T-DM1 and Non-pegylated Liposomal Doxorubicin in Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Metastatic Breast Cancer (THELMA)

Phase I Multicenter Clinical Trial Evaluating the Combination of Trastuzumab Emtansine (T-DM1) and Non-pegylated Liposomal Doxorubicin in HER2-positive Metastatic Breast Cancer

The primary goal is to determine the maximum tolerated dose (MTD) of the combination of T-DM1 and non-pegylated liposomal doxorubicin in metastatic breast cancer (mBC) patients previously treated with taxanes and trastuzumab-based therapy.

In addition, pharmacokinetic data on the combination of T-DM1 and liposomal doxorubicin will be obtained.

Study Overview

• Status: Completed
• Conditions: Breast Cancer
• Intervention / Treatment: Drug: Trastuzumab and non-pegylated liposomal doxorubicin

Detailed Description

Subjects: Age ≥ 18 years with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer that have relapsed or progressed on or after taxanes and trastuzumab-based therapy. Subjects must have histologic or cytologic confirmation of the HER2-positive metastatic breast cancer. Evidence of measurable or evaluable metastatic disease is required.

Primary objective:

• To determine the maximum tolerated dose (MTD) of the combination of T-DM1 and non-pegylated liposomal doxorubicin in metastatic breast cancer (mBC) patients previously treated with taxanes and trastuzumab-based therapy.

Secondary objectives:

• To determine the efficacy of the combination of T-DM1 and non-pegylated liposomal doxorubicin, defined by the overall response rate (ORR), clinical benefit rate (CBR), number of progressions and number and reasons for deaths.
• To assess the safety profile of the combination of T-DM1 and non-pegylated liposomal doxorubicin, defined by all toxicities reported during the study.
• To evaluate the cardiac safety of the combination of T-DM1 and non-pegylated liposomal doxorubicin measured by left ventricular ejection fraction (LVEF) as assessed by echocardiography, cardiac troponin I and B-type natriuretic peptide (BNP) levels.
• To evaluate the potential role of single nucleotide polymorphisms (SNP) in the predisposition for developing cardiotoxicity.
• To analyze the pharmacokinetics (PK) profile of T-DM1 and its metabolites and non-pegylated liposomal doxorubicin.

Type of study: This is a prospective dose-finding, multicenter and open-label phase I clinical trial.

Treatment: Trastuzumab emtansine (T-DM1) will be administered at a fixed dose of 3.6 mg/kg IV on Day 1 every 3 weeks and three cohorts of patients with three different dose levels of conventional non-pegylated liposomal doxorubicin (45 mg/m2, 50 mg/m2 and 60 mg/m2) IV on Day 1 in cycles of 21 days each are planned.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Phase 1

Contacts and Locations

Study Locations

• France
  • Paris, France, 75020
    • MedSIR Investigative Site
  • Paris, France, 92210
    • MedSIR Investigative Site
• Spain
  • Barcelone, Spain, 00835
    • MedSIR Investigative Site
  • Madrid, Spain, 08035
    • MedSIR Investigative Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Signed informed consent
• Patient able and willing to comply with protocol
• Cytologically or histologically confirmed carcinoma of the breast.
• Incurable locally advanced or metastatic disease who have previously received up to two previous chemotherapy regimens in this setting. Patient must have progressed or relapsed on or after taxane and trastuzumab-based therapy.
• HER2-positive disease

• At least one measurable lesion according to RECIST version 1.1; or patients with non measurable lesions could be included with these exceptions:

  o patients with only blastic bone lesions / with only pleural, peritoneal or cardiac effusion, or meningeal carcinomatosis

• ≥ 18 years of age
• Eastern Cooperative Oncology Group (ECOG) 0 or 1
• Life expectancy ≥ 3 months

• Adequate bone marrow function:

  • Hemoglobin ≥ 10 g/dl.
  • Absolute neutrophil count ≥ 1.5 x 109/L.
  • Platelets ≥ 100 x 109/L without transfusions within 21 days
  • International normalized ratio (INR) < 1.5 × the upper limit of normal (ULN).
• Adequate hepatic and renal function
• Adequate cardiovascular function with LVEF ≥ 55%
• Recovery from all reported toxicities of previous anti-cancer therapies to baseline or grade ≤ 1 (CTCAE version 4.0), except for alopecia
• For women of childbearing potential and not postmenopausal, and who have not undergone surgical sterilization with a hysterectomy and/or bilateral oophorectomy, and men with partners of childbearing potential, use of forms of contraception

Exclusion Criteria:

• Previous treatment with T-DM1 or anthracyclines
• More than two chemotherapeutic regimens for locally advanced incurable disease or metastatic disease
• Prior anti-cancer treatment with chemotherapy, immunotherapy or radiotherapy within 3 weeks (6 weeks for nitrosoureas or mitomycin-C), hormonal therapy or lapatinib within 7 days, prior trastuzumab within 21 days (7 days if weekly trastuzumab) or any other targeted therapy within the last 21 days prior to starting study treatment

• Previous radiotherapy for the treatment of unresectable, locally advanced/recurrent or mBC is not allowed if:

  • The last fraction of radiotherapy has been administered within 21 days prior to first study drug administration (except for brain irradiation; at least 28 days will be required)
  • More than 25% of marrow-bearing bone has been irradiated
• History of intolerance (including Grade 3 or 4 infusion reaction) or hypersensitivity to the active substance or to any of the excipients of T-DM1 or non-pegylated liposomal doxorubicin
• Patients with central nervous system (CNS) involvement. However, patients with metastatic CNS tumors may participate in this trial if the patient is > 4 weeks from radiotherapy completion, is clinically stable with respect to CNS tumor at the time of study entry and is not receiving steroid therapy for brain metastases
• Severe/uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit compliance with study requirements.
• Cardiopulmonary dysfunction
• Current peripheral neuropathy of Grade ≥ 3 per the NCI CTCAE, v4.0
• History of a decrease in LVEF to < 40% or symptomatic congestive heart failure (CHF) with previous trastuzumab treatment
• Prior malignancy, other than carcinoma in situ of the cervix, or non-melanoma skin cancer, unless the prior malignancy was cured ≥ 5 years before first dose of study drug with no subsequent evidence of recurrence
• Current known active infection with HIV, hepatitis B, and/or hepatitis C virus
• Women who are pregnant or breast-feeding

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Experimental arm; Trastuzumab emtansine (T-DM1) will be administered at a fixed dose of 3.6 mg/kg IV on Day 1 every 3 weeks and three cohorts of patients with three different dose levels of conventional non-pegylated liposomal doxorubicin (45 mg/m2, 50 mg/m2 and 60 mg/m2) IV

