Phase II randomized study of the EGFR, HER2, HER3 signaling inhibitor AZD8931 in combination with anastrozole (A) in women with endocrine therapy (ET) naive advanced breast cancer (MINT).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 531-531 ◽  
Author(s):  
Stephen R. D. Johnston ◽  
Mark Basik ◽  
Roberto Hegg ◽  
Wirote Lausoontornsiri ◽  
Lukasz Grzeda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Phase Ii ◽  
Interim Analysis ◽  
Randomized Study ◽  
Acquired Resistance ◽  
Endocrine Resistance ◽  
Population Data ◽  
Double Blind ◽  
Egfr Inhibition ◽  
Phase Ii Studies

531 Background: Preclinical data suggest a key role for EGFR inhibition in delaying acquired resistance to ET in ER+ breast cancer (BC). Retrospective analyses of 2 Phase II studies suggested adding gefitinib to ET delayed PFS in ET naive (ETN) BC. This randomized, double-blind, placebo-controlled multi-center study (NCT01151215) was conducted to prospectively test the hypothesis that adding AZD8931, an inhibitor of EGFR, HER2 and HER3 signaling, to A would be beneficial in delaying endocrine resistance in an advanced ETN BC population. Methods: Post-menopausal women with ER+ and/or PR+, ETN, HER2-negative, advanced BC were randomized (1:1:1) to receive A (1 mg od) plus AZD8931 20 or 40 mg bd or placebo (P). The primary endpoint was PFS (ITT population). Data presented are from an interim analysis (data cutoff 31 Aug 2012; 39% pts had a progression event). Results: Between Jun 2010 and Jun 2012, 359 pts (median age 61 years) were randomized to A combined with AZD8931 20 mg (n=118), 40 mg (n=120) or P (n=121). At the interim analysis, median PFS in the AZD8931 20 mg, 40 mg and P arms was 10.9, 13.8 and 14.0 months, respectively; PFS HR (95% CI) for AZD8931 20 mg:P was 1.37 (0.91–2.06, P=0.135) and for AZD8931 40 mg:P was 1.16 (0.77–1.75, P=0.485). Deaths were reported for 20 (17%), 16 (13%) and 12 pts (10%) in the AZD8931 20 mg, 40 mg and P arms, respectively. Grade ≥3 AEs were reported for 22 (19%), 44 (37%) and 18 (15%) pts in the AZD8931 20 mg, 40 mg, and P arms, respectively, the most frequent being rash (0% vs 8% vs 2%), acneiform dermatitis (0% vs 7% vs 0%) and hypertension (3% vs 3% vs 2%). Serious AEs were reported for 12%, 14% and 9% pts in the AZD8931 20 mg, 40 mg and P arms, respectively, and discontinuation (of AZD8931 or P) due to an AE in 5%, 8% and 2% pts, respectively. Conclusions: Co-blockade of EGFR, HER2, HER3 in combination with aromatase inhibition does not appear to delay endocrine resistance to ETN BC. Based on the low probability of demonstrating superior efficacy with addition of AZD8931 to A and the overall risk/benefit, the study was closed at the recommendation of the IDMC and pts discontinued AZD8931. Clinical trial information: NCT01151215.

A phase II study of anastrazole and fulvestrant in combination with gefitinib in patients with newly diagnosed ER-positive breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1050-1050
Author(s):  
S. A. Massarweh ◽  
Y. L. Tham ◽  
H. Weiss ◽  
S. Fuqua ◽  
J. Huang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adverse Events ◽  
Endocrine Therapy ◽  
Phase Ii ◽  
Kinase Inhibitor ◽  
De Novo ◽  
Endocrine Resistance ◽  
Neoadjuvant Endocrine Therapy ◽  
Egfr Inhibition ◽  
Biomarker Analysis

1050 Background: Endocrine therapy for ER+ breast cancer is effective and relatively nontoxic, but is limited by de novo and acquired resistance. Preclinical studies suggest that complete ER blockade along with inhibition of co-expressed growth factor receptors enhances endocrine response and overcomes resistance. Methods: We conducted a phase II trial of combined anastrazole and fulvestrant with gefitinib, an EGFR tyrosine kinase inhibitor, as intial therapy in postmenopausal women with locoregional or metastatic ER+ breast cancer. A tumor core biopsy was done at baseline and after 3 weeks. Patients received treatment for 4 months. Surgery was then offered if the tumor was operable. Primary endpoint was clinical response as defined by RECIST criteria and secondary endpoints were safety/tolerability, complete pathologic response rate (pCR), and biomarker analysis. Planned sample size was 60 patients, but the study closed after 15 patients were enrolled because of poor accrual. Results: Median age at diagnosis was 67 years. Median clinical tumor size was 7 cm and 4 patients had metastases. 11 patients (73%) had ER+/PgR+ tumors and 4 (27%) had ER+/PgR- disease. 3 patients withdraw from the study before response was assessed. Of the12 remaining patients there were 2 complete responses (17%), 5 partial responses (42%), 5 with stable disease (42%), and 2 (17%) with progressive disease. Of the 7 patients who had surgery at 4 months, none had pCR. Most common adverse events were rash in 4 patients, Diarrhea in 4, joint symptoms in 3, and abnormal LFT’s in 3. All adverse events were reversible. Biomarkers, including arrays and Ki67, are pending and will be presented at the meeting. Conclusions: Complete ER blockade using anastrazole and fulvestrant with EGFR inhibition is well-tolerated and has activity in this cohort of patients with relatively advanced ER+ breast cancer. Despite its documented benefit and low toxicity, accrual to neoadjuvant endocrine therapy studies remains poor in the US, largely because of physician hesitance to refer patients for non-chemotherapy studies. More effort is needed to increase physician awareness about the value of endocrine therapy, and to increase accrual to trials that address the question of endocrine resistance. [Table: see text]

MO126CLINICAL AND BIOMARKER CHARACTERISTICS OF PATIENTS WITH C3G OR IC-MPGN ENROLLED IN TWO PHASE II STUDIES INVESTIGATING THE FACTOR D INHIBITOR DANICOPAN*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Carla Nester ◽  
Steven Podos ◽  
Jonathan Hogan ◽  
Gerald Appel ◽  
Andrew Bomback ◽  
...  
Keyword(s):  
Phase Ii ◽  
Kidney Diseases ◽  
Alternative Pathway ◽  
Classical Pathway ◽  
Complement Factor ◽  
Open Label ◽  
Double Blind ◽  
Phase Ii Studies ◽  
Complement Dysregulation ◽  
Extension Trial

Abstract Background and Aims C3 glomerulopathy (C3G) and immune complex membranoproliferative glomerulonephritis (IC-MPGN) are rare, progressive kidney diseases requiring a biopsy for definite diagnosis. Both C3G and IC-MPGN are attributed to complement dysregulation, with dysregulation of the alternative pathway established in C3G and implicated in IC-MPGN (alongside classical pathway activation by immune complexes). We describe the baseline biomarker and clinical characteristics of patients participating in two C3G/IC-MPGN phase II studies of the investigational, oral complement factor D (FD) inhibitor, danicopan (ALXN2040/ACH-4471). Method The first study (NCT03369236) was a double-blind, placebo-controlled, randomised, 6-month (+open label extension) trial of patients with biopsy-confirmed C3G of the native kidney treated with danicopan or placebo. The second study (NCT03459443) was a single-arm, open-label, 12-month (+extension) trial of patients with biopsy-confirmed C3G or IC-MPGN treated with danicopan. In both studies, all patients were to have proteinuria ≥500 mg/day and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2 (calculated by the Modification of Diet in Renal Disease equation for patients ≥18 years and the Schwartz equation for patients <18 years). Complement biomarkers including, but not limited to, C3, C4, AP activity, classical pathway activity, FD, Ba, Bb, sC5b-9, and C5 were measured in serum or plasma prior to dosing. Spearman correlation coefficients (rs) were determined between biomarkers of complement, eGFR, and/or proteinuria. Results A total of 35 patients were included in this analysis (13 from study 1 and 22 from study 2). The majority of patients were male (9 [69%] in study 1, 12 [55%] in study 2), with mean (SD) ages at baseline of 25.2 (7.63) years in study 1 and 24.3 (9.90) years in study 2. Most patients had received prior angiotensin converting enzyme inhibitors/receptor blockers (12 [92%] in study 1, 19 [86%] in study 2), and/or immunosuppressants (10 [77%] in study 1, 12 [55%] in study 2). Baseline clinical and biomarker data are shown in Table 1. Baseline eGFR was moderately correlated with proteinuria (uPCR24, rs=-0.40 [p=0.022]); baseline uPCR24 was also moderately correlated with Ba (rs=0.42 [p=0.016]) and FD (rs=0.53 [p=0.002]). Ba and FD elevations showed strong correlations with lower eGFR (rs=-0.79 and -0.88, respectively [p<0.0001]), as seen in Figure 1A and B. Reduced circulating C3 strongly correlated with increased sC5b-9 (rs=-0.70 [p<0.0001]) and reduced C5 level (rs=0.80 [p<0.0001]), as seen in Figure 1C and D. Conclusion Data from two danicopan clinical studies in C3G patients show correlations with renal impairment and proteinuria were observed for some, but not all, complement biomarkers. Factor Ba and FD are strongly associated with eGFR, suggesting that these biomarkers cannot easily be used as markers of complement dysregulation or activity. Interpretation of changes in these complement proteins needs to include not only the nature of the complement dysregulation and influence of the complement therapeutic being tested, but also eGFR. Additional urinary biomarkers, biopsy findings, autoantibodies, and genetic variants are currently being analysed and findings from this study will contribute to a better understanding of C3G and IC-MPGN.

scholarly journals First-line paclitaxel and cisplatin used sequentially or in combination in metastatic breast cancer: A phase II randomized study

2018 ◽  
Vol 30 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Mostafa M. Elserafi ◽  
Ahmed A. Zeeneldin ◽  
Ibrahim M. Abdelsalam ◽  
Hanan R. Nassar ◽  
Manar M. Moneer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Phase Ii ◽  
Randomized Study ◽  
Metastatic Breast ◽  
First Line
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