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Trial record 1 of 1 for:    NCT01344031
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MK2206 in Combination With Anastrozole, Fulvestrant, or Anastrozole and Fulvestrant in Treating Postmenopausal Women With Metastatic Breast Cancer

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT01344031
First received: April 27, 2011
Last updated: November 21, 2014
Last verified: September 2014
  Purpose

This phase I trial studies the side effects and the best dose of MK 2206 (Akt inhibitor MK2206) when given with anastrozole, fulvestrant, or anastrozole and fulvestrant in treating postmenopausal women with breast cancer that has spread to other parts of the body. Estrogen can cause the growth of breast cancer cells. Hormone therapy using anastrozole or fulvestrant may fight breast cancer by lowering the amount of estrogen the body makes. Akt inhibitor MK2206 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving Akt inhibitor MK2206 together with anastrozole, fulvestrant, or anastrozole and fulvestrant may kill more tumor cells.


Condition Intervention Phase
Estrogen Receptor Positive
Recurrent Breast Carcinoma
Stage IV Breast Cancer
Drug: Akt Inhibitor MK2206
Drug: Anastrozole
Drug: Fulvestrant
Other: Laboratory Biomarker Analysis
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase 1 Trial of MK-2206 in Combination With Anastrozole, Fulvestrant, or Anastrozole Plus Fulvestrant in Postmenopausal Women With Estrogen Receptor Positive Metastatic Breast Cancer

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • MTD of Akt inhibitor MK-2206 in combination with anastrozole determined according to dose-limiting toxicities (DLTs) graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0) (Phase IA) [ Time Frame: 4 weeks ] [ Designated as safety issue: Yes ]
    Data analysis for the study will be descriptive in nature. Demographic and clinical characteristics of the subjects, toxicity by grade, adverse events, serious adverse events and death will be listed and summarized using descriptive statistics for each dose level.

  • RPTD of Akt inhibitor MK-2206 in combination with anastrozole evaluated by the tolerability of prolonged administration at the MTD assessed by CTCAE v4.0 (Phase IB) [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
    Data analysis for the study will be descriptive in nature. Demographic and clinical characteristics of the subjects, toxicity by grade, adverse events, serious adverse events and death will be listed and summarized using descriptive statistics for each dose level.

  • RPTD of fulvestrant in combination with Akt inhibitor MK-2206 assessed by CTCAE v4.0 (ARM C) [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
    Data analysis for the study will be descriptive in nature. Demographic and clinical characteristics of the subjects, toxicity by grade, adverse events, serious adverse events and death will be listed and summarized using descriptive statistics for each dose level.

  • RPTD of anastrozole plus fulvestrant in combination with Akt inhibitor MK-2206 assessed by CTCAE v4.0 (ARM D) [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
    Data analysis for the study will be descriptive in nature. Demographic and clinical characteristics of the subjects, toxicity by grade, adverse events, serious adverse events and death will be listed and summarized using descriptive statistics for each dose level.


Secondary Outcome Measures:
  • Incidence of toxicity, assessed by CTCAE v4.0 [ Time Frame: Up to 30 days post-treatment ] [ Designated as safety issue: Yes ]
  • Clinical benefit rate (CR+PR+SD for more than 6 months) [ Time Frame: Up to 30 days post-treatment ] [ Designated as safety issue: No ]
  • Serum levels of estradiol prior to and following 1 course of Akt inhibitor MK-2206 therapy [ Time Frame: Up to day 28 ] [ Designated as safety issue: No ]

Other Outcome Measures:
  • Change in PI3K pathway abnormalities [ Time Frame: Baseline up to 30 days post-treatment ] [ Designated as safety issue: No ]
  • Tumor cell AKT signaling [ Time Frame: Up to 30 days post-treatment ] [ Designated as safety issue: No ]
    Descriptive statistics will be calculated for each dose level.

  • Tumor cell proliferation [ Time Frame: Up to 30 days post-treatment ] [ Designated as safety issue: No ]
    Descriptive statistics will be calculated for each dose level.

  • Tumor cell apoptosis [ Time Frame: Up to 30 days post-treatment ] [ Designated as safety issue: No ]
    Descriptive statistics will be calculated for each dose level.

  • Changes in tumor cell glucose uptake by 2-[18F]fluoro-2-deoxy-D-glucose (FDG)/PET [ Time Frame: Baseline up to 24 hours post day 1 Akt inhibitor MK2206 ] [ Designated as safety issue: No ]
    Descriptive statistics will be calculated for each dose level. The associations between changes in standardized uptake value (SUV) and clinical outcomes will also be explored graphically.

  • Change in PIK3CA mutation status in circulating DNA [ Time Frame: Baseline up to 30 days post-treatment ] [ Designated as safety issue: No ]
    The relationship between tumor (or cell-free [cf]DNA) PIK3CA mutation status/loss of phosphatase and tensin homolog gene (PTEN) and response to treatment will be described using contingency tables. The concordance between cfDNA and PIK3CA mutation status will also be assessed using contingency tables at baseline and following study therapy.


Enrollment: 31
Study Start Date: April 2011
Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm A (anastrozole and Akt inhibitor MK2206)
Patients receive anastrozole PO on days 1-28. Beginning in course 2, patients receive Akt inhibitor MK2206 PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: Akt Inhibitor MK2206
Given PO
Other Name: MK2206
Drug: Anastrozole
Given PO
Other Names:
  • ANAS
  • ICI-D1033
  • ZD-1033
Other: Laboratory Biomarker Analysis
Correlative studies
Experimental: Arm B (Akt inhibitor MK2206 and anastrozole)
The RPTD of Akt inhibitor MK2206 with anastrozole is determined after 3 courses, administered as in Arm A.
Drug: Akt Inhibitor MK2206
Given PO
Other Name: MK2206
Drug: Anastrozole
Given PO
Other Names:
  • ANAS
  • ICI-D1033
  • ZD-1033
Other: Laboratory Biomarker Analysis
Correlative studies
Experimental: Arm C (Akt inhibitor MK2206 and fulvestrant)
Patients receive Akt inhibitor MK2206 PO on days 1, 8, 15, and 22, fulvestrant IM on day 1and day 15 of course 1 and then on day 1 of each course in each subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: Akt Inhibitor MK2206
Given PO
Other Name: MK2206
Drug: Fulvestrant
Given IM
Other Names:
  • ICI 182,780
  • ZD9238
Other: Laboratory Biomarker Analysis
Correlative studies
Experimental: Arm D (Akt inhibitor MK2206, anastrozole, fulvestrant)
Patients receive Akt inhibitor MK2206 PO as in Arm A, anastrozole PO on days 1-28 and fulvestrant IM on day 1. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Drug: Akt Inhibitor MK2206
Given PO
Other Name: MK2206
Drug: Anastrozole
Given PO
Other Names:
  • ANAS
  • ICI-D1033
  • ZD-1033
Drug: Fulvestrant
Given IM
Other Names:
  • ICI 182,780
  • ZD9238
Other: Laboratory Biomarker Analysis
Correlative studies

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have histologically or cytologically confirmed invasive breast cancer that is metastatic stage IV or recurrent metastatic (histologic/cytologic confirmation of recurrence preferred, but not required)
  • Either the primary or the metastatic tumor must be positive for estrogen-receptor (> 1% tumor cell staining by immunohistochemistry or an Allred score of >= 3 by immunohistochemistry)
  • Patient must have measurable or non-measurable lesions (defined by Response Evaluation Criteria In Solid Tumors [RECIST] 1.1 criteria)

    • To be eligible for the FDG PET imaging studies in Phase IA, the presence of measurable lesions of at least 1.5 cm or the presence of bone lesions is required
  • Patients may have undergone any number of prior lines of chemotherapy or endocrine regimens but must not have a history of disease progression on anastrozole (Phase IA and Phase IB), fulvestrant (Arm C), or both anastrozole and fulvestrant (Arm D)

    • Phase IA and IB:

      • Currently being treated with anastrozole with no evidence of disease progression OR
      • Currently being treated with letrozole or exemestane with no evidence of disease progression and willing to switch to anastrozole for study enrollment OR
      • Considering switching to anastrozole due to disease progression from the most recent anti-cancer therapy
    • Arm C:

      • Currently being treated with fulvestrant with no evidence of disease progression OR
      • Considering switching to fulvestrant due to disease progression from the most recent anti-cancer therapy
    • Arm D:

      • Currently being treated with either anastrozole or fulvestrant with no evidence of disease progression OR
      • Currently being treated with letrozole or exemestane with no evidence of disease progression and willing to switch to anastrozole for study enrollment
      • Considering switching to anastrozole or fulvestrant due to disease progression from the most recent anti-cancer therapy
  • Patients must be postmenopausal women as defined by one of the following:

    • Women > 60 years
    • Women =< 60 years with spontaneous cessation of menses > 12 months prior to registration
    • Women =< 60 years with cessation of menses of duration < 12 months or secondary to hysterectomy AND an follicle stimulating hormone (FSH) level in the postmenopausal range according to institutional standards (or > 34.4 IU/L if institutional range is not available) prior to registration
    • Women =< 60 years on hormonal replacement therapy who have discontinued hormonal therapy AND an FSH level in the postmenopausal range according to institutional standards (or > 34.4 IU/L if institutional range is not available) prior to registration
    • Status post bilateral surgical oophorectomy
    • Premenopausal women on a gonadotropin-releasing hormone (GnRH) analog
  • Patients must have a life expectancy greater than 4 months
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) =< 1 (Karnofsky PS >= 70%)
  • Leukocytes >= 3,000/mcL
  • Absolute neutrophil count (ANC) >= 1,500/mcL
  • Platelet count >= 100,000/mcL
  • Total bilirubin not above the institutional upper limit of normal
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X institutional upper limit of normal
  • Creatinine not above the institutional upper limit of normal OR creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
  • If patients have diabetes mellitus, fasting glucose must be =< 120 mg/dL and hemoglobin (Hb)A1c =< 8%
  • Women of childbearing potential must use two forms of contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while she is participating in this study, the patient should inform the treating physician immediately
  • Patients with known brain metastases are eligible if stable (no evidence of local progression) >= 3 months after local therapy and are off steroid
  • Patients who are eligible for this study may also be eligible for and participate in National Cancer Institute (NCI) Protocol 9167, titled "Positron Emission Tomography (PET) with 18F-Fluoroestradiol (FES) as a Predictor of Response in Patients with Breast Cancer Scheduled to Be Treated with MK-2206 in Combination with Either an Aromatase Inhibitor or Fulvestrant on NCI Protocol 8762," in which case the FES-PET in Protocol 9167 has to be performed a minimum of 48 hours and a maximum of 30 days before the first dose of MK-2206; in addition, all FES-related side effects must have resolved before the first dose of MK-2206
  • Patients must have the ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Patients may not have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study; patient must have recovered from adverse events due to agents administered more than 4 weeks earlier
  • Patients may not be receiving any other investigational agents
  • Patients may not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to MK-2206 or other agents used in the study
  • Patients receiving any medications or substances that are strong inhibitors or inducers of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP 450 3A4) are ineligible

    • Oxidative metabolism of MK-2206 in human liver microsomes is catalyzed primarily by CYP3A4, although direct glucuronidation also occurs
    • Note: One week washout period is required in patients who were previously taking strong inhibitors or inducers of CYP450 3A4; patients who are currently taking moderate inhibitors or inducers of CYP450 3A4 are encouraged to switch to other medications that do not interact with CYP450 3A4
  • Preclinical studies demonstrated the potential of MK-2206 for induction of hyperglycemia in all preclinical species tested; patients with diabetes or in risk for hyperglycemia should not be excluded from trials with MK-2206, but the hyperglycemia should be well controlled on oral agents before the patient enters the trial (i.e. HbA1c =< 8% and fasting glucose =< 120 mg/dL)
  • Preclinical studies indicated transient changes in corrected QT (QTc) interval during MK-2206 treatment; prolongation of QTc interval is potentially a safety concern while on MK-2206 therapy; cardiovascular: baseline QT Fridericia formula (QTcF) > 450 msec (male) or QTcF > 470 msec (female) will exclude patients from entry on study
  • Patients may not have 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 or nursing patients are excluded from the study
  • Patients with known human immunodeficiency virus (HIV) positive status are excluded from this study; appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated
  • Patients may not have had disease progression on anastrozole (Phase IA and Phase IB), fulvestrant (Arm C), both anastrozole and fulvestrant (Arm D) in either the neoadjuvant, adjuvant (defined as disease recurrence identified within 6 months of adjuvant discontinuation), or metastatic setting
  • Patients may not have had grade 3 or intolerable grade 2 adverse events during run-in aromatase inhibitor (AI) or fulvestrant therapy prior to starting MK-2206
  • Patients may not have had prior therapy with an AKT inhibitor
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01344031

Locations
United States, Missouri
Washington University School of Medicine
Saint Louis, Missouri, United States, 63110
Sponsors and Collaborators
Investigators
Principal Investigator: Cynthia Ma Washington University School of Medicine
  More Information

No publications provided

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT01344031     History of Changes
Other Study ID Numbers: NCI-2011-02586, NCI-2011-02586, CDR0000699394, WU-201010701, 201010701, 8762, P30CA091842
Study First Received: April 27, 2011
Last Updated: November 21, 2014
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
Breast Neoplasms
Breast Diseases
Neoplasms
Neoplasms by Site
Skin Diseases
Anastrozole
Estradiol
Fulvestrant
Antineoplastic Agents
Antineoplastic Agents, Hormonal
Aromatase Inhibitors
Enzyme Inhibitors
Estrogen Antagonists
Estrogen Receptor Modulators
Estrogens
Hormone Antagonists
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on November 25, 2014