Aromatase Inhibitor and Durvalumab in Postmenopausal Breast Cancer

NCT03874325 | Terminated Phase 2 Results DMC FDA Drug

• 2 other identifiers: MCC-19803ESR-17-13182
• Study Type: interventional
• Target: 17
• Locations: 1 country
• Sites: 1

Brief Summary

This study is to find out if an investigational drug called Durvalumab (MEDI4736) given together with a standard of care aromatase inhibitor drug can help people with breast cancer.

Conditions

Breast Cancer; Hormone Receptor Positive Tumor

Keywords

HR+

Outcome Measures

Primary Outcomes (1)

• Rate of Modified Preoperative Endocrine Prognostic Index (mPEPI) Score of 0

  Modified preoperative endocrine prognostic index (mPEPI) of 0. Total PEPI score assigned to each patient is the sum of the risk points derived from the pathological (pT) stage, lymph node (pN) stage, Ki67 level, and estrogen receptor (ER) status of the surgical specimen. A hazard ratio (HR) in the range of 1-2 receives one risk point; a HR in the 2-2.5 range, two risk points; a HR greater than 2.5, three risk points. mPEPI score of 0 indicates a tumor size of 5 cm or less, negative lymph nodes, and Ki67 (proliferation index) of less than or equal to 2.7%. Drug combination will be determined to be efficacious if 7 or more participants achieve an mPEPI of 0.

  6 months

Secondary Outcomes (2)

• Clinical Complete Response (CR)

  6 months

• Clinical Partial Response (PR)

  6 months

Study Arms (2)

Safety Run In: Durvalumab + Aromatase Inhibitor

EXPERIMENTAL

Participants will be administered 1500 mg Durvalumab intravenously every 4 weeks for 6 cycles. Participants will also take standard of care 1 mg anastrozole daily by mouth for 6 months. Letrozole 2.5 mg or exemastane 25 mg may be substituted for anastrozole if an intolerance to anastrozole is exhibited. Six participants will be enrolled in the safety run in stage. If 1 or fewer of six participants have a DLT, expansion stage will open to enrollment.

Drug: Durvalumab; Drug: Anastrozole 1mg; Drug: Letrozole 2.5mg; Drug: Exemestane 25 MG

Expansion: Durvalumab + Aromatase Inhibitor

EXPERIMENTAL

Participants will be administered 1500 mg Durvalumab intravenously every 4 weeks for 6 cycles. Participants will also take standard of care 1 mg anastrozole daily by mouth for 6 months. Letrozole 2.5 mg or exemastane 25 mg may be substituted for anastrozole if an intolerance to anastrozole is exhibited.

Drug: Durvalumab; Drug: Anastrozole 1mg; Drug: Letrozole 2.5mg; Drug: Exemestane 25 MG

Interventions

Durvalumab DRUG

1500 mg Durvalumab will be administered intravenously every 4 weeks for 6 months.

Also known as: MEDI4736

Expansion: Durvalumab + Aromatase Inhibitor; Safety Run In: Durvalumab + Aromatase Inhibitor

Anastrozole 1mg DRUG

Participants will self administer 1 mg anastrozole by mouth daily for 6 months.

Also known as: Arimidex

Expansion: Durvalumab + Aromatase Inhibitor; Safety Run In: Durvalumab + Aromatase Inhibitor

Letrozole 2.5mg DRUG

Participants intolerant to anastrozole will self administer 2.5 mg letrozole by mouth daily for 6 months. Exemestane may be substituted.

Also known as: Femara

Expansion: Durvalumab + Aromatase Inhibitor; Safety Run In: Durvalumab + Aromatase Inhibitor

Exemestane 25 MG DRUG

Participants intolerant to anastrozole will self administer 25 mg exemestane by mouth daily for 6 months. Letrozole may be substituted.

Also known as: Aromasin

Expansion: Durvalumab + Aromatase Inhibitor; Safety Run In: Durvalumab + Aromatase Inhibitor

Eligibility Criteria

• Age: 18 Years+
• Gender Eligibility Details: Female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
• Postmenopausal, defined as meeting criteria per protocol.
• Clinical T2-T4c, any N, MO by American Joint Committee on Cancer staging, 8th edition, with the goal being definitive surgery after completion of neoadjuvant therapy. Tumor is palpable and its size can be measured bidimensionally by tape, ruler or caliper technique. Largest tumor diameter over 2.0 cm.
• Pathologic confirmation of invasive breast cancer that is estrogen receptor (ER) positive as defined in the protocol.
• Invasive breast cancer is Human Epidermal Growth Factor Receptor 2 (HER2) negative as defined in the protocol protocol.
• Documentation of mammogram and ultrasound \[including ductal carcinoma in situ (DCIS) and invasive cancer\] of the diseased breast performed within 60 days prior to enrollment. Mammograms for the unaffected contralateral breast is required within 12 months prior to enrollment.
• Adequate organ and marrow function, as defined in the protocol.
• Participants must be willing to undergo a research biopsy at baseline and after one cycle of treatment and to provide tissue obtained at surgery for biomarker and correlative studies.
• Participants must be willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.
• If taking herbal or natural remedies that may have immune modulatory effects, participants must be willing to discontinue use prior to first dose of durvalumab.
• Body weight over 30 kg.

You may not qualify if:

• Participation in another clinical study with an investigational product during the last 4 weeks.
• Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow up period of an interventional study.
• Inflammatory breast cancer defined as clinically significant erythema of the breast and/or documented dermal lymphatic invasion (not direct skin invasion by tumor or peau d'orange without erythema).
• An excisional biopsy of this breast cancer. Hormone replacement therapy of any type, megestrol acetate, or raloxifene within one week prior to registration.
• Surgical axillary staging procedure prior to study entry. Note: Fine needle aspiration (FNA) or core needle biopsy of axillary node is permitted.
• Treatment for this cancer including surgery, radiation therapy, chemotherapy, biotherapy, hormonal therapy or investigational agent prior to study entry.
• Any previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab
• History of another primary malignancy except for malignancy treated with curative intent and with no known active disease ≥ 5 years or adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease or adequately treated carcinoma in situ without evidence of disease e.g., cervical cancer in situ.
• History of ipsilateral invasive breast cancer regardless of treatment or ipsilateral ductal carcinoma in situ (DCIS) treated with radiotherapy or endocrine therapy or contralateral invasive breast cancer at any time.
• Current or prior use of immunosuppressive medication within 14 days before the first dose of durvalumab, with the exceptions of intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra-articular injection); systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid; or steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication).
• Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease \[e.g., colitis or Crohn's disease\], diverticulitis \[with the exception of diverticulosis\], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc\]). Some exceptions apply.
• History of primary immunodeficiency.
• History of allogeneic organ transplant.
• Known allergy or history of hypersensitivity to durvalumab, or any excipient.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, active bleeding diatheses, , or psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the subject to give written informed consent.

Sponsors & Collaborators

• H. Lee Moffitt Cancer Center and Research Institute: lead
• AstraZeneca: collaborator

Study Sites (1)

H. Lee Moffitt Cancer Center and Research Institute

Tampa, Florida, 33612, United States

Location

MeSH Terms

Conditions

Breast Neoplasms

Interventions

durvalumab; Anastrozole; Letrozole; exemestane

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases; Skin and Connective Tissue Diseases

Intervention Hierarchy (Ancestors)

Nitriles; Organic Chemicals; Triazoles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds

Results Point of Contact

• Title: Hung Khong, MD
• Organization: Moffit Cancer Center

hung.khong@moffitt.org

813-745-3828

Study Officials

• Hung Khong, MD

  H. Lee Moffitt Cancer Center and Research Institute

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 12, 2019
• First Posted: March 14, 2019
• Study Start: April 26, 2019
• Primary Completion: November 15, 2020
• Study Completion: January 6, 2021
• Last Updated: May 31, 2022
• Results First Posted: January 11, 2022

Record last verified: 2022-05

Locations

US (1)