Clinical Trials /

Fulvestrant, Palbociclib and Erdafitinib in ER+/HER2-/FGFR-amplified Metastatic Breast Cancer

NCT03238196

Description:

This is an open-label, multi-institution, phase Ib trial that evaluates the safety and tolerability and preliminary anti-tumor activity of fulvestrant, palbociclib and erdafitinib in patients with ER+/HER2-/FGFR-amplified metastatic breast cancer.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Fulvestrant, Palbociclib and Erdafitinib in ER+/HER2-/FGFR-amplified Metastatic Breast Cancer
  • Official Title: A Phase Ib Trial of Fulvestrant, Palbociclib (CDK4/6 Inhibitor) and Erdafitinib (JNJ- 42756493,Pan-FGFR Tyrosine Kinase Inhibitor) in ER+/HER2-/FGFR-Amplified Metastatic Breast Cancer (MBC)

Clinical Trial IDs

  • ORG STUDY ID: VICC BRE 16126
  • NCT ID: NCT03238196

Conditions

  • Metastatic Breast Cancer

Interventions

DrugSynonymsArms
ErdafitinibJNJ-42756493Escalation
PalbociclibIbranceEscalation
FulvestrantFaslodexEscalation

Purpose

This is an open-label, multi-institution, phase Ib trial that evaluates the safety and tolerability and preliminary anti-tumor activity of fulvestrant, palbociclib and erdafitinib in patients with ER+/HER2-/FGFR-amplified metastatic breast cancer.

Detailed Description

      Primary Objectives

      To determine the safety and tolerability of fulvestrant, palbociclib and erdafitinib in
      patients with ER+/HER2-/FGFR-amplified MBC.

      Secondary Objectives

        -  To determine the anti-tumor effect of fulvestrant, palbociclib and erdafitinib in
           patients with ER+/HER2-/FGFR-amplified MBC.

        -  Pharmacokinetic assessments of erdafitinib

      Correlative Objectives

        -  To determine the therapeutic predictive role of FGFR1-4, CCND1-2, CDK4 and CDK6
           amplifications, and RB1 and ESR1 mutations on clinical outcome

        -  To determine if the FGFR1 amplification levels is an early surrogate of response

        -  To determine if the cfDNA results at disease progression show new genomic alterations
           potentially associated with resistance to CDK4/6 and FGFR inhibition

        -  To determine pharmacodynamic biomarkers of FGFR inhibition
    

Trial Arms

NameTypeDescriptionInterventions
EscalationExperimentalFulvestrant - injection into muscle 1 time per month Palbociclib capsule taken by mouth 1 time per day every 21 days followed by 1 week of rest (no drug taken) Erdafitinib tablet taken by mouth 1 time per day
  • Erdafitinib
  • Palbociclib
  • Fulvestrant
ExpansionExperimentalFulvestrant - injection into muscle 1 time per month Palbociclib capsule taken by mouth 1 time per day every 21 days followed by 1 week of rest (no drug taken) Erdafitinib tablet taken by mouth 1 time per day
  • Erdafitinib
  • Palbociclib
  • Fulvestrant

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must be able to swallow and retain oral medication

          -  Patients must be ≥ 18 years of age

          -  Female patients of no childbearing potential must be post-menopausal. Postmenopausal
             female subjects should be defined prior to protocol enrollment by any of the
             following:

          -  Participants at least 60 years of age; OR

          -  Participants under 60 years of age and naturally (spontaneous, no alternative
             pathologic or physiological cause) amenorrhea for at least 12 months; OR

          -  Medical ovarian failure confirmed by follicle-stimulating hormone (FSH) and estradiol
             levels in the post menopausal range per local institutional normal range; OR

          -  Prior bilateral oophorectomy; OR

          -  Prior radiation castration with amenorrhea for at least 6 months; OR

          -  Treatment with a luteinizing hormone-releasing hormone (LH-RH) agonist (such as
             goserelin acetate or leuprolide acetate) is permitted for induction of ovarian
             suppression as long as it has been initiated at least 28 days prior to study
             enrollment

          -  Patients must have ECOG performance status 0 - 1

          -  Patients must have clinical stage IV or inoperable locoregional recurrent invasive
             mammary carcinoma that is:

          -  ER+ and/or PgR+ (≥ 1% positive stained cells) by immunohistochemistry (IHC)

          -  HER2-negative (by IHC or FISH, per ASCO guidelines)

          -  FGFR1 - 4 amplified

          -  Patients must have evaluable (may have either measurable or non-measurable) disease

          -  Patients must have available tissue for FGFR determination

          -  Patients must have had at least one line of therapy in the metastatic setting

          -  Current use of any of the drugs listed on the Cautionary Concomitant Med list has to
             be approved by the Study Chair

          -  Patients must have adequate hematologic, hepatic and renal function. All laboratory
             tests must be obtained within 2 weeks from study drug initiation. These include:

          -  ANC ≥ 1,500/mm3

          -  Platelet count ≥ 100,000/mm3

          -  HgB ≥ 9.0 g/dL

          -  Creatinine clearance ≥ 40 mL/min/1.73 m2

          -  SGOT, SGPT ≤ 2.5 x ULN if no liver metastasis present; SGOT, SGPT ≤ 4 x ULN if liver
             metastasis present

          -  Albumin ≥ 2.0 g/dL

          -  Total serum bilirubin ≤ 1.5 x ULN (≤ 3 x ULN or direct bilirubin ≤ 1.5 x ULN if known
             Gilbert's syndrome)

          -  Potassium within institutional normal limits

          -  Phosphorus ≤ institutional upper limit of normal

        Exclusion Criteria:

          -  Prior use of an FGFR inhibitor

          -  More than 2 lines of chemotherapy in the metastatic setting. No limit on endocrine
             therapy lines. Prior exposure to CDK4/6 inhibitor acceptable.

