Clinical Trials /

L-NMMA Plus Taxane Chemotherapy in Refractory Locally Advanced or Metastatic Triple Negative Breast Cancer Patients

NCT02834403

Description:

This is a Phase Ib/II study assessing the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), recommended Phase 2 dose (RP2D), and efficacy of L-NMMA when combined with docetaxel in refractory locally advanced or metastatic triple negative breast cancer patients. The Phase Ib portion of the study is designed to investigate the combination at two dose levels of docetaxel (75 and 100 mg/m2) and 7 dose levels of L-NMMA (5, 7.5, 10, 12.5, 15, 17.5, and 20 mg/kg). The starting dose of L-NMMA will be 7.5 mg/kg. In the Phase II portion of the study, the starting dose will be the RP2D determined in the Phase Ib portion of the study.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Completed

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: L-NMMA Plus Taxane Chemotherapy in Refractory Locally Advanced or Metastatic Triple Negative Breast Cancer Patients
  • Official Title: Clinical Phase Ib/II Trial of L-NMMA Plus Taxane Chemotherapy in the Treatment of Refractory Locally Advanced or Metastatic Triple Negative Breast Cancer Patients

Clinical Trial IDs

  • ORG STUDY ID: Pro00011685
  • NCT ID: NCT02834403

Conditions

  • Metastatic Triple Negative Breast Cancer

Interventions

DrugSynonymsArms
L-NMMANG-monomethyl-l-arginineExperimental
DocetaxelTAXOTEREExperimental
Amlodipinebesylate salt of amlodipine; NORVASCExperimental
PegfilgrastimNEULASTAExperimental
Enteric-coated aspirinacetylsalicylic acidExperimental

Purpose

This is a Phase Ib/II study assessing the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), recommended Phase 2 dose (RP2D), and efficacy of L-NMMA when combined with docetaxel in refractory locally advanced or metastatic triple negative breast cancer patients. The Phase Ib portion of the study is designed to investigate the combination at two dose levels of docetaxel (75 and 100 mg/m2) and 7 dose levels of L-NMMA (5, 7.5, 10, 12.5, 15, 17.5, and 20 mg/kg). The starting dose of L-NMMA will be 7.5 mg/kg. In the Phase II portion of the study, the starting dose will be the RP2D determined in the Phase Ib portion of the study.

Detailed Description

      This is a Phase Ib/II study assessing the maximum tolerated dose (MTD), dose-limiting
      toxicities (DLTs), recommended Phase 2 dose (RP2D), and efficacy of L-NMMA when combined with
      docetaxel in refractory locally advanced or metastatic triple negative breast cancer
      patients. The Phase Ib portion of the study is designed to investigate the combination at two
      dose levels of docetaxel (75 and 100 mg/m2) and 7 dose levels of L-NMMA (5, 7.5, 10, 12.5,
      15, 17.5, and 20 mg/kg). The starting dose of L-NMMA will be 7.5 mg/kg. L-NMMA dose will
      escalate/de-escalate based on DLT occurrence. For the 5, 7.5, 10, 12.5, and 15 mg/kg L-NMMA
      doses, docetaxel will be administered at 75 mg/m2. For the 17.5 and 20 mg/kg L-NMMA doses,
      docetaxel will be administered at 100 mg/m2. In the Phase II portion of the study, the
      starting dose will be the RP2D determined in the Phase Ib portion of the study. In the phase
      II portion of the study, patients will be treated with L-NMMA and taxane (docetaxel,
      paclitaxel, or nab-paclitaxel) per physician's choice. Patients will be treated with L-NMMA
      and taxane chemotherapy (docetaxel, paclitaxel, or nab-paclitaxel) per physician's choice.
      L-NMMA will be administered on Days 1-5 and taxane chemotherapy on Day 1 Q3W or Day 1 Q1W.
      L-NMMA and docetaxel will be administered at the RP2D determined in the phase Ib portion of
      the study. Paclitaxel at 175 mg/m2 will be IV infused over 3 hours or 80 mg/m2 will be IV
      infused over 1 hour, and nab-paclitaxel at 260 mg/m2 will be IV infused over 30 minutes. For
      L-NMMA-induced hypertension, amlodipine (10 mg) and enteric-coated low-dose aspirin (81 mg)
      will be orally administered. Amlodipine will be administered for 6 days at each cycle,
      starting 24 hours before the first dose of L-NMMA. Enteric-coated low-dose aspirin will be
      administered once daily during the 6 21-day cycles. For docetaxel-induced leukopenia,
      pegfilgrastim (6 mg) will be administered via subcutaneous injection approximately 24 hours
      after every dose of docetaxel.
    

Trial Arms

NameTypeDescriptionInterventions
ExperimentalExperimentalPhase Ib: L-NMMA and docetaxel will be given for 6 21-day cycles. L-NMMA at doses of 5, 7.5 (starting dose), 10, 12.5, 15, 17.5, and 20 mg/kg will be administered IV on Days 1-5. For 5-15 mg/kg L-NMMA doses, docetaxel will be administered at 75 mg/m2. For 17.5 and 20 mg/kg L-NMMA doses, docetaxel will be administered at 100 mg/m2. Docetaxel will be administered IV 15 min after the Day 1 L-NMMA infusion. Amlodipine (10 mg) will be orally administered daily for 6 days, starting 24 hours before the Day 1 L-NMMA infusion. Enteric-coated aspirin (81 mg) will be orally administered once daily during the 6 21-day cycles. Pegfilgrastim (6 mg) will be administered subcutaneously 24 h after docetaxel. Phase II: L-NMMA starting dose will be the RP2D determined in the Phase Ib portion of the study.
  • L-NMMA
  • Docetaxel
  • Amlodipine
  • Pegfilgrastim
  • Enteric-coated aspirin

Eligibility Criteria

        Inclusion Criteria:

        Patient must meet all of the following criteria:

        • Female patients with pathologically determined advanced (progressive disease or
        refractory to 3 cycles of standard chemotherapy) or metastatic (any line) triple negative
        breast cancer (TNBC). TNBC is defined as: Estrogen receptor negative and progesterone
        receptor negative (<10% staining by immunohistochemistry [IHC]).

        Human epidermal growth factor receptor 2 (HER2) negative. HER2 negativity must be confirmed
        by one of the following:

          -  Fluorescence in situ hybridization (FISH)-negative (FISH ratio <2), or

          -  IHC 0-1+, or

          -  IHC 2+ AND FISH-negative (FISH ratio <2). Eastern Cooperative Oncology Group
             performance status of ≤ 2

               -  Age ≥ 18 years

               -  Laboratory values within the following ranges:

          -  Hemoglobin ≥9.0 g/dL (transfusions permitted)

          -  Absolute neutrophil count ≥1500/mm3 (1.5 x 109/L)

          -  Platelet count ≥100,000/mm3 (100 x 109/L)

          -  Total bilirubin <2 X upper limit of normal (ULN)

          -  Creatinine (Cr) <2 X ULN and Cr clearance (CrCl) ≥30 by Cockcroft and Gault

          -  Alanine transaminase (ALT) and aspartate transaminase (AST) <2 X ULN (if liver
             metastases are present then ALT and AST must be <5 X ULN)

               -  Have adequate organ function (cardiac ejection fraction of ≥ 45%)

               -  Negative serum pregnancy test within 7 days of the administration of the first
                  treatment dose for women of childbearing potential (WOCBP). For WOCBP, adequate
                  contraception must be used throughout the study.

               -  Ability to understand the requirements of the study, provide written informed
                  consent and authorization of use and disclosure of protected health information,
                  and agree to abide by the study restrictions and return for the required
                  assessments.

               -  Patient must be willing to undergo biopsies as required by the study protocol.
                  Biopsies will be based on acceptable clinical risks as judged by investigator.
                  Tissue from a previous biopsy will be accepted in the form of tissue slides.

        Exclusion Criteria:

        History of poorly controlled hypertension (defined as systolic blood pressure >150 mmHg at
        baseline)

          -  Patients with metastatic disease who have received radiation therapy, chemotherapy, or
             non-cytotoxic investigational agents within 2 weeks of study treatment initiation.

          -  Patients who received docetaxel at any line of treatment within the past 12 months

          -  Evidence of New York Heart Association class III or greater cardiac disease

          -  History of myocardial infarction, stroke, ventricular arrhythmia, or symptomatic
             conduction abnormality within the past 12 months

          -  History of congenital QT prolongation

          -  Absolute corrected QT interval of >480 msec in the presence of potassium >4.0
             milliequivalent/L and magnesium >1.8 mg/dL

          -  Any medical or psychiatric condition that would prevent informed consent or limit
             expected survival to less than 4 weeks

          -  Symptomatic central nervous system metastases

          -  Pregnant or nursing women

          -  Hypersensitivity or intolerance to L-NMMA, docetaxel, amlodipine, pegfilgrastim, or
             their components

          -  Use of amlodipine or another calcium channel blocker in the past 14 days

          -  Alcoholism or hepatic disease with the exception of liver metastases

          -  Severe renal insufficiency (CrCl <30 mL/min [Cockcroft and Gault])

          -  History of gastrointestinal bleeding, ulceration, or perforation

          -  Concurrent use of potent cytochrome P450 (CYP)3A4 inhibitors

          -  Concurrent use of potent CYP3A4 inducers

          -  Concurrent use of medications that interact with nitrate/nitrites

          -  Use of an investigational drug within 14 days preceding the first dose of study
             medication.

          -  Concurrent use of any complementary or alternative medicines

          -  Patients with > Grade 2 neuropathy

          -  Inability to take aspirin
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:MTD
Time Frame:18 weeks
Safety Issue:
Description:Primary outcome measure for Phase Ib: Assess the MTD of L-NMMA when combined with docetaxel/amlodipine

Secondary Outcome Measures

Measure:DLTs and other adverse events
Time Frame:18 weeks
Safety Issue:
Description:Describe the DLTs and other adverse events associated with L-NMMA when combined with docetaxel/amlodipine, as assessed by the CTCAE v4.03
Measure:RP2D of the L-NMMA and docetaxel combination
Time Frame:18 weeks
Safety Issue:
Description:Determine the RP2D of the L-NMMA and docetaxel combination based on the occurrence of DLTs and MTD determination
Measure:Antitumor activity
Time Frame:18 weeks
Safety Issue:
Description:Assess the antitumor activity of L-NMMA when combined with taxane chemotherapy (docetaxel, paclitaxel, or nab-paclitaxel)/amlodipine, as assessed by the RECIST 1.1.
Measure:Maximum plasma concentration of the L-NMMA and docetaxel combination
Time Frame:18 weeks
Safety Issue:
Description:Determine the maximum plasma concentration of the L-NMMA and docetaxel combination

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:Polly A. Niravath, MD

Trial Keywords

  • breast cancer
  • nitric oxide synthase
  • docetaxel
  • L-NMMA

Last Updated

June 2, 2021