AKT Inhibitor in Oestrogen Positive Breast Cancer (STAKT)

The Short Term Effects of an AKT Inhibitor (AZD5363) on Biomarkers of the AKT Pathway and Anti-tumour Activity in a Breast Cancer Paired Biopsy Study

To compare the effect of four and a half days treatment of a range of doses of AZD5363 on selected markers of the AKT pathway and anti-proliferation compared with placebo in oestrogen receptor positive breast cancers.

To assess the tolerability of four and a half days treatment of AZD5363.

Study Overview

• Status: Completed
• Conditions: Invasive Breast Cancer
• Intervention / Treatment: Drug: AZD5363

Detailed Description

The principal research questions to be addressed are whether (or not) AZD5363 is "hitting its therapeutic target" sufficiently and to the extent that is required to produce efficacy in pre-clinical experiments.

The primary endpoint markers have been selected to determine this.

Reductions in markers of the AKT pathway and increases in markers of anti-proliferation will characterise the degree of biological activity arising from the inhibition of AKT across a range of doses of AZD5363.

• Study Type: Interventional
• Enrollment (Actual): 48
• Phase: Phase 2

Contacts and Locations

Study Locations

• United Kingdom
  • Derbyshire
    • Derby, Derbyshire, United Kingdom, DE22 3DT
      • Royal Derby Hospital
  • Devon
    • Derriford, Plymouth, Devon, United Kingdom, PL6 8DH
      • Plymouth Hospitals NHS Trust
  • Dorset
    • Bournemouth, Dorset, United Kingdom, BH7 7DW
      • Royal Bournemouth Hospital
    • Poole, Dorset, United Kingdom, BH15 2JB
      • Poole Hospital NHS Foundation Trust
  • Leicestershire
    • Leicester, Leicestershire, United Kingdom, LE1 5WW
      • Leicester Royal Infirmary
  • Lothian
    • Edinburgh, Lothian, United Kingdom, EH4 2XU
      • Western General Hospital
  • Merseyside
    • Liverpool, Merseyside, United Kingdom, L7 8XP
      • Royal Liverpool University Hospital
  • Nottinghamshire
    • Sutton-in-Ashfield, Nottinghamshire, United Kingdom, NG17 4JL
      • Kingsmill Hospital
  • South Yorkshire
    • Sheffield, South Yorkshire, United Kingdom, S10 2SJ
      • Sheffield Cancer Research Centre
  • West Midlands
    • Birmingham, West Midlands, United Kingdom, B15 2TT
      • University Hospital Birmingahm
  • West Yorkshire
    • Leeds, West Yorkshire, United Kingdom, LS9 7TF
      • Leeds St James Institue of Oncology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Written informed consent
2. WHO performance status 0-1.
3. Able to swallow & retain oral medication.

4. Patients who fall in to either category (a) or (b):

   1. Post-menopausal patients
   2. Pre-menopausal patients who also meet at least one of the criteria (i), (ii) or (iii) below:

   i) hysterectomy or bilateral fallopian tube ligation at least 6 weeks ago plus a negative pregnancy test.

   ii) true abstinence iii) willing to have pregnancy testing and use 2 forms of contraception

5. Female patients, aged 18 years and over, with histological confirmation of ER positive invasive breast carcinoma.
6. Stage 1/2/3 or Stage 4 with primary tumour in the breast amenable to biopsies. New primary breast tumours (ipsi- or contra-lateral) despite prior endocrine treatment for an earlier primary breast tumour with at least 12 months interval between cessation of endocrine therapy and Visit 1 are eligible.
7. Scheduled to have chemotherapy based on tumour characteristics and local treatment protocols.
8. Tumours large enough to provide sufficient tissue to be taken by core-cut or tru-cut biopsy to provide tissue sections for the marker assays.

Exclusion Criteria:

1. Prior treatment for breast cancer except new primary breast tumours arising despote prior endocrine treatment for an earlier primary breas tumour with at least 12 months interval between cessation of endocrine therapy and Visit 1 (see inclusion criteria 6).
2. Known ER negative tumour.
3. Female patients with histological confirmation of ER+ve invasive breast carcinoma not scheduled to have chemotherapy
4. Exposure to potent inhibitors or inducers of CYP3A4 or CYP2D6 or substrates of CYP3A4 within 2 weeks before the first dose of study treatment (3 weeks for St Johns Wort).
5. Clinically significant abnormalities of glucose metabolism
6. Major surgery (excluding placement of vascular access) within 4 weeks before the first dose of study treatment.
7. Spinal cord compression or brain metastases.
8. Evidence of severe or uncontrolled systemic disease.

