Clinical Trials /

Standard of Care Chemotherapy Plus Pembrolizumab for Breast Cancer

NCT02734290

Description:

The goal of this study is to establish the safety and tolerability of pembrolizumab when administered in combination with either of two chemotherapy regimens (weekly paclitaxel or capecitabine) in unresectable/metastatic triple negative breast cancer (MTNBC) patients.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Standard of Care <span class="go-doc-concept go-doc-intervention">Chemotherapy</span> Plus <span class="go-doc-concept go-doc-intervention">Pembrolizumab</span> for Breast Cancer

Title

  • Brief Title: Standard of Care Chemotherapy Plus Pembrolizumab for Breast Cancer
  • Official Title: A Pilot and Phase II Study to Assess the Safety, Tolerability and Efficacy of Pembrolizumab Plus Chemotherapy in Metastatic Triple Negative Breast Cancer Patients
  • Clinical Trial IDs

    NCT ID: NCT02734290

    ORG ID: 16-001

    Trial Conditions

    Triple Negative Breast Cancer

    Trial Interventions

    Drug Synonyms Arms
    Pembrolizumab Keytruda Arm A, Arm B
    Paclitaxel Taxol Arm A
    Capecitabine Xeloda Arm B

    Trial Purpose

    The goal of this study is to establish the safety and tolerability of pembrolizumab when
    administered in combination with either of two chemotherapy regimens (weekly paclitaxel or
    capecitabine) in unresectable/metastatic triple negative breast cancer (MTNBC) patients.

    Detailed Description

    In the pilot phase, patients will be enrolled to one of two experimental arms, which will be
    selected by the treating investigator (arm A: pembrolizumab + weekly paclitaxel; arm B:
    pembrolizumab + capecitabine).

    Subjects will receive pembrolizumab via intravenous (IV) infusion at 200mg every three weeks
    (Q3W), and continue treatment Q3W until progression of disease, initiation of alternative
    cancer therapy, unacceptable toxicity, or other reasons to discontinue treatment occur, up
    to 24 months.

    Paclitaxel will be administered intervenously on a weekly schedule at a dose of 80mg/m2.

    Oral capecitabine will be administered at total daily dose of 4,000 mg (2,000 mg two times
    each day (abbreviated BID)). Capecitabine will be administered as intermittent therapy given
    on days 1-7 in 14-day cycles.

    Trial Arms

    Name Type Description Interventions
    Arm A Experimental pembrolizumab + weekly paclitaxel Pembrolizumab, Paclitaxel
    Arm B Experimental pembrolizumab + capecitabine Pembrolizumab, Capecitabine

    Eligibility Criteria

    Inclusion Criteria:

    Be willing and able to provide written informed consent/assent for the trial.

    - Be 18 years of age on day of signing informed consent.

    - HER2-negative breast cancer (defined by immunohistochemistry (IHC) 0-1 (or) IHC 2 and
    in situ hybridization (ISH) HER2 / centromere on chromosome 17 (CEP17) < 2.0);

    - ER and PR-negative breast cancer (defined by IHC<1%);

    - Measurable metastatic or unresectable disease based on response evaluation criteria
    in solid tumours (RECIST) 1.1.

    - Indicated for treatment with either weekly paclitaxel or oral capecitabine, as first
    or second-line chemotherapy in the metastatic/unresectable setting (as determined by
    the consenting investigator);

    - Be willing to provide tissue from a newly obtained core or excisional biopsy of a
    tumor lesion. Newly-obtained is defined as a specimen obtained during screening.
    Archival tissue is acceptable if no intervening anti-neoplastic therapy has been
    administered, and if sufficient material is available for analysis (see section 8.0
    for requirements);

    - Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG)
    Performance Scale.

    - Demonstrate adequate organ function as defined by protocol defined lab values

    - Female subjects of childbearing potential must have a negative urine or serum
    pregnancy within 72 hours prior to receiving the first dose of study medication. If
    the urine test is positive or cannot be confirmed as negative, a serum pregnancy test
    will be required.

