A Randomized Study of AZD2014 in Combination With Fulvestrant in Metastatic or Advanced Breast Cancer

NCT ID: NCT02216786

Last Updated: 2024-12-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

333 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-16

Study Completion Date

2021-12-31

Brief Summary

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This is an open-label, multicentre, 4-arm randomised phase II trial of fulvestrant + AZD2014 versus fulvestrant + everolimus versus fulvestrant alone in patients with ER-positive, HER2-negative advanced or metastatic breast cancer, whose disease relapsed during treatment with (or within 12 months after discontinuation of) an AI in the adjuvant setting or progressed during treatment with an AI in the metastatic setting. Patients will be randomised (2:3:3:2) to one of the four treatment arms:

* Fulvestrant
* Fulvestrant + AZD2014 (continuous daily schedule)
* Fulvestrant + AZD2014 (intermittent schedule - 2 days on, 5 days off)
* Fulvestrant + everolimus

Randomization will be stratified by the following criteria:

* Measurable disease (vs. non-measurable).
* Sensitivity to prior endocrine therapy (sensitive versus resistant)

Detailed Description

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This is an open-label, multicentre, 4-arm randomised phase II trial of fulvestrant + AZD2014 versus fulvestrant + everolimus versus fulvestrant alone in patients with ER-positive, HER2-negative advanced or metastatic breast cancer, whose disease relapsed during treatment with (or within 12 months after discontinuation of) an AI in the adjuvant setting or progressed during treatment with an AI in the metastatic setting. Patients will be randomised (2:3:3:2) to one of the four treatment arms:

* Fulvestrant
* Fulvestrant + AZD2014 (continuous daily schedule)
* Fulvestrant + AZD2014 (intermittent schedule - 2 days on, 5 days off)
* Fulvestrant + everolimus

Randomization will be stratified by the following criteria:

* Measurable disease (vs. non-measurable).
* Sensitivity to prior endocrine therapy (sensitive versus resistant) Sensitivity to prior endocrine therapy is defined as (i) at least 24 months of endocrine therapy before recurrence in the adjuvant setting or (ii) a complete or partial response to prior metastatic endocrine treatment, or (iii) stabilization for at least 24 weeks of endocrine therapy for advanced disease.

Treatment will be continued until disease progression unless there is evidence of unacceptable toxicity or if the patient requests to be withdrawn from the study. If one of the treatments (fulvestrant or mTOR inhibitor) is discontinued prior to disease progression, patients should be continued on single agent treatment until progression, evidence of unacceptable toxicity or if the patient requests to be withdrawn from the study.

At the time of documented disease progression (using RECIST 1.1), patients randomised to receive fulvestrant + everolimus who still meet eligibility criteria may be permitted to receive open-label crossover treatment with fulvestrant + AZD2014. Crossover therapy must begin no later than 28 days after the clinic visit at which progression was determined. Patients will receive crossover therapy until progression, intolerable toxicity, elective withdrawal from the study, or until the completion or termination of the study, whichever occurs first.

Tumour evaluations will be performed before the initiation of treatment, every 8 weeks during the first 40 weeks and every 12 weeks thereafter until disease progression.

The study will also assess the relationship between the anticipated anti-tumour activity of the treatment regimen and biological characteristics of patients' tumour at baseline

Conditions

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Estrogen Receptor Positive Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Fulvestrant and AZD2014 (continuous)

Experimental arm

Group Type EXPERIMENTAL

AZD2014

Intervention Type DRUG

Oral tablet

Fulvestrant

Intervention Type DRUG

Im injection

Everolimus and Fulvestrant

Comparator arm

Group Type ACTIVE_COMPARATOR

Everolimus

Intervention Type DRUG

Oral tablet

Fulvestrant

Intervention Type DRUG

Im injection

Fulvestrant

Control 1

Group Type ACTIVE_COMPARATOR

Fulvestrant

Intervention Type DRUG

Im injection

Fulvestrant +AZD2014 (intermittent)

