A Phase 3, Randomized Study to Evaluate Plinabulin Versus Pegfilgrastim in the Prevention of Severe Neutropenia in Breast Cancer Patients Receiving Myelosuppressive Chemotherapy With Docetaxel, Doxorubicin, and Cyclophosphamide (TAC) (Protective 2)
试验速览
- 阶段
- 3 期
- 状态
- 进行中（未招募）
- 入组人数
- 221
- 试验地点
- 20
- 主要终点
- Percentage of patients with Duration of Severe Neutropenia (DSN) =0
研究概览
简要总结
The primary purpose of this study is to compare the percentage of patients with Duration of Severe Neutropenia (DSN) =0 in patients treated with:
Docetaxel, doxorubicin, and cyclophosphamide (TAC) + pegfilgrastim versus Docetaxel, doxorubicin, and cyclophosphamide (TAC) + combination plinabulin/pegfilgrastim
Severe neutropenia is an absolute neutrophil count (ANC) <0.5 × 10^9/L.
Docetaxel, doxorubicin, and cyclophosphamide (TAC) will be used as the chemotherapy in this study.
详细描述
This is a multi-center randomized study, double-blind phase 3 trial. Approximately 222 patients are planned to be enrolled in Phase 3.
Docetaxel, doxorubicin, and cyclophosphamide (TAC) will be used as the chemotherapy in this study. These agents are among the most active and commonly used chemotherapeutic agents employed for treating patients with breast carcinoma. In particular, TAC chemotherapy has been used for the adjuvant treatment of HER2 negative early breast cancer patients with node positive disease as well as for node negative breast cancer patients who have a high risk of recurrence.
Plinabulin is a novel small molecule that is being developed for the mitigation of chemotherapy-induced neutropenia. Administered by IV infusion on the same day of (approximately 1 hour after) chemotherapy (TAC), plinabulin will be given in a single dose per cycle. Plinabulin is being studied to see if it is a convenient alternative to G-CSF, pegfilgrastim, for the prevention of chemotherapy-induced neutropenia.
In this trial, treatment will be double blinded, approximately 222 patients with breast cancer are expected to be enrolled. Patients are randomly assigned to one of the treatment arms, with 111 patients enrolled in each arm, with the arm designation and planned intervention as follows:
Arm 1: TAC + pegfilgrastim (6.0 mg) + placebo matching plinabulin.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Triple (Participant, Care Provider, Investigator)
盲法说明
Plinabulin is masked using a double-dummy design. Docetaxel/Doxorubicin/Cyclophasphamide administration is not masked.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Women who are at least 18 years of age at the time of signing the informed consent form.
- •In the opinion of their treating oncology investigator, are candidates for at least 4 cycles of chemotherapy with TAC (docetaxel, doxorubicin, & cyclophosphamide).
- •Patients who are candidates for adjuvant or neoadjuvant TAC will meet all of the following criteria:
- •Biopsy-proven, early stage (Stage I and II) and Stage III breast cancer, and
- •Have had no prior chemotherapy.
- •Pathological confirmation of cancer is required.
- •Eastern Cooperative Oncology Group (ECOG) performance status of 0 or
- •Have life expectancy of 3 months or more.
- •Laboratory results provided by the central laboratory within 14 days prior to study drug administration within noted ranges, per study protocol (local laboratories may be accepted on a case by case basis after discussion with the medical monitor; however in this case central laboratories must also be taken within the screening time window)
- •Prothrombin time (PT) and International Normalized Ratio (INR) ≤1.5 × ULN, activated partial thromboplastin time (PTT) ≤1.5 × ULN, based on central laboratory results.
- •Women of childbearing potential have a negative pregnancy test at screening.
排除标准
- •History of myelogenous leukemia, myelodysplastic syndrome, or sickle cell disease.
- •Use of strong CYP3A4, CYP2D6 or P-glycoprotein (P-gp) inhibitors and inducers, within 14 days of the first administration of study drug and for the duration of the study.
- •Received an investigational agent or tumor vaccine within 2 weeks before the first dose of study drug; patients must have recovered from toxicity of prior treatment and have no >Grade 1 Common Terminology Criteria for Adverse Events (CTCAE) (v4.03) treatment emergent adverse events (TEAE).
- •Receiving any concurrent anticancer therapies (including concomitant anti-HER2/neu agents such as trastuzumab [Herceptin®], trastuzumab emtansine [TDM 1, Kadcyla®], pertuzumab [Perjeta®], lapatinib [Tykerb®]).
- •Received a prior bone marrow or stem cell transplant.
- •Have a co-existing active infection or received systemic anti-infective treatment within 72 hours before the first dose of study drug.
- •Concurrent or prior radiation therapy within 4 weeks before the first dose of study drug.
- •Chronic use of filgrastim, pegfilgrastim, or any bioequivalent (biosimilar) for severe chronic neutropenia or other chronic neutropenia syndrome.
- •Presence of any serious or uncontrolled illness including, but not limited to: uncontrolled diabetes, ongoing or active infection, symptomatic congestive heart failure unstable angina pectoris, uncontrolled cardiac arrhythmia, uncontrolled arterial thrombosis, symptomatic pulmonary embolism, and psychiatric illness that would limit compliance with study requirements or any other conditions that would preclude the patient from study treatment as per the discretion of the Investigator.
- •Significant cardiovascular history:
- •Cardiac ventricular dysfunction inhibiting the patient's ability to receive 4 cycles of doxorubicin.
- •History of myocardial infarction or ischemic heart disease within 1 year (within a window of up to 18 days less than 1 year) before first study drug administration
- •Uncontrolled arrhythmia
- •History of congenital QT prolongation
- •Electrocardiogram (ECG) findings consistent with active ischemic heart disease
- •New York Heart Association Class III or IV cardiac disease;
- •Uncontrolled hypertension: blood pressure consistently >150 mm Hg systolic and > 100 mm Hg diastolic in spite of antihypertensive medication
- •History of hemorrhagic diarrhea, inflammatory bowel disease, or active uncontrolled peptic ulcer disease. (Concomitant therapy with ranitidine or its equivalent and/or omeprazole or its equivalent is acceptable). History of ileus or other significant gastrointestinal disorder known to predispose to ileus or chronic bowel hypomotility.
- •Any other active malignancy requiring active therapy.
- •Known human immunodeficiency virus (HIV) seropositivity.
- •Active Hepatitis B virus (HBV) infection which requires antiviral treatment or the patient has detectable Hepatitis B surface Antigen (HBsAg); hepatitis B surface antibody (anti-HBs) without detectable HBsAg does not exclude patients from the study. Hepatitis C infection (Hepatitis C antibody reactive) which requires treatment also excludes patients from the study.
- •Female patient who is pregnant or lactating.
- •Use of prophylactic antibiotics.
- •Unwilling or unable to comply with procedures required in this protocol.
- •History of allergy to any of the study drugs.
研究组 & 干预措施
TAC + Pegfilgrastim
Phase 3:TAC + Pegfilgrastim (6 mg)+ D5W placebo
D5W Placebo: 250 ml D5W to match the administration of plinabulin diluted in 250 ml D5W
干预措施: Pegfilgrastim (Drug)
TAC + Pegfilgrastim
Phase 3:TAC + Pegfilgrastim (6 mg)+ D5W placebo
D5W Placebo: 250 ml D5W to match the administration of plinabulin diluted in 250 ml D5W
干预措施: D5W Placebo (Other)
TAC + Pegfilgrastim
Phase 3:TAC + Pegfilgrastim (6 mg)+ D5W placebo
D5W Placebo: 250 ml D5W to match the administration of plinabulin diluted in 250 ml D5W
干预措施: Docetaxel, doxorubicin, and cyclophosphamide (TAC) (Drug)
TAC + Pegfilgrastim + Plinabulin
Phase 3: TAC+ Plinabulin (40 mg) + Pegfilgrastim (6 mg)
干预措施: Plinabulin (Drug)
TAC + Pegfilgrastim + Plinabulin
Phase 3: TAC+ Plinabulin (40 mg) + Pegfilgrastim (6 mg)
干预措施: Docetaxel, doxorubicin, and cyclophosphamide (TAC) (Drug)
结局指标
主要结局
Percentage of patients with Duration of Severe Neutropenia (DSN) =0
时间窗: Duration of Grade 4 neutropenia assessed during the first cycle (21 days)
DSN is defined as Days of Grade 4 Neutropenia (ANC less than 0.5 X 109/L)
次要结局
- Mean DSN assessment(From day 1 to day 8 in first cycle (21 days))
- Percentage of patients with relative dose intensity < 85%(Duration of all 4 cycle (21 days))
- Percentage of Patients without grade 3 and grade 4 neutropenia(Duration of first cycle (21 days))
- Mean DSN assessment within 15 days(From day 1 to day 15 in the first cycle (21 days))
- Rate of composite risks(Duration of all 4 cycle (21 days))
- Average change in bone pain(From -1 day over the observational period)
- Mean ANC nadir(Duration of first cycle (21 days))