Clinical Trials /

Sapanisertib in Combination With Fulvestrant in Women With Advanced or Metastatic Breast Cancer After Aromatase Inhibitor Therapy

NCT02756364

Description:

The primary purpose of this study is to compare the progression free survival (PFS) of participants treated with the combination of fulvestrant plus daily sapanisertib and fulvestrant plus weekly sapanisertib versus participants treated with single-agent fulvestrant.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Completed

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Sapanisertib in Combination With Fulvestrant in Women With Advanced or Metastatic Breast Cancer After Aromatase Inhibitor Therapy
  • Official Title: An Open-Label Phase 2 Study of MLN0128 (A TORC1/2 Inhibitor) in Combination With Fulvestrant in Women With ER-Positive/HER2-Negative Advanced or Metastatic Breast Cancer That Has Progressed During or After Aromatase Inhibitor Therapy

Clinical Trial IDs

  • ORG STUDY ID: C31006
  • SECONDARY ID: 2015-003612-20
  • SECONDARY ID: U1111-1174-2165
  • NCT ID: NCT02756364

Conditions

  • Breast Neoplasms

Interventions

DrugSynonymsArms
FulvestrantFulvestrant 500 mg
SapanisertibMLN0128Fulvestrant 500 mg + Sapanisertib 30 mg

Purpose

The primary purpose of this study is to compare the progression free survival (PFS) of participants treated with the combination of fulvestrant plus daily sapanisertib and fulvestrant plus weekly sapanisertib versus participants treated with single-agent fulvestrant.

Detailed Description

      The drug being tested in this study is called sapanisertib. Sapanisertib is being tested to
      treat postmenopausal women with advanced or metastatic estrogen receptor (ER) positive, human
      epidermal growth factor receptor-2 (HER2) negative breast cancer that has progressed during
      or after aromatase inhibitor (AI) therapy. This study will evaluate the efficacy and safety
      of combination of fulvestrant + daily sapanisertib and fulvestrant + weekly sapanisertib
      compared with fulvestrant alone.

      The study will enroll approximately 153 patients. Participants will be randomly assigned (by
      chance, like flipping a coin) to one of the three treatment groups-which will remain
      undisclosed to the participant and study doctor during the study (unless there is an urgent
      medical need):

        -  Fulvestrant 500 mg

        -  Fulvestrant 500 mg + Sapanisertib 4 mg

        -  Fulvestrant 500 mg + Sapanisertib 30 mg

      All participants will receive either fulvestrant 500 mg intramuscularly (IM), fulvestrant 500
      mg + sapanisertib 4 mg daily or fulvestrant 500 mg + sapanisertib 30 mg weekly.

      This multicenter trial will be conducted Spain and the USA. Participants will make multiple
      visits to the clinic, and end of treatment (EOT) visit which will occur 30 to 40 days after
      receiving their last dose of study drug or before the start of any subsequent anticancer
      therapy. After EOT, participants will be followed for progression free survival (PFS) and
      overall survival (OS).
    

Trial Arms

NameTypeDescriptionInterventions
Fulvestrant 500 mgActive ComparatorFulvestrant 500 mg, intramuscularly (IM), once on Days 1 and 15 in Cycle 1, and then on Day 1 of each subsequent 28-day cycle until progressive disease, unacceptable toxicity, or withdrawal of consent (Median duration of treatment was 16.0 weeks).
  • Fulvestrant
Fulvestrant 500 mg + Sapanisertib 4 mgExperimentalFulvestrant 500 mg, IM, once on Days 1 and 15 in Cycle 1, and then on Day 1 of each subsequent 28-day cycle along with the sapanisertib 4 mg, capsules, orally, once daily in each 28-day treatment cycle until progressive disease, unacceptable toxicity, or withdrawal of consent (Median duration of treatment was 20.1 and 20.3 weeks for fulvestrant and sapanisertib respectively).
  • Fulvestrant
  • Sapanisertib
Fulvestrant 500 mg + Sapanisertib 30 mgExperimentalFulvestrant 500 mg, IM, once on Days 1 and 15 in Cycle 1, and then on Day 1 of each subsequent 28-day cycle along with sapanisertib 30 mg, capsule, orally, once weekly in each 28-day treatment cycle until progressive disease, unacceptable toxicity, or withdrawal of consent (Median duration of treatment was 17.0 weeks for fulvestrant and sapanisertib, each).
  • Fulvestrant
  • Sapanisertib

Eligibility Criteria

        Inclusion Criteria:

          1. Female participants aged 18 years or older who are postmenopausal.

          2. Histologically proven diagnosis of breast cancer with evidence of metastatic disease
             or locoregional recurrence.

          3. Histological confirmation and documentation of estrogen receptor (ER)-positive status
             (≥1% positive stained cells).

          4. Histological or cytological confirmation and documentation of human epidermal growth
             factor receptor-2 (HER2)-negative status by local laboratory testing using criteria in
             the American Society of Oncology (ASCO)/College of American Pathologists (CAP)
             Clinical Practice Guideline update.

          5. Measurable disease defined as either of the following:

               -  At least 1 extra-osseous lesion that could be accurately measured in at least 1
                  dimension.

               -  The lesion must have measured ≥20 mm with conventional imaging techniques or ≥10
                  mm with spiral CT or MRI. Lymph nodes must be ≥1.5 cm in the short axis to be
                  considered measurable.

               -  Bone lesions (lytic or mixed [lytic plus sclerotic]) in the absence of measurable
                  disease as defined above. Note: Participants with sclerotic/osteoblastic bone
                  lesions only, in the absence of measurable disease, were not eligible.

          6. Progressive Disease (PD) during prior aromatase inhibitor (AI) therapy.

          7. Have a history of brain metastasis provided that all of the following criteria are
             met:

               -  Brain metastases have been treated.

               -  No evidence of PD for ≥3 months before the first dose of study drug.

               -  No hemorrhage after treatment.

               -  Off dexamethasone treatment for ≥4 weeks before the first dose of study drug.

               -  No ongoing requirement for dexamethasone or anti-epileptic drugs.

          8. Eastern cooperative oncology group (ECOG) performance status of 0 or 1.

          9. Clinical laboratory values as specified below within 4 weeks before the first dose of
             study drug:

               -  Bone marrow reserve consistent with absolute neutrophil count (ANC) ≥1.5*10^9/L;
                  platelet count ≥100*10^9/L; hemoglobin (Hgb) ≥9 g/dL.

               -  Total bilirubin ≤1.5*the upper limit of the normal range (ULN), aspartate
                  aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5*ULN (≤5*ULN if
                  liver metastases are present).

               -  Creatinine clearance ≥40 mL/min based on Cockcroft-Gault estimate or based on a
                  12- or 24-hour urine collection.

               -  Fasting serum glucose ≤130 mg/dL and fasting triglycerides ≤300 mg/dL.

        Exclusion Criteria:

          1. Prior therapy with mechanistic target of rapamycin (mTOR), phosphoinositide-3-kinase
             (PI3K), or dual PI3K-mTOR inhibitors, serine/threonine-specific protein kinase (AKT)
             inhibitors, or fulvestrant.

          2. Prior treatment with >1 line of chemotherapy for metastatic breast cancer or for
             locoregional recurrence that was not amenable to resection or radiation therapy with
             curative intent.

          3. Experienced PD on >2 endocrine therapies for metastatic breast cancer or for
             locoregional recurrence that was not amenable to resection or radiation therapy with
             curative intent.

          4. Life-threatening metastatic visceral disease (defined as extensive hepatic involvement
             or symptomatic pulmonary lymphangitic spread).

          5. Poorly controlled diabetes mellitus defined as hemoglobin A1c (glycosylated
             hemoglobin; HbA1c) >7%; participants with a history of transient glucose intolerance
             due to corticosteroid administration may be eligible if all other inclusion/exclusion
             criteria are met.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression Free Survival (PFS)
Time Frame:Up to 40 months
Safety Issue:
Description:PFS was defined as the time from the date of randomization to the date of first documentation of progressive disease (PD) or death due to any cause, whichever occurred first. Per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1, PD was defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.

Secondary Outcome Measures

Measure:Overall Survival (OS)
Time Frame:Up to 164 weeks
Safety Issue:
Description:OS was defined as the time from the date of randomization to the date of death.
Measure:Time to Progression (TTP)
Time Frame:Up to 40 months
Safety Issue:
Description:TTP was defined as the time from the date of randomization to the date of first documentation of progression. Per RECIST v1.1, PD was defined as at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.
Measure:Objective Response Rate (ORR)
Time Frame:Up to 40 months
Safety Issue:
Description:ORR was defined as the percentage of participants who achieve a best response of complete response (CR) or partial response (PR) according to RECIST v1.1 criteria. CR was defined as disappearance of all target lesions, non-target lesions, no new lesions, and normalization of tumor marker level. PR was defined as at least a 30% decrease in the sum of diameters of target lesions, no progression in non-target lesion, and no new lesions.
Measure:Clinical Benefit Rate (CBR)
Time Frame:Up to 40 months
Safety Issue:
Description:CBR was defined as the percentage of participants who achieved a best response of CR, PR, or stable disease (SD) of any duration. CR was defined as disappearance of all target lesions, non-target lesions, no new lesions, and normalization of tumor marker level. PR was defined as at least a 30% decrease in the sum of diameters of target lesions, no progression in non-target lesion, and no new lesions. SD was defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD.
Measure:Percentage of Participants Who Experienced at Least One Treatment-emergent Adverse Event (TEAE)
Time Frame:Up to 164 weeks
Safety Issue:
Description:An Adverse Event (AE) is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have to have a causal relationship with this treatment. A TEAE is defined as an adverse event with an onset that occurs after receiving study drug.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:Millennium Pharmaceuticals, Inc.

Trial Keywords

  • Drug Therapy

Last Updated

December 19, 2020