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Study of Fulvestrant +/- Everolimus in Post-Menopausal, Hormone-Receptor + Metastatic Breast Ca Resistant to AI (PrE0102)

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ClinicalTrials.gov Identifier: NCT01797120
Recruitment Status : Completed
First Posted : February 22, 2013
Last Update Posted : January 2, 2018
Information provided by (Responsible Party):

Brief Summary:

Post-menopausal women with hormone-receptor positive (HR+) metastatic breast cancer resistant to aromatase inhibitor (AI) therapy will be randomized to receive Fulvestrant (Faslodex) with Everolimus or Fulvestrant (Faslodex) with a placebo (no active ingredients).

Fulvestrant has demonstrated activity when used as first, second, or third line endocrine therapy, making it an attractive therapy for combination with other agents. In addition, it is commonly reserved for use following disease progression on AI therapy.

Everolimus is an orally administered drug that blocks a signaling pathway called "mTOR". "mTOR" acts as a regulator for many processes in the body, including cell growth. Blocking this pathway may have an effect on cell growth.

The combination of a novel class of agents (mTOR inhibitors) and an established standard treatment for metastatic HR+ breast cancer may potentially increase the clinical benefit by targeting multiple different biological pathways.

Condition or disease Intervention/treatment Phase
Metastatic Breast Cancer Drug: Fulvestrant Drug: Everolimus Drug: Placebo (for Everolimus) Phase 2

Detailed Description:

Breast cancer is the most commonly diagnosed malignancy in women worldwide. In the United States, an estimated 230,480 new cases of invasive breast cancer were diagnosed in 2011, with 39,520 breast cancer deaths. In 40-80% of women with node-positive disease at diagnosis, their breast cancer will recur. When distant metastases occur, median survival is 18 to 36 months from time of recurrence. Among the 60-70% of women with HR+ breast cancer, 40-60% of them will benefit from endocrine therapy. Endocrine therapy has shown to yield similar survival rates in hormone-sensitive disease as compared to chemotherapy; although response rates are lower and responses develop more slowly. Endocrine therapy is considerably less toxic than chemotherapy, and is therefore the preferred treatment option for patients with HR+ disease.

Endocrine therapy represents the foundation of treatment for HR+ metastatic and locally advanced breast cancer. Multiple compounds in varying classes exist, and those most widely used include the selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and the selective estrogen receptor down-regulators (SERDs). Although the utility of these drugs is well established, as many as 50% of women with HR+ breast cancer will fail to respond to endocrine treatment. Moreover, those who do respond will inevitably develop acquired resistance.

Fulvestrant is the first drug which acts as a pure estrogen receptor (ER) antagonist without known agonist effects. It competitively binds to the ERs with an approximately 100 times greater affinity than that of tamoxifen. Fulvestrant promotes the degradation of ERs and subsequently prevents ER-mediated gene transcription.

Everolimus (RAD001) is an oral derivative of rapamycin that is an m-TOR inhibitor. At cellular and molecular levels, everolimus acts as a signal transduction inhibitor. Everolimus selectively inhibits mTOR (mammalian target of rapamycin); a key and highly conserved serine-threonine kinase which is present in all cells and is a central regulator of protein synthesis and ultimately cell growth, cell proliferation, angiogenesis and cell survival. mTOR is the only currently known target of everolimus.

In oncology, everolimus has been in clinical development since 2002 for patients with various hematologic and non-hematologic malignancies as a single agent or in combination with antitumor agents, including cytotoxic chemotherapeutic agents, targeted therapies, antibodies and hormonal agents.

Patients will be randomized (1:1) to receive everolimus or placebo with fulvestrant after consideration of stratification factors of performance status (0 vs. 1), measurable disease (with or without non-measurable) vs. non-measurable disease, and prior chemotherapy for metastatic disease vs. no prior chemotherapy.

Patients will be evaluated for disease response every 12 weeks and treated until disease progression or unacceptable toxicity for a total of 12 cycles.

