A Study of Poziotinib in Combination With T-DM1 in HER2-Positive Breast Cancer

Study Overview
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Brief Summary
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This is a Phase 1b, open-label, multicenter study to determine the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) of poziotinib when administered with standard dosing of T-DM1 (3.6 mg/kg IV on Day 1 of each 21-day cycle) in women with advanced or metastatic HER2+ breast cancer. The poziotinib dose identified in Part 1 of the study will be used in combination with standard dose of T-DM1 in Part 2 of the study to confirm the poziotinib dose and evaluate the preliminary efficacy of the combination therapy.

Detailed Description
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In Part 1, the dose of poziotinib, in combination with the standard dose of T-DM1 (3.6 mg/kg IV) on Day 1 of each cycle will be determined using a 3+3 design with up to 3 dose levels tested beginning with 8 mg/day. Poziotinib dose escalation/de-escalation for the next dose cohort will proceed based on the occurrence of dose-limiting toxicities (DLTs) during Cycle 1 of the dose cohort. Patients in the dose cohort, if not discontinued, will continue treatment until discontinuation. In Part 2 of the study, approximately 10 patients will be treated at the MTD/MAD to confirm dose for safety of the combination and to evaluate preliminary efficacy. Treatment for all patients will continue until disease progression, unacceptable toxicity, or continuation of study treatment is not in the best interest of the patient. The Screening period (Day -30 to Day -1) will last up to 30 days prior to Cycle 1, Day 1. During each 21-day cycle, eligible patients will receive poziotinib at the assigned dose, orally, once daily. T-DM1 3.6 mg/kg IV will be administered on Day 1 of each treatment cycle. All treated patients will be followed for response until disease progression or the start of new treatment and then for survival (3 year study duration).

Official Title
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A Phase 1b Study of Poziotinib in Combination With T-DM1 in Women With Advanced or Metastatic HER2-Positive Breast Cancer

Conditions
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Breast Cancer

Intervention / Treatment
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* Drug: Poziotinib
* Drug: T-DM1


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient must be female, at least 18 years of age, but not older than 90 years, with advanced or metastatic HER2+ breast cancer and a life expectancy of more than 6 months Patient must have confirmed HER2 overexpression or gene-amplified tumor via immunohistochemistry [IHC] with IHC 3+ or IHC 2+ with confirmatory fluorescence in situ hybridization [FISH]+ or [ISH]+ Patients must have had at least 1 line of anti-HER2 directed therapy either in the metastatic or early-stage disease setting Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 Exclusion Criteria: Patient has had previous treatment with poziotinib. Patient has received anticancer chemotherapy, TKIs, biologics, immunotherapy, radiotherapy, or investigational treatment within 15 days. (There is no washout for hormonal therapy for breast cancer). Patient has a life expectancy less than 3 years due to other malignancies. Patient is pregnant or breast-feeding.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Part 1: Dose Finding To determine the MTD/MAD of poziotinib in combination with the standard dose of T-DM1 by using a 3+3 design. At least 3 patients may be enrolled in each cohort before a decision is made to proceed to the next cohort. Part 2: MTD/MAD Expansion An additional 10 patients will be treated at the dose identified during Part 1 of the study to further evaluate the safety and efficacy.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Poziotinib<br>Part 1: Dose Finding The MTD/MAD of poziotinib in combination with the standard dose of T-DM1 will be determined by using a 3+3 design. At least 3 patients may be enrolled in each cohort before a decision is made to proceed to the next cohort. Part 2: MTD/MAD Expansion An additional 10 patients will be treated at the dose identified during Part 1 to further evaluate the combination at the MTD or the MAD. | Drug: Poziotinib<br>* Poziotinib is a tablet for oral administration.<br>Drug: T-DM1<br>* T-DM1 (ado-trastuzumab emtansine) is a HER2-targeted therapy for I.V. administration.<br>* Other names: ado-trastuzumab emtansine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objective Response Rate (ORR) | Evaluate the Objective Response Rate (ORR) in patients treated with daily poziotinib in combination with T-DM1 (every 3 weeks) in women with advanced or metastatic HER2 positive breast cancer. | 3 Years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease Control Rate (DCR) | Evaluate the Disease Control Rate (DCR) at 9, 18, and 27 weeks in patients treated at the MTD/MAD. | 27 weeks | 
| Progression-free Survival (PFS) | Evaluate Progression-free Survival (PFS) in patients treated with MTD/MAD. | 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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T-DM1, Poziotinib, HER2 Positive