- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02025192
A Study of Tucatinib (ONT-380) Combined With Capecitabine and/or Trastuzumab in Patients With HER2+ Metastatic Breast Cancer
A Phase 1b, Open-label Study to Assess the Safety and Tolerability of Tucatinib (ONT-380) Combined With Capecitabine and Trastuzumab, Alone and in Combination in HER2+ Metastatic Breast Cancer
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a study of tucatinib (ONT-380) given in combination with capecitabine alone, trastuzumab alone and with both capecitabine and trastuzumab in patients with HER2+ metastatic breast cancer.
This study will use a 3+3 dose escalation design to evaluate escalating dose levels of tucatinib (ONT-380) in each of these three combinations in order to identify the maximal tolerated dose/recommended phase 2 dose (MTD/RP2D) of tucatinib (ONT-380). The MTD/RP2D of tucatinib (ONT-380) to be used in combination with either capecitabine alone (Combination 1) or trastuzumab alone (Combination 2) will be determined prior to evaluating tucatinib (ONT-380) in combination with both capecitabine and trastuzumab (Combination 3). If Combination 1 and Combination 2 are found to be tolerable, then tucatinib (ONT-380) will be evaluated in Combination 3, using the lowest MTD/RP2D or other SMC-recommended dose of tucatinib (ONT-380) determined for either of the two drug combinations. This will be followed by enrollment of an expansion cohort of patients treated at the MTD/RP2D for Combination 3. Additional expansion cohorts for either Combination 1 (tucatinib (ONT-380) and capecitabine) or Combination 2 (tucatinib (ONT-380) and trastuzumab) may also be enrolled.
Capecitabine will be given twice per day orally at 1000 mg/m^2 on Days 1-14 of each 21-day cycle. Trastuzumab will be given as a loading dose of 8 mg/kg IV followed by 6 mg/kg once every 21 days. However, a loading dose of trastuzumab will not be given to patients who have received trastuzumab within 4 weeks of the first study dose of trastuzumab. These patients will receive trastuzumab at 6 mg/kg each cycle, including Cycle 1. Trastuzumab may also be given on a weekly basis at 2 mg/kg IV q 7 days, but only in the circumstance that trastuzumab infusion has been delayed, and weekly infusions are required to resynchronize the cycle length to 21 days, after discussion with the medical monitor. Trastuzumab infusion rates will be per institutional guidelines. Tucatinib (ONT-380) will be given twice per day orally at a dose dependent upon the dosing cohorts to which the patient is enrolled.
There will be 3-6 evaluable patients enrolled in each cohort in the dose escalation phase, unless that dose is found to be intolerable prior to completion of enrollment. At least 6 evaluable patients are to be treated at a dose level in order for an MTD/RP2D to be determined.
Provided that only seven dose cohorts are needed for dose escalation and only the expansion cohort for Combination 3 is enrolled, up to 66 evaluable patients may be enrolled. Additional patients may be enrolled if additional expansion cohorts are opened.
Study Type
Enrollment (Actual)
Phase
- Phase 1
Contacts and Locations
Study Locations
-
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Colorado
-
Aurora, Colorado, United States, 80045
- University of Colorado
-
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Oregon
-
Portland, Oregon, United States, 97213
- Providence Cancer Center
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Tennessee
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Nashville, Tennessee, United States, 37203
- Sarah Cannon Research Institute
-
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Texas
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Houston, Texas, United States, 77030
- MD Anderson Cancer Center
-
-
Washington
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Tacoma, Washington, United States, 98405
- Northwest Medical Specialties
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria
- Metastatic breast cancer, documented as HER2+ by fluorescence in situ hybridization (FISH) and/or 3+ staining by immunohistochemistry (IHC).
- Progressive disease, with a history of prior treatment with both trastuzumab and T-DM1 (unless deemed intolerant to or ineligible for T-DM1 by the investigator) for metastatic disease.
- If female and of child-bearing potential, has negative pregnancy test within 14 days prior to treatment.
- If a sexually active male or a sexually active female of child-bearing potential, agrees to use dual (two concurrent) forms of medically accepted contraception from the time of consent until 6 months after the last dose of ONT-380, capecitabine, or trastuzumab, whichever is longest.