Experimental arm

Group Type EXPERIMENTAL

AZD2014

Intervention Type DRUG

Oral tablet

Fulvestrant

Intervention Type DRUG

Im injection

Interventions

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AZD2014

Oral tablet

Intervention Type DRUG

Everolimus

Oral tablet

Intervention Type DRUG

Fulvestrant

Im injection

Intervention Type DRUG

Other Intervention Names

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Afinitor Faslodex

Eligibility Criteria

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Inclusion Criteria

1. Written informed consent prior to admission to this study
2. Women, age ≥18 years
3. Histologically confirmed breast cancer
4. Metastatic or locally recurrent disease; locally recurrent disease must not be amenable to resection with curative intent (patients who are considered suitable for surgical or ablative techniques following potential down-staging with study treatment are not eligible).
5. Patients must have:

1. at least one lesion, not previously irradiated, that can be measured accurately at baseline as ≥ 10mm in the longest diameter (except lymph nodes which must have short axis ≥ 15mm) with computed tomography (CT) or magnetic resonance imaging (MRI) which is suitable for accurate repeated measurements, or
2. lytic or mixed (lytic + sclerotic) bone lesions in the absence of measurable disease as defined above; patients with sclerotic/osteoblastic bone lesions only in the absence of measurable disease are not eligible
6. Radiological or clinical evidence of recurrence or progression
7. ER-positive disease
8. HER2-negative disease with 0, 1+ or 2+ intensity on IHC and no evidence of amplification on ISH.
9. Formalin fixed, paraffin embedded tumour sample from the primary and/or recurrent cancer must be available for central testing
10. Postmenopausal women.
11. Disease refractory to aromatase inhibitors (AI)
12. Haematologic and biochemical indices within acceptable limits
13. ECOG performance status 0-2
14. Non-childbearing potential (i.e., physiologically incapable of becoming pregnant), including any female who has had a hysterectomy, bilateral oophorectomy, bilateral tubular ligation or is post-menopausal (total cessation of menses for ≥ 1 year

Exclusion Criteria

1. Presence of life-threatening metastatic visceral disease, defined as extensive hepatic involvement or any degree of brain or leptomeningeal involvement (past or present), or symptomatic pulmonary lymphangitic spread. Patients with discrete pulmonary parenchymal metastases are eligible, provided their respiratory function is not compromised as a result of disease.
2. More than one line of prior chemotherapy for metastatic breast cancer
3. Prior chemotherapy, biological therapy, androgens, thalidomide, immunotherapy, other anticancer agents or any investigational agents within 14 days of starting study treatment (not including palliative radiotherapy at focal sites), radiotherapy with a wide field of radiation (greater than or equal to 30% marrow or whole pelvis or spine) within 4 weeks of starting study treatment, or strontium-90 (or other radiopharmaceuticals) within the past 3 months or major surgery within 4 weeks prior to entry into the study (excluding the placement of vascular access); with the exception of alopecia, all unresolved toxicities from prior treatment should be no greater than CTCAE grade 1 at the time of starting study treatment
4. Prior treatment with fulvestrant or everolimus
5. Prior treatment with PI3K inhibitors, Akt inhibitors or other mTOR inhibitors.
6. Patients receiving concomitant immunosuppressive agents or chronic systemic corticosteroids (≥10 mg prednisolone or an equivalent dose of other anti-inflammatory corticosteroids) use for ≥28 days at the time of study entry except in cases outlined below: Topical applications (e.g. rash), inhaled sprays (e.g. obstructive airways diseases), eye drops or local injections (e.g. intra-articular) are allowed. Patients on stable low dose of corticosteroids for at least two weeks before randomisation are allowed
7. Current refractory nausea and vomiting, chronic gastrointestinal disease or inability to swallow the formulated product or previous significant bowel resection that would preclude adequate absorption of the study medication
8. Clinically significant pulmonary dysfunction
9. Significant cardiovascular disease
10. QTc prolongation defined as a QTc interval \>470 msecs or other significant ECG abnormalities including 2nd degree (type II) or 3rd degree AV block or bradycardia (ventricular rate \<50 beats/min)
11. Concomitant medications known to prolong QT interval, or with factors that increase the risk of QTc prolongation or risk of arrhythmic events (such as heart failure, hypokalaemia, congenital long QT syndrome, family history of long QT syndrome, or unexplained sudden death under 40 years of age)
12. Clinically significant abnormalities of glucose metabolism
13. Exposure to potent or moderate inhibitors or inducers of CYP3A4/5 within 2 weeks before the first dose of study treatment
14. Exposure to potent or moderate inhibitors or inducers of CYP2C8 within 1 week before the first dose of study treatment.
15. Application of haemopoietic growth factors (e.g. G-CSF, GM-CSF) within 2 weeks before receiving study drug
16. Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that, in the investigator's opinion, gives reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug, may affect the interpretation of the results, render the patient at high risk from treatment complications or interferes with obtaining informed consent.
17. History of hypersensitivity to active or inactive excipients of AZD2014 or everolimus or drugs with a similar chemical structure or class to AZD2014 or everolimus
18. History of hypersensitivity to active or inactive excipients of fulvestrant and/or castor oil.
19. Patients presenting with anaemia symptoms (haemoglobin ≤ 90 g/L).
20. Currently receiving (and are unwilling to discontinue) oestrogen replacement therapy (last dose ≤ 7 days prior to randomisation)
21. Psychological, familial, sociological or geographical conditions that do not permit compliance with the study protocol.
22. Detained persons or prisoners
23. Pregnant or nursing women (including no breast feeding from two weeks before the first dose of study medication, till 8 weeks after the last dose of study medication).
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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AstraZeneca

INDUSTRY

Sponsor Role collaborator

Queen Mary University of London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter Schmid, Prof

Role: PRINCIPAL_INVESTIGATOR

Queen Mary's University of London

Locations

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ICO Paul Papin

Angers, , France

Site Status

Institut Sainte Catherine

Avignon, , France

Site Status

Antoine Lacassagne Centre De Lutte Contre Le Cancer De Nice

Nice, , France

Site Status

Hospital Center Private Saint-Grégoire

Saint-Grégoire, , France

Site Status

Centre Paul Strauss

Strasbourg, , France

Site Status

Clinic Health House

Tbilisi, , Georgia

Site Status

Institute of Clinical Oncology

Tbilisi, , Georgia

Site Status

S. Khechinashvili University Clinic

Tbilisi, , Georgia

Site Status

Tbilisi Cancer Center

Tbilisi, , Georgia

Site Status

Frauenärztliche Gemeinschaftspraxis - Onkologie

Braunschweig, , Germany

Site Status

Kliniken Essen-Mitte Senologie

Essen, , Germany

Site Status

Klinik für Gynäkologie & Geburtshilfe/Brustzentrum

Frankfurt, , Germany

Site Status

Praxis für interdisziplinäre Onkologie & Hämatologie

Freiburg im Breisgau, , Germany

Site Status

MediProjekt GbR Hannover

Hannover, , Germany

Site Status

SLK-Kliniken Heilbronn GmbH

Heilbronn, , Germany

Site Status

Dokusan GmbH

Herne, , Germany

Site Status

St. Vincentius Kliniken

Karlsruhe, , Germany

Site Status

Schwerpunktpraxis Hämatologie / Onkologie MVZ Lahr

Lahr, , Germany

Site Status

Klinikum Neumarkt

Neumarkt, , Germany

Site Status

Onkologische Praxis

Oldenburg, , Germany

Site Status

Praxis für Innere Medizin

Singen, , Germany

Site Status

MVZ Klinik Dr. Hancken GmbH

Stade, , Germany

Site Status

Mutterhaus der Borromäerinnen

Trier, , Germany

Site Status

Schwarzwald Baar Klinikum, Villingen-Schwenningen

Villingen-Schwenningen, , Germany

Site Status

Uzsoki Street Hospital

Budapest, , Hungary

Site Status

Bacs-Kiskun County Hospital

Kalocsa, , Hungary

Site Status

University of Pecs, Institute of Oncology

Pécs, , Hungary

Site Status

Zala County Szent Rafael Hospital

Zalaegerszeg, , Hungary

Site Status

Hospital da Luz

Lisbon, , Portugal

Site Status

Ipo Porto

Porto, , Portugal

Site Status

Center of Oncology Euroclinic

Bucharest, , Romania

Site Status

Oncology Center Sf Nectarie

Caracal, , Romania

Site Status

Cluj County Clinical Emergency Hospital, Clinical Department of Medical Oncology

Cluj-Napoca, , Romania

Site Status

Oncology Institute "Prof. Dr. Ion Chiricuta"

Cluj-Napoca, , Romania

Site Status

Oncology Center Oncolab Craiova

Craiova, , Romania

Site Status

National Cancer Center South Korea

Goyang, , South Korea

Site Status

Korea University Medical Center Guro Hospital

Seoul, , South Korea

Site Status

Yonsei University Health System

Seoul, , South Korea

Site Status

Hospital Universitari Vall D'Hebron

Barcelona, , Spain

Site Status

Instituto Oncologico Dr. Rosell

Barcelona, , Spain

Site Status

Consorcio Hospitalario Provincial de Castellon

Castelló, , Spain

Site Status

Cafeteria Hospital San Pedro de Alcantara

Cáceres, , Spain

Site Status

Hospital Ico Josep Trueta

Girona, , Spain

Site Status

University Hospital Arnau de Vilanova

Lleida, , Spain

Site Status

Hospital Clinico Universitario San Carlos

Madrid, , Spain

Site Status

Hospital Son Llàtzer

Palma, , Spain

Site Status

Hospital Son Espases

Palma de Mallorca, , Spain

Site Status

Hospital Universitario de Canarias

San Cristóbal de La Laguna, , Spain

Site Status

Hospital Universitari Sant Joan de Reus

Tarragona, , Spain

Site Status

Wansbeck General Hospital

Ashington, , United Kingdom

Site Status

Princess of Wales Hospital

Bridgend, , United Kingdom

Site Status

Royal Sussex County Hospital

Brighton, , United Kingdom

Site Status

Kent and Canterbury Hospital

Canterbury, , United Kingdom

Site Status

Cumberland Infirmary

Carlisle, , United Kingdom

Site Status

Broomfield Hospital

Chelmsford, , United Kingdom

Site Status

University Hospital of North Durham

Durham, , United Kingdom

Site Status

Calderdale Royal Hospital

Halifax, , United Kingdom

Site Status

Huddersfield Royal Infirmary

Huddersfield, , United Kingdom

Site Status

Kidderminster Hospital

Kidderminster, , United Kingdom

Site Status

Royal Glamorgan Hospital

Llantrisant, , United Kingdom

Site Status

Queen Mary University of London

London, , United Kingdom

Site Status

Charring Cross Hospital

London, , United Kingdom

Site Status

King's College Hospital

London, , United Kingdom

Site Status

Mount Vernon Hospital

London, , United Kingdom

Site Status

Queen Elizabeth Hospital, Woolwich

London, , United Kingdom

Site Status

Saint Bartholomew's Hospital

London, , United Kingdom

Site Status

The Royal Free Hospital

London, , United Kingdom

Site Status

The Kent Oncology Centre

Maidstone, , United Kingdom

Site Status

North Tyneside General Hospital

North Shields, , United Kingdom

Site Status

Nottingham City Hospital

Nottingham, , United Kingdom

Site Status

Derriford Hospital

Plymouth, , United Kingdom

Site Status

Weston Park Hospital

Sheffield, , United Kingdom

Site Status

Solihull Hospital

Solihull, , United Kingdom

Site Status

Southend University Hospital

Southend-on-Sea, , United Kingdom

Site Status

Royal Stoke University Hospital

Stoke-on-Trent, , United Kingdom

Site Status

King's Mill Hospital

Sutton in Ashfield, , United Kingdom

Site Status

Great Western Hospital

Swindon, , United Kingdom

Site Status

Wrexham Maelor

Wrexham, , United Kingdom

Site Status

Yeovil District Hospital

Yeovil, , United Kingdom

Site Status

Countries

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France Georgia Germany Hungary Portugal Romania South Korea Spain United Kingdom

References

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Schmid P, Zaiss M, Harper-Wynne C, Ferreira M, Dubey S, Chan S, Makris A, Nemsadze G, Brunt AM, Kuemmel S, Ruiz I, Perello A, Kendall A, Brown J, Kristeleit H, Conibear J, Saura C, Grenier J, Mahr K, Schenker M, Sohn J, Lee KS, Shepherd CJ, Oelmann E, Sarker SJ, Prendergast A, Marosics P, Moosa A, Lawrence C, Coetzee C, Mousa K, Cortes J. Fulvestrant Plus Vistusertib vs Fulvestrant Plus Everolimus vs Fulvestrant Alone for Women With Hormone Receptor-Positive Metastatic Breast Cancer: The MANTA Phase 2 Randomized Clinical Trial. JAMA Oncol. 2019 Nov 1;5(11):1556-1564. doi: 10.1001/jamaoncol.2019.2526.

Reference Type RESULT
PMID: 31465093 (View on PubMed)

Other Identifiers

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009175QM

Identifier Type: -

Identifier Source: org_study_id