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BYL719 and Nab-Paclitaxel in Locally Recurrent or Metastatic HER-2 Negative Breast Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02379247
Recruitment Status : Active, not recruiting
First Posted : March 4, 2015
Results First Posted : September 28, 2021
Last Update Posted : September 28, 2021
Sponsor:
Collaborator:
Novartis Pharmaceuticals
Information provided by (Responsible Party):
Priyanka Sharma, University of Kansas Medical Center

Brief Summary:
Investigate the use of BYL719 (alpelisib) as combination therapy with Nab-Paclitaxel in locally recurrent or metastatic HER-2 negative breast cancer.

Condition or disease Intervention/treatment Phase
Breast Cancer Drug: BYL-719 (alpelisib) Drug: Nab-paclitaxel Phase 1 Phase 2

Detailed Description:

Breast cancer is the most common cancer and the second leading cause of cancer related death in American women. Despite recent improvement in the treatment of breast cancer, 40,000 women still die each year in the US as a result of breast cancer. Chemotherapy (usually consisting of sequential single agent) remains the backbone of treatment for patients with HER-2 negative metastatic breast cancer. A majority of patients show an initial response to treatment, but all eventually show disease progression.

The purpose of this study is to determine the highest dose of BYL719 (alpelisib) combined with Nab-Paclitaxel that results in no serious side effects. The safety and effectiveness of BYL719 combined with Nab-Paclitaxel to treat patients with HER-2 negative metastatic breast cancer will be assessed, along with the determination of how long this drug combination will keep the disease from getting worse.

The study will be done in two parts:

Part 1 will determine the highest dose of BYL719 that is safe and tolerable to take in combination with Nab-Paclitaxel. Part 1 will be completed before Part 2 begins.

Part 2 will investigate whether taking BYL719 (at the dose determined in Part 1) + Nab-Paclitaxel is safe and effective for patients with HER-2 negative metastatic breast cancer.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 43 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/II Study of BYL719 and Nab-Paclitaxel in Subjects With Locally Recurrent or Metastatic HER-2 Negative Breast Cancer
Actual Study Start Date : February 2015
Actual Primary Completion Date : September 21, 2017
Estimated Study Completion Date : March 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Breast Cancer
Drug Information available for: Paclitaxel

Arm Intervention/treatment
Experimental: Dose level 1 BYL-719/alpelisib (250mg)+Nab-paclitaxel

BYL-719 (alpelisib): 250mg daily on day 1-28

Nab-paclitaxel: 100mg/m2 IV days 1, 8, 15 of each 28 day cycle (Window for Nab-paclitaxel is +/- 1 day)

Drug: BYL-719 (alpelisib)
Oral PI3K inhibitor
Other Name: Piqray

Drug: Nab-paclitaxel
IV taxane
Other Name: Abraxane

Experimental: Dose level 2 BYL-719 (alpelisib) (300mg)+Nab-paclitaxel

BYL-719 (alpelisib): 300mg by mouth daily on day 1-28 of each 28 day cycle

Nab-paclitaxel: 100mg/m2 given IV on days 1, 8, 15 of each 28 day cycle (Window for Nab-paclitaxel is +/- 1 day)

Drug: BYL-719 (alpelisib)
Oral PI3K inhibitor
Other Name: Piqray

Drug: Nab-paclitaxel
IV taxane
Other Name: Abraxane

Experimental: Dose level 3 BYL-719 (alpelisib) (350mg)+Nab-paclitaxel

BYL-719 (alpelisib): 350mg by mouth daily on day 1-28 of each 28 day cycle

Nab-paclitaxel: 100mg/m2 given IV on days 1, 8, 15 of each 28 day cycle (Window for Nab-paclitaxel is +/- 1 day)

Drug: BYL-719 (alpelisib)
Oral PI3K inhibitor
Other Name: Piqray

Drug: Nab-paclitaxel
IV taxane
Other Name: Abraxane

Experimental: BYL-719 (alpelisib) Dose Expansion

BYL-719 (alpelisib): RP2D from Phase I by mouth daily on day 1-28 of each 28 day cycle

Nab-paclitaxel: 100mg/m2 given IV on days 1, 8, 15 of each 28 day cycle (Window for Nab-paclitaxel is +/- 1 day)

