Clinical Trials /

Alternative Dosing Schedule of Palbociclib in Metastatic Hormone Receptor Positive Breast Cancer

NCT03007979

Description:

The investigators propose to conduct a study to test an alternative dosing schedule of palbociclib. With the current three-week on and one week off schedule, a significant number of patients develop grade 3 or higher degree of neutropenia and require dose reduction and sometimes discontinuation. This potentially compromises the efficacy of the drug. In addition, as the half-life of palbociclib is 27 hours, 1 week break with the standard 3 weeks on and 1 week off dosing schedule could potentially lead to recovery of Rb phosphorylation during the off week. Hence, the investigators propose a 5 days on and 2 days off schedule each week without any weeks off drug. Although the cumulative doses each 28-day cycle is roughly the same with this schedule compared to conventional dosing, the bone marrow is not exposed to the drug continuously for 21 days and rather gets frequent breaks from therapy. The investigators hypothesize that the 5 days on and 2 days off schedule is more tolerable with less frequent high grade neutropenia and dose interruption/reduction. In addition, this schedule also provides for a more continuous drug delivery to the patient since there is not a week's break in therapy, which could ultimately prove to be more efficacious.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Alternative Dosing Schedule of Palbociclib in Metastatic Hormone Receptor Positive Breast Cancer
  • Official Title: A Phase II Clinical Trial Assessing the Safety of an Alternative Dosing Schedule of Palbociclib in Metastatic Hormone Receptor Positive Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: 201612098
  • NCT ID: NCT03007979

Conditions

  • Breast Cancer
  • Breast Carcinoma
  • Cancer of Breast
  • Malignant Tumor of Breast

Interventions

DrugSynonymsArms
PalbociclibIbrancePalbociclib + letrozole or + fulvestrant
LetrozoleFemaraPalbociclib + letrozole or + fulvestrant
FulvestrantFaslodexPalbociclib + letrozole or + fulvestrant
GoserelinZoladexPalbociclib + letrozole or + fulvestrant

Purpose

The investigators propose to conduct a study to test an alternative dosing schedule of palbociclib. With the current three-week on and one week off schedule, a significant number of patients develop grade 3 or higher degree of neutropenia and require dose reduction and sometimes discontinuation. This potentially compromises the efficacy of the drug. In addition, as the half-life of palbociclib is 27 hours, 1 week break with the standard 3 weeks on and 1 week off dosing schedule could potentially lead to recovery of Rb phosphorylation during the off week. Hence, the investigators propose a 5 days on and 2 days off schedule each week without any weeks off drug. Although the cumulative doses each 28-day cycle is roughly the same with this schedule compared to conventional dosing, the bone marrow is not exposed to the drug continuously for 21 days and rather gets frequent breaks from therapy. The investigators hypothesize that the 5 days on and 2 days off schedule is more tolerable with less frequent high grade neutropenia and dose interruption/reduction. In addition, this schedule also provides for a more continuous drug delivery to the patient since there is not a week's break in therapy, which could ultimately prove to be more efficacious.

Detailed Description

Trial Arms

NameTypeDescriptionInterventions
Palbociclib + letrozole or + fulvestrantExperimentalPalbociclib should be taken by mouth with food on a 5 days on/2 days off schedule (meaning: on Days 1-5, 8-12, 15-19, and 22-26 of each 28-day cycle). Patients who are receiving letrozole will take it daily by mouth, every day of each 28-day cycle. Patients who are receiving fulvestrant will receive it as two intramuscular injections (one into each buttock) on Days 1 and 15 of Cycle 1 and then on Day 1 of each cycle thereafter. Goserelin is given as a subcutaneous injection every 28 days. It is preferred to be given on Day 1 of each cycle, but it may be administered on any day of the treatment cycle to accommodate its specific Q28-day cycle. It will be given to pre- or peri-menopausal women only. Optional research biopsy at baseline and progression Blood for research at baseline, cycle 1 day 15, cycle 2 day 1, every 2-3 months (to coincide with imaging studies), and time of progression
  • Palbociclib
  • Letrozole
  • Fulvestrant
    • Goserelin

    Eligibility Criteria

    Inclusion Criteria:

    - Histologically confirmed metastatic ER+ and/or PR+ and HER2- breast cancer who are candidates for palbociclib in combination with either letrozole or fulvestrant per treating physician.

    - Presence of measurable or non-measurable disease by RECIST 1.1 criteria.

    - One prior systemic therapy in the metastatic setting is allowed, but patients who have not had any prior systemic therapies in the metastatic setting are also eligible.

    - At least 18 years of age.

    - Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2

    - Normal bone marrow and organ function as defined below:

    - Absolute neutrophil count ≥ 1,500/mcl

    - Platelets ≥ 100,000/mcl

    - Total bilirubin ≤ institutional upper limit of normal (IULN) or total bilirubin ≤ 3.0 x IULN with direct bilirubin within normal range in patients with documented Gilbert's syndrome

    - AST(SGOT)/ALT(SGPT) ≤ 1.5 x IULN (up to 5 x IULN in patients with liver disease)

    - Creatinine ≤ IULN OR creatinine clearance ≥ 60 mL/min/1.73 m2 for patients with serum creatinine levels above institutional normal

    - Pre- or post-menopausal women are allowed. If pre- or peri-menopausal, concurrent ovarian suppression for pre- or peri-menopausal women is required.

    - Women of childbearing potential must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.

    - Able to swallow and retain oral medication.

    - Washout of at least 3 weeks from prior chemotherapy or targeted therapy that induces myelosuppression and recovery of treatment related adverse events to grade 1 or less, with the exception of alopecia, is required prior to the start of palbociclib.

    - Ability to understand and willingness to sign an Institutional Review Board (IRB) approved written informed consent document (or that of legally authorized representative, if applicable).

    Exclusion Criteria:

    - Prior therapy with any CDK inhibitor.

    - Currently receiving any other investigational agents.

    - Currently receiving exogenous hormone therapy (topical vaginal estrogen therapy is allowed).

    - Known brain metastases. Patients with known brain metastases must be excluded from this clinical trial because of their poor prognosis which could affect the evaluation of all-cycle adverse events.

    - A history of allergic reactions attributed to compounds of similar chemical or biologic composition to palbociclib or other agents used in the study.

    - Receiving any medications or substances that are potent inhibitors or inducers of CYP3A isoenzymes within 7 days prior to registration.

    - Clinically significant history of liver disease.

    - A condition that would interfere with enteric absorption.

    - Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.

    - Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 7 days of study entry.

    - Known HIV-positivity on combination antiretroviral therapy because of the potential for pharmacokinetic interactions with palbociclib. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.

    Maximum Eligible Age:N/A
    Minimum Eligible Age:18 Years
    Eligible Gender:Female
    Healthy Volunteers:No

    Primary Outcome Measures

    Measure:Rate of grade 3 or higher neutropenia
    Time Frame:Through the first 29 days of treatment
    Safety Issue:
    Description:The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting. Grade 3 neutropenia: <1000-500/mm^3; <1.0-0.5 x 10e9/L Grade 4 neutropenia: <500/mm^3; <0.5 x 10e9/L

    Secondary Outcome Measures

    Measure:Rate of grade 3 or higher neutropenia
    Time Frame:Through 30 day follow-up (estimated to be 25 months)
    Safety Issue:
    Description:The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting. Grade 3 neutropenia: <1000-500/mm^3; <1.0-0.5 x 10e9/L Grade 4 neutropenia: <500/mm^3; <0.5 x 10e9/L
    Measure:Rate of palbociclib dose reduction
    Time Frame:Through the completion of treatment (estimated to be 24 months)
    Safety Issue:
    Description:
    Measure:Rate of palbociclib dose interruption
    Time Frame:Through the completion of treatment (estimated to be 24 months)
    Safety Issue:
    Description:
    Measure:Rate of palbociclib discontinuation
    Time Frame:Through the completion of treatment (estimated to be 24 months)
    Safety Issue:
    Description:
    Measure:Adverse event profile of palbociclib
    Time Frame:Through the 30 day follow-up (estimated to be 25 months)
    Safety Issue:
    Description:-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 will be utilized for all toxicity reporting.
    Measure:Progression-free survival (PFS)
    Time Frame:1 year
    Safety Issue:
    Description:PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions).
    Measure:Overall response rate (complete response + partial response)
    Time Frame:Time of progression (estimated to be 24 months)
    Safety Issue:
    Description:Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm, dDisappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis). Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters
    Measure:Clinical benefit rate (complete response + partial response + stable disease) for at least 6 months)
    Time Frame:Time of progression (estimated to be 24 months)
    Safety Issue:
    Description:Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm, dDisappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis). Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.

    Details

    Phase:Phase 2
    Primary Purpose:Interventional
    Overall Status:Not yet recruiting
    Lead Sponsor:Washington University School of Medicine

    Trial Keywords

      Last Updated

      January 18, 2017