Exemestane With or Without Entinostat in Treating Patients With Recurrent Hormone Receptor-Positive Breast Cancer That is Locally Advanced or Metastatic
Condition: Anatomic Stage III Breast Cancer AJCC v8; Anatomic Stage IV Breast Cancer AJCC v8; Breast Adenocarcinoma; HER2/Neu Negative; Locally Advanced Breast Carcinoma; Metastatic Breast Carcinoma; Recurrent Breast Carcinoma
MeSH terms: Carcinoma; Breast Neoplasms
Intervention: Biospecimen Collection; Computed Tomography; Entinostat; Exemestane; Goserelin; Goserelin Acetate; Magnetic Resonance Imaging; Placebo Administration; Quality-of-Life Assessment
Intervention description: Undergo collection of blood and archived tissue samples; Undergo CT; Given PO; Given PO; Given PO; Given SC; Undergo MRI; Given PO; Ancillary studies
Intervention MeSH terms: Exemestane; Goserelin; Entinostat; Histone Deacetylase Inhibitors
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 608.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This randomized phase III trial studies exemestane and entinostat to see how well they work
      compared to exemestane alone in treating patients with hormone receptor-positive breast
      cancer that has spread to nearby tissue or lymph nodes (locally advanced) or another place in
      the body (metastatic). Estrogen can cause the growth of breast cancer cells. Endocrine
      therapy using exemestane may fight breast cancer by lowering the amount of estrogen the body
      makes. Entinostat may stop the growth of tumor cells by blocking some of the enzymes needed
      for cell growth. It is not yet known whether exemestane is more effective with or without
      entinostat in treating breast cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Estrogen receptor (ER) and/or progesterone receptor (PR) positive histologically
             confirmed adenocarcinoma of the breast with staining of >= 1% cells will be considered
             positive; receptor status may be based on any time during treatment prior to study
             randomization, and from any site (i.e. primary, recurrent, or metastatic)

          -  Patients whose tumors have HER2 immunohistochemistry (IHC) 3+, in situ hybridization
             (ISH) >= 2.0, or average HER2 copy number >= 6.0 signals per cell are not eligible;
             receptor status may be based on any time during treatment prior to study
             randomization, and from any site (i.e. primary, recurrent, or metastatic)

          -  Patients must have measurable or non-measurable stage III/locally advanced or
             metastatic carcinoma of the breast where local therapy with curative intent is not
             possible; lesions must be evaluated =< 4 weeks prior to study randomization;
             diagnostic-quality computed tomography (CT) scans with both oral and intravenous (IV)
             contrast are the expected radiologic method, unless an alternative is approved

               -  NOTE: Where baseline imaging has already been performed =< 6 weeks prior to study
                  randomization, repeat imaging may not be required

               -  NOTE: As of October 16, 2016, accrual of new patients having non-measurable
                  disease has stopped; the planned accrual for this target population has been
                  reached

          -  Pre/peri- and postmenopausal women and all men are eligible for this trial;
             postmenopausal is defined as:

               -  Age >= 55 years and one year or more of amenorrhea

               -  Age < 55 years and one year or more of amenorrhea, with estradiol < 20 pg/ml

               -  Age < 55 with prior hysterectomy but intact ovaries, with estradiol < 20 pg/ml

               -  Prior bilateral oophorectomy

                    -  NOTE: Women who do not fit the criteria for being postmenopausal as above
                       are deemed pre-or peri-menopausal; pre/perimenopausal women and all men can
                       enroll provided they agree to receive concomitant luteinizing
                       hormone-releasing hormone (LHRH) agonist; pre/perimenopausal women must have
                       commenced treatment with LHRH agonist at least 4 weeks prior to
                       randomization; if patients have received alternative LHRH agonist prior to
                       study entry, they must switch to goserelin for the duration of the trial

          -  Sexually active males and pre/perimenopausal women must agree to use an accepted and
             effective method of contraception or to abstain from sexual intercourse for the
             duration of their participation in the study and for 3 months after discontinuation of
             therapy

          -  Women must not be pregnant or breast-feeding; all females of childbearing potential
             must have a blood test or urine study =< 2 weeks prior to randomization

               -  A female of childbearing potential is any woman, regardless of sexual orientation
                  or whether they have undergone tubal ligation, who meets the following criteria:
                  1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been
                  naturally postmenopausal for at least 24 consecutive months (i.e., has had menses
                  at any time in the preceding 24 consecutive months)