9. Any of the following cardiac criteria:

   • Mean resting corrected QT interval (QTc)>450 msec obtained from 3 consecutive ECGs; - Any clinically important abnormalities in rhythm, conduction or morphology of resting ECG
   • Any factors that increase the risk of QTc prolongation or risk of arrhythmic events.
   • Any of the following procedures or conditions in the preceding 6 months: coronary artery bypass graft, angioplasty, vascular stent, myocardial infarction, angina pectoris, congestive heart failure NYHA Grade 2.
   • Uncontrolled hypotension.
10. Absolute neutrophil count <1.5 x 10,000,000,000/L
11. Platelet count <100 x 10,000,000,000/L.
12. Haemoglobin <90 g/L
13. ALT >2.5 times ULN if no demonstrable liver metastases or >5 times ULN in the presence of liver metastases.
14. Elevated ALP is not exclusionary if due to the presence of bone metastasis and liver function is otherwise considered adequate
15. Total bilirubin >1.5 times ULN if no liver metastases or >3 times ULN in the presence of liver metastases.
16. Creatinine >1.5 times ULN concurrent with creatinine clearance <50 ml/min; confirmation of creatinine clearance is only required when creatinine is >1.5 times ULN
17. Proteinuria >3+ on dipstick analysis.
18. Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product or previous significant bowel resection that would preclude adequate absorption of AZD5363.
19. History of hypersensitivity to active or inactive excipients of AZD5363 or drugs with a similar chemical structure or class to AZD5363.
20. Current disease or condition known to interfere with absorption, distribution, metabolism or excretion of drugs.
21. Past medical history of interstitial lung disease, drug induced interstitial lung disease, radiation pneumonitis which required steroid treatment, or any evidence of clinically active interstitial lung disease.
22. Evidence of dementia, altered mental status or any psychiatric condition that would prohibit understanding or rendering of informed consent
23. Previous allogeneic bone marrow transplant.
24. Known immunodeficiency syndrome.
25. Pregnant or lactating patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: TRIPLE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: AZD5363 480mg; STAGE 1 ONLY AZD5363 480mg Twice daily dosing for 4 and 1/2 days (9 doses) Oral Capsule	Drug: AZD5363; Stage 1: AZD5363 480mg or placebo twice daily oral dosing for 4 and 1/2 days (9 doses) Stage 2: AZD5363 360mg or 240mg daily oral dosing for 4 and 1/2 days (9 doses)
PLACEBO_COMPARATOR: Placebo; STAGE 1 ONLY Twice daily dosing for 4 and 1/2 days (9 doses) Oral Capsule	Drug: AZD5363; Stage 1: AZD5363 480mg or placebo twice daily oral dosing for 4 and 1/2 days (9 doses) Stage 2: AZD5363 360mg or 240mg daily oral dosing for 4 and 1/2 days (9 doses)
EXPERIMENTAL: AZD360mg; STAGE 2 AZD5363 360mg Twice daily dosing for 4 and 1/2 days (9 doses) Oral Capsule	Drug: AZD5363; Stage 1: AZD5363 480mg or placebo twice daily oral dosing for 4 and 1/2 days (9 doses) Stage 2: AZD5363 360mg or 240mg daily oral dosing for 4 and 1/2 days (9 doses)
EXPERIMENTAL: AZD5363 240mg; STAGE 2 AZD5363 240mg Twice daily dosing for 4 and 1/2 days (9 doses) Oral Capsule	Drug: AZD5363; Stage 1: AZD5363 480mg or placebo twice daily oral dosing for 4 and 1/2 days (9 doses) Stage 2: AZD5363 360mg or 240mg daily oral dosing for 4 and 1/2 days (9 doses)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary endpoint: Pharmacodynamic biomarker analysis in tumour tissue to assess the biological effect of AZD5363 on markers of anti-proliferation and the AKT pathway	Changes in pPRAS40, pGSK3b, Ki67	Up to 42 months: Stage 1: up to 60 participants in up to 20 months. Stage 1 biomarker analysis early in Stage 2. Stage 2 proceeds where reduction in 1 of the 3 primary biomarkers. Stage 2: up to 60 participants in up to 16 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compare anti-proliferative effect on markers of the AKT pathway after 4&1/2days treatment at 3 different doses of AZD5363 vs placebo in Er +ve breast cancers	By measuring biological changes in the tumour and circulation via measurement of changes in alternative biological markers which relate to the AKT pathway: Tumour total and pAKT Tumour: cleaved caspase 3; pS6 (IHC); FOXO3a Blood (platelet-rich plasma): Total and pPRAS40; Total and pGSK3b; Total and pAKT.	Up to 42 months. Stage 1: up to 60 participants in up to 20 months. Stage 2: up to 60 participants in up to 16 months.
Compare direct effect on markers of the AKT pathway after 4&1/2days treatment at 3 different doses of AZD5363 vs placebo in Er +ve breast cancers	By measuring biological changes in the tumour and circulation via measurement of changes in alternative biological markers which relate to the AKT pathway: Tumour total and pAKT Tumour: cleaved caspase 3; pS6 (IHC); FOXO3a Blood (platelet-rich plasma): Total and pPRAS40; Total and pGSK3b; Total and pAKT.	Up to 42 months. Stage 1: up to 60 participants in up to 20 months. Stage 2: up to 60 participants in up to 16 months.
To measure tolerability and toxicity following short term (four and a half days) exposure to AZD5363	Tolerability and toxicity will be measured following short term exposure to AZD5363 by incidence and severity of adverse events. Participants will be monitored for adverse events during the study and for at least 30 days after the end of treatment. Analysis of toxicity following the completion of Stage 1, taking into consideration that Stage 2 will use lower doses of AZD5363, and at the end of Stage 2.	Up to 42 months. Stage 1: up to 60 participants in up to 20 months. Stage 2: up to 60 participants in up to 16 months.

Collaborators and Investigators

• Sponsor: University of Nottingham
• Collaborators: AstraZeneca; Cancer Research UK; National Cancer Research Network
• Investigators: Study Chair: John FR Robertson, MD, University of Nottingham

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (ACTUAL): February 21, 2017
• Study Completion (ACTUAL): February 21, 2017

Study Registration Dates

• First Submitted: January 16, 2014
• First Submitted That Met QC Criteria: February 28, 2014
• First Posted (ESTIMATE): March 4, 2014

Study Record Updates

• Last Update Posted (ACTUAL): May 4, 2017
• Last Update Submitted That Met QC Criteria: May 3, 2017
• Last Verified: May 1, 2017

More Information

Terms related to this study

• Keywords: Breast cancer; AZD5363; ER positive; AKT inhibitor; post menopausal; Anti-tumour activity; Oestrogen positive; chemotherapy required; no prior cancer treatment
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms
• Other Study ID Numbers: 12076

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO