BYL719 and Letrozole in Post-Menopausal Patients With Hormone Receptor-Positive Metastatic Breast Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by Vanderbilt-Ingram Cancer Center
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Ingrid Mayer, MD, Vanderbilt-Ingram Cancer Center
ClinicalTrials.gov Identifier:
NCT01791478
First received: February 11, 2013
Last updated: June 17, 2014
Last verified: June 2014
  Purpose

This phase I trial studies the side effects and best dose of the PI3K inhibitor BYL719 when given together with letrozole in treating patients with hormone receptor-positive metastatic breast cancer. The PI3K inhibitor BYL719 may stop the growth of tumor cells by blocking some of the proteins needed for cell growth. Hormone therapy using letrozole may fight breast cancer by blocking the use of estrogen by the tumor cells. Giving the PI3K inhibitor BYL719 together with letrozole may kill more tumor cells


Condition Intervention Phase
Estrogen Receptor-positive Breast Cancer
HER2-negative Breast Cancer
Invasive Ductal Breast Carcinoma
Progesterone Receptor-positive Breast Cancer
Recurrent Breast Cancer
Stage IV Breast Cancer
Drug: PI3K inhibitor BYL719
Drug: letrozole
Other: laboratory biomarker analysis
Other: pharmacological studies
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase Ib Trial of BYL719 (an α-Specific PI3K Inhibitor) in Combination With Endocrine Therapy in Post-Menopausal Patients With Hormone Receptor-Positive Metastatic Breast Cancer

Resource links provided by NLM:


Further study details as provided by Vanderbilt-Ingram Cancer Center:

Primary Outcome Measures:
  • Maximum tolerated dose of BYL719 in combination with letrozole [ Time Frame: 4 weeks ] [ Designated as safety issue: Yes ]
    Highest dose of BYL719 tested in which a DLT is experienced by 0 out of 3 or 1 of 6 patients, based on the NCI Common Toxicity Criteria for Adverse Events (CTCAE) version 4.0


Secondary Outcome Measures:
  • Highest tolerated dose of BYL719 in combination with letrozole [ Time Frame: 8 weeks ] [ Designated as safety issue: Yes ]
    Highest dose of BYL719 without CTC Grade > 2 hyperglycemia(fasting glucose > 200 mg/dL) for > 2 weeks, Grade > 3 rash for > 2 weeks , Grade > 2 gastrointestinal toxicity for > 2 weeks and Grade > 2 creatinine, bilirubin, AST, ALT for > 2 weeks.

  • Clinical benefit rate [ Time Frame: At 6 months of study treatment ] [ Designated as safety issue: No ]
    Per Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1; percentage of patients with complete response (CR) + partial response (PR) + stable disease (SD) for more than 6 months.

  • Overall progression-free survival [ Time Frame: Up to 4 weeks after interruption of study treatment ] [ Designated as safety issue: No ]
    Duration from on-study date to date of progressive disease.

  • Overall response [ Time Frame: Every 8 weeks to interruption of treatment ] [ Designated as safety issue: No ]
    Per RECIST version 1.1. number of patients each with CR, PR, SD, and progressive disease (PD) as their best response.

  • Worst grade toxicities [ Time Frame: Up to 4 weeks after interruption of study treatment ] [ Designated as safety issue: Yes ]
    Number of patients with worst-grade toxicity at each of five grades (grade 1, least severe; to grade 5, most severe) following NCI Common Toxicity Criteria 4.0.


Estimated Enrollment: 30
Study Start Date: April 2013
Estimated Study Completion Date: March 2016
Estimated Primary Completion Date: October 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment (PI3K inhibitor BYL719, letrozole)
Patients receive PI3K inhibitor BYL719 PO QD and letrozole PO QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Drug: PI3K inhibitor BYL719
Given PO
Other Name: BYL719, a-specific phosphoinositide 3-kinase inhibitor BYL719
Drug: letrozole
Given PO
Other Names:
  • 112809-51-5, 4,4'-(1H-1,2,4triazol-1-ylmethylene)dibenzonitrile, 719345, CGS 20267,
  • Femara,LTZ
Other: laboratory biomarker analysis
Correlative studies
Other: pharmacological studies
Correlative studies
Other Name: pharmacological studies

Detailed Description:

PRIMARY OBJECTIVE: To determine the safety and tolerability of BYL719 given in combination with endocrine therapy in post-menopausal patients with hormone receptor-positive metastatic breast cancer by determining:

I. Dose limiting toxicities (DLTs) during the first 4 weeks of treatment (cycle 1).

II. Maximum tolerated dose (MTD) of BYL719 (PI3K inhibitor BYL719) given in combination with letrozole.

III. Highest tolerated dose - ability to tolerate BYL719 with letrozole for a total of 8 weeks without development of:

  • Hyperglycemia (fasting glucose > 200 mg/dL) for more than 2 weeks in a row despite optimal medical treatment
  • CTC Grade 3 or > rash for more than 2 weeks in a row despite optimal medical treatment
  • CTC Grade 2 or > GI toxicity for more than 2 weeks in a row despite optimal medical treatment
  • CTC Grade 2 or > serum creatinine, bilirubin, AST, ALT elevation from baseline for more than 2 weeks in a row despite optimal medical treatment

SECONDARY OBJECTIVES: To determine the anti-tumor effect of the combinations of endocrine therapy with BYL719 in post-menopausal patients with hormone receptor-positive metastatic breast cancer by assessing:

I. Progression free survival (PFS). II. Objective response rate (ORR). III. Clinical benefit rate (complete response [CR]+partial response [PR]+stable disease [SD] >= 6 months).