Patients with no evidence of progressive disease who remain on study after completing 12 cycles are unblinded and continue to receive fulvestrant alone (if originally randomized to placebo) or in combination with everolimus (if originally randomized to everolimus) at the same dose and schedule. Patients will continue to be evaluated for disease response every 12 weeks and continue until disease progression or unacceptable toxicity.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 131 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Randomized, Double-Blind, Placebo-Controlled Phase II Trial of Fulvestrant (Faslodex) Plus Everolimus in Post-Menopausal Patients With Hormone-Receptor Positive Metastatic Breast Cancer Resistant to Aromatase Inhibitor Therapy
Actual Study Start Date : May 31, 2013
Primary Completion Date : March 22, 2017
Study Completion Date : September 12, 2017

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Active Comparator: Fulvestrant & Everolimus
Fulvestrant Day 1 & 15 of Cycle 1, then Day 1 of all subsequent cycles (every 28 days for 12 cycles) plus everolimus daily x 12 cycles.
Drug: Fulvestrant

Fulvestrant 500 mg Day 1 & 15 of Cycle 1, then 500 mg Day 1 of all subsequent cycles (every 28 days for 12 cycles).

If no evidence of disease progression after 12 cycles, unblind and continue same dose and schedule until progression or unacceptable toxicity.

Other Name: Faslodex
Drug: Everolimus

Everolimus 10 mg (2 tablets) daily x 12 cycles.

If no evidence of disease progression after 12 cycles, unblind and continue same dose and schedule until progression or unacceptable toxicity.

Other Names:
  • mTOR Inhibitor
  • RAD001
  • Afinitor
Placebo Comparator: Fulvestrant & Placebo
Fulvestrant Day 1 & 15 of Cycle 1, then Day 1 of all subsequent cycles (every 28 days for 12 cycles) plus placebo daily x 12 cycles.
Drug: Fulvestrant

Fulvestrant 500 mg Day 1 & 15 of Cycle 1, then 500 mg Day 1 of all subsequent cycles (every 28 days for 12 cycles).

If no evidence of disease progression after 12 cycles, unblind and continue same dose and schedule until progression or unacceptable toxicity.

Other Name: Faslodex
Drug: Placebo (for Everolimus)
Placebo (2 tablets) daily x 12 cycles. Placebo manufactured to mimic everolimus tablet.
Other Name: Sugar Pill

Primary Outcome Measures :
  1. Progression-free survival [ Time Frame: Every 3 months until progression or up to 3 years ]
    Progression-free survival documented by Physical Exam, CT Scan or MRI in post-menopausal patients with hormone-receptor positive metastatic breast cancer that is resistant to aromatase inhibitor therapy treated with fulvestrant and everolimus compared to fulvestrant alone from randomization to documented disease progression or death.

Secondary Outcome Measures :
  1. Participant Adverse Events as a Measure of Safety and Tolerability [ Time Frame: Monthly up to 3 years ]
    Comparison of overall toxicity and of grade 3-4 toxicity in the combination arm and the fulvestrant arm.

  2. Objective Response Rate [ Time Frame: Every 3 months until progression or up to 3 years ]
    Objective response rates (by Physical Exam, CT or MRI) will be provided for each arm.

  3. Time to Progression [ Time Frame: Every 3 months until progression or up to 3 years ]
    Median time to progression (by Physical Exam, CT or MRI) will be estimated for each arm.

  4. Overall Survival [ Time Frame: Every 3 months until progression or up to 3 years ]
    Overall survival will be characterized using Kaplan-Meier plots and other descriptive metrics.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Signed informed consent.
  2. ≥18 years.
  3. ECOG Performance Status 0 or 1.
  4. Histologically or cytologically confirmed adenocarcinoma of the breast.
  5. Stage IV disease or inoperable locally advanced disease.
  6. ER and/or PR-positive disease. Tumors must be HER-2/neu negative or equivocal.
  7. Aromatase Inhibitor (AI) resistant, defined as:

    • relapsed while receiving adjuvant therapy with an AI or,
    • progressive disease while receiving an AI for metastatic disease
  8. Received one prior cycle of fulvestrant within 28 days of randomization are eligible.

