Clinical Trials /

A Study of Trifluridine/Tipiracil in Triple Negative Metastatic Breast Cancer

NCT04149444

Description:

This is an open-label, single arm, multi-stage, phase II trial of Trifluridine/tipiracil as a palliative treatment for patients with metastatic triple negative breast cancer who have failed both a taxane and anthracycline or have contraindications to these agents.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: A Study of Trifluridine/Tipiracil in Triple Negative Metastatic Breast Cancer
  • Official Title: A Phase 2 Study of Trifluridine/Tipiracil in Triple Negative Metastatic Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: OZM-103
  • NCT ID: NCT04149444

Conditions

  • Metastatic Triple Negative Breast Cancer

Interventions

DrugSynonymsArms
Trifluridine/TipiracilTAS-102ARM 1

Purpose

This is an open-label, single arm, multi-stage, phase II trial of Trifluridine/tipiracil as a palliative treatment for patients with metastatic triple negative breast cancer who have failed both a taxane and anthracycline or have contraindications to these agents.

Detailed Description

      This is an open-label, single arm, multi-stage, phase II trial of Trifluridine/tipiracil
      (TAS-102) as a palliative treatment for patients with metastatic triple negative breast
      cancer who have failed both a taxane and anthracycline or have contraindications to these
      agents.

      The trial will begin with a safety run-in of 10 patients treated as follows:

      Cycle 1: Trifluridine/tipiracil administered at 30 mg/m2 orally bid, 5 days per week, with 2
      days of rest, for 2 weeks, followed by 14 day rest. Intra-patient dose escalation to 35 mg/m2
      orally bid, 5 days per week, with 2 days of rest, for 2 weeks, followed by 14 day rest for
      subsequent cycles in the absence of dose limiting toxicities. As long as at least 80% of
      patients tolerate dose escalation, the trial will proceed to the next stage.

      Patients enrolled in stages I and II will start Trifluridine/tipiracil at 35 mg/m2 orally
      bid, 5 days per week, with 2 days of rest, for 2 weeks, followed by 14 day rest.
    

Trial Arms

NameTypeDescriptionInterventions
ARM 1ExperimentalDose escalation cohort - First 10 patients enrolled on study. Trifluridine/Tipiracil 30mg/m2 - to start, if no significant dose limiting side effects the dose will be increased to 35mg/m2 for the duration of the trial. After first 10 patients enrolled on study - Trifluridine/Tipiracil 35mg/m2 Each cycle is 28 days. Two doses per day during days 1-5 with a two day rest for days 6 and 7. Then two doses per day for days 8-12, followed by a rest period for days 13-28 with the next cycle starting the day after day 28.
  • Trifluridine/Tipiracil

Eligibility Criteria

        Inclusion Criteria:

          -  Age ≥ 18 years

          -  Life expectancy of ≥ 3 months

          -  Histologically or cytologically confirmed locally recurrent or metastatic breast
             cancer that is Estrogen receptor negative, Progesterone receptor negative, and HER2
             normal on local testing

          -  Up to three prior chemotherapy regimens for advanced and/or metastatic disease

          -  Prior therapy with an anthracycline and a taxane in the adjuvant or metastatic setting
             or documented unsuitability

          -  Patients who developed advanced or metastatic disease within 6 months of completing
             adjuvant therapy are eligible with no prior therapy for advanced disease.

          -  Resolution of all chemotherapy- or radiation-related toxicities to ≤ grade 1 (except
             for stable sensory neuropathy ≤ grade 2 and alopecia) prior to commencement of study
             participation

          -  Eastern Cooperative Oncology Group performance status of 0 to 2

          -  Adequate renal function: creatinine clearance ≥ 40 mL/min Cockcroft and Gault formula

          -  Adequate bone marrow function: absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L,
             hemoglobin ≥ 10.0 g/dL (a hemoglobin <10.0 g/dL is acceptable if it is corrected by
             growth factor or transfusion), and platelet count ≥ 100 x 10^9/L

          -  Adequate liver function: bilirubin ≤ 1.5 times the upper limits of normal (ULN),
             alanine aminotransferase (ALT ≤ 3 x ULN (in the case of liver metastases ≤ 5 x ULN)

          -  Measurable disease (RECIST 1.1)

          -  Patients with known BRCA or ATM mutations or abnormalities (based on genomic profiling
             of tumor or germline genetic testing) are eligible if they meet all other inclusion
             criteria and have none of the exclusion criteria. The trial will not perform tumor
             genomic profiling or genetic testing but will document this information if available
             at study enrolment.

          -  Patients with known central nervous system (CNS) disease are eligible provided all of
             the following criteria are met:

               -  Measurable disease outside the CNS

               -  Metastases are limited solely to cerebellar and supratentorial lesions (i.e., no
                  metastases to midbrain, pons, medulla, or spinal cord)

               -  If corticosteroids are required, the patient must be on a stable dose or tapering
                  dose of corticosteroids for 4 weeks prior to enrolment as therapy for CNS disease

               -  Anticonvulsants at a stable dose are allowed as long as the patient has been
                  seizure free for 3 weeks prior to enrolment

               -  No stereotactic radiation within 7 days or whole-brain radiation within 14 days
                  prior to randomization

               -  No evidence of progression or haemorrhage after completion of CNS directed
                  therapy

               -  Note: Patients with new asymptomatic CNS metastases detected at the screening
                  scan must receive radiation therapy and/or surgery for CNS metastases. Following
                  treatment, these patients may then be eligible, if all other criteria above are
                  met.

          -  Women of child-bearing potential and males with female partners with child bearing
             potential must use highly effective contraceptive measures while taking
             Trifluridine/tipiracil and for 6 months after stopping treatment.
             Trifluridine/tipiracil may reduce the effectiveness of hormonal contraceptives, and
             therefore women using hormonal contraceptives should add a barrier contraceptive
             method.

          -  Ability to understand and the willingness to sign a written informed consent document.

          -  Ability to take and retain oral medications

        Exclusion Criteria:

          -  Radiation therapy encompassing more than 30% of marrow

          -  Spinal cord compression not definitively treated with surgery and/or radiation, or
             previously diagnosed and treated spinal cord compression without evidence that disease
             has been clinically stable for at least 2 weeks prior to randomization.

          -  Leptomeningeal disease

          -  Patients who are receiving any other investigational agents

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to Trifluridine/tipiracil .

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, or psychiatric illness/social situations that would limit compliance with
             study requirements.

          -  Pregnant women are excluded from this study because Trifluridine/tipiracil is an agent
             with the potential for teratogenic or abortifacient effects.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall Response Rate (ORR)
Time Frame:8 weeks
Safety Issue:
Description:The Primary Endpoint ORR is calculated by taking the number of patients who at 8 weeks following initiation of Trifluridine/tipiracil have either a CR or a PR on first scan and dividing it over the total number of evaluable patients. Patients with stable disease are not included in this calculation.

Secondary Outcome Measures

Measure:Progression Free Survival (PFS)
Time Frame:From date of randomization until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to 45 months.
Safety Issue:
Description:Progression free survival is defined as the time (in weeks) from the date of randomization until the date of the investigator-assessed radiological disease progression or death due to any cause. All patients will be followed until disease progression is documented according to RECIST 1.1 Criteria. The time measured in weeks between their baseline CT Scan and the first CT scan showing progressive disease as will be recorded as the progression free survival for that patient.
Measure:Disease Control Rate (DCR)
Time Frame:From date of randomization until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to 45 months.
Safety Issue:
Description:All patients who have either a Complete Response, Partial Response or exhibit stable disease for a minimum of 16 weeks will be counted as having achieved disease control. The number of patients attaining disease control will be divided by the total number of evaluable patients to attain a DCR for the entirety of the trial cohort.
Measure:Overall Survival
Time Frame:From date of randomization until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to 45 months.
Safety Issue:
Description:The death of any patient in the trial from any cause will be recorded and the amount of time from enrollment in the trial until death will be recorded in weeks. A median overall survival for the entire cohort will then be calculated using this information.
Measure:Safety and Tolerability: All adverse events experienced by all patients
Time Frame:From date of randomization until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to 45 months.
Safety Issue:
Description:All adverse events experienced by all patients exposed to Trifluridine/tipiracil will be recorded and graded according to CTCAE version 5. These will be compared to the side effect profile presented in both the product monograph as well as the previously published phase III trial upon which the Health Canada approval is based.
Measure:Quality of Life - Using EQ5D - A standardized questionnaire measuring quality of life
Time Frame:From date of randomization until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to 32 months.
Safety Issue:
Description:Quality of life will be scored using the EQ5D. Patients will fill out this questionnaire prior to each follow up visit and the results will be compared within the same patient from visit to visit.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:AHS Cancer Control Alberta

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