A Phase 1/2 interventional study of Biomarker Analysis and Enzalutamide in Estrogen Receptor Negative, Estrogen Receptor Positive and HER2/Neu Negative, sponsored by Vanderbilt-Ingram Cancer Center. Terminated at 12 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-08-22.
Sponsored by Vanderbilt-Ingram Cancer Center · Phase 1/2, Interventional, and Treatment
This partially randomized phase Ib/II trial studies the side effects and best dose of taselisib when given together with enzalutamide and to see how well they work in treating patients with androgen receptor positive triple-negative breast cancer that has spread to other places in the body. Taselisib is a PI3K inhibitor. The PI3K pathway is involved is cancer growth. Androgen may cause the growth of tumor cells. Enzalutamide may stop the growth of tumor cells by blocking the androgen receptor from working. Giving taselisib with enzalutamide may be a better treatment for patients with breast cancer.
PRIMARY OBJECTIVES:
I. To determine the safety and tolerability of taselisib given in combination with enzalutamide: Assessment of dose limiting toxicities (DLTs) during the first 4 weeks of treatment (cycle 1). (Phase Ib) II. To determine the safety and tolerability of taselisib given in combination with enzalutamide: Determination of the maximally tolerated dose (MTD) of taselisib given in combination with enzalutamide. (Phase Ib) III. To evaluate the efficacy, as measured by clinical benefit rate (CBR), of enzalutamide + taselisib in patients with androgen receptor positive (AR+) triple negative (TN) metastatic breast cancer (MBC). (Phase II)
SECONDARY OBJECTIVES:
I. To determine the progression free survival (PFS) of enzalutamide + taselisib in patients with AR+ TN MBC.
II. To assess the pharmacokinetics (PKs) of taselisib and enzalutamide in patients with AR+ TN MBC.
TERTIARY OBJECTIVES:
I. To explore predictors of biomarker response and mechanisms of resistance based on exploratory analysis of tumor tissue obtained through biopsies.
II. Levels of phosphatase and tensin homolog (PTEN) expression by immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qPCR).
III. Presence of mutations in the phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) gene.
IV. Human epidermal growth factor receptor 2 (HER2) (IHC, fluorescence in situ hybridization [FISH]) and estrogen receptor (ER)/progesterone receptor (PR) levels (IHC) in tumor biopsy from a metastatic site.
V. Levels of mitogen-activated protein kinase kinase (MEK) activity measured by phosphorylated extracellular-signal-regulated kinases (p-ERK1/2) (IHC) and phosphorylated p-ribosomal protein S6 (S6) (S235/236 and S240/244) at baseline and upon progression of disease.
VI. Levels of phosphorylated v-akt murine thymoma viral oncogene homolog 1 (p-AKT) (IHC) at baseline and upon progression of disease.
VII. Gene expression profiling to assign a triple negative subtype. VIII. Whole exome deoxyribonucleic acid (DNA)-sequencing (seq) on DNA isolated at baseline and upon progression.
IX. Plasma for circulating tumor DNA (ctDNA) analysis to assess PIK3CA mutation status in response and resistance.
X. To assess the predictive effects of PIK3CA mutations and PTEN loss on PFS and CBR.
XI. To evaluate the ability of multi-parametric magnetic resonance imaging (MRI) performed early in therapy to predict both biological and clinical response.
OUTLINE: This is a phase Ib, dose-escalation study of taselisib followed by a randomized phase II study.
PHASE IB: Patients receive taselisib orally (PO) once daily (QD) on days 1-28 and enzalutamide PO QD on days 9-28 of course 1 and days 1-28 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
PHASE II: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive taselisib PO QD and enzalutamide as in Phase Ib. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients experiencing unacceptable toxicity due to enzalutamide may continue to receive taselisib.
ARM II: Patients receive enzalutamide PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Upon disease progression, patients may crossover to Arm I.
After completion of study treatment, patients are followed up for 30 days and then every 3 months for 3 years.
12,543 studies on the registry are indexed under Breast Neoplasms; 2,892 are open to participants now.
This study's enrollment of 30 is below the median of 72 across 9,302 interventional studies indexed under Breast Neoplasms.
Browse Breast Neoplasms studies →Vanderbilt-Ingram Cancer Center is the lead sponsor of 220 studies on the registry; 32 are open to participants now.
Of its 23 completed or terminated interventional studies of FDA-regulated products, 18 (78%) have results posted.
Counted across the registry records on this site, refreshed daily.
For patients without known type II diabetes, the following is required at screening:
For patients with type II diabetes receiving only oral anti-hyperglycemic therapy (patients receiving insulin are not eligible), the following are required at screening:
For patients who are not postmenopausal or surgically sterile (absence of ovaries and/or uterus), agreement to remain abstinent or to use two adequate methods of contraception (e.g., condoms, diaphragm, vasectomy/vasectomized partner, tubal ligation), during the treatment period and for at least 30 days after the last dose of study treatment or 3 months after discontinuation of taselisib and/or enzalutamide, whichever is longer; hormone based oral contraceptives are not allowed on study; postmenopausal is defined as:
Exclusion Criteria:
Uncontrolled intercurrent illness including, but not limited to:
Patients receive taselisib PO QD on days 1-28 and enzalutamide PO QD on days 9-28 of course 1 and days 1-28 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients experiencing unacceptable toxicity due to enzalutamide may continue to receive taselisib.