- Must have target or non-target lesions as per Response Evaluation Criteria In Solid Tumors (RECIST) 1.1.
- All toxicity related to prior cancer therapies must have resolved to ≤ Grade 1, with the following exceptions: alopecia; neuropathy, which must have resolved to ≤ Grade 2; and congestive heart failure (CHF), which must have been ≤ Grade 1 in severity at the time of occurrence and must have resolved completely.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 at screening.
- In the opinion of the Investigator, life expectancy > 6 months.
Adequate hematologic function as defined by:
- Hemoglobin ≥ 9 g/dL
- Absolute neutrophil count (ANC) ≥ 1000 cells/μL
- Platelets ≥ 100,000/μL
Adequate hepatic function as defined by the following:
- Total bilirubin ≤ 1.5 X upper limit of normal (ULN), unless a known history of Gilbert's disease
- Transaminases (aspartate aminotransferase/serum glutamic oxaloacetic transaminase [AST/SGOT] and alanine aminotransferase/serum glutamic pyruvic transaminase [ALT/SGPT]) ≤ 2.5 X ULN (< 5 X ULN if liver metastases are present)
- International normalized ratio (INR) and activated partial thromboplastin time (aPTT) ≤ 1.5 X ULN unless on medication known to alter INR and aPTT.
- Creatinine clearance ≥ 50 mL/min.
- Left ventricular ejection fraction (LVEF) must be within institutional limits of normal as assessed by echocardiogram (ECHO) or multiple-gated acquisition scan (MUGA) documented within 4 weeks prior to first dose of study drug.
Exclusion Criteria
- Medical, social, or psychosocial factors that, in the opinion of the Investigator, could impact safety or compliance with study procedures.
- Patient is breastfeeding.
- Previous treatment with any experimental agent within 14 days or five half-lives of study treatment, whichever is greater.
- Previous treatment with trastuzumab or other antibody-based therapy within three weeks of starting study treatment or with chemotherapy or hormonal cancer therapy within two weeks of starting study treatment.
- Previous treatment with cumulative dose of doxorubicin > 360 mg/m2 or previous treatment with another anthracycline with cumulative dose equivalent to > 360 mg/m2 doxorubicin.
Previous treatment with:
- Capecitabine for metastatic disease at any time, for patients assigned to cohorts using capecitabine plus ONT-380 (Combination 1) or capecitabine plus trastuzumab plus ONT-380 (Combination 3). However, patients who have previous treatment with capecitabine for metastatic disease are eligible for enrollment into cohorts using trastuzumab plus ONT-380 (Combination 2). Patients who have received capecitabine for adjuvant or neoadjuvant treatment at least 12 months prior to starting study treatment are eligible to enroll into all cohorts (Combination 1, 2, or 3).
- Any small molecule HER2 inhibitors including (but not limited to) lapatinib, neratinib, or afatinib within the last 4 weeks prior to initiation of study therapy.
CNS disease:
- Patients with leptomeningeal disease are excluded.
- Dose escalation and expansion cohorts: Patients with symptomatic CNS metastases are excluded. Patients with treated CNS metastases or untreated asymptomatic CNS metastases not requiring immediate local therapy may be eligible. Enrollment of patients with metastases must be approved by the study medical monitor.
- Optional CNS disease expansion cohorts: Patients with untreated asymptomatic CNS metastases not requiring immediate local therapy or patients with progressive CNS disease following local therapy may be eligible with medical monitor approval.
- History of allergic reactions to compounds of similar chemical or biological composition to capecitabine (for patients assigned to Combination 1 or 3 only), trastuzumab (for patients assigned to Combination 2 or 3 only), or ONT-380, except for a history of Grade 1 or Grade 2 Infusion Related Reaction to trastuzumab, which has been successfully managed.
- Patients with uncorrectable electrolyte abnormalities.
- Known to be HIV positive. HIV testing is not required for those patients who are not known to be positive.
- Known carrier of Hepatitis B and / or Hepatitis C (whether active disease or not).
- Known liver disease, autoimmune hepatitis, or sclerosing cholangitis.
- Inability to swallow pills or any significant gastrointestinal diseases, which would preclude adequate absorption of oral medications.
- Use of a strong CYP3A4 inhibitor or inducer within three elimination half-lives of the inhibitor or inducer prior to the start of study treatment.
