Clinical Trials /

ATI-450 in Combination With Paclitaxel or Capecitabine in Patients With Hormone Receptor-positive and HER2 Negative Metastatic Breast Cancer With Bone Metastasis

NCT04606342

Description:

This is a dose-escalating phase I using a rolling 6 design and randomized phase II study of ATI-450 in combination with chemotherapy testing the hypothesis that the combination of chemotherapy (paclitaxel or capecitabine) and ATI-450 will improve progression-free survival and reduce bone turnover, improve patient bone density, improve patient quality of life, and improve clinical efficacy.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: ATI-450 in Combination With Paclitaxel or Capecitabine in Patients With Hormone Receptor-positive and HER2 Negative Metastatic Breast Cancer With Bone Metastasis
  • Official Title: A Phase I/II Trial of ATI-450 in Combination With Paclitaxel or Capecitabine in Patients With Hormone Receptor-positive and HER2 Negative Metastatic Breast Cancer With Bone Metastasis

Clinical Trial IDs

  • ORG STUDY ID: 20-x343
  • NCT ID: NCT04606342

Conditions

  • Breast Cancer
  • Cancer of Breast

Interventions

DrugSynonymsArms
ATI-450Phase I Dose Level 1: ATI-450 + Capecitabine
PaclitaxelPhase I Dose Level 1: ATI-450 + Paclitaxel
CapecitabinePhase I Dose Level 1: ATI-450 + Capecitabine
Antiresorptive AgentsPhase II Arm 3: antiresorptive + chemotherapy

Purpose

This is a dose-escalating phase I using a rolling 6 design and randomized phase II study of ATI-450 in combination with chemotherapy testing the hypothesis that the combination of chemotherapy (paclitaxel or capecitabine) and ATI-450 will improve progression-free survival and reduce bone turnover, improve patient bone density, improve patient quality of life, and improve clinical efficacy.

Trial Arms

NameTypeDescriptionInterventions
Phase I Dose Level 1: ATI-450 + CapecitabineExperimental-Patients will receive ATI-450 by mouth (PO) twice per day (BID) along with standard chemotherapy capecitabine (1000 mg/m^2 PO BID on Days 1 through 14 of every 21-day cycle). In phase I, two dose levels of ATI-450 will be tested (dose level 1: 50 mg PO BID; dose level 2: 100 mg PO BID). For each chemotherapy cohort (paclitaxel and capecitabine), 6 patients will be enrolled at Dose Level 1. If no more than 1 of 6 patients at Dose Level 1 experiences a dose limiting toxicity (DLT), then 6 patients will be enrolled to Dose Level 2 for each chemotherapy cohort.
  • ATI-450
  • Capecitabine
Phase I Dose Level 1: ATI-450 + PaclitaxelExperimental-Patients will receive ATI-450 by mouth (PO) twice per day (BID) along with standard chemotherapy paclitaxel (80 mg/m^2 intravenous (IV) weekly) of every 21-day cycle. In phase I, two dose levels of ATI-450 will be tested (dose level 1: 50 mg PO BID; dose level 2: 100 mg PO BID). For each chemotherapy cohort (paclitaxel and capecitabine), 6 patients will be enrolled at Dose Level 1. If no more than 1 of 6 patients at Dose Level 1 experiences a dose limiting toxicity (DLT), then 6 patients will be enrolled to Dose Level 2 for each chemotherapy cohort.
  • ATI-450
  • Paclitaxel
Phase I Dose Level 2: ATI-450 + PaclitaxelExperimental-Patients will receive ATI-450 by mouth (PO) twice per day (BID) along with standard chemotherapy paclitaxel (80 mg/m^2 intravenous (IV) weekly) of every 21-day cycle. In phase I, two dose levels of ATI-450 will be tested (dose level 1: 50 mg PO BID; dose level 2: 100 mg PO BID). For each chemotherapy cohort (paclitaxel and capecitabine), 6 patients will be enrolled at Dose Level 1. If no more than 1 of 6 patients at Dose Level 1 experiences a dose limiting toxicity (DLT), then 6 patients will be enrolled to Dose Level 2 for each chemotherapy cohort.
  • ATI-450
  • Paclitaxel
Phase I Dose Level 2: ATI-450 + CapecitabineExperimental-Patients will receive ATI-450 by mouth (PO) twice per day (BID) along with standard chemotherapy of capecitabine (1000 mg/m^2 PO BID on Days 1 through 14 of every 21-day cycle)). In phase I, two dose levels of ATI-450 will be tested (dose level 1: 50 mg PO BID; dose level 2: 100 mg PO BID). For each chemotherapy cohort (paclitaxel and capecitabine), 6 patients will be enrolled at Dose Level 1. If no more than 1 of 6 patients at Dose Level 1 experiences a dose limiting toxicity (DLT), then 6 patients will be enrolled to Dose Level 2 for each chemotherapy cohort.
  • ATI-450
  • Capecitabine
Phase II Arm 1: ATI-450 (dose level 1) + chemotherapyExperimental-Patients will receive ATI-450 (dose level 1) by mouth (PO) twice per day (BID) along with standard chemotherapy (either paclitaxel (80 mg/m^2 intravenous (IV) weekly) or capecitabine (1000 mg/m^2 PO BID on Days 1 through 14 of every 21-day cycle)). The chemotherapy will be physician's decision.
  • ATI-450
  • Paclitaxel
  • Capecitabine
Phase II Arm 2: ATI-450 (dose level 2) + chemotherapyExperimental-Patients will receive ATI-450 (dose level 2) by mouth (PO) twice per day (BID) along with standard chemotherapy (either paclitaxel (80 mg/m^2 intravenous (IV) weekly) or capecitabine (1000 mg/m^2 PO BID on Days 1 through 14 of every 21-day cycle)). The chemotherapy will be physician's decision.
  • ATI-450
  • Paclitaxel
  • Capecitabine
Phase II Arm 3: antiresorptive + chemotherapyActive Comparator-Antiresorptive = bisphosphonate or denosumab on a 21-day cycle
  • Paclitaxel
  • Capecitabine
  • Antiresorptive Agents

Eligibility Criteria

        Inclusion Criteria:

          -  Phase I: Biopsy-proven hormone receptor-positive, HER2 negative metastatic breast
             cancer with bone metastasis.

          -  Phase II: Biopsy-proven hormone receptor-positive, HER2 negative metastatic breast
             cancer with progressive bone metastasis per the latest tumor imaging studies.

          -  Measurable or non-measurable but evaluable disease by RECIST v 1.1.

          -  No more than one prior chemotherapy for metastatic disease (phase II only). There are
             no limits on prior endocrine therapy-based regimens.

          -  Phase I: Washout from prior chemotherapy other than capecitabine (for the capecitabine
             cohort) or paclitaxel (for the paclitaxel cohort) for 3 weeks or passed 5 half-lives
             and recovered AEs to grade 1 (except for alopecia).

          -  Phase II: Washout from prior chemotherapy for 3 weeks or passed 5 half-lives and
             recovered AEs to grade 1 (except for alopecia).

          -  A washout period of 1 week is required from the completion of radiation therapy.

          -  Phase I: Planning to start or on stable doses of capecitabine (for the capecitabine
             cohort: no less than 1000 mg/m2 BID, 14 days on and 7 days off) or paclitaxel (for the
             paclitaxel cohort: no less than 80 mg/m2 weekly dosing).

          -  Phase II: Candidate for initiating capecitabine or paclitaxel treatment per physician
             decision.

          -  At least 18 years of age.

          -  ECOG performance status ≤ 2

          -  Life expectancy of at least 12 weeks.

          -  Adequate bone marrow and organ function as defined below:

               -  Leukocytes ≥ 3,000/mcL

               -  Absolute neutrophil count ≥ 1,500/mcL

               -  Platelets ≥ 100,000/mcL

               -  Total bilirubin ≤ 1.5 x IULN

               -  AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN

               -  Creatinine clearance > 60 mL/min by Cockcroft-Gault

          -  Prior treatment with denosumab and zoledronic acid is allowed if at least 4 weeks have
             passed before the start of study treatment.

          -  The effects of ATI-450 on the developing human fetus are unknown. For this reason,
             women of childbearing potential and men must agree to use adequate contraception
             (hormonal or barrier method of birth control, abstinence) prior to study entry, for
             the duration of study participation, and 30 days after completion of the study. Should
             a woman become pregnant or suspect she is pregnant while participating in this study,
             she must inform her treating physician immediately. Men treated or enrolled on this
             protocol must also agree to use adequate contraception prior to the study, for the
             duration of the study, and 90 days after completion of the study

          -  Ability to understand and willingness to sign an IRB approved written informed consent
             document (or that of legally authorized representative, if applicable).

        Exclusion Criteria:

          -  A history of other malignancy with the exception of malignancies for which all
             treatment was completed at least 2 years before registration and the patient has no
             evidence of disease.

          -  Currently receiving any other investigational agents.

          -  Untreated brain metastases. Patients with treated brain metastases are eligible if
             they show no evidence of progression and are off steroids.

          -  A history of allergic reactions attributed to compounds of similar chemical or
             biologic composition to ATI-450 or other agents used in the study.

          -  History of acute, untreated skeletal related events (SRE) or active untreated SRE or a
             change or an anticipated change in the SOC antiresorptive agents after entering the
             study (phase II only).

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac
             arrhythmia.

          -  Pregnant and/or breastfeeding. Women of childbearing potential must have a negative
             pregnancy test within 14 days of study entry.

