CLINICAL TRIAL / NCT06099769
A Study of Enzalutamide, Enzalutamide in Combination with Mifepristone, or Chemotherapy in People with Metastatic Breast Cancer
- Interventional
- Recruiting
- NCT06099769
Contact Information
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
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.
Gender
All
Age Group
18 Years and up
Accepting Healthy Volunteers
No
Inclusion Criteria:
- 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.
Exclusion Criteria:
- History of seizure or any condition that may predispose to seizure (e.g., prior
cortical stroke, significant brain trauma) at any time in the past. History of loss
of consciousness or transient ischemic attack within 12 months.
- History of brain metastases or leptomeningeal disease.
- Prior antiandrogen therapy (AR antagonist or CYP17 inhibitors).
- Other concurrent investigational anticancer agents.
- Confirmed QT interval with Fridericia correction (QTcF) > 480 msec.
- Any severe concurrent disease, infection, or comorbid condition that renders the
patient inappropriate for enrollment in the opinion of the investigator or that
interferes with the patient's ability to participate in the study requirements.
- Pregnant patients are not eligible for study.
- Women with a history of unexplained vaginal bleeding or with endometrial hyperplasia
with atypia or endometrial carcinoma are excluded from study.
- An active gastrointestinal disorder affecting absorption (e.g., gastrectomy,
uncontrolled celiac disease).
- Use of concurrent or chronic daily corticosteroid use. Topical or inhaled
corticosteroids are permitted.
- Use of concurrent medications that are strong inducers/inhibitors or substrates of
CYP3A4. Patients may be switched to alternative medications for eligibility
purposes. A list of CYP3A4 substrates, inducers, and/or inhibitors
- Hypersensitivity reaction to the active pharmaceutical ingredient or any of the
tablet components, including Labrasol, butylated hydroxyanisole, and butylated
hydroxytoluene.