          -  Radiation therapy ≤ 2 weeks prior to study entry. Patients who have received prior
             radiotherapy must have recovered from toxicity (≤ grade 1) induced by this treatment
             (except for alopecia)

          -  Prior cancer therapy (except for endocrine therapy) must have been discontinued for 1
             week prior to initiation of study drugs

          -  Concurrent anti-cancer therapy other than the ones specified in the protocol is not
             permitted during study participation. Bisphosphonates or denosumab are allowed

          -  Major surgery within 4 weeks of enrollment

          -  Herbal preparations are not allowed throughout the study, and should be discontinued
             14 days prior to initiation of study treatment

          -  Any corneal or retinal abnormality likely to increase the risk of eye toxicity, such
             as:

          -  Current corneal pathology such as keratitis, keratoconjunctivitis, keratopathy,
             corneal abrasion, inflammation or ulceration

          -  Uncontrolled glaucoma despite standard of care therapy

          -  Diabetic retinopathy with macular edema

          -  Known active wet, age-related macular degeneration (AMD)

          -  Known central serous retinopathy (CSR) or retinal vascular occlusion (RVO)

          -  Uncontrolled intercurrent illness including, but not limited to:

          -  Malabsorption syndrome significantly affecting gastrointestinal function

          -  Ongoing or active infection requiring antibiotics/antivirals

          -  Impairment of lung function (COPD > grade 2, lung conditions requiring oxygen therapy)

          -  Symptomatic congestive heart failure

          -  Unstable angina pectoris, angioplasty, stenting, or myocardial infarction within 6
             months

          -  Clinically significant cardiac arrhythmia (multifocal premature ventricular
             contractions, bigeminy, trigeminy, ventricular tachycardia that is symptomatic or
             requires treatment [National Cancer Institute -Common Terminology Criteria for Adverse
             Events, Version 4.03, grade 3]

          -  QTcF ≥ 480 msec on screening EKG

          -  Known history of clinically significant QT/QTc prolongation or Torsades de
             Pointes(TdP)

          -  ST depression or elevation of ≥ 1.5 mm in 2 or more leads

          -  Diarrhea of any cause ≥ CTCAE grade 2 that does not resolve within a few days when
             adequately treated with anti-diarrhea medications

          -  Psychiatric illness/social situations that would compromise patient safety or limit
             compliance with study requirements including maintenance of a compliance/pill diary

          -  Symptomatic brain metastases (patients with a history of brain metastases must be
             clinically stable for more than 4 weeks from completion of radiation treatment and be
             off steroids)

          -  Known history of chronic liver or chronic renal failure

          -  Poor wound healing capacity
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of Treatment-Emergent Adverse Events [Safety]
Time Frame:From the time of randomization up to 4 weeks of treatment (cycle 1), for each patient
Safety Issue:
Description:Assessment of DLT and determination of MTD

Secondary Outcome Measures

Measure:Progression-free survival
Time Frame:Imaging studies will be performed every 8 weeks from date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 48 months
Safety Issue:
Description:Assessment of clinical impact [anti-tumor effect] of the combination of erdafitinib, palbociclib and fulvestrant in patients with ER+/ FGFR amplified metastatic breast cancer will be assessed by measuring the interval (in months) between treatment initiation and disease progression.
Measure:Overall response rate
Time Frame:Imaging studies will be performed every 8 weeks from date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 48 months
Safety Issue:
Description:Assessment of clinical impact [anti-tumor effect] of the combination of erdafitinib, palbociclib and fulvestrant in patients with ER+/ FGFR amplified metastatic breast cancer by measure the rate (%) of complete and partial responses seen in patients with measurable disease
Measure:Clinical benefit rate (CBR; complete response + partial response + stable disease without disease progression at 6 months)
Time Frame:From the time of randomization up to 6 months for each patient
Safety Issue:
Description:Assessment of clinical impact [anti-tumor effect] of the combination of erdafitinib, palbociclib and fulvestrant in patients with ER+/ FGFR amplified metastatic breast cancer by measure the rate (%) of complete and partial responses + stability of disease at 6 months seen in patients with measurable disease
Measure:Pharmacokinetic assessment of erdafitinib - Area Under the Curve (AUC)
Time Frame:From the time of randomization up to 4 weeks of treatment for each patient
Safety Issue:
Description:The area under the plasma concentration-time curve from time zero to the last measurable concentration
Measure:Pharmacokinetic assessment of erdafitinib - Cmax (maximum plasma concentration)
Time Frame:From the time of randomization up to 4 weeks of treatment for each patient
Safety Issue:
Description:The maximum (peak) observed plasma drug concentration after oral dose administration
Measure:Pharmacokinetic assessment of erdafitinib - Tmax
Time Frame:From the time of randomization up to 4 weeks of treatment for each patient
Safety Issue:
Description:Time to reach maximum (Cmax) plasma drug concentration after oral dose administration (time)
Measure:Pharmacokinetic assessment of erdafitinib - CL/F
Time Frame:From the time of randomization up to 4 weeks of treatment for each patient
Safety Issue:
Description:Apparent total body clearance of drug from the plasma after oral administration
Measure:Incidence of Treatment-Emergent Adverse Events [Tolerability]
Time Frame:From date of randomization until 28 days post treatment discontinuation from any cause, assessed up to 48 months
Safety Issue:
Description:Assessment of adverse events throughout the study

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Vanderbilt-Ingram Cancer Center

Trial Keywords

  • FGFR inhibitor
  • ER+ metastatic breast cancer
  • CDK4/6 inhibitor
  • Endocrine therapy

Last Updated

August 17, 2021