Clinical Trials /

WI231696: ASPIRE Bosutinib

NCT03854903

Description:

This is an open-label, single-arm, phase I trial. It is designed with a conservative dose escalation plan to ensure patient's safety and with a strong translational component to inform if target inhibition is achieved. With concerns regarding safety, based on extensive available pharmacokinetic data and clinical efficacy experience, bosutinib will be given 5-days in a row followed by 2 days rest in a weekly basis, instead of daily. The protocol will enroll patients per 3+3 escalation design. The Dose Limiting Toxicity (DLT) observation period is 28 days. At the end of DLT observation period of each cohort of 3 patients, decision will be made regarding further escalation or de-escalation according to this plan. Once the MTD of the combination is reached, the safety data will be analyzed. There will be no dose reductions during DLT observation period. Dose reduction within patients (individually) is allowed after the 4-week DLT observation period. Treatment in this phase I trial will be administered until there is disease progression or unacceptable toxicity.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: WI231696: ASPIRE Bosutinib
  • Official Title: A Phase I Trial of Palbociclib and Bosutinib With Fulvestrant in Patients With Metastatic Hormone Receptor Positive and HER2 Negative (HR+ HER2-) Breast Cancer Refractory to an Aromatase Inhibitor and a CDK4/6 Inhibitor

Clinical Trial IDs

  • ORG STUDY ID: STUDY00000057
  • NCT ID: NCT03854903

Conditions

  • Metastatic Breast Cancer
  • Human Epidermal Growth Factor 2 Negative Carcinoma of Breast
  • Hormone Receptor Positive Breast Cancer

Interventions

DrugSynonymsArms
PalbociclibIbranceDose Level A1
BosutinibBosulifDose Level A1
FulvestrantFaslodexDose Level A1

Purpose

This is an open-label, single-arm, phase I trial. It is designed with a conservative dose escalation plan to ensure patient's safety and with a strong translational component to inform if target inhibition is achieved. With concerns regarding safety, based on extensive available pharmacokinetic data and clinical efficacy experience, bosutinib will be given 5-days in a row followed by 2 days rest in a weekly basis, instead of daily. The protocol will enroll patients per 3+3 escalation design. The Dose Limiting Toxicity (DLT) observation period is 28 days. At the end of DLT observation period of each cohort of 3 patients, decision will be made regarding further escalation or de-escalation according to this plan. Once the MTD of the combination is reached, the safety data will be analyzed. There will be no dose reductions during DLT observation period. Dose reduction within patients (individually) is allowed after the 4-week DLT observation period. Treatment in this phase I trial will be administered until there is disease progression or unacceptable toxicity.

Trial Arms

NameTypeDescriptionInterventions
Dose Level A1ExperimentalPalbociclib: 75mg daily for 21 days of each 28 day cycle Bosutinib: 300mg on days 1-5 of each week of the 28 day cycle Fulvestrant: 500mg on days day 1, 5, and 28 of each 28 day cycle
  • Palbociclib
  • Bosutinib
  • Fulvestrant
Dose Level A2ExperimentalPalbociclib: 75mg daily for the first 21 days of each 28 day cycle Bosutinib: 300mg on days 1-5 of each week of the 28 day cycle
  • Palbociclib
  • Bosutinib
Dose Level B1ExperimentalPalbociclib: 100mg daily for 21 days of each 28 day cycle Bosutinib: 300mg on days 1-5 of each week of the 28 day cycle Fulvestrant: 500mg on days day 1, 5, and 28 of each 28 day cycle
  • Palbociclib
  • Bosutinib
  • Fulvestrant
Dose Level B2ExperimentalPalbociclib: 100mg daily for 21 days of each 28 day cycle Bosutinib: 500mg on days 1-5 of each week of the 28 day cycle Fulvestrant: 500mg on days day 1, 5, and 28 of each 28 day cycle
  • Palbociclib
  • Bosutinib
  • Fulvestrant

Eligibility Criteria

        Inclusion Criteria:

          1. Signed informed consent obtained prior to any study specific assessments and
             procedures.

          2. Age ≥18 years

          3. Premenopausal and postmenopausal women

          4. Biopsy proven diagnosis of ER and/or PR positive, HER2 negative, advanced breast
             cancer (locoregionally recurrent or metastatic disease), either from the primary or a
             metastatic site.

             ER, PR and HER2 measurements should be performed according to institutional
             guidelines, in a CLIA-approved setting.

             Breast cancer is ER-positive and/or PR-positive tumor (≥1% positive stained cells)
             based on local CLIA-certified laboratory results

             HER2-negative breast cancer:

             Cut-off values for positive/negative staining should be in accordance

          5. A formalin-fixed paraffin-embedded (FFPE) tumor tissue block from diagnostic biopsy
             must be transmitted to MedStar Georgetown University Hospital Pathology Department
             repository and confirmation of receipt must be available prior to initiation of
             treatment on study.

          6. ECOG performance status 0-1

          7. Must have received no more than 3 lines of chemotherapy for the treatment of breast
             cancer and be progressive on at least one aromatase inhibitor and one CDK 4/6
             inhibitor.

          8. Pregnancy must be ruled out Serum or urine pregnancy test must be negative within 14
             days of treatment start in women of childbearing potential.

             Pregnancy testing does not need to be pursued in patients who are judged as
             postmenopausal before enrollment, or who have undergone bilateral oophorectomy, total
             hysterectomy, or bilateral tubal ligation.

             Patients may be considered postmenopausal in case that one of the following criteria
             applies (Section 5.4.1.2):

             Prior bilateral oophorectomy, OR Age ≥ 60 years, OR Age < 60 years with intact uterus
             and amenorrhoeic for ≥ 12 consecutive months prior to chemotherapy and/or endocrine
             therapy exposure, OR Age < 60 years hysterectomized and FSH and plasma estradiol
             levels in the post-menopausal range according to local policies prior to chemotherapy
             and/or endocrine therapy exposure

          9. Willingness to undergo adequate contraception if childbearing potential Women of
             childbearing potential must use adequate contraception for the duration of protocol
             treatment and for 3 months after the last treatment with palbociclib/bosutinib.

             Adequate contraception is defined as one highly effective form (i.e. abstinence,
             (fe)male sterilization) OR two effective forms (e.g. non-hormonal IUD and condom /
             occlusive cap with spermicidal foam / gel / film / cream / suppository).

         10. Patients must be able and willing to swallow and retain oral medication

         11. Absolute neutrophil count (ANC) ≥ 1,500/mm^3

         12. Platelets ≥ 100,000/mm^3

         13. Hemoglobin ≥ 9 g/dL

         14. AST and/or ALT ≤3 x ULN

         15. Alkaline phosphatase ≤2.5 x ULN (≤5.0 x ULN if bone metastases present)

         16. Total serum bilirubin ≤1.5 x ULN

         17. Serum creatinine within normal institutional limits or creatinine clearance ≥ 50
             mL/min/1.73 m^2 for patients with serum creatinine levels above institutional ULN.

         18. Resolution of all acute toxic effects of prior therapy, including radiotherapy to
             grade ≤1 (except toxicities not considered a safety risk for the patient) and recovery
             from surgical procedures.

         19. Patients who are willing and able to comply with scheduled visits, treatment plan,
             laboratory tests, and other study procedures.

        Exclusion Criteria:

          1. Concurrent therapy with other Investigational Products.

          2. Current use of food or drugs known to be potent inhibitors or inducers of CYP3A4

          3. Known hypersensitivity to fulvestrant, palbociclib or bosutinib, or to any of their
             excipients.

          4. Uncontrolled intercurrent illness including (active infection, symptomatic congestive
             heart failure, unstable angina pectoris, cardiac arrhythmia, diabetes, pulmonary
             embolism in the past 6 months, or psychiatric illness/social situations that would
             limit compliance with study requirements).

          5. Active uncontrolled or symptomatic brain metastases. Previously treated and clinically
             stable, as per Investigator's judgment, brain metastases are permitted.

          6. Unable to comply with study requirements

          7. Presence of a condition that would interfere with enteric absorption of
             palbociclib/bosutinib.

          8. Pregnant women, or women of childbearing potential without a negative pregnancy test
             (serum or urine) within 14 days prior to starting treatment on study Breastfeeding
             must be discontinued prior to study entry.

          9. Patients on combination antiretroviral therapy, i.e. those who are HIV-positive
             (potential for pharmacokinetic interactions or increased immunosuppression with
             palbociclib).

         10. Patients with clinically significant history of liver disease, including viral or
             other known hepatitis, current alcohol abuse, or cirrhosis, etc.

         11. Patients on chronic anticoagulation (fulvestrant is IM injection)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Toxicity of bosutinib when used in combination with palbociclib and fulvestrant in patients with advanced HR+MBC who are refractory to AI and CDK4/6 inhibitors
Time Frame:1 year
Safety Issue:
Description:Toxicity of adverse events will be measured via the Common Toxicity Criteria for Adverse Events (CTCAE 4.03)

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Georgetown University

Trial Keywords

  • breast cancer
  • HR+
  • HER2-
  • HR positive
  • HER2 negative
  • metastatic
  • aromatase inhibitor
  • CDK4/6 inhibitor
  • palbociclib
  • bosutinib
  • fulvestrant
  • Faslodex

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