CFI-400945 is a new type of drug for breast cancer. Laboratory tests show that it works by
blocking a specific protein called Polo-like Kinase 4 (PLK4) that is involved in cancer cell
growth. CFI-400945 may slow down the growth of cancer cells or may cause cancer cells to die.
This drug has been shown to shrink tumours in animals and has been studied in more than 60
patients. It appears to be well tolerated with few side effects. CFI-400945 seems promising
but it is not clear if it can offer better results than standard therapy.
Durvalumab is a new type of drug for many types of cancer. Durvalumab is an immunotherapy
drug and not a chemotherapy drug. Laboratory tests show that it works by allowing the immune
system (PD-1 and PD-L1 interaction) to detect your cancer and reactivating the immune
response. This may help to slow down the growth of cancer or may cause cancer cells to die.
Durvalumab has been shown to shrink tumours in animals and has been studied in more than 6000
people. In laboratory studies, when used together with CFI-400945, results seem promising but
it is not clear if it can offer better results than standard treatment alone. This is the
first time that the combination of CFI-400945 and durvalumab has been tested in patients.
Inclusion Criteria:
- Patients must have histologically and/or cytologically confirmed diagnosis of breast
cancer, that is advanced/metastatic or unresectable, for which no curative therapy
exists, and be negative for ER, PR and HER2 by ASCO/CAP criteria on the most recent
sample. Patients with tumour with either low (< 10%) ER expression who are PR and HER2
negative, or ER and HER2 negative but with low PR (< 10%) may be enrolled after
discussion and confirmation with CCTG
- Only female patients will be enrolled
- All patients must have a formalin fixed paraffin embedded tissue block (from primary
or metastatic tumour) available and must have provided informed consent for the
release of the block.
- Presence of clinically and/or radiologically documented disease. All radiology studies
must be performed within 21 days prior to enrollment (within 28 days if negative).
- All patients must have measurable disease as defined by RECIST 1.1. The criteria for
defining measurable disease are as follows:
- Chest x-ray ≥ 20 mm
- CT scan (with slice thickness of 5 mm) ≥ 10 mm -> longest diameter
- Physical exam (using calipers) ≥ 10 mm
- Lymph nodes by CT scan ≥ 15 mm -> measured in short axis
- Patients must be ≥ 18 years of age
- Patients must have an ECOG performance status of 0 or 1
- Patients must have a life expectancy of 3 months or longer
- Laboratory Requirements (must be done within 7 days prior to enrollment) Absolute
neutrophils ≥ 1.5 x 10^9/L Platelets ≥ 100 x 10^9/L Bilirubin ≤ 1.5 x ULN (upper limit
of normal) AST and ALT ≤ 2.5 x ULN, ≤ 4.0 x ULN if patient has liver metastases Serum
creatinine ≤ 1.5 x ULN or Creatinine clearance ≥ 50 mL/min
- Patients must be able to swallow oral medications and have no known gastrointestinal
disorders that may interfere with absorption (such as malabsorption).
- Patients must have had at least 1 prior line of cytotoxic chemotherapy for breast
cancer, in any setting, which must have included an anthracycline and a taxane (unless
contraindicated). Select patients that have not received both anthracycline and taxane
therapy may be considered eligible after discussion with CCTG. There is no limit to
the number of prior chemotherapy regimens.
- Patients may have received other therapies including endocrine therapy and/or targeted
therapies (including CDK4/6 inhibitors and PARP inhibitors).
- Patients may not have received prior immunotherapies of any kind, nor any agent
targeting PLK4.
- Patients must have recovered (to at least grade 0 or 1) from all reversible toxicity
related to prior chemotherapy or systemic therapy and have adequate washout as
follows: Longest of one of the following:
- Two weeks,
- 5 half-lives for investigational agents,
- Standard cycle length of standard therapies.
- Prior external beam radiation is permitted provided a minimum of 28 days (4 weeks)
have elapsed between the last dose of radiation and date of enrollment. Exceptions may
be made for low-dose, non-myelosuppressive radiotherapy after consultation with CCTG.
Concurrent radiotherapy is not permitted.
- Previous surgery is permitted provided that a minimum of 21 days (3 weeks) have
elapsed between any major surgery and date of enrollment, and that wound healing has
occurred.
- Patient consent must be appropriately obtained in accordance with applicable local and
regulatory requirements. Each patient must sign a consent form prior to enrollment in
the trial to document their willingness to participate.
- Patients must be accessible for treatment and follow-up. Patients enrolled on this
trial must be treated and followed at the participating centre. This implies there
must be reasonable geographical limits (for example: 1 ½ hour's driving distance)
placed on patients being considered for this trial
- In accordance with CCTG policy, protocol treatment is to begin within 2 working days
of patient enrollment
- Women of childbearing potential must have agreed to use a highly effective
contraceptive method.
- Women of childbearing potential will have a pregnancy test to determine eligibility as
part of the Pre-Study Evaluation; this may include an ultrasound to rule-out pregnancy
if a false-positive is suspected
- Subjects should not donate blood while participating in this study, or for at least 90
days following the last infusion of durvalumab
Exclusion Criteria:
- Patients with a history of other malignancies, except: adequately treated non-melanoma
skin cancer, curatively treated in-situ cancer of the cervix, or other solid tumours
curatively treated with no evidence of disease for > 2 years and which do not require
ongoing treatment.
- Patients with serious illnesses or medical conditions which would not permit the
patient to be managed according to the protocol (including corticosteroid
administration), or would put the patient at risk. This includes but is not limited
to:
- History of significant neurologic or psychiatric disorder which would impair the
ability to obtain consent or limit compliance with study requirements.
- Active infection requiring systemic therapy; (including any patient known to have
active hepatitis B, hepatitis C or human immunodeficiency virus (HIV) or
tuberculosis or any infection requiring systemic therapy).
- Active peptic ulcer disease or gastritis.
- Known pneumonitis or pulmonary fibrosis with clinically significant impairment of
pulmonary function.
- Patients with diabetes mellitus are eligible but must be clinically stable on
therapy (if applicable) and investigator and patient should be aware of the
potential risk of immune mediated pancreatic toxicity and B cell destruction.
- Patients are not eligible if they have a known hypersensitivity to the study drug(s)
or their components.
- Patients who have experienced untreated and/or uncontrolled cardiovascular conditions
and/or have symptomatic cardiac dysfunction (unstable angina, congestive heart
failure, myocardial infarction within the previous year or cardiac ventricular
arrhythmias requiring medication, history of 2nd or 3rd degree atrioventricular
conduction defects). Patients with a significant cardiac history, even if controlled,
should have a LVEF ≥ 50%.
- Patients may not receive concurrent treatment with other anti-cancer therapy (other
than bone- targeted therapy, if already taking and stable) or investigational agents
while on protocol therapy.
- Patients who have received growth factors within 28 days prior to initiation of dosing
of CFI- 400945 or who will require treatment with growth factors throughout the
duration of the trial.
- Pregnant or breastfeeding women.
- Patients being treated with drugs listed in Appendix VI Table 1 are excluded. Patients
being treated with drugs listed in Appendix VI Table 2 may be enrolled, but should be
monitored carefully for toxicities resulting from potential interactions between
CFI-400945 and these drugs. In addition, patients must avoid consumption of the fruit
or juice of Seville oranges (e.g. marmalade), grapefruit, pomelos and star fruit from
7 days before the first dose of study drug and during the entire study due to
potential CYP3A4 interaction with the study drug. Regular orange juice is allowed.
- Patients with history of central nervous system metastases or spinal cord compression
unless they have received definitive treatment, are clinically stable and do not
require corticosteroids.
- Patients with any medical condition that would impair the administration of oral
agents including significant bowel resection, inflammatory bowel disease or
uncontrolled nausea or vomiting.
- Active or prior documented autoimmune or inflammatory disorders including inflammatory
bowel disease (e.g. colitis or Crohn's disease), diverticulitis with the exception of
diverticulosis, celiac disease or other serious gastrointestinal chronic conditions
associated with diarrhea), systemic lupus erythematosus, Sarcoidosis syndrome, or
Wegener syndrome (granulomatosis with polyangiitis), rheumatoid arthritis,
hypophysitis, uveitis, etc., within the past 3 years prior to the start of treatment.
The following are exceptions to this criterion:
- Patients with alopecia.
- Patients with Grave's disease, vitiligo or psoriasis not requiring systemic
treatment (within the last 2 years).
- Patients with hypothyroidism (e.g. following Hashimoto syndrome) stable on
hormone replacement.
- History of primary immunodeficiency, history of allogenic organ transplant that
requires therapeutic immunosuppression and the use of immunosuppressive agents within
28 days of enrollment *.
* NOTE: Intranasal/inhaled corticosteroids or systemic steroids that do not to exceed
10 mg/day of prednisone or equivalent dose of an alternative corticosteroid are
permissible.
- Live attenuated vaccination administered within 30 days prior to enrollment or within
30 days of receiving durvalumab.
- Any previous treatment with a PD-1 or PD-L1 inhibitor, including durvalumab or an
anti-CTLA4.
- Patients being treated with full dose warfarin. Patients with history of deep vein
thrombosis or pulmonary embolus who are being treated with therapeutic doses of low
molecular weight heparin, direct factor Xa inhibitors or prophylactic dose
anticoagulants may be enrolled.
