Characterization of Circulating Tumor Cells (CTC) From Patients With Metastatic Breast Cancer Using the CTC-Endocrine Therapy Index (COMETI P2)

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Janssen Diagnostics, LLC
ClinicalTrials.gov Identifier:
NCT01701050
First received: October 1, 2012
Last updated: January 11, 2016
Last verified: January 2016
  Purpose
Utilizing CellSearch® technology, the ability to both enumerate and reliably and reproducibly characterize circulating tumor cells (CTC) for tumor markers that predict endocrine sensitivity (estrogen receptor [ER] and Bcl-2) and resistance (HER2 and Ki67) has been demonstrated. An algorithm for a CTC-Endocrine Therapy Index (CTC-ETI) has been constructed that can be calculated for each patient using the CTC enumeration and marker results. The primary goal of this study is to determine a CTC-ETI in ER positive, HER2 negative metastatic breast cancer patients before the initiation of a new endocrine therapy for the identification of patients that will progress rapidly.

Condition Intervention
Metastatic Breast Cancer
Other: Blood collection

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: COMETI Phase 2: Characterization of Circulating Tumor Cells (CTC) From Patients With Metastatic Breast Cancer Using the CTC-Endocrine Therapy Index

Resource links provided by NLM:


Further study details as provided by Janssen Diagnostics, LLC:

Primary Outcome Measures:
  • Rapid Disease Progression [ Time Frame: Within 3 months after initiation of a new line of enrocrine therapy ] [ Designated as safety issue: No ]
    Within 30 days prior to the initiation of therapy, chest & abdomen body imaging (computed tomography [CT], or magnetic resonance imaging [MRI] scanning) plus bone scintigraphic imaging (bone scans or PET scans) or PET-CT scans which encompass both will be performed to identify target and non-target lesions that will be followed with the same imaging techniques 3 months after the initiation of therapy. Objective tumor response will be determined using RECIST v1.1 criteria. Rapid disease progression will be defined as disease progression according to RECIST v1.1 criteria or death due to metastatic breast cancer within 3 months of starting a new ET.


Secondary Outcome Measures:
  • Progression Free Survival (PFS) [ Time Frame: Up to 12 months after initiation of therapy ] [ Designated as safety issue: No ]
    Within 30 days prior to the initiation of of a new line of endocrine therapy (ET), chest & abdomen body imaging (computed tomography [CT], or magnetic resonance imagine [MRI] scanning) plus bone scintigraphic imaging (bone scans or PET scans) or PET-CT scans which encompass both will be performed to identify target and non-target lesions that will be followed with the same imaging techniques 3 months, 6 months, 9 months, and up to 12 months after the initiation of therapy. Objective tumor response will be determined using RECIST v1.1 criteria. Progression Free Survival (PFS) will be measured as the time from the date of starting ET until the date of first documentation of progressive disease according to RECIST v1.1 criteria or death due to any cause. In the absence of these events, PFS will be censored at the date of the last objective disease assessment (up to a maximum of 12 months after the initiation of ET).


Other Outcome Measures:
  • Biomarker correlations [ Time Frame: End of study (up to 12 months after enrollment of final patient) ] [ Designated as safety issue: No ]
    Correlate the status of the biomarkers on baseline circulating tumor cells (CTC) with the status of the same biomarkers in primary and/or metastatic tissue collected from the patients.

  • Analytic Validity [ Time Frame: Baseline blood draw (within 30 days prior to the initiation of therapy) ] [ Designated as safety issue: No ]

    Demonstrate that the circulating tumor cell (CTC) endocrine therapy index (CTC-ETI) can be accurately determined at initiation of a new endocrine therapy (baseline) in patients with ER positive, HER2 negative metastatic breast cancer in multiple centers across North America. Baseline blood sample will be evaluated for the following:

    • successful calculation of CTC-ETI;
    • successful enumeration of CTC in the four aliquots;
    • successful determination of CTC Bio-Score for all 4 markers when the average number of cells is ≥5 CTC/7.5mL of blood.


