Clinical trial NCT04134884: Study of ASTX727 Plus Talazoparib in Patients With Triple Negative or Hormone Resistant/HER2-negative Metastatic Breast Cancer
Official title: A Phase I Study of ASTX727 Plus Talazoparib in Patients With Triple Negative or Hormone Resistant/ Human Epidermal Growth Factor Receptor 2 (HER2)-Negative Metastatic Breast Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Metastatic Breast Cancer
Triple Negative Breast Cancer
Hormone Receptor Positive Tumor
Keywords: Breast Cancer
Phase 1
Lead sponsor: Indiana University
Sponsor class: OTHER
Collaborators: name: Pfizer
name: Astex Pharmaceuticals, Inc.
name: Van Andel Institute Stand Up to Cancer Team
First posted: 2019-10-22
Enrollment: 34
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SEQUENTIAL
Intervention model description: The dose escalation phase will begin by enrolling 3 patients to the cohort 1 dose level. Patients will be observed for 28 days or one cycle of therapy for dose limiting toxicity (DLT).

If 0 of 3 patients experience a DLT, the study will proceed to cohort 2. If 1 patient experiences a DLT, 3 additional patients will be enrolled into cohort 1. If 1 of 6 patients experience a DLT, the study will proceed to the cohort 2 dose level. If \> 2/3 or 2/6 patients in cohort 1 experience DLT, we will de-escalate to cohort -1. Identical DLT evaluation and dose escalation/de-escalation decision rules will be used in subsequent cohorts. A total of 6 patients will be treated at the highest dose level achieved to ensure that 6 patients have been treated at the proposed maximum tolerated dose before proceeding to the expansion cohorts.
Primary purpose: TREATMENT

Brief summary: This is a Phase I study to test the safety of a combination of ASTX727 with talazoparib in patients with triple negative breast cancer or hormone resistant/HER2-negative metastatic breast cancer

Detailed description: The phase I portion will use a traditional 3 + 3 design and standard definitions of DLT based on toxicity experienced during the first cycle of therapy. Patients with triple negative breast cancer (TNBC) and hormone resistant/HER2 negative (HRBC) metastatic disease will be enrolled and analyzed together during the dose escalation cohorts. Once the maximum tolerated dose is determined, we will enroll a small expansion cohort to further characterize safety and provide preliminary efficacy estimates.The expansion cohort will be limited to 14 patients; 7 with TNBC and 7 with HRBC. The dose level selected for expansion will be based on the totality of the data available including toxicity during the DLT evaluation period, toxicity during subsequent cycles, and correlative results.

Eligibility criteria: Inclusion Criteria:

1. ≥ 18 years old at the time of informed consent
2. Ability to provide written informed consent and HIPAA authorization
3. Locally recurrent (not amenable to local therapy with curative intent) or metastatic breast cancer

   1. Patients with triple negative breast cancer must have received at least one prior chemotherapy regimen for metastatic disease.
   2. Patients with hormone-positive, HER2-negative disease must have received treatment with and progressed on at least one prior endocrine therapy including a CDK4/6 inhibitor in the metastatic setting.
4. Measurable or evaluable disease based on RECIST 1.1 criteria.
5. Only subjects who have disease amenable to biopsy will be asked to consent to serial tumor biopsies. Consent for biopsy is not required for participation.

   a. NOTE: If no amendable disease is present at the time of biopsy, subjects may continue participation in the study and further study specific biopsies will not be required.
6. Eastern Cooperative Oncology Group Performance Status 0 or 1
7. Patients with treated, asymptomatic central nervous system (CNS) disease may participate if the patient is \> 4 weeks from completion of CNS therapy (radiation and/or surgery), is clinically stable at the time of study entry, and is receiving a stable or decreasing dose of corticosteroid therapy. Brain MRI or head CT is required at screening for patients with known brain metastases.
8. Adequate organ function as indicated by:

   1. Total bilirubin \</= ULN (upper limit of normal) (except in patients with documented Gilbert's disease, who must have a total bilirubin \</= 3.0 mg/dL)
   2. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \</= 3.0 x ULN (\</= 1.5-3.0 x baseline if baseline is abnormal)
   3. Calculated creatinine clearance of \>/= 60 mL/min using the Cockcroft-Gault formula
   4. Absolute neutrophil count (ANC) \>/= 1.5 K/mm3
   5. Platelets \>/= 100 K/mm3
   6. Hemoglobin (Hgb) \>/= 9.0 g/dL
9. Women of childbearing potential must have a negative pregnancy test within 14 days of protocol registration. Women are considered to have childbearing potential (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) unless they meet one of the following criteria:

   1. Has undergone a hysterectomy or bilateral oophorectomy; or
   2. Has been naturally amenorrheic for at least 24 consecutive months.
10. Women of childbearing potential and men must agree to use effective contraception throughout the study and for 7 months after the last study treatment. Note: Acceptable methods of birth control include abstinence, partner with previous vasectomy, placement of an intrauterine device (IUD), condom with spermicidal foam/gel/film/cream/suppository, diaphragm or cervical vault cap, or hormonal birth control (pills or injections).

Exclusion Criteria:

1. Prior treatment with decitabine, guadecitabine or other known DNA Methyltransferase inhibitors (DNMTis)
2. Prior treatment with talazoparib or other known PARPi (poly(ADP-ribose polymeras inhibitor)
3. Known deleterious breast cancer susceptibility gene (BRCA) mutation. Patients with BRCA variants of unknown significance (VUS) or who have not had germline genetic testing may participate.
4. Active or symptomatic CNS disease
5. Patients with HER2+ disease

   * HER2 will be considered positive if scored 3+ by immunohistochemistry (IHC) or 2+ by IHC associated with a fluorescence in situ hybridization (FISH) ratio of \> 2.0 or \> 6 total HER2 gene copies per cell.
6. Patients with active malignancy other than breast cancer. Patients with prior malignancies without recurrence after standard treatment will not be excluded
7. Chemotherapy within 3 weeks of registration
8. Radiation therapy within 2 weeks of registration
9. Hormone therapy within 2 weeks of registration
10. Patients requiring ongoing therapy with strong P-gp inhibitors

Primary outcomes:
measure: Safety of ASTX727 plus talazoparib using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v 5.0
timeFrame: through study completion i.e up to 1 year
measure: Rate of dose limiting toxicity
timeFrame: 28 days
Secondary outcomes:
measure: Overall response rate
timeFrame: through study completion (i.e. up to 1 year)
measure: Clinical benefit response for triple negative disease subjects
timeFrame: 18 weeks
measure: Clinical benefit response for hormone receptor positive/ HER2 negative subjects
timeFrame: 24 weeks
measure: Progression free survival in all enrolled subjects
timeFrame: through study completion (i.e. up to 1 year)
Other outcomes:
Locations:
city: Indianapolis
country: United States
facility: Indiana University Melvin & Bren Simon Cancer Center
state: Indiana
city: Winston-Salem
country: United States
facility: Wake Forest Baptist Comprehensive Cancer Center
state: North Carolina
Study officials:
affiliation: Indiana University
name: Kathy Miller, MD
role: PRINCIPAL_INVESTIGATOR
References: