= to 100,000 /uL
- Hemoglobin >= to 9 g/dL
- Creatinine clearance >= to 50 ml/min
- Total bilirubin =< to 1.5 X upper limit of normal (ULN)
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< to 2.5 X ULN
Exclusion Criteria:
- Patients who have received any other previous antitumor therapies (other than
anthracycline-based neoadjuvant chemotherapy for the current cancer event)
- Breast-feeding at screening or planning to become pregnant during the course of
therapy
- Patients who have had major surgery within 21 days before cycle 1, day 1
- Patients with known history of hypersensitivity to paclitaxel that did not resolve
with pre-medication
- Patients with left ventricular ejection fraction < 50% or 10% decrease from baseline
on echocardiogram after anthracycline based chemotherapy
- Patients with gastrointestinal impairment that would affect the absorption of
enzalutamide or previous history of colitis
- Subjects requiring daily corticosteroids, other than those given as premedication for
the anthracycline-based chemotherapy
- Patients with known or suspected brain metastasis or active leptomeningeal disease
- History of seizure or any condition that may predispose to seizure (e.g., prior
cortical stroke, significant brain trauma) at any time in the past; also, history of
loss of consciousness or transient ischemic attack within 12 months of day 1 visit
- Myocardial infarction within 6 months before starting therapy, symptomatic congestive
heart failure (New York Heart Association > class II), unstable angina, or unstable
cardiac arrhythmia requiring medication
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Incidence of pathologic complete response (residual cancer burden-zero) and residual cancer burden-index |
Time Frame: | Up to 30 days after surgery |
Safety Issue: | |
Description: | Using a Simon optimal two-stage design with alpha = beta = 10%, and then setting the threshold for an acceptable pathologic complete response or residual cancer burden-index rate at 20%. Will be estimated by the proportion of patients with pathologic complete response (residual cancer burden-zero) or residual cancer burden-index as the response rate along with an appropriate 95% confidence interval. |
Secondary Outcome Measures
Measure: | Progression-free survival distribution |
Time Frame: | From enrollment to progression of disease or death whichever comes first, up to 30 days after surgery |
Safety Issue: | |
Description: | Estimated using Kaplan-Meier method. Progression of disease defined as > 20% increase in tumor. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Trial Keywords
- Androgen Receptor positive TNBC
Last Updated
March 11, 2021