          -  Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or
             they have a history of AIDS-defining opportunistic infection within the 12 months
             prior to registration. Concurrent treatment with effective ART according to DHHS
             treatment guidelines is recommended.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of toxicities as measured by CTCAE v. 5.0 (Phase I only)
Time Frame:From baseline through 30 days after end of treatment (estimated to be 11 months)
Safety Issue:
Description:PFS is defined from date of treatment start to date of progression or date of death or date of last imaging showing progression free if no progression or death occurs. Progressive Disease (PD): At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions).

Secondary Outcome Measures

Measure:Changes in Inflammatory cytokines as measured by clinical laboratory assay (Phase I only)
Time Frame:Baseline, cycle 1 day 15, day 1 of each cycle (each cycle is 21 days long), and at progression (estimated to be 10 months)
Safety Issue:
Description:
Measure:Immune markers as measured by patient's plasma (Phase I only)
Time Frame:Baseline, day 1 of each cycle (each cycle is 21 days long), and at progression (estimated to be 10 months)
Safety Issue:
Description:-Patient's plasma will be analyzed for immune markers using the Luminex system
Measure:Steady state ATI-450 trough concentration (Phase I only)
Time Frame:Cycle 2 Day 1 (approximately Day 22 - each cycle is 21 days long)
Safety Issue:
Description:-ATI-450 concentrations in plasma samples are determined by LC-MS/MS following protein precipitation using a validated method
Measure:Changes in bone turnover markers as measured by ELISA (Phase II only)
Time Frame:Baseline, cycle 1 day 8 (each cycle is 21 days long), and at progression (estimated to be 10 months)
Safety Issue:
Description:
Measure:Changes in inflammatory cytokines as measured by clinical laboratory assay (Phase II only)
Time Frame:Baseline, cycle 1 day 15, day 1 of each cycle (each cycle is 21 days long), and at progression (estimated to be 10 months)
Safety Issue:
Description:
Measure:Time to maximum reduction of serum CTX (Phase II only)
Time Frame:Baseline, cycle 1 day 1, cycle 1 day 8, cycle 1 day 15, day 1 of each cycle (each cycle is 21 days long), and at progression (estimated to be 10 months)
Safety Issue:
Description:
Measure:Incidence of adverse events as measured by CTCAE v. 5.0 (Phase II only)
Time Frame:From baseline through 30 days after end of treatment (estimated to be 11 months)
Safety Issue:
Description:
Measure:Change in quality of life as measured by EORTC QLQ-C30 (Phase II only)
Time Frame:Prior to start of treatment, cycle 5 day 1 (each cycle is 21 days long), every 4 cycles thereafter, and at progression (estimated to be 10 months)
Safety Issue:
Description:-The QLQ-C30 is composed of five functional scales, three symptom scales, a global health status/QoL scale and six single items. All of the scales and single-item measures range in score from 0 to 100. A high score of functional scale, symptom scales and global health status/QoL scale corresponds to a high/healthy level of functioning, high level of symptomatology/problems, and high QoL, respectively
Measure:Change in pain as measured by Brief Pain Inventory (Phase II only)
Time Frame:Prior to start of treatment, cycle 3 day 1 (each cycle is 21 days long), every 2 cycles thereafter, and at progression (estimated to be 10 months)
Safety Issue:
Description:-Brief pain inventory (BPI) rapidly assesses the severity of pain and its impact on daily functioning. It assesses the severity of pain, impact of pain on daily function, location of pain, pain medications and amount of pain relief in the past 24 hours or the past week. This version has front and back body diagrams, the four pain severity items and seven pain interference items rated on 0-10 scales, and the question about percentage of pain relief by analgesics.
Measure:Change in neuropathy as measured by CIPN20 (Phase II - paclitaxel containing arm only)
Time Frame:Prior to start of treatment, cycle 3 day 1 (each cycle is 21 days long), every 2 cycles thereafter, and at progression (estimated to be 10 months)
Safety Issue:
Description:-Chemotherapy-induced peripheral neuropathy 20-item scale (CIPN20) provides sensory, motor, and autonomic subscales. It is a validated instrument designed to elicit cancer patients' experience of symptoms and functional limitations related to chemotherapy-induced peripheral neuropathy.
Measure:Overall response rate (ORR) (Phase II only)
Time Frame:Through completion of treatment (estimated to be 10 months)
Safety Issue:
Description:ORR: Number of complete response + partial response Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis). Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Measure:Clinical benefit rate (CBR) (Phase II only)
Time Frame:24 weeks
Safety Issue:
Description:CBR is defined number of patients with complete response (CR) and partial response (PR) Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis). Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters
Measure:Overall survival (OS) (Phase II only)
Time Frame:Through completion of follow-up (estimated to be 46 months)
Safety Issue:
Description:

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Washington University School of Medicine

Last Updated

October 21, 2020