    - Female subjects of childbearing potential must avoid becoming pregnant while on
    treatment. Men must avoid fathering a child while on treatment.

    Exclusion Criteria:

    - Is currently participating and receiving study therapy or has participated in a study
    of an investigational agent and received study therapy or used an investigational
    device within 4 weeks of the first dose of treatment.

    - Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any
    other form of immunosuppressive therapy within 7 days prior to the first dose of
    trial treatment.

    - Has a known history of active TB (Bacillus Tuberculosis)

    - Hypersensitivity to pembrolizumab or any of its excipients.

    - Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study,
    Day 1 or who has not recovered (i.e., Grade 1 or at baseline) from adverse events
    due to agents administered more than 4 weeks earlier. Denosumab is allowed.

    - Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy
    within 2 weeks prior to study Day 1 or who has not recovered (i.e., Grade 1 or at
    baseline) from adverse events due to a previously administered agent. Note: Subjects
    with Grade 2 neuropathy and alopecia are an exception to this criterion and may
    qualify for the study.

    - Has received the assigned chemotherapy regimen previously in the metastatic setting,
    or has received the assigned chemotherapy regimen previously in the (neo)adjuvant
    setting within 12 months of consent;

    - If subject received major surgery, they must have recovered adequately from the
    toxicity and/or complications from the intervention prior to starting therapy.

    - Has a known additional malignancy that progressed or required active treatment in the
    last 5 years.

    - Has known active central nervous system (CNS) metastases and/or carcinomatous
    meningitis. Subjects with previously treated brain metastases may participate
    provided they are stable (without evidence of progression by imaging for at least
    four weeks prior to the first dose of trial treatment and any neurologic symptoms
    have returned to baseline), have no evidence of new or enlarging brain metastases,
    and are not using steroids for at least 7 days prior to trial treatment. This
    exception does not include carcinomatous meningitis which is excluded regardless of
    clinical stability.

    - Has active autoimmune disease that has required systemic treatment in the past 2
    years (i.e. with use of disease modifying agents, corticosteroids or
    immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or
    physiologic corticosteroid replacement therapy for adrenal or pituitary
    insufficiency, etc.) is not considered a form of systemic treatment.

    - Has history of/active pneumonitis requiring treatment with steroids or history
    of/active interstitial lung disease.

    - Has an active infection requiring systemic therapy.

    - Has a history or current evidence of any condition, therapy, or laboratory
    abnormality that might confound the results of the trial, interfere with the
    subject's participation for the full duration of the trial, or is not in the best
    interest of the subject to participate, in the opinion of the treating investigator.

    - Has known psychiatric or substance abuse disorders that would interfere with
    cooperation with the requirements of the trial.

    - Is pregnant or breastfeeding, or expecting to conceive or father children within the
    projected duration of the trial, starting with the pre-screening or screening visit
    through 120 days after the last dose of trial treatment.

    - Has received prior therapy with an anti-programmed death 1 (anti-PD-1),
    anti-programmed death ligand 1 (anti-PD-L1), or anti-programmed death ligand 2
    (anti-PD-L2) agent or has participated in a Merck-sponsored pembrolizumab study.

    - Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).

    - Has known active Hepatitis B or Hepatitis C.

    - Has received a live vaccine within 30 days of planned start of study therapy. Note:
    Seasonal influenza vaccines for injection are generally inactivated flu vaccines and
    are allowed; however intranasal influenza vaccines (e.g., Flu-Mist) are live
    attenuated vaccines, and are not allowed.

    Minimum Eligible Age: 18 Years

    Maximum Eligible Age: N/A

    Eligible Gender: Both

    Primary Outcome Measures

    Treatment-Associated Adverse Events

    Number of patients who complete chemotherapy without a dose delay of more than 21 days.

    Secondary Outcome Measures

    Overall response rate

    Trial Keywords

    metastatic

    Human epidermal growth factor receptor 2 (Her2) negative breast cancer

    Estrogen Receptor (ER) negative breast cancer

    Progesterone Receptor (PR) negative breast cancer