Study of Combined Fulvestrant and Everolimus in Advanced/Metastatic Breast Cancer After Aromatase Inhibitor Failure (BRE-43)

This study has been completed.
Sponsor:
Collaborator:
Novartis
Information provided by (Responsible Party):
Suleiman Massarweh, University of Kentucky
ClinicalTrials.gov Identifier:
NCT00570921
First received: December 7, 2007
Last updated: January 8, 2015
Last verified: January 2015
  Purpose

The primary objective of this study is to determine if estrogen receptor-targeted therapy with fulvestrant used in combination with Everolimus is an effective and safe therapy for women with hormone receptor positive metastatic breast cancer after failure of aromatase inhibitor therapy.


Condition Intervention Phase
Breast Cancer
Drug: Everolimus
Drug: Fulvestrant
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Study of Combined Fulvestrant (Faslodex) and Everolimus in Advanced/Metastatic Breast Cancer After Aromatase Inhibitor Failure

Resource links provided by NLM:


Further study details as provided by University of Kentucky:

Primary Outcome Measures:
  • Time to Progression [ Time Frame: Duration of time start of treatment to time of documented progression or death ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Objective Response Rates [ Time Frame: Evaluated 60 days after therapy start ] [ Designated as safety issue: No ]
    Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

  • Clinical Benefit Rate [ Time Frame: Duration of response or stable disease for 24 weeks or more ] [ Designated as safety issue: No ]
    Clinical benefit rate is defined as a complete response, partial response, or stable disease (CR, PR, SD) by Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for a minimum of at least 24 weeks or more.


Enrollment: 33
Study Start Date: April 2008
Study Completion Date: January 2015
Primary Completion Date: February 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Fulvestrant + Everolimus

Fulvestrant + Everolimus

Fulvestrant was administered intramuscularly (in the gluteus maximus) in a loading dose schedule as follows: 500 mg in two divided doses—one on each side on day 1, then 250 mg on day 14, and then 250 mg on day 28 and every 4 weeks ± 3 days thereafter. Everolimus was administered initially at a dose of 5 mg daily in the first 5-patient cohort for the first month of treatment and then increased to 10 mg PO daily after that.

Drug: Everolimus
Everolimus tablets, two-5 mg tablets a day
Other Name: RAD001
Drug: Fulvestrant
intramuscular, 500 mg in two divided doses- one on each side- on day 1, then 250mg on day 14, then 250 mg on day 28 and every 4 weeks +/- 3 days thereafter
Other Name: Faslodex

Detailed Description:

Fulvestrant, which degrades ER, is used after aromatase inhibitor (AI) failure in metastatic breast cancer but resistance develops quickly. We hypothesized that using everolimus to inhibit mammalian target of rapamycin (mTOR), a key signaling pathway in endocrine resistance, may delay fulvestrant resistance in patients and thus improve its efficacy. We conducted a phase II trial of combined fulvestrant and everolimus in postmenopausal women with disease progression or relapse after an AI. Primary endpoint was time to progression (TTP) and secondary endpoints included objective response rate, clinical benefit rate (CBR), safety, and biomarker correlates. Tumor blocks were collected and biopsy of accessible tumor was done for future biomarker analysis.

