Orteronel as Monotherapy in Patients With Metastatic Breast Cancer (MBC) That Expresses the Androgen Receptor (AR)

Phase 2

Completed

Conditions: Metastatic Breast Cancer

Interventions: Drug: Orteronel

Registration Number: NCT01990209

Lead Sponsor: SCRI Development Innovations, LLC

Brief Summary: The androgen receptor (AR) is expressed in 70-90 percent of primary breast tumors and in 75 percent of breast metastases. There is evidence to suggest that Androgen Receptor (AR) may be a target in patients with advanced breast cancer. Breast cancer patients whose tumors do not express the ER, PR or HER2 (triple negative) have very few options for treatment. Orteronel is being developed as an endocrine therapy for relevant hormone-sensitive cancers such as prostrate cancer and breast cancer. Triple-negative metastatic breast cancer patients with AR expression could potentially benefit from anti-androgen therapy like orteronel.

Detailed Description: This open-label multicenter study will be conducted in 2 stages.

* Lead-in Phase: The first 6 patients treated will be evaluated to confirm the safety and feasibility of this regimen. After all 6 patients complete at least 4 weeks of treatment, and if no prohibitive toxicities are identified, continuous study treatment will begin.

* Continuous Study Treatment: Patients will continue to be enrolled into both cohorts based on their tumor specificities with an anticipated total of 31 patients in Cohort 1 (ER-/PR-/HER2-/AR+) and an anticipated total of 55 patients in Cohort 2 (ER+ and/or PR+/AR+).

Patients will be evaluated every eight weeks for response to treatment. All patients who respond to treatment (complete response \[CR\] or partial response \[PR\]) or have stable disease (SD) will continue to receive orteronel until they develop progressive disease (PD) or unacceptable toxicity.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 71

Inclusion Criteria

Voluntary written informed consent before performance of any study-related procedure not part of normal medical care
Patients must have MBC that is measurable or evaluable as defined by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria. Patients with metastases limited to the bones are eligible.
Patients with breast tumors that are AR+ (≥10% staining by immunohisto-chemistry). Archived tumor tissue from a primary biopsy or metastatic lesion for centralized determination of AR expression is mandatory. If tissue is limited, the additional correlative testing is optional. If tissue is not available, a patient will not be eligible for enrollment into the study. Patients may enroll based on local laboratory AR assessment, but will need to submit tissue for confirmation at the central laboratory.
In addition to having AR+ tumors, patients must fit into 1 of the 2 following categories:
- Triple negative (ER-/PR-/HER2-) (Note: This group of patients must have received at least 1 and up to 3 prior chemotherapy regimens in the advanced setting.)
- ER+ and/or PR+ (Note: This group of patients must have received at least 1 and up to 3 prior hormonal therapies and at least one prior chemotherapy treatment in the advanced setting. HER2+ patients in this group must have received a minimum of 2 lines of HER2-directed therapy in the advanced setting.) This group of patients may be pre-menopausal with ovarian suppression or post-menopausal. LHRH agonists maybe used to render ovarian suppression with post-menopausal ranges of estradiol or FSH per institutional guidelines.
Female or male patients ≥18 years-of-age
Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2
Patient has recovered (to Grade ≤1) from all clinically significant toxicities related to prior antineoplastic therapies (with the exception of alopecia)
Adequate hematological function, defined as:
- Absolute neutrophil count (ANC) ≥1.25 x 109/L
- Platelets ≥75 x 109/L
- Hemoglobin ≥9 g/dL
Adequate liver function, defined as:
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 x the upper limit of normal (ULN), if no liver involvement or ≤5 x ULN with liver involvement
- Total bilirubin ≤1.5 times the upper limit of normal (ULN) (in patients with known Gilbert Syndrome, a total bilirubin ≤3.0 x ULN, with direct bilirubin ≤1.5 x ULN)
Adequate renal function, defined as:
- Creatinine ≤1.5 x ULN or creatinine clearance ≥40 mL/min as calculated by the Cockcroft-Gault method
Screening calculated LVEF of ≥50% by echocardiogram (ECHO) or multiple-gated acquisition (MUGA) scan
Ability to swallow and retain oral medication
Male patients (even those post vasectomy) who are willing to use adequate contraceptive measures or abstain from heterosexual intercourse during the entire study treatment period and for 4 months after the last dose of study drug
Female patients who are not of child-bearing potential and female patients of child-bearing potential who agree to use adequate contraceptive measures or abstain from heterosexual intercourse during the entire study treatment period and for 4 months after the last dose of study drug, who are not breastfeeding, and who have had a negative serum/urine pregnancy test ≤7 days prior to dosing
Life expectancy of ≥3 months
Willingness and ability to understand the nature of this study and to comply with the study and follow-up procedures.