          -  Patients must not have known central nervous system metastasis or a history of central
             nervous system (CNS) metastases; patients with leptomeningeal disease are not eligible

          -  Patients must be disease-free of prior invasive malignancies for > 5 years with the
             exception of curatively-treated basal cell or squamous cell carcinoma of the skin or
             carcinoma in situ of the cervix

               -  NOTE: If there is a history of prior malignancy, patients must not be receiving
                  other specific treatment for that cancer

          -  Patients must meet at least one of the following criteria:

               -  Disease progression any time after non-steroidal AI use in the advanced disease
                  setting

               -  Relapse while on or within =< 12 months of end of adjuvant non-steroidal AI
                  therapy with or without prior endocrine therapy for advanced disease

               -  NOTE: In either setting, treatment with any prior endocrine therapy must be
                  completed >= 2 weeks prior to cycle 1 day 1 (C1D1) of study treatment with the
                  exception of exemestane which is permitted in the advanced disease setting within
                  =< 4 weeks immediately prior to C1D1; prior adjuvant exemestane is allowed if the
                  disease free interval is > 12 months from the discontinuation of exemestane;
                  prior faslodex, everolimus, palbociclib or other cyclin-dependent kinase (CDK)
                  inhibitor (e.g. ribociclib, abemaciclib) use are allowed and must have been
                  completed >= 2 weeks prior to C1D1; failure to adhere to this washout guideline
                  will result in a protocol violation

          -  Patients may have received only one prior chemotherapy regimen for metastatic disease
             provided treatment was completed >= 3 weeks prior to randomization

          -  Patients may be treated with bone modifying agents such as bisphosphonates or
             RANK-ligand agents (e.g. denosumab) per American Society of Clinical Oncology (ASCO)
             guidelines; whenever possible, patients requiring bone modifying agents should start
             treatment >= 7 days prior to study therapy and should continue the same agent
             throughout study unless clinically compelled to change

          -  Prior radiotherapy must in general have been completed >= 2 weeks prior to
             randomization and patients must have recovered from the toxicity of the radiation

               -  NOTE: Patients may receive concurrent radiation therapy to painful sites of bony
                  disease or areas of impending fracture as long as sites of measurable or
                  non-measurable disease outside the radiation therapy port are available to follow

          -  Patients must NOT receive concurrent anti-cancer therapy or investigational agent
             unless specified in protocol

          -  Patients must NOT be receiving valproic acid, an histone deacetylase (HDAC) inhibitor,
             and may not have previously received any HDAC inhibitor prior to enrollment (e.g.
             valproic acid, entinostat, vorinostat) unless discussed with the study chair; patients
             must not have received prior HDAC therapy for the treatment of their malignancy

          -  Patients must have no known allergies to exemestane, entinostat, or medications that
             have a benzamide structure (e.g., tiapride, remoxipride, clebropride)

          -  Patients must NOT suffer from medical or psychiatric conditions that would interfere
             with protocol compliance, the ability to provide informed consent, or assessment of
             response or anticipated toxicities; this includes uncontrolled intercurrent illness
             including, but not limited to ongoing or active infection

          -  Patients must have recovered from all clinically relevant adverse events to grade 1 or
             baseline due to previous agents administered (except alopecia)

          -  Patients must have adequate hematologic, liver and renal function =< 28 days prior to
             randomization

               -  NOTE: It is preferred that laboratory values for eligibility be assessed after
                  the last dose of prior treatment, especially in cases where most-recent treatment
                  prior to study entry is chemotherapy

          -  Hemoglobin (HgB) >= 9.0 g/dL (=< 28 days prior to randomization)

          -  Platelet count >= 100,000/mcL (=< 28 days prior to randomization)

          -  Absolute neutrophil count >= 1,500/mcL (=< 28 days prior to randomization)

          -  Creatinine =< 2.0 mg/dL (=< 28 days prior to randomization)

          -  Total bilirubin < 1.5 x institutional upper limit of normal (=< 3 mg/dL in case of
             Gilbert's syndrome) (=< 28 days prior to randomization)

          -  Transaminases (alanine aminotransferase [ALT], aspartate aminotransferase [AST]) =<
             2.5 x institutional upper limit normal (=< 28 days prior to randomization)

          -  Known human immunodeficiency virus (HIV)-positive patients should have a cluster of
             differentiation (CD)4 count > 250/mm^3

          -  Patients must have Eastern Cooperative Oncology Group (ECOG) performance status 0-1

          -  Patients must have a life expectancy >= 12 weeks

          -  Patients must be able to swallow tablets