Drug: BYL-719 (alpelisib)
Oral PI3K inhibitor
Other Name: Piqray

Drug: Nab-paclitaxel
IV taxane
Other Name: Abraxane




Primary Outcome Measures :
  1. Phase I: Recommended Phase II Dose (RP2D) of BYL-719 (Alpelisib) + Nab-paclitaxel to be Used in Combination to Treat Advanced HER2-negative Breast Cancer [ Time Frame: 12 months ]
    Phase I was a 3+3 dose escalation design (three dose levels of alpelisib: 250mg, 300mg, and 350mg orally once daily, continuous dosing) with dose-limiting toxicities (DLT) assessed during the first treatment cycle. If two or more of the six patients experienced a dose-limiting toxicity, dosing escalation would cease and maximum tolerated dose (MTD) would be reached. RP2D was the next lower dose at which <1/6 subjects experienced a DLT.

  2. Phase II: Overall Response Rate (ORR) of Subjects Treated at the Recommended Phase II Dose (RP2D) [ Time Frame: 24 months ]
    ORR includes complete response (CR) plus partial response (PR). As evaluated per RECIST version 1.1.


Secondary Outcome Measures :
  1. Clinical Benefit Rate (CBR) at 16 Weeks of Study Treatment [ Time Frame: 16 weeks ]
    CBR includes complete response (CR), partial response (PR), plus stable disease (SD) ≥16 weeks. As evaluated per RECIST version 1.1.

  2. Pharmacokinetics of BYL-719 (Alpelisib) When Administered With Nab-paclitaxel [ Time Frame: In cycle 1 day 1, from prior to alpelisib dosing through 8 hours after alpelisib dosing ]
    Area under the curve (AUC): sampling pre-dose and 1.5, 2, 2.5, 3, 3.5, 4, 6, and 8 hours post-alpelisib dose

  3. Pharmacokinetics of (Total) Nab-paclitaxel When Administered With BYL-719 (Alpelisib) [ Time Frame: In cycle 1 day 1, from prior to alpelisib dosing through 8 hours after alpelisib dosing ]
    Area under the curve (AUC): sampling pre-dose and 1.5, 2, 2.5, 3, 3.5, 4, and 6 hours post-alpelisib dose

  4. Progression-free Survival (PFS) and Overall Survival (OS) [ Time Frame: 36 months ]
    PFS was defined as the time in months from the date of enrollment to the date of progression or death, whichever was earlier. OS was defined as the time in months from the date of enrollment to death as a result of any cause. Survival curves were assessed by the Kaplan-Meier method.


Other Outcome Measures:
  1. Correlation of PIK3CA Mutation With Clinical Benefit Rate [ Time Frame: 24 months ]
    Comparison of clinical benefit rate between participants with and without PIK3CA mutation in tumor tissue and/or circulating tumor DNA. Clinical benefit rate includes complete response (CR), partial response (PR), plus stable disease (SD) ≥16 weeks, as evaluated per RECIST version 1.1. Tumor DNA was isolated from archived formalin-fixed, paraffin-embedded tumor tissue (primary or metastatic site) and subjected to next-generation sequencing for assessment of PIK3CA mutation using ONCOReveal Multi-Cancer Panel (Pillar Biosciences). Circulating tumor DNA was isolated from pre-treatment plasma samples and subjected to next-generation sequencing for assessment of PIK3CA mutation using FoundationOne CDx testing or ONCOReveal Multi-Cancer Panel.



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:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Ability to understand and the willingness to sign a written Informed Consent Form.
  2. Age ≥ 18 years
  3. Histologically proven HER-2 negative breast cancer (HER-2 negative defined as HER IHC 0 or 1+ and/or HER-2 FISH negative); HER-2 negative breast cancer includes hormone positive (ER and/or PR positive) breast cancer and TNBC
  4. HER-2 negative breast cancer that at the time of study entry is either stage III (locally advanced) disease not amenable to curative therapy or stage IV disease. Histological confirmation of recurrent/metastatic disease is encouraged but not required if clinical evidence of stage IV disease is available
  5. Have measurable (defined as at least one lesion that can be accurately measured in at least one dimension [longest diameter to be recorded] with minimum lesion size of ≥ 2 cm on conventional measurement techniques or ≥ 1 cm on spiral computed tomography (CT) scan
  6. No limitations to number of prior chemotherapies for metastatic disease. Treatment with prior taxanes (except Nab-Paclitaxel) is allowed as long as it has been 6 months or more since exposure to prior taxane.