Exclusion Criteria

Known hypersensitivity to orteronel or to orteronel excipients, which are listed by formulation in the Investigator Brochure
Patients receiving other treatment for breast cancer (includes standard hormonal therapy, chemotherapy, biologic therapy, immunotherapy, or radiation therapy). Patients receiving chronic bisphosphonate or denosumab therapy are eligible.
Female patients who are both lactating and breastfeeding or have a positive serum pregnancy test during the screening period.
Prior anti-androgen therapy
Use of an investigational drug ≤21 days or 5 half-lives (whichever is shorter) prior to the first dose of orteronel, or concurrent treatment. For investigational drugs for which 5 half-lives is less than 21 days, a minimum of 10 days between termination of the investigational drug and administration of orteronel is required.
Active brain metastases or leptomeningeal disease. Previously treated brain metastases are allowed provided lesions are stable for at least 3 months as documented by head CT scan or magnetic resonance imaging (MRI) of the brain. Patients must be off steroids, but anti-convulsants are allowed.
Patients with known adrenal insufficiency, or patients receiving treatment with ketoconazole, abiraterone, or aminoglutethimide.
Wide field radiotherapy (including therapeutic radioisotopes such as strontium 89) administered ≤28 days or limited field radiation for palliation ≤7 days prior to starting study drug or has not recovered from side effects of such therapy.
Major surgical procedures ≤28 days of beginning study treatment or minor surgical procedures ≤7 days. No waiting is required following port-a-cath placement.
Presence of active gastrointestinal (GI) disease or other condition that will interfere significantly with the absorption, distribution, metabolism, or excretion of oral therapy (eg, ulcerative disease, uncontrolled nausea, vomiting, diarrhea ≥ Grade 2, and malabsorption syndrome).
History of myocardial infarction, unstable symptomatic ischemic heart disease, ongoing arrhythmias > Grade 2 (National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE], Version 4.0), thromboembolic events (eg, deep vein thrombosis, pulmonary embolism, or symptomatic cerebrovascular events), or any other cardiac condition (eg, pericardial effusion restrictive cardiomyopathy) within 6 months prior to first dose of study drug. Chronic stable atrial fibrillation on stable anticoagulant therapy is allowed.
New York Heart Association (NYHA) Class III or IV heart failure
Electrocardiogram (ECG) abnormalities of Q-wave infarction, unless identified 6 or more months prior to screening or QTc Fridericia (F) interval >460 msec
Inadequately controlled hypertension (ie, systolic blood pressure [SBP] >160 mmHg or diastolic BP [DBP] >90 mmHg) at 2 separate measurements no more than 60 minutes apart during the Screening visit. Note: patients may be rescreened after adjustment of antihypertensive medications.
Known diagnosis of human immunodeficiency virus, active chronic hepatitis B, or C, life-threatening illness unrelated to cancer, or any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with participation in this study
Uncontrolled diabetes mellitus. Patients with Type II diabetes are eligible if they require only oral hypoglycemic agents and fasting blood glucose level is ≤120. Patients with Type I diabetes are eligible if their glycosylated hemoglobin (HbAlc) is ≤7.
Diagnosis or treatment for another malignancy within 2 years of enrollment, with the exception of adequately treated in-situ carcinoma of the cervix, uteri, basal or squamous cell carcinoma or non-melanomatous skin cancer
Inability or unwillingness (including psychological, familial, sociological, or geographical conditions) to comply with study and/or follow-up procedures as outlined in the protocol.
Use of a prohibited concomitant medication that cannot be safely discontinued or substituted.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Orteronel	Orteronel	The planned dose of orteronel is 300mg orally (PO) twice daily (BID), for a total daily dose of 600mg.

