Molecular Mechanisms of Resistance and Sensitivity to Palbociclib Re-challenge in ER+ mBC (BioPER)

An International, Non-controlled Phase II Trial to Identify the Molecular Mechanisms of Resistance and Sensitivity to Palbociclib Re-challenge Upon Progression to a Palbociclib Combination in ER-positive Metastatic Breast Cancer Patients

This is an international, open-label, non-controlled, multicenter phase II clinical trial with two different primary objectives: a biological and a clinical objective.

From a clinical point of view, the objective is to assess the clinical benefit of the combination of palbociclib and hormonotherapy in patients with advance breast cancer that had previously received endocrine therapy in combination with palbociclib and had achieved clinical benefit during palbociclib treatment with subsequent disease progression.

From a biological point of view, the challenge is to define a molecular profile that allow identifying patients that could benefit more from continuing on palbociclib after progression on a prior palbociclib-containing regimen

Study Overview

• Status: Completed
• Conditions: Metastatic Breast Cancer
• Intervention / Treatment: Drug: Palbociclib; Drug: Endocrine therapy (non IMP)

Detailed Description

Eligible patients will receive palbociclib capsules orally for 21 days every four weeks in combination with endocrine therapy (physician's choice based on prior administered agent including tamoxifen, exemestane, fulvestrant, anastrozole, or letrozole).

Patients will receive treatment until disease progression (with the exception of patients who develop isolated progression in the brain), unacceptable toxicity, death, or discontinuation from the study treatment for any other reason.

Patients discontinuing the study treatment period will enter a post-treatment follow-up period during which survival and new anti-cancer therapy information will be collected every six months (± 14 days) from the last dose of investigational product. The treatment follow-up period will conclude at six months after the last patient has received first treatment dose in the study.

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Phase 2

Contacts and Locations

Study Locations

• Italy
  • Milan, Italy
    • Istituto Europeo Di Oncologia
  • Udine, Italy
    • Azienda Sanitaria Universitaria Integrata di Udine
• Spain
  • A Coruña, Spain
    • Clinico Universitario A Coruña
  • Barcelona, Spain
    • Hospital Universitari Vall d'Hebron
  • Barcelona, Spain, 08003
    • Hospital del Mar
  • Castellón De La Plana, Spain
    • Hospital Provincial de Castellón
  • Cordoba, Spain
    • Hospital Reina Sofía
  • Madrid, Spain
    • Hospital La Paz
  • Reus, Spain
    • Hospital Sant Joan de Reus
  • Sevilla, Spain
    • Hospital Virgen del Rocío
  • Valencia, Spain
    • Hospital Clinico Universitario de Valencia
  • Valencia, Spain
    • Hospital Universitari i Politècnic La Fe
  • Valencia, Spain
    • Instituto Valenciano de Oncologia - IVO
  • Barcelona
    • Badalona, Barcelona, Spain
      • ICO Badalona
    • L'Hospitalet de Llobregat, Barcelona, Spain, 08007
      • ICO l'Hospitalet

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:

• Pre- and postmenopausal women age ≥ 18 years (Premenopausal women must be treated with LHRH analogues for at least 28 days prior to study entry)
• Hormone receptor-positive [estrogen receptor (ER) and/or progesterone receptor (PR)] and HER2-negative
• Locally advanced or mBC that had previously received no more than two prior lines of endocrine therapy and no more than one prior line of chemotherapy for advanced disease.
• Inmmediate previous treatment with palbociclib in combination with endocrine therapy had achieved clinical benefit during palbociclib-based treatment
• Evidence of measurable and biopsable metastatic disease is required
• Confirmed disease progression on immediate previous palbociclib plus endocrine therapy.
• Last dose of palbociclib administered no later than eight weeks and not earlier than three weeks from study entry.
• No prior use of at least one of the reasonable endocrine therapy options: tamoxifen, fulvestrant, letrozole/anastrozole, or exemestane.
• Patients agree to collection of blood samples (liquid biopsy) and collection of metastatic tumour sample (biopsy) at the time of inclusion and progression (if appropriate).
• Adequate organ function.
• Resolution of all acute toxic effects of prior anti-cancer therapy or surgical procedures

