Patient case: 72-year-old male with Cholangiocarcinoma. Genetic variant: BRCA2. Other conditions: Diabetes.

Clinical trial: A Study Evaluating Talazoparib (BMN 673), a PARP Inhibitor, in Advanced and/or Metastatic Breast Cancer Patients With BRCA Mutation (EMBRACA Study)

Summary: The purpose of this open-label, 2:1 randomized phase III trial is to compare the safety and efficacy of talazoparib (also known as BMN 673) versus protocol-specific physician's choice in patients who have locally advanced and/or metastatic breast cancer with germline BRCA mutations.


Eligibility: Inclusion Criteria:
  -  Histologically or cytologically confirmed carcinoma of the breast
  -  Locally advanced breast cancer that is not amenable to curative radiation or surgical cure and/or metastatic disease appropriate for systemic single cytotoxic chemotherapy
  -  Documentation of a deleterious, suspected deleterious, or pathogenic germline BRCA1 or BRCA2 mutation from Myriad Genetics or other laboratory approved by the Sponsor
  -  No more than 3 prior chemotherapy-inclusive regimens for locally advanced and/or metastatic disease (no limit on prior hormonal therapies or targeted anticancer therapies such as mechanistic target of rapamycin (mTOR) or CDK4/6 inhibitors, immune-oncology agents, tyrosine kinase inhibitors, or monoclonal antibodies against CTL4 or VEGF)
  -  Prior treatment with a taxane and/or anthracycline in the neoadjuvant, adjuvant, locally advanced, or metastatic setting unless medically contraindicated
  -  Have measurable or non-measurable, evaluable disease by the revised response evaluation criteria in solid tumors (RECIST) v.1.1
  -  Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
  Exclusion Criteria:
  -  First-line locally advanced and/or metastatic breast cancer with no prior adjuvant chemotherapy unless the Investigator determines that one of the 4 cytotoxic chemotherapy agents in the control arm would otherwise be offered to the subject
  -  Prior treatment with a PARP inhibitor (not including iniparib)
  -  Not a candidate for treatment with at least 1 of the treatments of protocol-specific physician's choice (ie, capecitabine, eribulin, gemcitabine, vinorelbine)
  -  Subjects who had objective disease progression while receiving platinum chemotherapy administered for locally advanced or metastatic disease; subjects who received low-dose platinum therapy administered in combination with radiation therapy are not excluded
  -  Subjects who have received platinum in the adjuvant or neoadjuvant setting are eligible; however, subjects may not have relapsed within 6 months of the last dose of prior platinum therapy
  -  Cytotoxic chemotherapy within 14 days before randomization
  -  Radiation or anti-hormonal therapy or other targeted anticancer therapy within 14 days before randomization
  -  HER2 positive breast cancer
  -  Active inflammatory breast cancer
  -  CNS metastases
  -  Exception: Adequately treated brain metastases documented by baseline CT or MRI scan that has not progressed since previous scans and that does not require corticosteroids (except prednisone ≤ 5 mg/day or equivalent) for management of CNS symptoms. A repeat CT or MRI following the identification of CNS metastases (obtained at least 2 weeks after definitive therapy) must document adequately treated brain metastases.
  -  Subjects with leptomeningeal carcinomatosis are not permitted
  -  Prior malignancy except for any of the following:
  -  Prior BRCA-associated cancer as long as there is no current evidence of the cancer
  -  Carcinoma in situ or non-melanoma skin cancer
  -  A cancer diagnosed and definitively treated ≥ 5 years before randomization with no subsequent evidence of recurrence
  -  Known to be human immunodeficiency virus positive
  -  Known active hepatitis C virus, or known active hepatitis B virus
  -  Known hypersensitivity to any of the components of talazoparib

Relevance to patient case: not relevant