    • ≥2 prior doses of fulvestrant are not eligible
  9. Must be female and postmenopausal.
  10. May have received ≤1 prior systemic chemotherapy regimen for metastatic disease.
  11. Adequate organ function:

    • WBC ≥3.0 x 10⁹/L, ANC ≥1.5 x 10⁹/L and platelet count ≥100 x 10⁹/L
    • hemoglobin ≥9 g/dL
    • serum bilirubin ≤1.5 X ULN (Upper Limit of Normal)
    • AST or ALT ≤2.5 X ULN (≤5 x ULN in patients with liver metastases)
    • serum creatinine ≤1.5 X ULN
    • serum albumin ≥3 g/dL
    • fasting serum cholesterol ≤300 mg/dL OR ≤7.75 mmol/L AND fasting triglycerides ≤2.5 x ULN.
    • PT with INR ≤1.5
  12. May have measurable disease, non-measurable disease, or both.
  13. Basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix within the past five years treated with curative intent. History of prior malignancy are eligible if disease-free for >3 years.

Exclusion Criteria:

  1. Major surgery or significant traumatic injury within 4 weeks of randomization or patients that may require major surgery during the course of the study.
  2. Investigational agents within 4 weeks of randomization.
  3. Anticancer treatment within 4 weeks of randomization, with the following exceptions:

    • Bisphosphonates or Zometa for bone metastases
    • a GnRH analog is permitted if the patient had progressive disease on a GnRH (Gonadotropin-Releasing Hormone) analog plus a SERM (Selective Estrogen Receptor Modulators) or an AI; the GnRH analog may continue but the SERM or AI must be discontinued.
  4. Prior treatment with an mTOR inhibitor.
  5. Receiving chronic, systemic treatment with corticosteroids or another immunosuppressive agent ≥ 5 mg prednisone or equivalent daily.
  6. Receive immunization with attenuated live vaccines within one week of randomization or during the study period.
  7. Current or a prior history of brain metastases or leptomeningeal disease. Must not have rapidly progressive, life-threatening metastases.
  8. Known hypersensitivity/history of allergic reactions attributed to compounds of similar chemical or biologic composition to everolimus or fulvestrant.
  9. Congenital or acquired immune deficiency at increased risk of infection.
  10. Impairment of gastrointestinal function/disease that may significantly alter the absorption of everolimus.
  11. Active, bleeding diathesis.
  12. History of any condition or uncontrolled intercurrent illness that in the opinion of the local investigator might interfere with or limit the patient's ability to comply with the protocol or pose additional or unacceptable risk to the patient.
  13. Severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:

    • Symptomatic congestive heart failure of New York Heart Association Class III or IV
    • Unstable angina pectoris, myocardial infarction within 6 months of randomization, serious uncontrolled cardiac arrhythmia or any other clinically significant cardiac disease
    • History of symptomatic pulmonary disease or non-malignant pulmonary disease requiring treatment.
    • Uncontrolled diabetes as defined by fasting serum glucose >1.5 x ULN
    • Active (acute or chronic) or uncontrolled severe infections
    • Liver disease such as cirrhosis or severe hepatic impairment (Child-Pugh Class C).

Note: Detailed assessment of Hepatitis B/C medical history and risk factors must be done at screening.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01797120

  Show 25 Study Locations
Sponsors and Collaborators
Study Chair: Noah S Kornblum, MD Saint Barnabas Cancer Center, Montefiore Medical Center

Responsible Party: PrECOG, LLC.
ClinicalTrials.gov Identifier: NCT01797120     History of Changes
Other Study ID Numbers: PrE0102
First Posted: February 22, 2013    Key Record Dates
Last Update Posted: January 2, 2018
Last Verified: December 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: Data is proprietary.

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by PrECOG, LLC.:
Post-Menopausal Patients
Hormone-Receptor Positive
Resistant to Aromatase Inhibitor Therapy
mTOR Inhibitor

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