EXPLORATORY OBJECTIVES:

I. Pharmacokinetics of BYL719 in combination with letrozole: Plasma concentration-time profiles and derived basic pharmacokinetic (PK) parameters of BYL719 and letrozole, including but not limited to area under the plasma concentration-time curve from time zero to the last measurable concentration (AUC0-tlast), AUC curve to infinite time (AUC0-inf), maximum observed concentration (Cmax), time to peak concentration (Tmax), clearance over bioavailability (CL/F), apparent volume of distribution (Vz/F) and the terminal half-life (t1/2) and other PK parameters if deemed appropriate.

II. Correlation of response with alterations of the PI3K pathway: Mutational analysis of PIK3CA (exons 9 and 20), phosphatase and tensin homolog (PTEN), and AKT1 in formalin-fixed paraffin blocks (FFPB) from previous surgeries or fresh-frozen biopsies (if available) on all patients enrolled in the trial.

OUTLINE: This is an open-label phase Ib dose-escalation study of the PI3K inhibitor BYL719 in combination with letrozole in post-menopausal patients with ER+ metastatic breast cancer.

Patients receive BYL719 orally (PO) once daily (QD) and letrozole PO QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 4 weeks.

  Eligibility

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

Inclusion Criteria

  • Patients must provide informed written consent.
  • Patients must be >/= 18 years of age.
  • ECOG performance status 0 - 1.
  • Clinical stage IV invasive mammary carcinoma, ER-positive and/or PR-positive by immunohistochemistry (IHC) and HER2 negative (by IHC or ISH). Patients may have either measurable or non-measurable disease, both are allowed.
  • A minimum of 10 patients in the trial (~50%) will need to have a PIK3CA mutation in their cancer
  • Patients must have had at least one line of endocrine therapy in the metastatic setting, or be diagnosed with metastatic breast cancer during or within 1 year of adjuvant endocrine therapy. There is no limit on lines of prior treatment in the metastatic setting.
  • Patients must have available tissue (archived formalin-fixed paraffin embedded blocks (FFPB) or fresh frozen tissue from original diagnosis or metastatic setting) for correlative studies. Tissue needs to be located and available at the time of registration (tissue needs to be submitted within 3 weeks of study initiation). Patients will not be able to start study drugs without tissue availability.
  • Life expectancy ≥ 6 months
  • Patients must have adequate hematologic, hepatic, and renal function. All laboratory tests must be obtained less than 1 week from study entry. This includes:

    1. ANC >/= 1,500/mm3
    2. platelet count >/=100,000/mm3
    3. HgB ≥ 9 g/dL
    4. Creatinine ≤ 1.5x ULN
    5. INR ≤ 2
    6. Fasting plasma glucose ≤ 140 mg/dL
    7. HgBA1C ≤ 8%
    8. Total Serum Bilirubin ≤ 1.5 x ULN (Patients with known Gilbert Syndrome, a total bilirubin ≤ 3.0 x ULN, with direct bilirubin ≤ 1.5 x ULN)
    9. SGOT, SGPT ≤ 3 X ULN if no liver metastasis present
    10. SGOT, SGPT ≤ 5 X ULN if liver metastasis present
  • Patients must be able to swallow and retain oral medication.
  • Patients must be post-menopausal. Post-menopausal female subjects should be defined prior to protocol enrollment by any of the following:

    1. Subjects at least 55 years of age; OR
    2. Subjects under 55 years of age and naturally (spontaneous) amenorrhea for at least 12 months or follicle-stimulating hormone (FSH) values ≥ 40 IU/L and estradiol levels </= 20 IU/L; OR
    3. Prior bilateral oophorectomy; OR
    4. Prior radiation castration with amenorrhea for at least 6 months

      NOTE: Treatment with a luteinizing hormone-releasing hormone (LH-RH) agonist (such as goserelin acetate or leuprolide acetate) is not permitted for induction of ovarian suppression.

  • Patients must complete all screening assessments as outlined in the protocol.

