Palbociclib and FES PET

Early Identification of Patients Who Benefit From Palbociclib in Addition to Letrozole

The purpose is to evaluate whether non invasive in vivo imaging of the estrogen receptor (ER) presence in metastatic breast cancer patient by means of 18F-fluoro-estradiol (FES) positron emission tomography (PET) can be used to predict treatment response to palbociclib plus letrozole. As ER expression predicts response to palbociclib in metastatic breast cancer patients the investigators hypothesize that lesions with low uptake on FES-PET will not respond to the combination of letrozole plus palbociclib.

Study Overview

• Status: Completed
• Conditions: Breast Cancer
• Intervention / Treatment: Drug: Palbociclib; Device: FES PET; Drug: Letrozole

Detailed Description

To evaluate in a feasibility study whether low uptake on FES-PET at baseline is related to non response to letrozole plus palbociclib treatment. The investigators will perform this feasibility study in 15 patients with metastatic breast cancer, eligible for letrozole and palbociclib therapy.

All patients will be treated with letrozole 2.5mg daily continuously throughout a 28-day cycle. This is combined with palbociclib 125 mg daily for 21 consecutive days followed by 7 days off treatment. At baseline all patients will have a FES PET scan. Currently the combination with palbociclib and letrozole has been approved by the FDA as initial endocrine-based therapy for postmenopausal women with ER positive HER2 negative advanced breast cancer. This is based on improved progression free survival with 10 months compared to endocrine therapy alone in both first and second line hormonal treatment for ER-positive metastatic breast cancer. In Europe, approval is expected late 2016. Therefore, in this study, all patients will receive a (presumably effective) treatment combination, that patients do not have standard access to in the Netherlands yet. In addition to the standard control visits to the clinic, two extra visits will be performed as part of the study: for screening and for the FES-PET scan. In the future, this study may potentially contribute to improved selection of patients for this combination treatment. This is of relevance in view of optimal treatment for individual patients, avoiding unnecessary toxicity and financial burden.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Phase 2

Contacts and Locations

Study Locations

• Netherlands
  • Groningen, Netherlands, 9713 GZ
    • University Medical Center Groningen

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:

In order to be eligible to participate in this study, a subject must meet all of the following criteria:

1. Patients with ER positive (i.e. >1% staining), HER2 negative metastatic breast cancer (preferably assessment on fresh metastasis biopsy, alternatively archival metastasis biopsy)

2. Post-menopausal status defined as:

   • Age ≥60 years
   • Previous bilateral oophorectomy
   • Age <60 years and amenorrhea for >12 months in the absence of interfering hormonal therapies (such as LH-RH agonists and ER-antagonists
   • Age <60 years using ER antagonists should have amenorrhea for >12 months and FSH >24U/L and LH>14U/L

3. Adequate bone marrow and organ function defined as follows:

   • Absolute neutrophil count > 1.5 x 109/L
   • Platelet count >100 x 109/L
   • White blood cell count >3 x 109/L
   • AST and ALT <3.0 x upper limit of normal (ULN) or <5 xULN in case of known liver metastases.
   • Alkaline phosphatase <2.5 x ULN
   • Total serum bilirubin < ULN or total bilirubin <3.0 x ULN with direct bilirubin within normal range in patients with Gilbert's Syndrome
   • Creatinine clearance >50mL/min
   • Lipase/amylase <1/5 x ULN
   • Prothrombin time, partial thromboplastin time and INR <1.5 x ULN
4. ECOG performance 0-2
5. Signed written informed consent
6. Able to comply with the protocol
7. Age ≥18 years

Exclusion Criteria:

A potential subject who meets any of the following criteria will be excluded from participation in this study:

1. Life expectancy < 3 months
2. Evidence of central nervous system metastases
3. Presence of life-threatening visceral metastases
4. Prior use of CDK4/6 inhibitor
5. Use of estrogen receptor ligands including estrogens, fulvestrant or tamoxifen <6 weeks before study entry.
6. Use of other anticancer therapy < 2 weeks prior to start with palbociclib
7. Concurrent malignancy
8. Active cardiac disease or a history of cardiac dysfunction
9. Patient is currently receiving any of the following medications and cannot be discontinued 7 days prior to the start of treatment that are known strong inducers or inhibitors of CYP3A4/5, known risk to prolong the QT interval or induce Torsades de Pointes, or narrow therapeutic window and are predominantly metabolized through CYP3A4/5.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Palbociclib and FES PET; To evaluate whether low uptake on FES-PET at baseline is related to non-response to letrozole plus palbociclib treatment.	Drug: Palbociclib; all patients will be treated with palbociclib, on a 3 weeks on, 1 week off cycle until progression; Device: FES PET; all patients will have a FES PET at baseline; Drug: Letrozole; all patients will be treated with Letrozole daily until progression

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The relation between low uptake on FES-PET to response per lesion	8 weeks after start of treatment

Secondary Outcome Measures

Outcome Measure	Time Frame
quantitative FES-uptake and correlation with progression free survival	6 months
analysis of circulating tumor DNA and correlation with FES-PET results and progression free survival	6 months

Collaborators and Investigators

• Sponsor: University Medical Center Groningen
• Investigators: Principal Investigator: C. P. Schröder, MD, PhD, University Medical Center Groningen

Publications and helpful links

General Publications

• Boers J, Venema CM, de Vries EFJ, Glaudemans AWJM, Kwee TC, Schuuring E, Martens JWM, Elias SG, Hospers GAP, Schroder CP. Molecular imaging to identify patients with metastatic breast cancer who benefit from endocrine treatment combined with cyclin-dependent kinase inhibition. Eur J Cancer. 2020 Feb;126:11-20. doi: 10.1016/j.ejca.2019.10.024. Epub 2019 Dec 28.

Study record dates

Study Major Dates

• Study Start (Actual): September 16, 2016
• Primary Completion (Actual): September 28, 2022
• Study Completion (Actual): September 28, 2022

Study Registration Dates

• First Submitted: May 17, 2016
• First Submitted That Met QC Criteria: June 17, 2016
• First Posted (Estimate): June 20, 2016

Study Record Updates

• Last Update Posted (Actual): October 12, 2022
• Last Update Submitted That Met QC Criteria: October 11, 2022
• Last Verified: October 1, 2022

More Information

Terms related to this study

• Keywords: Palbociclib; FES PET
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Hormones, Hormone Substitutes, and Hormone Antagonists; Protein Kinase Inhibitors; Hormone Antagonists; Aromatase Inhibitors; Steroid Synthesis Inhibitors; Estrogen Antagonists; Letrozole; Palbociclib
• Other Study ID Numbers: 201600066

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED