Adjuvant Ribociclib With Endocrine Therapy in Hormone Receptor+/HER2- High Risk Early Breast Cancer
- Conditions
- Breast Cancer
- Interventions
- Registration Number
- NCT03078751
- Lead Sponsor
- Novartis Pharmaceuticals
- Brief Summary
This was an open label, multi-center protocol for U.S. patients enrolled in the study of ribociclib with endocrine therapy as an adjuvant treatment in patients with hormone receptor-positive, HER2-negative, high risk early breast cancer
- Detailed Description
The purpose of this study was to evaluate the preliminary safety and tolerability of ribociclib to standard adjuvant endocrine therapy (ET) in patients with hormone receptor (HR) positive, Human Epidermal Growth Factor Receptor2 (HER2) negative high risk early breast cancer (EBC).
Originally, this was a randomized, Phase III, double-blind, placebo-controlled, multi-center, international study to evaluate efficacy and safety of ribociclib with ET as an adjuvant treatment in patients with HR-positive, HER2-negative, high risk EBC.
Patients were randomized at a ratio of 1:1 to receive either ribociclib or placebo for approximately 24 months in combination with a standard adjuvant ET with ET continued for at least 60 months.
However, following a review of the ribociclib development program strategy, a decision was taken to explore a different approach by initiating a single Phase III study for simplicity of trial logistics and for the purpose of analyzing the overall population through a single clinical trial. Therefore, this study was closed to enrollment early and was amended to be an open label, multi-center Phase II study conducted in the US only. All randomized patients were unblinded; patients randomized to placebo were permanently discontinued from the study and patients randomized to ribociclib were offered the option to continue treatment with ribociclib + ET.
The study included a screening phase (28 days), a treatment phase composed of maximum of 26 cycles of ribociclib in combination with ET (approximately 24 months) or until disease recurrence, intolerable toxicity, withdrawal of consent, or discontinuation from the study treatment for any other reason, whichever was earlier, and a 30 days safety follow up from last dose of ribociclib. Ribociclib was given orally once a day on days 1 to 21 in each 28 days cycle.
Safety was assessed for each patient until 30 days after the last dose of ribociclib and included routine safety monitoring except in case of death, loss to follow up or withdrawal of consent.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 54
- Histologically confirmed unilateral primary invasive adenocarcinoma of the breast
- Estrogen receptor-positive and/or progesterone receptor-positive, HER2-negative breast cancer
- Patient is after surgical resection of the tumor where tumor was removed completely, with the final surgical specimen microscopic margins free from tumor and with available archival tumor tissue from the surgical specimen
- Patient who received adjuvant chemotherapy and have AJCC 8th edition Prognostic Stage Group III tumor; or patient who received neoadjuvant chemotherapy and have 1 or more ipsilateral axillary lymph nodes with residual tumor metastases greater than 2.0 mm in lymph node(-s) and residual tumor greater than 10.0 mm in breast tissue
- Patient has completed multi-agent adjuvant or neoadjuvant chemotherapy of ≥ 4 cycles or ≥ 12 weeks which included taxanes prior to screening
- Patient has completed adjuvant radiotherapy (if indicated) prior to screening
- Patient may already have initiated adjuvant endocrine therapy (ET) at the time of randomization, but randomization must take place within 52 weeks of date of initial histological diagnosis of breast cancer and within 12 weeks of initiating ET
- ECOG Performance Status 0 or 1
- Adequate bone marrow and organ function
- Sodium, potassium, phosphorus, magnesium and total calcium laboratory values within normal limits
- QTcF interval < 450 msec and mean resting heart rate 50-90 bpm
Key
- Prior treatment with CDK4/6 inhibitor
- Prior treatment with tamoxifen, raloxifen or aromatase inhibitors for reduction in risk (chemoprevention) of breast cancer and/or treatment for osteoporosis within last 2 years
- Prior treatment with anthracyclines at cumulative doses of 450 mg/m² or more for doxorubicin or 900 mg/m² or more for epirubicin
- Distant metastases of breast cancer beyond regional lymph nodes
- Patient has not recovered from clinical and laboratory acute toxicities of chemotherapy, radiotherapy and surgery
- Clinically significant, uncontrolled heart disease and/or cardiac repolarization abnormality, or clinically significant cardiac arrhythmias
- Uncontrolled hypertension with systolic blood pressure >160 mmHg
- Patient is currently receiving any of the prohibited substances that cannot be discontinued 7 days prior to Cycle 1 Day 1: concomitant medications, herbal supplements, and/or fruits and their juices that are known as strong inhibitors or inducers of CYP3A4/5; medications that have a narrow therapeutic window and are predominantly metabolized through CYP3A4/5; systemic corticosteroids ≤ 2 weeks prior to starting study drug, or who have not fully recovered from side effects of such treatment; concomitant medications with a known risk to prolong the QT interval and/or known to cause torsades de points that cannot be discontinued or replaced by safe alternative medication.
- Pregnant or breast-feeding (lactating) women or women who plan to become pregnant or breast-feed during the study
- Women of child-bearing potential unless they are using highly effective methods of contraception during the study treatment and for 21 days after stopping the study treatment.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Ribociclib + adjuvant endocrine therapy (ET) Adjuvant endocrine therapy Patients in this arm took Ribociclib in combination with standard adjuvant endocrine therapy. ET was one of these 4: Letrozole, Anastrozole, Exemestane, Tamoxifen (Tamoxifen no longer permitted after protocol amendment 2) Ribociclib + adjuvant endocrine therapy (ET) Ribociclib Patients in this arm took Ribociclib in combination with standard adjuvant endocrine therapy. ET was one of these 4: Letrozole, Anastrozole, Exemestane, Tamoxifen (Tamoxifen no longer permitted after protocol amendment 2) Placebo + adjuvant endocrine therapy (ET) Adjuvant endocrine therapy Patients in this arm took Placebo in combination with standard adjuvant endocrine therapy. ET was one of these 4: Letrozole, Anastrozole, Exemestane, Tamoxifen Placebo + adjuvant endocrine therapy (ET) Placebo Patients in this arm took Placebo in combination with standard adjuvant endocrine therapy. ET was one of these 4: Letrozole, Anastrozole, Exemestane, Tamoxifen
- Primary Outcome Measures
Name Time Method Number of Participants With Adverse Events and Serious Adverse Events Up to 26 months These are the number of participants who had adverse events or serious adverse events regardless of whether is was suspected to be drug-related or not
Percentage of Participants With Adverse Events and Serious Adverse Events Up to 26 months These are the percentage of participants that had adverse events or serious adverse events regardless of whether is was suspected to be drug-related or not
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (33)
Memorial Regional Hospital
🇺🇸Hollywood, Florida, United States
Northside Hospital Central Research Dept.
🇺🇸Atlanta, Georgia, United States
Tennessee Oncology, PLLC
🇺🇸Chattanooga, Tennessee, United States
Baylor Charles A. Sammons Cancer Center
🇺🇸Dallas, Texas, United States
Fairfax Northern Virginia Hem/Onc
🇺🇸Fairfax, Virginia, United States
Wenatchee Valley Hospital and Clinics
🇺🇸Wenatchee, Washington, United States
Arizona Oncology Associates PC- HAL
🇺🇸Tucson, Arizona, United States
Highlands Oncology Group
🇺🇸Fayetteville, Arkansas, United States
Florida Cancer Specialists South Region
🇺🇸Fort Myers, Florida, United States
Hematology Oncology Associates of the Treasure Coast
🇺🇸Port Saint Lucie, Florida, United States
Eastern Connecticut Hematology and Oncology Associates
🇺🇸Norwich, Connecticut, United States
Maryland Oncology Hematology P A
🇺🇸Silver Spring, Maryland, United States
Florida Cancer Specialists - North Florida Cancer Specialist N
🇺🇸Saint Petersburg, Florida, United States
Millennium Oncology
🇺🇸Houston, Texas, United States
Health Midwest Ventures Group, Inc d/b/a HCA MidAmerica Div.
🇺🇸Leawood, Kansas, United States
SCRI - Tennessee Oncology
🇺🇸Nashville, Tennessee, United States
Cancer Care Network of South Texas
🇺🇸San Antonio, Texas, United States
Rocky Mountain Cancer Centers Regulatory
🇺🇸Denver, Colorado, United States
CBCC Global Research
🇺🇸Bakersfield, California, United States
University of California - Los Angeles
🇺🇸Los Angeles, California, United States
Ventura County Hematology and Oncology
🇺🇸Oxnard, California, United States
Innovative Clinical Research Institute
🇺🇸Whittier, California, United States
TRIO - Torrance Health Association
🇺🇸Redondo Beach, California, United States
Summit Cancer Care, PC
🇺🇸Savannah, Georgia, United States
Saint Barnabas Medical Center 2nd Floor East Wing
🇺🇸Livingston, New Jersey, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Pro Health Care Associates
🇺🇸New Hyde Park, New York, United States
The Presbyterian Hospital
🇺🇸Charlotte, North Carolina, United States
The West Clinic
🇺🇸Germantown, Tennessee, United States
Texas Oncology P A Texas Oncology - Houston
🇺🇸Dallas, Texas, United States
Multicare Institute for Research and Innovation
🇺🇸Tacoma, Washington, United States
Texas Oncology PA - Tyler
🇺🇸Tyler, Texas, United States
Northwest Medical Specialties
🇺🇸Tacoma, Washington, United States