Drug: Trastuzumab and non-pegylated liposomal doxorubicin; 3 Cohorts (3+3 design): Cohort 1- Trastuzumab 3.6 mg/kg IV on Day 1 every 3 weeks and non-pegylated liposomal doxorubicin (45 mg/m2) IV Cohort 2- Trastuzumab 3.6 mg/kg IV on Day 1 every 3 weeks and non-pegylated liposomal doxorubicin (50 mg/m2) IV Cohort 3- Trastuzumab 3.6 mg/kg IV on Day 1 every 3 weeks and non-pegylated liposomal doxorubicin (60 mg/m2) IV; Other Names: T-DM1 and non-pegylated liposomal doxorubicin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hematological - Dose Limiting Toxicities	Treatment-related adverse events (AEs) of any grade reported in ≥10% of patients.	Baseline up to 6 weeks after patient entry (Cycle2Day21)
Non-Hematological - Dose Limiting Toxicities	Treatment-related AEs of any grade reported in ≥10% of patients.	Baseline up to 6 weeks after patient entry (Cycle2Day21)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Response Rate	Patients with best overall response of confirmed complete response (CR) or partial response (PR) based on local investigator's assessment according to RECIST criteria guidelines (version 1.1) for target lesions and assessed by CT or MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR	Baseline up to 24 months after patient entry
Best Overall Response	Patients with best overall response of confirmed complete response (CR) or partial response (PR) based on local investigator's assessment according to RECIST criteria guidelines (version 1.1)	Baseline up to 24 months after patient entry
Clinical Benefit Rate	Clinical benefit rate (CBR) is defined as the proportion of patients with a best overall response of complete response (CR) or partial response (PR) or stable disease (SD) lasting more than 24 weeks based on local investigator's assessment	Baseline up to 24 months after patient entry
Progression-free Survival	Patients with progression. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions, or measurable increase in a non-target lesion, or the appearance of new lesions	Baseline up to 24 months after patient entry
Grade 3/4 Adverse Events, SAEs, Deaths and Discontinuations	Patients with grade 3/4 adverse events, Serious Adverse Events (SAEs), deaths and discontinuations	Baseline up to 24 months after patient entry
Discontinuation of the Study Drugs Due to Any Cardiotoxicity	Rate of patients who discontinued treatment due to Cardiac Function or Due to Cardiac Cause	Baseline up to 24 months after patient entry
Left Ventricular Dysfunction Class IV	New York Heart Association grading of Level II cardiotoxicities characterized by dose-independent reversible myocardial damage. The classes used in this system, I to IV with I indicating less severity and higher numbers indicating greater severity.	Baseline up to 24 months after patient entry
Serum HER-2 Levels	Serum human epidermal growth factor receptor 2 (HER-2) Levels (ng/mL) - Cycle 1 Day 1 and Cycle 4 Day 1.	Baseline and after 4 cycles of treatment (Cycle4Day21)
Doxorubicinol - Concentration (Cmax)	Plasma concentration of Doxorubicinol using a validated liquid chromatography electrospray tandem mass spectrometry (LC-MS/MS) method	Baseline (Cycle1Day1) and end of Cycle 2 (C2D21)
Doxorubicinol - Area Under Curve (AUC)	Area under the plasma concentration versus time curve for the pharmacokinetic parameters for doxorubicinol by treatment dose level	Baseline (Cycle1Day1) and end of Cycle 2 (C2D21)
Doxorubicinol - Apparent Half-life (t1/2)	Apparent half-life for doxorubicinol by treatment dose level.	Baseline (Cycle1Day1) and end of Cycle 2 (C2D21)
Doxorubicinol - Tmax	Maximum concentration of drug in plasma (Tmax)	Baseline (Cycle1Day1) and end of Cycle 2 (C2D21)
Trastuzumab - Cmax	Pharmacokinetic parameters for trastuzumab	Baseline (Cycle1 Day1)
Trastuzumab - AUC	Pharmacokinetic parameters for trastuzumab	Baseline (Cycle1Day1)
Trastuzumab - Tmax	Pharmacokinetic parameters for trastuzumab	Baseline (Cycle1Day1)
DM-1 - Cmax	Pharmacokinetic parameters for emtansine (DM1) by treatment dose level	Baseline (Cycle1Day1)
DM-1 - AUC	Pharmacokinetic parameters for DM1 by treatment dose level	Baseline (Cycle1Day1)
DM-1 - Tmax	Pharmacokinetic parameters for DM1 by treatment dose level	Baseline (Cycle1Day1)

Collaborators and Investigators

• Sponsor: MedSIR
• Collaborators: Roche Pharma AG; Experior
• Investigators: Study Director: Javier Cortés, MD, Hospital Ramon y Cajal, Madrid, Spain

Study record dates

Study Major Dates

• Study Start: October 1, 2015
• Primary Completion (Actual): December 1, 2018
• Study Completion (Actual): December 1, 2018

Study Registration Dates

• First Submitted: September 17, 2015
• First Submitted That Met QC Criteria: September 25, 2015
• First Posted (Estimate): September 29, 2015

Study Record Updates

• Last Update Posted (Actual): February 23, 2022
• Last Update Submitted That Met QC Criteria: February 8, 2022
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Topoisomerase II Inhibitors; Topoisomerase Inhibitors; Antineoplastic Agents, Immunological; Antibiotics, Antineoplastic; Trastuzumab; Doxorubicin; Liposomal doxorubicin
• Other Study ID Numbers: MedOPP038; 2014-001056-28 (EudraCT Number)