  Eligibility

Ages Eligible for Study:   45 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Postmenopausal status, defined as any one of the following criteria: Documented history of bilateral oophorectomy, Age 60 years or more, OR Age 45 to 59 and satisfying one or more of the following criteria: Amenorrhea for at least 12 months and intact uterus OR Amenorrhea for less than 12 months and a follicle stimulating hormone (FSH) concentration - within postmenopausal range including: Patients who have had a hysterectomy or Patients who have received hormone replacement
  • Patients must have histologically confirmed invasive breast cancer
  • Metastatic or locally advanced disease
  • Patients must have estrogen receptor and/or progesterone receptor positive disease
  • Measurable or evaluable disease
  • Failure of aromatase inhibitor therapy within the previous 6 months. Patients who received prior tamoxifen are eligible to enroll
  • Prior aromatase inhibitor therapy or other endocrine therapy must be discontinued at least 1 week prior to enrollment and any toxicity from such therapy must have reverted to grade I or less at the time of enrollment
  • Patients must not have received chemotherapy, radiation therapy, or had surgery within 4 weeks prior to enrollment and any toxicity from such therapy must have recovered to grade 1 or less prior to enrollment
  • Patients must not have received either of the study medications previously
  • WHO performance status of 0, 1, or 2
  • Adequate organ function defined as follows: Adequate renal function, defined by a serum creatinine within the upper limits of normal, Adequate liver function, defined by a bilirubin of < 1.5 the upper limit of normal (ULN) and aspartate aminotransferase (AST), alanine aminotransferase (ALT) of ≤ 2.5 times the ULN, Adequate bone marrow function, defined as an absolute neutrophil count (ANC) ≥ 1.5 x 109/L, platelet count (PLT) >100,000/ul, Hb >9 gm/dl, international normalized ratio (INR) <1.3, and because fulvestrant is administered intramuscularly, it should not be used in patients with bleeding diatheses, thrombocytopenia or in patients on anticoagulants
  • Patients will be asked to provide a tumor paraffin block if available
  • Ability to understand and sign a written informed consent for participation in the trial

Exclusion Criteria:

  • Known severe hypersensitivity to everolimus (or similar drugs) or any of the excipients of this product
  • Premenopausal status
  • Other coexisting malignancies with the exception of basal cell carcinoma or cervical cancer in situ
  • Patients with brain metastasis or leptomeningeal involvement
  • Patients with malignant pleural effusion or ascites only disease
  • Rapidly progressive visceral disease
  • WHO performance status of 3 or 4
  • As judged by the investigator, uncontrolled intercurrent illness including, but not limited to: Ongoing or active infection, Symptomatic congestive heart failure, Unstable angina pectoris or significant cardiac arrhythmia, Psychiatric illness/social situations that would limit compliance with study requirements, Severely impaired lung function such as severe chronic obstructive pulmonary disease (COPD) or interstitial lung disease, a known forced expiratory volume at one second (FEV1) of < 1.5 liters, or dyspnea of grade III or greater, Uncontrolled diabetes as defined by a fasting blood sugar (FBS) of > 1.5 ULM, Known liver disease such as cirrhosis or chronic hepatitis, Known HIV positivity, OR known condition causing malabsorption
  • Chronic treatment with systemic steroids or other immunosuppressive agents
  • Patients should not receive immunization with attenuated live vaccines within one week of study entry or during study period
  • Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the subject to participate in the clinical trial
  • Prior treatment with an mTOR inhibitor
  • Treatment with a non-approved or investigational drug within 30 days or 5 half-lives of the drug, whichever is greater, before Day 1 of study treatment
  • In the opinion of the investigator, bleeding diathesis or anticoagulation therapy that would preclude intramuscular injections
  • History of hypersensitivity to castor oil
  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: NCT00570921

Locations
United States, Kentucky
University of Kentucky
Lexington, Kentucky, United States, 40536
Sponsors and Collaborators
Suleiman Massarweh
Novartis
Investigators
Principal Investigator: Suleiman Massarweh, M.D. University of Kentucky
  More Information

Publications:
Responsible Party: Suleiman Massarweh, Clinical Faculty, Internal Medicine / Oncology, University of Kentucky
ClinicalTrials.gov Identifier: NCT00570921     History of Changes
Other Study ID Numbers: 07-BRE-43-NP
Study First Received: December 7, 2007
Results First Received: December 18, 2014
Last Updated: January 8, 2015
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Kentucky:
Breast cancer
Fulvestrant
Everolimus

Additional relevant MeSH terms:
Breast Neoplasms
Breast Diseases
Neoplasms
Neoplasms by Site
Skin Diseases
Aromatase Inhibitors
Everolimus
Fulvestrant
Sirolimus
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antifungal Agents
Antineoplastic Agents
Antineoplastic Agents, Hormonal
Enzyme Inhibitors
Estrogen Antagonists
Estrogen Receptor Modulators
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on March 26, 2015