Description:
This phase 1b study will determine the safety and efficacy of combined treatment of Abraxane
and phenelzine sulfate (Nardil) for metastatic or locally advanced breast cancer.
Participants may be eligible to join this study if they are aged 18 years or above and have
been diagnosed with metastatic breast cancer or inoperable locally advanced breast cancer.
All participants will receive a combination of intravenous Abraxane and an oral dose of
phenelzine sulfate. Abraxane will be administered weekly for the first 3 weeks of a 4-week
cycle for 3 consecutive cycles. Phenelzine sulfate will be taken daily for the duration of
the 3 cycles. Five patient cohort groups will receive a progressively increasing dose of
phenelzine sulfate. Safety and efficacy will be assessed weekly over the 3 cycles of
treatment.
Although both drugs have been used in clinical care for more than a decade, they have not
been intentionally combined together in a cancer therapy setting. This means that the
combined effect of these two drugs has not been documented. This is being addressed in this
study.
Title
- Brief Title: An Early Phase Study of Abraxane Combined With Phenelzine Sulfate in Patients With Metastatic or Advanced Breast Cancer
- Official Title: A Phase Ib Safety and Pharmacokinetics (PK)/ Pharmacodynamics (PD) Study to Determine the Dosage of Abraxane in Combination With Phenelzine Sulfate in Metastatic or Inoperable Locally Advanced Breast Cancer
Clinical Trial IDs
- ORG STUDY ID:
EpiAxis 001-0716
- NCT ID:
NCT03505528
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Nanoparticle albumin-bound paclitaxel | Abraxane | Cohort Group |
Phenelzine Sulfate | Nardil | Cohort Group |
Purpose
This phase 1b study will determine the safety and efficacy of combined treatment of Abraxane
and phenelzine sulfate (Nardil) for metastatic or locally advanced breast cancer.
Participants may be eligible to join this study if they are aged 18 years or above and have
been diagnosed with metastatic breast cancer or inoperable locally advanced breast cancer.
All participants will receive a combination of intravenous Abraxane and an oral dose of
phenelzine sulfate. Abraxane will be administered weekly for the first 3 weeks of a 4-week
cycle for 3 consecutive cycles. Phenelzine sulfate will be taken daily for the duration of
the 3 cycles. Five patient cohort groups will receive a progressively increasing dose of
phenelzine sulfate. Safety and efficacy will be assessed weekly over the 3 cycles of
treatment.
Although both drugs have been used in clinical care for more than a decade, they have not
been intentionally combined together in a cancer therapy setting. This means that the
combined effect of these two drugs has not been documented. This is being addressed in this
study.
Detailed Description
Nanoparticle albumin-bound paclitaxel (Abraxane) will be administered intravenously over 3
cycles at a fixed dosage of 100mg/m2 to each study participant. This dose will be
administered weekly for the first 3 consecutive weeks, over the 4 week cycle, before
commencing the second and third cycles.
In addition to the fixed dose of nanoparticle albumin-bound paclitaxel, all patients will
receive a continuous daily oral dose of phenelzine sulfate across all three cycles,
Each of the five patient cohort groups will receive a progressively higher starting dose of
phenelzine sulfate, consecutively. Cohort A will start at 15mg/day and will be increased to
30mg/d by week 2 and further increased to 45mg/d for week 3, which will be maintained
throughout the study. Cohort B will start at 45mg/d and will be held constant throughout the
Study. Similarly, Cohort C, D & E will start at 60, 75 and 90mg/d, respectively, and will
also be held on this dose throughout the study. The decision to escalate the dose for the
next cohort will be made on the basis of the number of dose limiting toxicity (DLT) events
observed during the first 8 weeks in the preceding cohort group.
Phenelzine sulfate compliance will be monitored weekly based on drug tablet returns.
