Clinical Trials /

Abemaciclib and Letrozole in Treating Patients With Endometrial Cancer

NCT04049227

Description:

This early phase I trial studies how well abemaciclib and letrozole work in treating patients with endometrial cancer and determines whether there are changes in patients' cancer cell biomarkers (a genetic feature or specific protein) for cell growth before and after treatment. Antihormone therapy with aromatase inhibitors, such as letrozole, may lessen the amount of estrogen made by the body. Abemaciclib blocks the activities of a class of proteins called cyclin-dependent kinase, which are involved in cell duplication. Giving letrozole and abemaciclib together may slow down cancer cell growth in patients with endometrial cancer.

Related Conditions:
  • Endometrial Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Early Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Abemaciclib and Letrozole in Treating Patients With Endometrial Cancer
  • Official Title: A Pilot, Multicenter, Single Arm, Open Label, Surgical Window of Opportunity Study of Abemaciclib and Letrozole for Endometrioid Adenocarcinoma of the Endometrium

Clinical Trial IDs

  • ORG STUDY ID: NU 18G07
  • SECONDARY ID: STU00209370
  • SECONDARY ID: NU 18G07
  • SECONDARY ID: P30CA060553
  • SECONDARY ID: NCI-2019-04599
  • NCT ID: NCT04049227

Conditions

  • Endometrial Endometrioid Adenocarcinoma

Interventions

DrugSynonymsArms
AbemaciclibLY-2835219, LY2835219, VerzenioTreatment (letrozole, abemaciclib)
LetrozoleCGS 20267, FemaraTreatment (letrozole, abemaciclib)

Purpose

This early phase I trial studies how well abemaciclib and letrozole work in treating patients with endometrial cancer and determines whether there are changes in patients' cancer cell biomarkers (a genetic feature or specific protein) for cell growth before and after treatment. Antihormone therapy with aromatase inhibitors, such as letrozole, may lessen the amount of estrogen made by the body. Abemaciclib blocks the activities of a class of proteins called cyclin-dependent kinase, which are involved in cell duplication. Giving letrozole and abemaciclib together may slow down cancer cell growth in patients with endometrial cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine whether there are changes in Ki-67 expression from the pretreatment specimen
      (e.g. biopsy or dilation and curettage [D&C]) to the post-treatment hysterectomy specimen
      following treatment with letrozole and abemaciclib.

      SECONDARY OBJECTIVES:

      I. To determine the proportion of tumors with complete cell cycle arrest (CCCA) response as
      measured by Ki-67 expression between the pre-treatment tumor and the posttreatment tumor.

      II. To identify biological characteristics of tumors (e.g. mismatch repair [MMR] status, PTEN
      mutational status, etc.) correlating with decreased Ki-67 expression induced by the letrozole
      and abemaciclib combination.

      III. To determine the frequency of adverse events associated with use of abemaciclib and
      letrozole.

      EXPLORATORY OBJECTIVES:

      I. To evaluate the correlation of the expression of Ki-67 with that of cyclin D1, p16, pRB,
      and PTEN as well as with MMR deficiency.

      OUTLINE:

      Patients receive letrozole orally (PO) once daily (QD) and abemaciclib PO twice daily (BID)
      on days 1-14. Patients then undergo standard of care hysterectomy on day 15.

      After completion of study treatment, patients are followed up at 30 days and at 2 and 6 weeks
      after surgery.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (letrozole, abemaciclib)ExperimentalPatients receive letrozole PO QD and abemaciclib PO BID on days 1-14. Patients then undergo standard of care hysterectomy on day 15.
  • Abemaciclib
  • Letrozole

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must have a new histologically confirmed diagnosis of endometrioid
             adenocarcinoma of the endometrium who are candidates for hysterectomy.

               -  Note: Patients with recurrent disease are not eligible.

          -  Patients must be willing to provide archival tumor biopsy slides from the specimen
             (e.g. endometrial biopsy or dilation and curettage) which diagnosed them with
             endometrial cancer.

               -  (Please note: Given the amount of tissue obtained from these specimens is often
                  much more than a core needle biopsy, we do not anticipate difficulties with
                  insufficient tissue.)

          -  Patients should be treatment naive. They should not have received any endometrial
             cancer directed therapy including medroxyprogesterone acetate, aromatase inhibitors,
             other hormonal treatments or radiation therapy for treatment of endometrial cancer.

               -  Note: Patients can have used oral contraceptives or hormonal replacement therapy
                  provided these were discontinued 28 days prior to trial enrollment.

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2 within 28 days prior
             to registration for protocol therapy.

          -  Patients must have adequate organ function for all of the following criteria within 28
             days of registration.

          -  Absolute neutrophil count (ANC) >= 1.5 x 10^9 /L (within 28 days of registration).

          -  Platelets >= 100 x 10^9 /L (within 28 days of registration).

          -  Hemoglobin >= 8 g/dL (within 28 days of registration).

               -  Patients may receive erythrocyte transfusions to achieve this hemoglobin level at
                  the discretion of the investigator. Initial treatment must not begin earlier than
                  the day after the erythrocyte transfusion.

          -  Total bilirubin =< 1.5 x upper limit of normal (ULN) (within 28 days of registration).

               -  Patients with Gilbert?s syndrome with a total bilirubin =< 2.0 times ULN and
                  direct bilirubin within normal limits are permitted.

          -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x ULN (within
             28 days of registration).

          -  Serum creatinine =< 1.5 x ULN (within 28 days of registration).

          -  Patients with a history of surgical sterilization are eligible for this study. OR

          -  Patients must have post-menopausal status due to menopause (surgical or natural).
             Patients must meet at least one of the following criteria:

               -  Bilateral oophorectomy

               -  Age >= 55 years

               -  Age =< 55 years and amenorrhea (absence of menstruation) for > 12 months OR

          -  Patients who are not post-menopausal or previously sterilized.

               -  i.e. a female of childbearing potential (patients who are not post-menopausal),
                  must have a negative serum pregnancy test within 7 days of the first dose of
                  study treatment (abemaciclib and/or letrozole). Patient must agree to use
                  adequate birth control (condoms with spermicidal agent or abstinence) while on
                  the study and for 3 weeks after completion of treatment.

          -  Patients should be able to swallow oral medications.

          -  Patients must have the ability to understand and the willingness to sign a written
             informed consent prior to registration on study.

          -  Patients must be willing and able to have a window of >= 15 days prior to their
             scheduled hysterectomy surgery after registration.

        Exclusion Criteria:

          -  Patients who have had chemotherapy, hormonal therapy or radiotherapy directed at the
             treatment of endometrial cancer prior to entering the study or those who have not
             recovered from adverse events due to agents administered more than 4 weeks prior to
             registration are not eligible.

          -  Patients may not be receiving any other investigational agents. A wash out period of 4
             weeks before registration is required for eligibility.

          -  Patients who have a history of allergic reactions attributed to compounds of similar
             chemical or biologic composition to abemaciclib or letrozole or any of its excipients
             are not eligible.

          -  Patients receiving CYP3A inducers or strong CYP3A inhibitors will not be eligible for
             this study. A wash-out period of minimum 5 half-lives or 7 days, whichever is shorter,
             before registration is required for the patient to become eligible.

          -  Patients who have a known personal history of any of the following conditions: syncope
             of cardiovascular etiology, ventricular arrhythmia of pathological origin (including,
             but not limited to, ventricular tachycardia and ventricular fibrillation), or sudden
             cardiac arrest are not eligible.

          -  Patients who have known active bacterial infection (requiring intravenous [IV]
             antibiotics at time of initiating study treatment), fungal infection, or detectable
             viral infection (such as known human immunodeficiency virus [HIV] positivity or with
             known active hepatitis B or C (for example, hepatitis B surface antigen positive).
             Screening is not required for enrollment.

               -  Note: patients with uncomplicated urinary tract infection or uncomplicated
                  cystitis are eligible.

          -  Patients who have an uncontrolled intercurrent illness including, but not limited to
             any of the following, are not eligible:

               -  Hypertension that is not controlled on medication

               -  Baseline grade 2 or higher diarrhea.

               -  Ongoing or active infection requiring systemic treatment.

               -  Symptomatic congestive heart failure.

               -  Unstable angina pectoris.

               -  Psychiatric illness that would limit compliance with study requirements.

               -  Social situations that would limit compliance with study requirements.

               -  Serious preexisting medical condition(s) that would preclude participation in
                  this study (for example, interstitial lung disease, severe dyspnea at rest or
                  requiring oxygen therapy, history of major surgical resection involving the
                  stomach or small bowel, or preexisting Crohn?s disease or ulcerative colitis or a
                  preexisting chronic condition resulting in baseline grade 2 or higher diarrhea).

               -  Any other illness or condition that the treating investigator feels would
                  interfere with study compliance or would compromise the patient?s safety or study
                  endpoints.

          -  Female patients who are pregnant or nursing are not eligible.

          -  Patients who are unable to retain oral medication, and patients who have
             gastrointestinal disorders or abnormalities that would interfere with absorption of
             the study drugs are not eligible.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Changes in Ki-67 expression
Time Frame:Baseline up to 6 weeks
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Proportion of tumors with complete cell cycle arrest (CCCA) response
Time Frame:At day 15
Safety Issue:
Description:Will be measured by Ki-67 between the pre-treatment tumor and the post-treatment tumor. CCCA response is defined as less than 3% of tumor cells staining positive for Ki-67 from specimens obtained at time of hysterectomy. Baseline biomarker levels will be compared between patients who do vs. do not achieve complete CCCA using a two-sample t-test.
Measure:Biological characteristics of tumors: MMR status
Time Frame:Up to 6 weeks
Safety Issue:
Description:Will be measured to correlate with decreased Ki-67 expression induced by the letrozole and abemaciclib combination.
Measure:Biological characteristics of tumors: PTEN mutational status
Time Frame:Up to 6 weeks
Safety Issue:
Description:Will be measured to correlate with decreased Ki-67 expression induced by the letrozole and abemaciclib combination.
Measure:Biological characteristics of tumors: expression of cyclin D1
Time Frame:Up to 6 weeks
Safety Issue:
Description:Will be measured to correlate with decreased Ki-67 expression induced by the letrozole and abemaciclib combination.
Measure:Biological characteristics of tumors: p16
Time Frame:Up to 6 weeks
Safety Issue:
Description:Will be measured to correlate with decreased Ki-67 expression induced by the letrozole and abemaciclib combination.
Measure:Biological characteristics of tumors: pRB
Time Frame:Up to 6 weeks
Safety Issue:
Description:Will be measured to correlate with decreased Ki-67 expression induced by the letrozole and abemaciclib combination.
Measure:Incidence of adverse events associated with abemaciclib and letrozole
Time Frame:Up to 6 weeks
Safety Issue:
Description:Categorized and graded according to Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.

Details

Phase:Early Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Northwestern University

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