    NOTE: For subjects who are, or who have previously received endocrine therapy for breast cancer, the treating investigator will decide how many days should pass between the last dose of endocrine therapy and the first dose of study treatment.

  7. All patients should have received at least one line of chemotherapy in either the advanced or adjuvant setting and hormonal therapy (where appropriate)
  8. Performance status of 2 or better as per ECOG criteria (See Appendix A for details)
  9. Subject is able to swallow and retain oral medicines
  10. Adequate marrow and organ function as defined below (labs must be performed within 14 days of subject registration)

    • Absolute neutrophil count ≥ 1500/uL
    • Platelets 100,000/uL (no transfusion allowed within 2 weeks)
    • Hemoglobin > 9 g/dL (which may be reached by transfusion)
    • Total bilirubin within normal range or ≤ 1.5X IULN if liver metastases are present or total bilirubin ≤ 3.0X IULN with direct bilirubin within normal range in subjects with well-documented Gilbert's Syndrome, which is defined as presence of unconjugated hyperbilirubinemia with normal results from CBC (including normal reticulocyte count and blood smear), normal liver function test results and absence of other contributing disease processes at the time of diagnosis
    • AST(SGOT)/ALT(SPGT) ≤ 2.5X IULN or ≤ 5X IULN if liver metastases are present
    • Serum creatinine ≤ 1.5X IULN
    • INR ≤ 1.5
    • Fasting plasma glucose ≤ 140 mg/dL or 7.8 mmol/L (NOTE: Fasting whole blood glucose testing is acceptable if fasting plasma glucose is not feasible.)
    • HBA1c ≤ 8%
    • Potassium, calcium (corrected for serum albumin) and magnesium within IULN
    • Serum Amylase < 2 x ULN and serum lipase within normal limits
  11. IV bisphosphate and denosumab for bony metastatic disease will be allowed
  12. Prior palliative radiation therapy to bony metastases is allowed. There should be a minimum of 14 days between the end of radiation treatment and start of study treatment
  13. Subjects with previously treated brain metastases who are free of CNS symptoms and are > 3 months from treatment of brain metastases are eligible Subjects should be > 2 weeks from prior systemic chemotherapy for breast cancer AND should have recovered to Grade 1 or better (except alopecia) from related side effects of any prior antineoplastic therapy prior to study entry NOTE: For subjects who are, or who have previously received endocrine therapy for breast cancer, the treating investigator will decide how many days should pass between the last dose of endocrine therapy and the first dose of study treatment.
  14. Women of child bearing potential (WOCBP) and their partners must agree to use adequate contraception (barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. After confirmation of negative pregnancy test at screening, should a WOCBP become pregnant or suspect that she is pregnant while participating in this study, she should inform her treating physician and the investigator immediately.

    • WOCBP are defined as any females (regardless of sexual orientation, having undergone tubal ligation, or remaining celibate by choice) who meet the following criteria:

      • Have not undergone a hysterectomy or bilateral oophorectomy OR
      • Have not been naturally postmenopausal for at least 12 consecutive months (i.e. has had menses at any time in the preceding 12 consecutive months)

Exclusion criteria:

  1. Subject has any other medical or psychiatric disorder that, in the opinion of the treating physician, would contraindicate the use of drugs in this protocol or place the subject at undue risk for treatment complications
  2. Subject is pregnant or lactating
  3. Subject has previously been treated with Nab-Paclitaxel NOTE: Subjects who have had previous treatment with Nab-Paclitaxel will NOT be excluded if given in the adjuvant or neoadjuvant setting Only in the metastatic setting, will subjects previously treated with Nab-Paclitaxel be excluded from this trial. Exceptions may be made for subjects who discontinued treatment with a previous Nab-Paclitaxel inhibitor for reasons other than progression and as long as it has been > 12 months since discontinuation of the previous Nab-Paclitaxel. This exception will require prior approval from the study PI at KUMC.
  4. Subject has inflammatory breast cancer
  5. Subject has a known hypersensitivity to any of the excipients of Nab-Paclitaxel or BYL719/alpelisib
  6. Subject has a concurrent malignancy or malignancy within 3 years of study enrollment (with the exception of adequately treated, basal or squamous cell carcinoma, non-melanomatous skin cancer or curatively resected cervical cancer)
  7. Subject has clinically manifest diabetes mellitus or documented steroid-induced diabetes mellitus
  8. Subject has impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of the study drugs (e.g. ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection)
  9. Subject is classified into Child-Pugh class C
  10. Subject has a known history of HIV infection (testing not mandatory)
  11. Subject has active, uncontrolled infection
  12. Subject has symptomatic/untreated CNS disease
  13. Subject has ≥ Grade 2 peripheral neuropathy
  14. Subject has active cardiac disease or a history of cardiac dysfunction including any of the following:

    • Unstable angina pectoris within 6 months prior to study entry
    • Symptomatic peritonitis
    • Documented myocardial infarction within 6 months prior to study entry
    • History of documented congestive heart failure (New York Heart Association functional classification III-IV)
    • Documented cardiomyopathy
    • Subject has a Left Ventricular Ejection Fraction (LVEF) < 50% as determined by Multiple Gated Acquisition (MUGA) scan or echocardiogram (ECHO)
    • Subject has any of the following cardiac conduction abnormalities
    • Ventricular arrhythmias except for benign premature ventricular contractions
    • Supraventricular and nodal arrhythmias requiring a pacemaker or not controlled with medicine
    • Conduction abnormality requiring a pacemaker
    • Other cardiac arrhythmia not controlled with medication
  15. Subject has a QTcF > 480 msec on the screening ECG (using the QTcF formula)
  16. Subject is currently receiving treatment with a medication that has a known risk to prolong the QT interval or induce Torsades de Pointes and the treatment cannot be discontinued or switched to a different medication prior to randomization
  17. Subject has had major surgery within 14 days prior to starting study drug or has not recovered from major side effects
  18. Subject is currently receiving or has received systemic corticosteroids ≤ 2 weeks prior to starting study drug or who have not fully recovered from side effects of such treatment
  19. Subject is currently receiving treatment with drugs known to be moderate or strong inhibitors or inducers of isoenzyme CYP3A. The subject must have discontinued strong inducers for at least one week and must have discontinued strong inhibitors before the start of treatment
  20. Subject is currently receiving warfarin or other coumarin-derived anti-coagulant for treatment, prophylaxis or otherwise. Therapy with heparin, low molecular weight heparin (LMWH), or fondaparinux is allowed
  21. Subject has received previous treatment with a PI3K inhibitor. Exceptions may be made for subjects who discontinued treatment with a previous PI3K inhibitor for reasons other than toxicity or progression and as long as it has been > 12 months since discontinuation of the previous PI3K inhibitor. This exception will require prior approval from the study PI at KUMC.
  22. Subjects who have received an investigational agent within 30 days OR within 5 half-lives of the investigational agent (whichever is shorter) prior to the possible enrollment date on this study.
  23. Subject with history of acute within one year of study entry or past medical history of chronic pancreatitis.

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): NCT02379247


Locations
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United States, Kansas
University of Kansas Cancer Center
Kansas City, Kansas, United States, 66205
University of Kansas Cancer Center - Overland Park
Overland Park, Kansas, United States, 66210
United States, Missouri
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri, United States, 64064
United States, Tennessee
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee, United States, 37232
Sponsors and Collaborators
Priyanka Sharma
Novartis Pharmaceuticals
Investigators
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Principal Investigator: Priyanka Sharma, MD University of Kansas Medical Center
  Study Documents (Full-Text)

Documents provided by Priyanka Sharma, University of Kansas Medical Center:
Publications of Results:
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Responsible Party: Priyanka Sharma, Medical Doctor, University of Kansas Medical Center
ClinicalTrials.gov Identifier: NCT02379247    
Other Study ID Numbers: CBYL719XUS06T
First Posted: March 4, 2015    Key Record Dates
Results First Posted: September 28, 2021
Last Update Posted: September 28, 2021
Last Verified: September 2021
Keywords provided by Priyanka Sharma, University of Kansas Medical Center:
HER-2 Negative
Metastatic Breast Cancer
Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Paclitaxel
Albumin-Bound Paclitaxel
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action