Trial Arms
Name | Type | Description | Interventions |
---|
Cohort Group | Experimental | There are five patient cohort groups. Each will receive a progressively higher starting dose of phenelzine sulfate, consecutively. Cohort A will start at 15mg/day and will be increased to 30mg/d by week 2 and further increased to 45mg/d for week 3, which will be maintained throughout the study. Cohort B will start at 45mg/d and will be held constant throughout the Study. Similarly, Cohort C, D & E will start at 60, 75 and 90mg/d, respectively, and will also be held on this dose throughout the study. The decision to escalate the dose for the next cohort will be made on the basis of the number of dose limiting toxicity (DLT) events observed during the first 8 weeks in the preceding cohort group. In addition, all cohort groups will receive a constant dose of Abraxane at 100mg/m2. | - Nanoparticle albumin-bound paclitaxel
- Phenelzine Sulfate
|
Eligibility Criteria
Inclusion Criteria:
1. Patients who are 18 years or older;
2. Fluent in written and spoken English and in a position to provide written informed
consent to participate;
3. A patient who is in a position to attend a 12-week treatment regimen and end of study
visit;
4. Metastatic Breast Cancer (MBC) or inoperable locally advanced breast cancer diagnosis
based on pre-existing documented histopathology and medical imaging results, either
Triple Negative Metastatic Breast Cancer (TNBC) or not;
5. Women with metastatic breast cancer or inoperable locally advanced breast cancer who
have not received any cytotoxic therapy in the last 3 weeks;
6. Volunteers of child-bearing potential must have a negative serum pregnancy test (serum
beta-human chorionic gonadotropin or ß-hCG) and have agreed to practice an effective,
reliable contraceptive regimen for the duration of this clinical trial, such as an
intrauterine device (IUD) or intrauterine system (IUS) with a failure rate of <1%
stated on the product label or a male partner who is has been sterilised (vasectomy
with documented azoospermia);
7. ECOG Performance Status 0 or 1; and
8. Adequate liver function as evidenced by bilirubin of <1.5 times upper limit of normal
(ULN) and ALT/AST <2 times of ULN. However, AST and ALT of <5 times ULN if liver
metastases are present.
Exclusion Criteria:
1. A patient who has been diagnosed as having HER2-positive metastatic breast cancer;
2. A concurrent condition that may limit the decision-making capabilities of the
participant during the informed consent process;
3. A previous positive diagnosis of Human Immunodeficiency Virus (HIV) and/or Hepatitis C
Virus (HCV) and/or Hepatitis B Virus (HBV) infection;
4. Women who are pregnant or lactating;
5. Uncontrolled, untreated intra-cranial metastases. However, controlled intra-cranial
metastases are allowed, i.e. stable patients with more than a month after the
completion of whole brain radiotherapy and not currently on steroids or
anticonvulsants;
6. Current use of monoamine oxidase inhibitors (MOAI) or use of dextromethorphan
7. Current use of CNS depressants such as selective serotonin re-uptake inhibitors as
well as specific medication for pain management including pethidine, tramadol,
dextromethorphan, fentanyl and/or methadone. This includes the concurrent use of any
serotoninergic agents or buspirone hydrochloride during the week preceding phenelzine
sulfate administration, the active study treatment phase and the washout period at the
end of study. Serotoninergic drugs may include but are not limited to the following:
dexfenfluramine, fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram and
venlafaxine;
8. Previous use of nanoparticle albumin-bound paclitaxel;
9. Known allergy to phenelzine sulfate or similar MOAI; and
10. Known or suspected history of alcohol abuse;
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose-Limiting Toxicity (DLT) events |
Time Frame: | Assessed throughout the first 56 days |
Safety Issue: | |
Description: | The number of DLT events for nanoparticle albumin-bound paclitaxel and phenelzine sulfate combined, with the following events assessed using the NCI's CTCAE v4.3 toxicity criteria:
Grade 3 Febrile neutropenia;
Grade ≥2 peripheral neuropathy;
Any Grade 3 non-haematological toxicity except alopecia; nausea, vomiting, or diarrhoea for 72 hrs due to inadequate use of prophylaxis;
Grade 3 fatigue for > 7 days;
Non-hematologic Grade 3 or 4 laboratory AE that do not return to baseline or to Grade 1 within 7 days;
Grade 3 thrombocytopenia with signs of significant bleeding or platelet count Grade 4;
Blood bilirubin (total) Grade ≥3 for 72 hrs, AST or ALT Grade 3 for >7 consecutive days, AST or ALT Grade 4;
Persistent Grade 3 hypertension for >7 days & not responding to antihypertensive therapy or Grade 4 hypertension;
An inability to administer treatment (with >7 day delay) during Cycle 1 and Cycle 2 for toxicity reason; &
Any other treatment emergent SAE. |
Secondary Outcome Measures
Measure: | Abraxane Cmax |
Time Frame: | Cmax will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate. |
Safety Issue: | |
Description: | To assess maximum plasma concentration (ng/ml) of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate. |
Measure: | Abraxane Tmax |
Time Frame: | Tmax will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate. |
Safety Issue: | |
Description: | To assess the time after infusion of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate to achieve peak maximum plasma concentration (minutes). |
Measure: | Abraxane Half-life |
Time Frame: | Half-life will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate. |
Safety Issue: | |
Description: | To assess the terminal half-life (minutes) of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate. |
Measure: | Abraxane AUC |
Time Frame: | AUC will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate. |
Safety Issue: | |
Description: | To assess the area under nanoparticle albumin-bound paclitaxel concentration time curve from 0 to infinity (ng minutes / ml) and when combined with phenelzine sulfate. |
Measure: | Nardil Cmax |
Time Frame: | Cmax will be assessed on day 57. |
Safety Issue: | |
Description: | To assess maximum plasma concentration (ng/ml) of phenelzine sulfate when combined with nanoparticle albumin-bound paclitaxel. |
Measure: | Nardil Tmax |
Time Frame: | Tmax will be assessed on day 57. |
Safety Issue: | |
Description: | To assess the time after ingestion of phenelzine sulfate, when combined with nanoparticle albumin-bound paclitaxel, to achieve peak maximum plasma concentration (minutes). |
Measure: | Nardil Half-life |
Time Frame: | Half-life will be assessed on day 57. |
Safety Issue: | |
Description: | To assess the terminal half-life (minutes) after ingestion of phenelzine sulfate, when combined with nanoparticle albumin-bound paclitaxel. |
Measure: | Nardil AUC |
Time Frame: | AUC will be assessed on day 57. |
Safety Issue: | |
Description: | To assess the area under Phenelzine Sulfate concentration time curve from 0 to infinity (ng minutes / ml) when combined with nanoparticle albumin-bound paclitaxel. |
Measure: | Circulating Tumour Cell (CTC) burden |
Time Frame: | CTC burden will assessed be at baseline and again at day 29, 57 and 85, whereas the CSC burden will assessed only at baseline and again at day 85. |
Safety Issue: | |
Description: | The CTC burden is expressed as the number of tumour cells observed per 30ml of blood. |
Measure: | PDL1 expressing Circulating Tumour Cell (CTC) burden |
Time Frame: | The PDL1 CTC expression burden will be assessed at baseline and again at day 29, 57 and 85, whereas the CSC burden will assessed only at baseline and again at day 85. |
Safety Issue: | |
Description: | The PDL1 expressing CTC burden is expressed as the number of CTC observed per 30ml of blood with PDL1 expression. |
Measure: | HER2 expressing Circulating Tumour Cell (CTC) burden |
Time Frame: | The HER2 CTC expression burden will be assessed at baseline and again at day 29, 57 and 85, whereas the CSC burden will assessed only at baseline and again at day 85. |
Safety Issue: | |
Description: | The HER2 expressing CTC burden is expressed as the number of CTC observed per 30ml of blood with PDL1 expression. |
Measure: | FFPE Tumour cells burden |
Time Frame: | Then burden will be assessed at baseline and again at day 85. |
Safety Issue: | |
Description: | The number of tumour cells observed per FFPE slide. |
Measure: | FFPE Stoma cells burden |
Time Frame: | Then burden will be assessed at baseline and again at day 85. |
Safety Issue: | |
Description: | The number of stoma cells observed per FFPE slide. |
Measure: | FFPE Cancer Stem Cells (CSC) burden |
Time Frame: | Then burden will be assessed at baseline and again at day 85. |
Safety Issue: | |
Description: | The number of CSC observed per FFPE slide. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | EpiAxis Therapeutics |
Trial Keywords
- Nanoparticle albumin-bound paclitaxel (Abraxane)
- Phenelzine Sulfate
- Cancer stem cells
- epigenetics
- LSD1
Last Updated
November 13, 2019