Description:
This is a multi-center, randomized phase II trial that will randomise women with ER-positive,
HER2-negative (Human Epidermal Growth factor Receptor 2-negative) metastatic or locally
relapsed breast cancer in a ratio of 1:1 to receive a metronomic regimen of vinorelbine plus
cyclophosphamide and capecitabine, or the conventional paclitaxel monotherapy.
Title
- Brief Title: MEtronomic TrEatment Option in Advanced bReast cAncer
- Official Title: A Randomized Phase II Trial of Metronomic Oral Vinorelbine Plus Cyclophosphamide and Capecitabine (VEX) Versus Weekly Paclitaxel as First-line or Second-line Treatment in Patients With ER-positive/HER2-negative Advanced or Metastatic Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
IBCSG 54-16
- SECONDARY ID:
2016-002200-39
- NCT ID:
NCT02954055
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Paclitaxel | Paclitaxel Sandoz | Arm A |
Cyclophosphamide | Endoxan Baxter | Arm B |
Capecitabine | Xeloda | Arm B |
Vinorelbine | Navelbine | Arm B |
Purpose
This is a multi-center, randomized phase II trial that will randomise women with ER-positive,
HER2-negative (Human Epidermal Growth factor Receptor 2-negative) metastatic or locally
relapsed breast cancer in a ratio of 1:1 to receive a metronomic regimen of vinorelbine plus
cyclophosphamide and capecitabine, or the conventional paclitaxel monotherapy.
Detailed Description
The prognosis for patients with locally advanced or metastatic disease (ABC) remains poor,
with a median survival of 2-4 years. About 10% of newly diagnosed BC patients present with
ABC, and 30% to 50% of patients diagnosed at earlier stages will subsequently develop
metastatic disease.
In the first-line treatment of HER2 (Human Epidermal Growth factor Receptor 2) negative ABC
patients, various chemotherapy regimens can be used including taxanes, which are among the
most active agents in BC. Single agent response rates range from 20 to 50%. However,
eventually all patients will progress with a median time to progression of 5 to 7 months. A
weekly (qw) over a three-weekly (q3w) administration schedule of paclitaxel has been shown to
be more effective in the metastatic as well as in the adjuvant setting after standard
chemotherapy
The VEX regimen was recently investigated within a phase II trial currently ongoing at the
European Institute of Oncology (IEO) (IEO number IEOS582/111; EudraCT Number: 2010-024266-21;
title: "A phase II study of metronomic oral chemotherapy with cyclophosphamide plus
capecitabine and vinorelbine in metastatic breast cancer patients"). Patients received
vinorelbine 40 mg orally on days 1, 3 and 5 every week, cyclophosphamide 50 mg daily and
capecitabine 500 mg 3 times a day.
Given the promising activity of the VEX regimen in a pre-treated population of advanced
breast cancer patients and the good tolerability, the aim of the present trial is to
investigate whether the VEX schedule may improve efficacy and tolerability as compared to
standard paclitaxel treatment in advanced or metastatic ER-positive/HER2-negative breast
cancer patients.
The concept of the VEX metronomic treatment is to administer the combination for as long as
the patient has the possibility of deriving a benefit from it. The time to treatment failure
(TTF) has been chosen as primary endpoint for this trial. TTF is defined as time from the
date of randomization to the date when the final dose of trial treatment is administered.
Chemotherapy may need to be stopped due to lack of tolerability, lack of efficacy or patient
preference through subjective symptom assessment. TTF is a composite endpoint combining all
these feasibility aspects of a treatment. It is therefore uniquely suited to the research
question of the current trial. The secondary endpoints progression-free survival, disease
control and safety will allow further assessment of the feasibility of the VEX metronomic
treatment versus the paclitaxel monotherapy regimen.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm A | Active Comparator | Paclitaxel 90 mg/m2 days 1, 8, 15 q4w. Patients will continue to receive assigned treatment until progression or lack of tolerability. | |
Arm B | Experimental | Metronomic VEX:
Cyclophosphamide 50 mg orally once daily continuously, Capecitabine 500 mg, orally 3 times a day (1500 mg/day) continuously, Vinorelbine 40 mg orally days 1, 3, 5 each week continuously. Patients will continue to receive assigned treatment until progression or lack of tolerability. | - Cyclophosphamide
- Capecitabine
- Vinorelbine
|
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically confirmed HER2-negative locally advanced or metastatic
(stage IV) breast cancer.
- Maximum of one prior line of chemotherapy for advanced or metastatic breast cancer.
- Measurable or non-measurable, but radiologically evaluable (except for skin lesions),
disease according to RECIST 1.1 criteria.
- Female aged 18 years or older.
- Life expectancy > 3 months.
- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
- ER-positive disease by local laboratory, determined on most recent available tissue
(latest biopsy of metastatic lesion, otherwise prior biopsy or surgical specimen).
