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Neoadjuvant Study of Targeting ROS1 in Combination With Endocrine Therapy in Invasive Lobular Carcinoma of the Breast (ROSALINE) (ROSALINE)

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ClinicalTrials.gov Identifier: NCT04551495
Recruitment Status : Recruiting
First Posted : September 16, 2020
Last Update Posted : July 8, 2021
Sponsor:
Collaborator:
Hoffmann-La Roche
Information provided by (Responsible Party):
Jules Bordet Institute

Brief Summary:
Despite different clinical characteristics including the response to treatment and the patterns of metastatic relapse, invasive lobular breast carcinoma (ILBC) is treated like invasive ductal breast carcinoma (IDBC) carcinoma both in the clinics and in clinical trials. A large majority of ILBC are ER+/HER2- and almost 90% have loss of E-cadherin (CDH1) expression. A non-clinical study of CDH1 synthetic lethality interactions has identified ROS1 as a potential target. In vivo, ROS1 inhibitors produced profound antitumor effects in multiple models of E-cadherin-defective breast cancer, providing the preclinical rationale for assessing ROS1 inhibitors in this setting. Endocrine therapy being the mainstay of therapy for ER+/HER2- ILBC and the pre-operative setting offering a platform for rapid drug evaluation and biomarker research, the ROSALINE phase 2 study will evaluate the efficacy of Entrectinib (a potent inhibitor of ROS1 among other targets) in combination with letrozole (+ goserelin in premenopausal women) in the early setting of ILBC (stages 1 to 3). The neoadjuvant therapy will last 4 months and post-operative therapy will follow local practice. Biomarker research will include RNA sequencing of initial biopsis and surgical specimens, as well as liquid biopsies.

Condition or disease Intervention/treatment Phase
Invasive Lobular Breast Carcinoma ER+ Breast Cancer HER2-negative Breast Cancer Drug: Entrectinib Drug: Letrozole Drug: Goserelin Phase 2

Detailed Description:

The neoadjuvant setting has been the target of increasing interest recently, as it offers the possibility of direct evaluation of treatment effect on tumour size, better surgical results as well as for the possible research opportunities it provides via the comparative analysis of tumour biology and clinical outcomes before and after treatment.

Invasive lobular breast cancer (ILBC) is the second most common histologic subtype (5-15%) after invasive ductal breast cancer (IDBC). Despite clinical and pathologic differences, ILBC is still treated as IDBC. Indeed, subjects with ILBC tend to have lower response rates to conventional chemotherapeutic agents and some results have suggested that they might derive increased benefit with aromatase inhibitors.

CDK4/6 inhibitors in combination with endocrine therapy are FDA-approved for the treatment of ER-positive/HER2-negative metastatic breast cancer following the results of 7 positive phase 3 trials. These agents are currently tested in phase 3 studies in the adjuvant setting and might achieve the status of standard of care for subjects with ER-positive/HER2-negative early breast cancer treated with curative intent. In the NeoPAL (UCBG10/4, NCT02400567) neoadjuvant randomized study, Residual Cancer Burden (RCB) 0-1 status was achieved for 7.7% of subjects in the letrozole + palbociclib arm. This rate is not available for the 7 subjects with lobular breast cancer enrolled in this arm.

In lobular breast cancer, loss of E-cadherin (CDH1) expression is the most frequent oncogenic event and is present in 90% of cases. In vitro, ex vivo, and in vivo model systems as well as different functional profiling modalities (genetic and chemical screens) have been used to identify CDH1 synthetic lethality interactions. In vivo, ROS1 inhibitors produced profound antitumor effects in multiple models of E-cadherin-defective breast cancer, providing the preclinical rationale for assessing ROS1 inhibitors in this setting. A study is currently investigating this hypothesis in ER+/HER2- metastatic lobular breast cancer (NCT03620643).

Entrectinib is a potent small-molecule tyrosine kinase inhibitor that targets oncogenic rearrangements in NTRK, ROS1, and ALK. In vitro, entrectinib potently ROS1 at low nanomolar concentrations, with an average median inhibitory concentration of 0.007 μM against ROS1.

This single arm, multi-center, phase 2 trial will include pre and post-menopausal women with ER-positive/HER2-negative early stage invasive lobular carcinoma of the breast to evaluate the effect of combining endocrine therapy with entrectinib. Subjects will receive four 28-day cycles of letrozole 2.5 mg daily in combination with entrectinib 600 mg daily. Pre-menopausal women will receive goserelin 3.6 mg every 28 days.

Subjects' response to therapy will be evaluated at screening, after 2 cycles and after the 4 cycles of treatment by breast magnetic resonance imaging (MRI). An ECG will be performed at screening and then before cycle 2. Surgery will take place after at least 16 weeks of treatment, during week 18 (+ 7-day window). Breast and axillary surgery will follow local practice.

Post-operative therapy will be at the discretion of the investigator and will follow local practice.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 45 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: Single arm, muti-center, phase 2 trial
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Neoadjuvant Study of Targeting ROS1 in Combination With Endocrine Therapy in Invasive Lobular Carcinoma of the Breast
Actual Study Start Date : January 14, 2021
Estimated Primary Completion Date : October 2022
Estimated Study Completion Date : March 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Breast Cancer

Arm Intervention/treatment
Experimental: Single Arm
Subjects will receive four 28-day cycles of letrozole 2.5 mg daily in combination with entrectinib 600 mg daily. Pre-menopausal women will receive goserelin 3.6 mg every 28 days.
Drug: Entrectinib
Entrectinib is administered orally at a dose of 600 mg once a day from days 1 to 28 of a 28-day cycle for four cycles

Drug: Letrozole
Letrozole is administered orally at a dose of 2.5 mg once a day from days 1 to day 28 of a 28 day cycle for four cycles

Drug: Goserelin
Goserelin is administered subcutaneously at a dose of 3.6 mg at the beginning of each cycle for 4 monthly cycles to pre-menopausal women




Primary Outcome Measures :
  1. Evaluation of the efficacy of endocrine therapy + entrectinib in women with ER+/HER2- early breast cancer of the lobular subtype:Residual Cancer Burden (RCB) [ Time Frame: At surgery ]
    Residual Cancer Burden (RCB) 0/1 by local evaluation in all enrolled subjects.


Secondary Outcome Measures :
  1. Evaluation of the efficacy of the combination by pathology: Pathologic complete response (pCR) rate [ Time Frame: At surgery ]
    Pathologic complete response (pCR) rate in breast and axilla (ypT0/Tis ypN0) by local evaluation


Other Outcome Measures:
  1. Evaluation the efficacy of the combination by imaging: Tumour objective response [ Time Frame: At surgery ]
    Tumour objective response assessed by locally-assessed breast MRI via modified Response Evaluation Criteria in Solid Tumours (RECIST 1.1.)

  2. Evaluation of the safety of endocrine therapy + entrectinib: adverse events [ Time Frame: Up to 5 months ]
    Incidence, nature, and severity of adverse events graded according to National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0 (NCI CTCAE, v5.0).



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Gender Based Eligibility:   Yes
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Female
  2. Age ≥ 18 years
  3. Histological diagnosis of invasive lobular breast adenocarcinoma that is ER+, and HER2- as per the updated American Society of Clinical Oncology (ASCO) - College of American Pathologists (CAP) guidelines according to local testing.
  4. Multifocal unilateral or bilateral breast adenocarcinoma tumours are allowed if all tested foci are lobular, ER+ and HER2-.

    • ER positive (ER+ is defined as having an IHC of 1% or more and/or an Allred of 3 or more and HER2-).
    • HER2 negative (HER2- is defined as having an IHC of 0 or 1+ without ISH OR IHC 2+ and ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells OR ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells [without IHC]);
  5. A primary non metastatic or locally advanced tumour of 15 mm or more, cN0 or cN1 without prior treatment candidate for preoperative treatment.
  6. ECOG Performance Status (PS) 0 or 1.
  7. Adequate Bone Marrow Function including:

    • Absolute Neutrophil Count (ANC) ≥1500/μL or ≥1.5x109/L;
    • Platelets ≥100000/μL or ≥100 x 109/L;
    • Haemoglobin ≥ 9 g/dL.
  8. Adequate Renal Function including:

    o Serum creatinine ≤ 1.5 x upper limit of normal (ULN) or estimated creatinine clearance ≥ 60 ml/min as calculated using the method standard for the institution.

  9. Adequate Liver Function, including all of the following parameters:

    • Total serum bilirubin ≤ 2.0 x ULN unless the subject has documented Gilbert syndrome
    • Aspartate and Alanine Aminotransferase (AST and ALT) ≤ 3 x ULN;
  10. Signed Informed Consent form (ICF) obtained prior to any study related procedure.
  11. Completion of all necessary screening procedures within 28 days prior to enrolment. Biopsies at screening must have been obtained up to max 6 weeks before the beginning of treatment.
  12. Subject is willing and able to comply with the protocol for the duration of the study including treatment and scheduled visits and examinations.
  13. Women who are not postmenopausal or have not undergone hysterectomy must have documented negative pregnancy test (serum) within 28 days prior to enrolment.
  14. Women of childbearing potential and their partners, who are sexually active, must agree to use one highly effective form of contraception (see protocol section 6.6.1) from the signing of the ICF until at least 5 weeks after last administration of entrectinib, or they must totally/truly abstain from any form of sexual intercourse. Use of oral hormonal contraceptive agents in this study is not permitted.

    Inclusion criterion applicable to FRANCE only:

  15. Subject is affiliated to the French Social Security System.

Exclusion Criteria:

  1. Clinical T4 disease including inflammatory breast cancer and/or cN3.
  2. Prior history of invasive cancer in the past 5 years except basal or squamous cell carcinoma of skin that has been definitively treated.
  3. Known hypersensitivity to the study drugs or excipients.
  4. Any illness or medical condition that is unstable or could jeopardize the safety of the subject or her compliance with study requirements.
  5. Subjects unable to swallow oral medications.
  6. Prior intake of letrozole, any ROS1 inhibitor, any TRK inhibitor or anticancer therapy (including endocrine therapy).
  7. Concurrent treatment with strong or moderate CYP3A inhibitor.
  8. Concurrent treatment with any of the drugs not permitted, i.e. strong CYP3A inducers and drugs known to cause QTc interval prolongation.
  9. LVEF ≤ 55% measured by echo or MUGA
  10. QTc exceeding 450 msec, history of prolonged QTc interval prolongation; risk factors for torsade de pointes; other concomitant medications that may prolong QTc; family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or Torsade de Pointes (TdP).
  11. Pregnant or lactating women.
  12. Known interstitial lung disease, interstitial fibrosis, or history of tyrosine kinase inhibitor-induced pneumonitis
  13. Peripheral neuropathy ≥ Grade 2
  14. Active gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut syndrome) or other malabsorption syndromes that would reasonably impact drug absorption.

Exclusion criterion applicable to France only 14. Vulnerable persons according to the article L.1121-6 of the CSP, adults who are the subject of a measure of legal protection or unable to express their consent according to article L.1121-8 of the CSP.


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): NCT04551495


Contacts
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Contact: Philippe Aftimos, MD +32 2 541 3208 philippe.aftimos@bordet.be
Contact: Diane Delaroche, PhD +32 2 541 7358 diane.delaroche@bordet.be

Locations
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Belgium
UZ Brussel Recruiting
Brussels, Belgium, 1090
Contact: Alex De Waele       alex.dewaele@uzbrussel.be   
Principal Investigator: Christel Fontaine, MD         
UCL Saint-Luc Recruiting
Brussels, Belgium, 1200
Contact: Nathalie Blondeel       nathalie.blondeel@uclouvain.be   
Principal Investigator: François Duhoux, MD         
Institut Jules Bordet Recruiting
Bruxelles, Belgium, 1000
Contact: Fanny Bustin       fanny.bustin@bordet.be   
Principal Investigator: Laurence Buisseret, MD         
Grand Hôpital de Charleroi Recruiting
Charleroi, Belgium, 6000
Contact: Stéphanie Adam       stephanie.adam@ghdc.be   
Principal Investigator: Jean-Luc Canon, MD         
UZ Gent Recruiting
Gent, Belgium, 9000
Contact: Lore Vansteelant       studiesmedonc@uzgent.be   
Principal Investigator: Hannelore Denys, MD         
CHU Namur - Sainte Elisabeth Recruiting
Namur, Belgium, 5000
Contact: Chloé Charloteaux       chloe.charloteaux@uclouvain.be   
Principal Investigator: Donatienne Taylor, MD         
France
Institut Bergonié Recruiting
Bordeaux, France, 33076
Contact: Leslie Ardilouze       L.Ardilouze@bordeaux.unicancer.fr   
Principal Investigator: Camille Chakiba, MD         
Institut Curie Recruiting
Paris, France, 75248
Contact: Anne Blondel       anne.blondel@curie.fr   
Principal Investigator: Florence Coussy, MD         
Institut Gustave Roussy Recruiting
Villejuif, France, 94805
Contact: Johanne Poty       Johanne.POTY@gustaveroussy.fr   
Principal Investigator: Barbara Pistilli, MD         
Sponsors and Collaborators
Jules Bordet Institute
Hoffmann-La Roche
Investigators
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Study Chair: Philippe Aftimos, MD Jules Bordet Insitute
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Responsible Party: Jules Bordet Institute
ClinicalTrials.gov Identifier: NCT04551495    
Other Study ID Numbers: IJB-LOB-2019
First Posted: September 16, 2020    Key Record Dates
Last Update Posted: July 8, 2021
Last Verified: September 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Carcinoma
Breast Neoplasms
Carcinoma, Lobular
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
Adenocarcinoma
Neoplasms, Ductal, Lobular, and Medullary
Letrozole
Goserelin
Entrectinib
Antineoplastic Agents
Aromatase Inhibitors
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Estrogen Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Protein Kinase Inhibitors