Exclusion Criteria

  • Locally recurrent resectable breast cancer.
  • Any kind of malabsorption syndrome significantly affecting gastrointestinal function.
  • Patients with clinically manifest diabetes mellitus (treated and/or clinical signs or with fasting glucose >/= 140 mg/dL / 7.8 mmol/L), history of gestational diabetes mellitus or documented steroid-induced diabetes mellitus.
  • Patients who have received radiation therapy </= 2 weeks prior to study entry. Patients who have received prior radiotherapy must have recovered from toxicity (≤ grade 1) induced by this treatment.
  • Patients who have received systemic anti-cancer therapy such as chemotherapy, immunotherapy and/or biologic therapy </= 4 weeks prior to study entry. Concurrent anti-cancer therapy (chemotherapy, immunotherapy, biologic therapy) other than the ones specified in the protocol is not permitted during study participation. Patients must have discontinued the above cancer therapies for 4 weeks prior to the first dose of study medication, as well as recovered from toxicity (to ≤ than grade 1, except for alopecia) induced by previous treatments. Any investigational drugs should be discontinued 4 weeks prior to the first dose of study medication.
  • Prior hormonal / endocrine therapy </= 2 weeks prior to study entry. Patients must have recovered from toxicity > grade 1, except for alopecia.
  • Prior therapy with a PI3K inhibitor. Prior use of Akt or mTOR inhibitors are allowed.
  • Patients who have received herbal medications </= 2 weeks prior to study entry. Herbal medications include, but are not limited to: St. John's wort, Kava, ephedra (ma huang), gingko biloba, dehydroepiandrosterone (DHEA), yohimbe, saw palmetto, and ginseng.
  • Use of drugs that are CYP3A4 modifiers
  • Patients who are currently receiving medication with a known risk of prolonging the QT interval or inducing Torsades de Pointes (TdP) and the treatment cannot either be discontinued or switched to a different medication prior to starting study drug treatment.
  • Patients with a family history of congenital long QT syndrome
  • Patients with abnormal calcium, potassium, or magnesium levels that cannot be adequately corrected to within normal range prior to initiation of study drugs
  • Uncontrolled intercurrent illness including, but not limited to:

    1. ongoing or active infection requiring parenteral antibiotics
    2. impairment of lung function (COPD > grade 2, lung conditions requiring oxygen therapy)
    3. symptomatic congestive heart failure (class III or IV of the New York Heart Association classification for heart disease)
    4. Left Ventricular Ejection Fraction (LVEF) < 50%
    5. unstable angina pectoris, angioplasty, stenting, or myocardial infarction within 6 months
    6. uncontrolled hypertension within 2 weeks of study initiation (systolic blood pressure > 180 mm Hg or diastolic blood pressure > 110 mm Hg, found on two consecutive measurements separated by a 1 or 2-week period despite adequate medical support)
    7. clinically significant cardiac arrhythmia (multifocal premature ventricular contractions, bigeminy,trigeminy, ventricular tachycardia that is symptomatic or requires treatment [National Cancer Institute -Common Terminology Criteria for Adverse Events, Version 4.0, grade 3]
    8. QTcF ≥ 480 msec on screening EKG
    9. known history of QT/QTc prolongation or Torsades de Pointes (TdP)
    10. ST depression or elevation of ≥ 1.5 mm in 2 or more leads
    11. Diarrhea of any cause ≥ CTCAE grade 2
    12. psychiatric illness/social situations that would compromise patient safety or limit compliance with study requirements including maintenance of a compliance/pill diary
    13. patients with symptomatic brain metastases (patients with a history of brain metastases must be clinically stable for more than 4 weeks from completion of radiation treatment)
    14. patients with known history of chronic liver or renal failure
    15. patients with known history of chronic or acute pancreatitis

Individuals of all races and ethnic groups are eligible for this trial. There is no bias towards age or race in the clinical trial outlined. This trial is open to the accrual of women.

  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: NCT01791478

Contacts
Contact: VICC Clinical Trials Information Program 800-811-8480

Locations
United States, Massachusetts
Massachusetts General Hospital, Dana-Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02114
Contact: Catherine Zeghibe       czeghibe@partners.org   
Contact: Ian Krop, MD    617-632-5858      
Principal Investigator: Dejan Juric, MD         
United States, Tennessee
Vanderbilt-Ingram Cancer Center Recruiting
Nashville, Tennessee, United States, 37232-6838
Contact: VICC Clinical Trials Information Program    800-811-8480      
Contact: Julie Scott, RN       julie.scott1@vanderbilt.edu   
Principal Investigator: Ingrid Mayer, MD         
Sponsors and Collaborators
Vanderbilt-Ingram Cancer Center
Investigators
Principal Investigator: Ingrid Mayer Vanderbilt-Ingram Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Ingrid Mayer, MD, Assistant Professor of Medicine; Clinical Director, Breast Cancer Program; Medical Oncologist, Vanderbilt-Ingram Cancer Center
ClinicalTrials.gov Identifier: NCT01791478     History of Changes
Other Study ID Numbers: VICC BRE 12101, NCI-2013-00102
Study First Received: February 11, 2013
Last Updated: June 17, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Vanderbilt-Ingram Cancer Center:
-Metastatic breast cancer, PI3K inhibitor, Endocrine therapy

Additional relevant MeSH terms:
Breast Neoplasms
Carcinoma, Ductal, Breast
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Carcinoma, Ductal
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Ductal, Lobular, and Medullary
Letrozole
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Aromatase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on September 22, 2014