- Use of a strong CYP2C8 inducer or inhibitor within three elimination half-lives of the inducer or inhibitor prior to the start of study treatment. (See Appendix F).
- Radiotherapy within 14 days of first dose of ONT-380; patient must have recovered from acute effects of radiotherapy to baseline.
- Known impaired cardiac function or clinically significant cardiac disease such as ventricular arrhythmia requiring therapy, congestive heart failure, and uncontrolled hypertension (defined as systolic blood pressure > 150 mmHg and/or diastolic blood pressure > 100 mmHg on antihypertensive medications).
- Myocardial infarction or unstable angina within 6 months prior to the first dose of study drug.
- Patient with known dihydropyrimidine dehydrogenase deficiency (for patients assigned to Combination 1 or 3 only).
- Patient requiring warfarin therapy with known history of difficulty in management of maintaining INR within therapeutic range. Patients on warfarin may be included if on a stable dose with a therapeutic INR.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Tucatinib (ONT-380) in combination with capecitabine
|
Administered twice per day, orally.
Other Names:
1000mg/m^2 administered twice per day, orally in Days 1-14 of each 21-day cycle.
Other Names:
|
EXPERIMENTAL: Tucatinib (ONT-380) in combination with trastuzumab
|
Administered twice per day, orally.
Other Names:
Administered at a loading dose of 8 mg/kg IV followed by 6 mg/kg once every 21 days.
Other Names:
|
EXPERIMENTAL: Tucatinib (ONT-380) combined with capecitabine and trastuzumab
|
Administered twice per day, orally.
Other Names:
1000mg/m^2 administered twice per day, orally in Days 1-14 of each 21-day cycle.
Other Names:
Administered at a loading dose of 8 mg/kg IV followed by 6 mg/kg once every 21 days.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidence of adverse events
Time Frame: Up to approximately 4 years
|
Up to approximately 4 years
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Severity of adverse events
Time Frame: Up to approximately 4 years
|
Up to approximately 4 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of clinical lab abnormalities (hematology, chemistry, liver function tests, coagulation, urinalysis)
Time Frame: Up to approximately 4 years
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Up to approximately 4 years
|
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Severity of clinical lab abnormalities (hematology, chemistry, liver function tests, coagulation, urinalysis)
Time Frame: Up to approximately 4 years
|
Up to approximately 4 years
|
|
Frequency of dose reductions in tucatinib (ONT-380
Time Frame: Up to approximately 4 years
|
Up to approximately 4 years
|
|
Frequency of dose reductions in capecitabine
Time Frame: Up to approximately 4 years
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Up to approximately 4 years
|
|
Plasma concentrations of tucatinib (ONT-380) and metabolite
Time Frame: 26 months
|
26 months
|
|
Plasma concentrations of capecitabine and metabolites
Time Frame: 26 months
|
26 months
|
|
Objective response rate (ORR)
Time Frame: 26 months
|
Objective response (OR) will be defined as a best response of complete response (CR) or partial response (PR).
The ORR will be calculated as the proportion of patients in the Efficacy Evaluable Patient Set who achieve an objective response.
|
26 months
|
Duration of response
Time Frame: 26 months
|
26 months
|
|
Disease control rate
Time Frame: 26 months
|
Disease control will be defined as a best response of CR, PR, or stable disease (SD).
The DCR will be calculated as the proportion of patients in the Efficacy Evaluable Patient Set who achieve disease control.
|
26 months
|
Clinical benefit rate (CBR)
Time Frame: 26 months
|
Clinical benefit will be defined as a best response of CR, PR, or SD for ≥ 6 months.
The CBR will be calculated as the proportion of patients in the Efficacy Evaluable Patient Set who achieve clinical benefit.
|
26 months
|
Progression-free survival (PFS)
Time Frame: Up to 6 years
|
PFS will be defined as the time from first dose of study drug until documentation of disease progression or death from any cause
|
Up to 6 years
|
Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Skin Diseases
- Neoplasms
- Neoplasms by Site
- Breast Diseases
- Breast Neoplasms
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Antineoplastic Agents, Immunological
- Protein Kinase Inhibitors
- Trastuzumab
- Capecitabine
- Tucatinib
Other Study ID Numbers
- ONT-380-005
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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