Exclusion criteria

• HR or HER2 unknown disease.
• HER2-positive disease based on local laboratory results [performed by immunohistochemistry/fluorescence in situ hybridization (FISH)].
• Locally advanced breast cancer candidate for a local treatment with a radical intention.
• Formal contraindication to endocrine therapy.
• Progressing central nervous system (CNS) disease.
• Patients with exclusive non-measurable/evaluable disease.
• Other malignancies within the past five years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix.
• Major surgery (defined as requiring general anaesthesia) or significant traumatic injury within four weeks of start of study drug, or patients who have not recovered from the side effects of any major surgery, or patients that may require major surgery during the course of the study.
• Patients with an active bleeding diathesis, previous history of bleeding diathesis, or anti-coagulation treatment (the use of low molecular weight heparin is allowed as soon as it is used as prophylaxis intention).
• Have a serious concomitant systemic disorder (i.e., active infection including HIV, or cardiac disease) incompatible with the study (at the discretion of investigator).
• Are unable to swallow tablets.
• History of malabsorption syndrome or other condition that would interfere with enteral absorption.
• Chronic daily treatment with corticosteroids with a dose of ≥10 mg/day methylprednisolone equivalent (excluding inhaled steroids).
• QTc >480 msec on basal assessments, personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or Torsade de Pointes (TdP).
• Uncontrolled electrolyte disorders that can compound the effects of a QTc-prolonging drug (i.e., hypocalcemia, hypokalemia, or hypomagnesemia).
• Known hypersensitivity to any palbociclib excipients.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: Palbociclib + Endocrine Therapy; Patients will receive palbociclib capsules orally for 21 days every four weeks in combination with endocrine therapy (physician's choice based on prior administered agent including tamoxifen, exemestane, fulvestrant, anastrozole, or letrozole). Treatment will continue until disease progression (with the exception of patients who develop isolated progression in the brain), unacceptable toxicity, death, or discontinuation from the study treatment for any other reason.

Drug: Palbociclib; palbociclib in combination with endocrine therapy (investigator's choice); Drug: Endocrine therapy (non IMP); Endocrine therapy (physician's choice based on prior administered agent including tamoxifen, exemestane, fulvestrant, anastrozole, or letrozole). Endocrine therapy must be different from previous treatment line.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
molecular patterns of resistance [with a special focus on retinoblastoma (Rb) status] upon progression to palbociclib plus endocrine therapy in patients who previously achieved clinical benefit with the combination	the percentage of patients with Rb loss [as defined by loss of expression, copy number variation (CNV), somatic mutation, or methylation dependent silencing]. The evaluation criteria will be the characterization of the molecular patterns of resistance with greater than 20% prevalence.	Baseline-Up to 24 months
clinical activity of the combination of palbociclib and endocrine therapy after prior progression to palbociclib in endocrine-sensitive patients.	percentage of patients that achieve clinical benefit (CBR) defined as complete response, partial response, or stable disease for at least 24 weeks per RECIST v.1.1.	Baseline-Up to 24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compare clinical activity with molecular patterns of resistance.	Patients with molecular patterns of resistance (Rb loss, biomarkers significant inhibition), mutations and expression profiles will be compared against patients without.	Baseline-Up to 24 months
Measure changes of immunostaining of Rb targets (E2F, DNMT, HIF1alpha, and SKP2) as a result of CDK4 and CDK6 inhibition and the potential predictive value of cyclin D, cyclin E, p16, p18, p21, and p27, in CDK4, and CDK6 inhibition	measure histoscore (Hscore) levels of the above targets	Baseline-Up to 24 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measure senescence and apoptosis (Ki67 and active caspase 3) in subgroups of patients with varying clinical responses.	Measure histoscore (Hscore) levels of Ki67 and active caspase 3	Baseline-Up to 24 months
Measure differences in expression profile, assessed by RNA microarrays	Differences in expression profiles, assessed by RNA microarrays.	Baseline-Up to 24 months
Correlation between inhibitory effects of palbociclib and clinical response		Baseline-Up to 24 months
Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs grade 3 and 4 and Serious Adverse Events)		Baseline-Up to 24 months
Compare inhibitory effects of palbociclib and clinical response in patients with visceral disease or patients who received prior (neo) adjuvant hormonal therapy		Baseline-Up to 24 months

Collaborators and Investigators

• Sponsor: MedSIR
• Investigators: Principal Investigator: Javier Cortes, MD PhD, Hospital Universitario Ramon y Cajal

Study record dates

Study Major Dates

• Study Start (ACTUAL): June 28, 2017
• Primary Completion (ACTUAL): October 27, 2020
• Study Completion (ACTUAL): October 27, 2020

Study Registration Dates

• First Submitted: June 6, 2017
• First Submitted That Met QC Criteria: June 8, 2017
• First Posted (ACTUAL): June 12, 2017

Study Record Updates

• Last Update Posted (ACTUAL): June 21, 2022
• Last Update Submitted That Met QC Criteria: June 14, 2022
• Last Verified: June 1, 2022

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; Protein Kinase Inhibitors; Palbociclib
• Other Study ID Numbers: MedOPP089; 2015-003892-31 (EUDRACT_NUMBER)

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No