A RANDOMIZED, PHASE II STUDY OF ENZALUTAMIDE, ENZALUTAMIDE WITH MIFEPRISTONE, and TREATMENT OF PHYSICIAN'S CHOICE IN PATIENTS WITH AR+ METASTATIC TRIPLE-NEGATIVE OR ER-LOW BREAST CANCER

Status: Recruiting
Location: See all (12) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

The researchers are doing this study to find out if the study drug, enzalutamide, alone or combined with the study drug, mifepristone, is effective in treating advanced or metastatic androgen receptor-positive (AR+) triple negative breast cancer (TNBC) or estrogen receptor-low breast cancer (ER-low BC), and whether these study treatments work as well as standard chemotherapy with carboplatin, paclitaxel, capecitabine, or eribulin.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

∙ Screening Cohort (non-MSK patients only):

• Age ≥18 years at time of consent

• signed the pre-screening informed consent document to allow for AR testing as part of study screening

∙ Treatment Cohort:

• Female or male

• Pathologically confirmed invasive breast cancer that is unresectable, locally advanced, or metastatic

• TNBC (ER/PgR \<1%) or ER-low defined as:

‣ ER and PgR 1-10%

⁃ HER2 negative per American Society of Clinical Oncology/College of American Pathologists guidelines

⁃ Local testing for ER/PgR and HER2 is acceptable for eligibility.

• Tumor must be AR positive. AR is considered positive by IHC if ≥10% of cell nuclei are immunoreactive.

• °AR testing performed locally must use protocol specified methodology to be acceptable for eligibility. Central testing is an option for those unable to perform local testing per this methodology. Please refer to the Section entitled Treatment Plan for AR testing methodology or refer to the laboratory manual.

• Evaluable or measurable disease per RECIST version 1.1; subjects with no evaluable AND no measurable disease (e.g., malignant effusions or bone marrow as the only manifestations of disease) are not eligible for enrollment.

• Eligible for one of the chemotherapy options listed as TPC (eribulin, capecitabine, paclitaxel, or carboplatin), as per investigator assessment.

• A representative, formalin-fixed, paraffin-embedded tumor specimen that enables the diagnosis of breast cancer, with adequate viable tumor cells in a tissue block (preferred) or 15 freshly cut unstained slides and 1 H\&E slide. Tissue from a metastatic site is preferred.

∙ If not available, tissue from the primary site may be obtained.

• Patients may have received up to 2 prior lines of chemotherapy for metastatic breast cancer.

‣ Patients with ER-low breast cancer may receive any number of lines of endocrine therapy +/- targeted therapy (i.e., CDK4/6 inhibitors, PI3K inhibitors).

⁃ Patients with PD-L1 positive breast cancer (CPS ≥ 10) should have received prior treatment with pembrolizumab in combination with chemotherapy in the first line setting unless there is a contraindication to checkpoint inhibitor therapy.

• Patients may receive bisphosphonate or denosumab.

• ECOG performance status 0-2.

• Age ≥18 years.

• Able to understand and the willingness to provide informed consent.

• Patients must not have another active malignancy that requires treatment.

• Women of child-bearing potential and men must agree to use 2 forms of adequate contraception (i.e., barrier contraception, abstinence, intrauterine device, or sterilization method) during study period and for 7 months following treatment end. Women must not breast feed while on study and for at least 3 months after final drug administration.

• Ability to swallow intact enzalutamide and mifepristone.

• Patient must be recovered from any recent major surgery. Radiation must have completed 14 days prior to study start. If treated in the second-line setting, the last chemotherapy or investigational anticancer therapy dose must be at least 14 days prior.

• Adequate organ and marrow function, as defined below:

‣ ANC ≥1000, hemoglobin ≥9 g/dL, platelets ≥100,000

⁃ Total bilirubin ≤1.5x upper limit of normal (ULN), except for patients with known Gilbert syndrome; AST/ALT ≤3x ULN (≤5x ULN if liver metastases); creatinine ≤ 1.5x ULN.

⁃ Cortisol within normal limits

• Patients must agree to research biopsy at study entry until 40 patients randomized to Arm A and 40 patients randomized to Arm B and 20 patients randomized to Arm C have been biopsied.

‣ Biopsy requirement may be waived in consultation with the study PI (Drs. Traina or Nanda) if not medically feasible.

Locations
United States
Alabama
University of Alabama at Birmingham
RECRUITING
Birmingham
California
University of California San Francisco (Data collection only)
RECRUITING
San Francisco
Illinois
University of Chicago Medical Center
RECRUITING
Chicago
Massachusetts
Dana Farber Cancer Institute (Data Collection Only)
RECRUITING
Boston
North Carolina
University of North Carolina
RECRUITING
Chapel Hill
New Jersey
Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities)
RECRUITING
Basking Ridge
Memorial Sloan Kettering Monmouth (Limited Protocol Activities)
RECRUITING
Middletown
Memorial Sloan Kettering Bergen (Limited Protocol Activities)
RECRUITING
Montvale
New York
Memorial Sloan Kettering Suffolk - Commack (Limited Protocol Activities)
RECRUITING
Commack
Memorial Sloan Kettering Westchester (All Protocol Activities)
RECRUITING
Harrison
Memorial Sloan Kettering Cancer Center (All Protocol Activities)
RECRUITING
New York
Memorial Sloan Kettering Nassau (Limited Protocol Activities)
RECRUITING
Uniondale
Contact Information
Primary
Tiffany Traina, MD
trainat@mskcc.org
646-888-4558
Backup
Ayca Gucalp, MD
646-888-4536
Time Frame
Start Date: 2023-10-18
Estimated Completion Date: 2027-10
Participants
Target number of participants: 201
Treatments
Experimental: Enzalutamide
Enzalutamide 160 mg/day, continuous daily dosing in a 21-day cycle
Experimental: Enzalutamide with Mifepristone
Enzalutamide 120mg/day and mifepristone 300mg/day, continuous daily dosing in a 21-day cycle
Active_comparator: Chemotherapy:Carboplatin, Paclitaxel, Eribulin or Capecitabine (TPC)
The treating physician must select from one of the following regimens.~* Eribulin 1.4 mg/m2 IV Day 1 and Day 8 in a 21-day cycle~* Capecitabine 1000-1250 mg/m2 twice daily, orally Day 1-14 in a 21-day cycle~* Paclitaxel 80 mg/m2 IV Day 1, Day 8 in a 21-day cycle~* Carboplatin AUC 6 IV Day 1 in a 21-day cycle~* Carboplatin AUC 2 IV Day 1, Day 8 and Day 15 in a 21-day cycle~Patients randomized to TPC may be offered crossover to enzalutamide plus mifepristone treatment at the time of disease progression if they continue to meet eligibility criteria.
Related Therapeutic Areas
Sponsors
Collaborators: Breast Cancer Research Foundation, Corcept Therapeutics, Astellas Pharma US, Inc.
Leads: Memorial Sloan Kettering Cancer Center

This content was sourced from clinicaltrials.gov

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