Primary Outcome Measures

Name	Time	Method
Response Rate (RR)	upto 36 months	Response rate (RR) will be estimated as the percentage of patients exhibiting complete response or partial response out of all evaluable cases. Complete Response is defined per RECIST as the disappearance of all target/non-target lesions and normalization of tumor markers. Partial Response is defined per RECIST as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. Complete and partial responses were confirmed at least 4 weeks after the initial response.
Disease Control Rate (DCR)	6 months	Defined as the percentage of patients who do not exhibit progression (CR+PR+SD) at 6 months among those patients who are evaluable for response by RECIST V1.1. Complete Response is defined per RECIST as the disappearance of all target/non-target lesions and normalization of tumor markers. Partial Response is defined per RECIST as At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. Stable disease is defined per RECIST as Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest (nadir) sum LD since the treatment started.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Treatment-Related Adverse Events as a Measure of Safety	weekly for 4 weeks then every 8 weeks until end of study treatment, up to 36 months.	Assessments will be made through analysis of the reported incidence of treatment-related Adverse Events as determined by the investigator and assessed by NCI CTCAE, Version 4.0.
Progression-free Survival (PFS)	Every 8 weeks during treatment then every 6 months for 2 years, annually thereafter up to 5 years.	Progression-free survival is defined as the time from the first day of treatment until the day tumor progression or date of death was documented. The response was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). Progressive Disease (PD): Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
Overall Survival (OS)	After disease progression is documented, survival was monitored every 6 months for 2 years and annually thereafter up to 5 years.	OS is defined as the time from the first treatment until the date of death due to any cause. In the absence of confirmation of death or lack of data beyond the follow-up period, the survival time was censored to the last date the participant was known to be alive.
Measurement of Serum Hormone Levels - Estradiol	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples collected At baseline, at day 1 of cycle 2 and 4, and at end of treatment visit to test for serum estradiol levels
Measurement of Serum Hormone Levels - Total Testosterone	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples were collected at baseline, on day 1 of cycles 2 and 4, and at end of treatment visit to test total testosterone levels
Measurement of Serum Hormone Levels - Free Testosterone	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples were collected At baseline, at day 1 of cycle 2 and 4, and at end of treatment visit to test free testosterone levels
Measurement of Serum Hormone Levels - Sex Hormone-binding Globulin	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples were collected at baseline, on day 1 of cycles 2 and 4, and at end of the treatment visit for sex hormone-binding globulin (SHBG) levels
Measurement of Serum Hormone Levels - Adrenocorticotropic Hormone	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples were collected at baseline, on day 1 of cycles 2 and 4, and at end of the treatment visit to test for adrenocorticotropic hormone (ACTH) levels
Measurement of Serum Hormone Levels - Dehydroepiandrosterone Sulfate (DHEA-S)	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples were collected at baseline, on day 1 of cycles 2 and 4, and at end of the treatment visit dehydroepiandrosterone sulfate (DHEA-S) levels
Measurement of Serum Hormone Levels - Cortisol	At baseline, at day 1 of cycle 2 and 4 (treatment cycle repeated every 4 weeks), and at end of treatment visit, up to 36 months	Blood samples to test for serum cortisol levels

Trial Locations

Locations (8): Hope Cancer Center
🇺🇸
Terre Haute, Indiana, United States
Cancer Research Consortium of West Michigan
🇺🇸
Grand Rapids, Michigan, United States
Northeast Georgia Medical Center
🇺🇸
Gainesville, Georgia, United States
Center for Cancer and Blood Disorders
🇺🇸
Fort Worth, Texas, United States
Cancer Centers of SW Oklahoma
🇺🇸
Lawton, Oklahoma, United States
Tennessee Oncology PLLC
🇺🇸
Nashville, Tennessee, United States
Yale School of Medicine
🇺🇸
New Haven, Connecticut, United States
Baptist Hospital East
🇺🇸
Louisville, Kentucky, United States