Biospecimen Retention:   Samples With DNA
Cartridges containing Circulating Tumor Cells (isolated by CellSearch) as well as primary and/or metastatic tumor tissue (blocks or slides).

Enrollment: 121
Study Start Date: April 2013
Estimated Study Completion Date: December 2016
Estimated Primary Completion Date: December 2016 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Blood collection
Female patients 18 years or older with estrogen receptor (ER) positive, HER2 negative, progressive metastatic breast cancer after one or more lines of endocrine therapy (ET) who are initiating a new ET will be enrolled into the study. Patients must have immunohistochemistry (IHC) proven ER positive disease, IHC and/or fluorescence in-situ hybridization (FISH) proven HER2 negative disease, and an ECOG performance status of 0-2. Patients with brain metastases only or those who are progressing on fulvestrant are not eligible for the study.
Other: Blood collection
Patients will have blood drawn for circulating tumor cell (CTC) endocrine therapy index (CTC-ETI) calculation at baseline (within 30 days prior to the initiation of endocrine therapy) and then subsequently 1, 2, 3 and up 12 months after the initiation of therapy, or at the time of disease progression, whichever occurs first.

Detailed Description:

Patients with estrogen receptor (ER) positive metastatic breast cancer (MBC) starting their first line of endocrine therapy (ET) only have a 30-50% chance of receiving clinical benefit. For the other 50-70% of patients, ET is ineffective and these patients should probably be treated with chemotherapy, as is done for ER negative patients. More importantly, in nearly every clinical trial of ET in ER positive, MBC patients, between 15-30% of enrolled patients progress in the first 2-3 months, regardless of whether they are receiving first or later lines of ET. Currently there is no validated method to identify which ER positive MBC patients will be refractory to ET. Therefore, almost all ER positive patients are treated with serial endocrine therapies before switching to chemotherapy. The investigators propose that a subset of these patients would be better served with chemotherapy, in spite of its increased toxicity profile, rather than delaying chemotherapy during a several month trial of ineffective, albeit less toxic, ET.

To try and predict benefit from or resistance to ET, an index (the CTC-ETI) has been created that takes into account the number of CTC (which is prognostic) as well as the phenotype of the CTC, based on the hypothesis that relative levels of ER and Bcl-2 (high=benefit) and HER2 and Ki67 (high=resistance) are predictive of ET responsiveness or resistance. Although the preliminary data demonstrate the ability to detect, enumerate, and characterize CTC utilizing the CellSearch® System, the purpose of the current study is to establish proof of principle that these 4 markers can be used to generate a CTC-ETI which can be performed at baseline from patients enrolled at different centers, and that baseline CTC-ETI predicts relative outcome for patients with ER positive MBC starting a new ET, and can be monitored in such patients during ET. Successful completion of this study will set the stage for a larger, definitive study designed to demonstrate the clinical utility of a "refined" CTC-ETI in patients with ER positive, HER2 negative MBC.

  Eligibility

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Female patients 18 years or older with estrogen receptor (ER) positive, HER2 negative, progressive metastatic breast cancer (MBC) after one or more lines of endocrine therapy (ET) who are initiating a new ET will be enrolled into the study. Patients must have immunohistochemistry (IHC) proven ER positive disease, IHC and/or fluorescence in-situ hybridization (FISH) proven HER2 negative disease, and an ECOG performance status of 0-2. Patients with brain metastases only or those who are progressing on fulvestrant are not eligible for the study.
Criteria

Inclusion Criteria:

  • Signed informed consent.
  • Women who are 18 years or older.
  • Patients must have estrogen receptor (ER) positive, HER2 negative metastatic breast cancer (MBC) with at least one non-irradiated distant site of metastasis.
  • ECOG performance status of 0-2.
  • Patients must have currently progressive metastatic disease according to RECIST v1.1 criteria, AND

    • They have progressed on at least one previous line of endocrine therapy (ET) for their metastatic disease (but are not currently progressing on fulvestrant), OR;
    • They show evidence of disease progression during or within 12 months of the end of adjuvant ET.
  • Patient is about to start a new line of ET for their metastatic disease
  • Patient is willing and able to undergo standard of care imaging studies (same imaging/staging modality being used at each evaluation), which are anticipated to be performed prior to the initiation of therapy and subsequently every 3 months.
  • Patient agrees to the collection and testing of their blood and is willing and able to provide approximately 40mL blood draw(s) at:

    • Baseline (prior to the initiation of new ET), and;
    • Subsequently at 1, 2, 3 and 12 months after the initiation of therapy, and/or;
    • Time of disease progression.

Exclusion Criteria:

  • Patients with local regional recurrence only or brain only metastasis.
  • Patients who are progressing on current fulvestrant therapy (patients who have had fulvestrant therapy in the past and were subsequently treated with other therapies or those who are starting fulvestrant as their next line of ET are eligible for the study).
  • Patients who are or will be taking other unapproved (i.e. not cleared/approved by the FDA) anti-neoplastic therapies concurrently are not eligible (exception: ET with everolimus is acceptable).
  • Patients with concomitant malignancies or previous malignancies within the last 5 years, with exception of adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix.
  • Unable to provide informed consent or high risk that patient may not comply with protocol requirements (i.e. due to health and/or participation in other research studies).
  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: NCT01701050

Locations
United States, Arizona
Arizona Oncology Associates
Phoenix, Arizona, United States, 85016
United States, Florida
Florida Cancer Specialists
Ft. Myers, Florida, United States, 33905
Florida Cancer Specialists
St. Petersburg, Florida, United States, 33705
United States, Massachusetts
Dana-Faber Cancer Institute
Boston, Massachusetts, United States, 02215
United States, Michigan
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, United States, 48109
United States, Minnesota
Minnesota Oncology Hematology
Minneapolis, Minnesota, United States, 55404
Mayo Clinic
Rochester, Minnesota, United States, 55905
United States, Nebraska
Nebraska Cancer Specialists
Omaha, Nebraska, United States, 68130
United States, Nevada
Comprehensive Cancer Centers of Nevada
Henderson, Nevada, United States, 89074
United States, New York
New York Oncology Hematology
New York, New York, United States, 12206
United States, North Carolina
Waverly Hematology Oncology
Cary, North Carolina, United States, 27518
Duke University
Durham, North Carolina, United States, 27710
United States, Oregon
Northwest Cancer Specialists
Portland, Oregon, United States, 97213
United States, Pennsylvania
Thomas Jefferson University
Philadelphia, Pennsylvania, United States, 19107
Abramson Cancer Center, University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
United States, Tennessee
Tennessee Oncology, PLLC
Nashville, Tennessee, United States, 37203
United States, Texas
Texas Oncology - Baylor
Dallas, Texas, United States, 75246
Texas Oncology
Houston, Texas, United States, 77024
Canada, Ontario
Mt. Sinai Hosp., Marvette Koffler Breast Center
Toronto, Ontario, Canada, M5G 1X5
Princess Margaret Hospital
Toronto, Ontario, Canada, M5G 2M9
Sponsors and Collaborators
Janssen Diagnostics, LLC
Investigators
Principal Investigator: Daniel F Hayes, M.D. University of Michigan Cancer Center
Principal Investigator: Costanza Paoletti, M.D. University of Michigan Cancer Center
  More Information

Publications:
Responsible Party: Janssen Diagnostics, LLC
ClinicalTrials.gov Identifier: NCT01701050     History of Changes
Other Study ID Numbers: COMETI-P2-2012 
Study First Received: October 1, 2012
Last Updated: January 11, 2016
Health Authority: United States: Institutional Review Board

Keywords provided by Janssen Diagnostics, LLC:
circulating tumor cells
CTC
metastatic breast cancer
endocrine therapy
hormone therapy

Additional relevant MeSH terms:
Breast Neoplasms
Neoplastic Cells, Circulating
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Neoplasm Metastasis
Neoplastic Processes
Pathologic Processes

ClinicalTrials.gov processed this record on July 28, 2016