- If previously treated with a taxane in the neoadjuvant or adjuvant setting, the period
from end of treatment to disease recurrence must have been > 12 months (> 365 days).
- Radiation therapy, if given and regardless of site, must be completed at least 2 weeks
prior to randomization.
- Normal hematologic status,
- Absolute neutrophil count ≥1000/mm3 (1.0 × 109/L),
- Platelets ≥ 100 × 109/L,
- Hemoglobin ≥ 9 g/dL (≥ 90 g/L).
- Normal renal function: serum creatinine ≤ 1.5 ULN or calculated creatinine clearance ≥
50 mL/min according to the Cockcroft-Gault formula.
- Normal liver function:
- Serum total bilirubin ≤ 1.5 × upper limit of normal (ULN). In the case of known
Gilbert's syndrome, a higher serum total bilirubin (< 3 × ULN) is allowed.
- Aspartate transaminase (AST) and Alanine transaminase (ALT) ≤ 3 × ULN; if the patient
has liver metastases, ALT and AST must be ≤ 5 × ULN.
- Women of child bearing potential must have documented negative pregnancy test within 2
weeks prior to randomization and agree to acceptable birth control (non-hormonal)
during and up to 6 months after trial therapy.
- Written Informed Consent (IC) must be signed and dated by the patient and the
Investigator prior to starting screening procedures and randomization.
- The patient has been informed of and agrees to data transfer and handling, in
accordance with national data protection guidelines.
Exclusion Criteria:
- More than one prior line of chemotherapy for advanced or metastatic breast cancer
- Previous treatment for advanced or metastatic disease with taxanes, or capecitabine or
vinorelbine or oral cyclophosphamide.
- More than 2 lines of previous endocrine therapy for locally advanced or metastatic
breast cancer.
- Known active central nervous system metastases, as indicated by clinical symptoms,
cerebral edema, and/or progressive growth (patients with history of Central Nervous
System (CNS) metastases or spinal cord compression are eligible if they are clinically
and radiologically stable for at least 4 weeks before first dose of trial treatment
and have not required high-dose steroid treatment in the last 4 weeks).
- Peripheral neuropathy grade 2 or higher (CTCAE version 4.0).
- Significant uncontrolled cardiac disease (i.e. unstable angina, myocardial infarction
within prior 6 months), patients classified as having a New York Heart Association
(NYHA) class III or IV congestive heart failure.
- Pregnant or lactating.
- Prior history of non-breast malignancy (except for adequately controlled basal cell
carcinoma of the skin, carcinoma in situ of the cervix, in situ carcinoma of the
bladder).
- Any concurrent condition which in the Investigator's opinion makes it inappropriate
for the patient to participate in the trial or which would jeopardize compliance with
the protocol.
- Contraindications or known hypersensitivity to the trial medication or excipients.
- The use of any anti-cancer investigational agents within 30 days prior to expected
start of trial treatment.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Time to treatment failure (TTF) compared between treatment groups. |
Time Frame: | From date of randomization until the date the final dose of trial treatment was given due to documented progression, lack of tolerability or until further treatment is declined, assessed up to 36 months from enrollment of the first patient. |
Safety Issue: | |
Description: | Efficacy and tolerability, measured by time to treatment failure, of metronomic oral vinorelbine plus cyclophosphamide and capecitabine (VEX) versus weekly paclitaxel, using an intent-to-treat analysis approach. |
Secondary Outcome Measures
Measure: | Frequency of targeted adverse events (safety and tolerability). |
Time Frame: | Time from day 1 of cycle 1 until 28 days after stopping trial treatment. |
Safety Issue: | |
Description: | Frequency of adverse events by type and worst grade experienced. |
Measure: | Disease control |
Time Frame: | From date of randomization until the date of first documented progression, assessed up to 36 months from enrollment of the first patient. |
Safety Issue: | |
Description: | Best overall response of complete response (CR) or partial response (PR), or stable disease (SD) lasting for at least 24 weeks, measured from randomisation to progression. |
Measure: | Progression free survival (PFS) |
Time Frame: | Time from randomization until documented disease progression, assessed up to 36 months from the enrollment of the first patient. |
Safety Issue: | |
Description: | Distribution of PFS for each treatment group using Kaplan-Meier; median PFS with two-sided 95% confidence interval (CI). PFS according to RECIST 1.1 criteria or death, whichever occurs first. |
Measure: | Overall Survival |
Time Frame: | From day 1 of cycle 1 until death from any cause (censored at date of last assessment of vital status for patients lost to follow up), assessed up to 36 months from the enrollment of the first patient. |
Safety Issue: | |
Description: | Overall survival from time of randomisation will be summarised for each treatment group. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | International Breast Cancer Study Group |
Trial Keywords
- locally advanced
- metastatic
- breast cancer
- ER-positive
- HER2-negative
- Stage IV
Last Updated
February 2, 2021