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study · Drug: Taselisib
Patients receive enzalutamide PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Upon disease progression, patients may crossover to receive Enzalutamide + Taselisib
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study
Patients receive taselisib PO QD on days 1-28 and enzalutamide PO QD on days 9-28 of course 1 and days 1-28 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients experiencing unacceptable toxicity due to enzalutamide may continue to receive taselisib.
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study · Drug: Taselisib
Patients receive taselisib PO QD on days 1-28 and enzalutamide PO QD on days 9-28 of course 1 and days 1-28 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients experiencing unacceptable toxicity due to enzalutamide may continue to receive taselisib.
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study · Drug: Taselisib
Patients receive taselisib PO QD on days 1-28 and enzalutamide PO QD on days 9-28 of course 1 and days 1-28 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients experiencing unacceptable toxicity due to enzalutamide may continue to receive taselisib.
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study · Drug: Taselisib
Patients receive enzalutamide PO QD starting on day 1 of cycle 1, and will receive Taselisib PO QD starting on day 1 of cycle 2. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study · Drug: Taselisib
Upon progression of disease, patients on the enzalutamide only arm will be allowed to crossover to enzalutamide + taselisib (must begin no later than 21 days after the clinic visit at which disease progression is determined) Enzalutamide and Taselisib will be taken PO QD
Other: Biomarker Analysis · Drug: Enzalutamide · Other: Pharmacological Study · Drug: Taselisib
Correlative studies
Given PO
Also known as: MDV3100, Xtandi
Correlative studies
Given PO
Also known as: GDC-0032
Clinical Benefit Rate (CBR) - Phase II
CBR is defined as the proportion of patients with a best response of complete response (CR), partial response (PR), or (SD) stable disease per RECIST criteria 1.1. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition, the sum must also demonstrate an absolute increase of at least 5 mm. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum of diameters while on study. It is calculated as the mean of binomial distribution.
Time frame: At 16 weeks
Maximum Tolerated Dose (MTD) of Taselisib Combined With 160mg Enzalutamide - Phase I
defined as the highest dose tested in which a dose limiting toxicity is experienced by 0 out of 3 or 1 out of 6 patients among the dose levels. Dose limiting toxicity will be graded according to the National Cancer Institute CTCAE version 4.0.
Time frame: 4 weeks
Overall Progression-Free Survival (PFS) of Patients Treated With Enzalutamide and Taselisib
The PFS time is defined as the time from treatment start to progression or death (whichever comes first), and those alive without progression were censored at the last date of follow up. PFS will be estimated using the Kaplan-Meier method. The median with 95% confidence intervals will be reported.
Time frame: Time from course 1, day 1 until objective tumor progression, assessed up to 3 years
Pharmacokinetic Profile
Pharmacokinetic sampling will occur in the phase Ib portion and in 10 patients in the phase II portion
Time frame: Approximately 4 months
13 enrolled in Phase Ib and 17 in phase II
| Milestone | PH1b E+T - Level 1 (Cohort 1) | PH1b E+T - Level 2 (Cohort 1 and 2) | PH1b E+T - Level 3 (Cohort 1) | PH1b E+T - Level 4 (Cohort 1) | PHII Enzalutamide | Phase II E+T |
|---|---|---|---|---|---|---|
| Started | 3 | 5 | 3 | 2 | 5 | 12 |
| Completed | 0 | 0 | 0 | 0 | 0 | 1 |
| Not completed | 3 | 5 | 3 | 2 | 5 | 11 |
| Withdrew: Withdrawal by subject | 0 | 0 | 0 | 0 | 0 | 1 |
| Withdrew: Adverse event | 0 | 2 | 1 | 1 | 1 | 3 |
| Withdrew: Disease progression | 3 | 3 | 1 | 1 | 4 | 6 |
| Withdrew: Other complicating illness | 0 | 0 | 0 | 0 | 0 | 1 |
| Withdrew: Death | 0 | 0 | 1 | 0 | 0 | 0 |
CBR is defined as the proportion of patients with a best response of complete response (CR), partial response (PR), or (SD) stable disease per RECIST criteria 1.1. CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. PR: At least a 30% decrease in the sum of diameters of target lesions. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition, the sum must also demonstrate an absolute increase of at least 5 mm. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum of diameters while on study. It is calculated as the mean of binomial distribution.
| proportion of patients | Arm I (Taselisib, Enzalutamide) | Arm II (Enzalutamide) |
|---|---|---|
| Clinical Benefit Rate (CBR) - Phase II | 0.357 (0.163 to 0.612) | 0 (0 to 0.434) |
defined as the highest dose tested in which a dose limiting toxicity is experienced by 0 out of 3 or 1 out of 6 patients among the dose levels. Dose limiting toxicity will be graded according to the National Cancer Institute CTCAE version 4.0.
| DLTs | 2mg Taselisib and 160mg Enzalutamide | 4mg Taselisib and 160mg Enzalutamide | 6mg Taselisib and 160mg Enzalutamide | 8mg Taselisib and 160mg Enzalutamide |
|---|---|---|---|---|
| Maximum Tolerated Dose (MTD) of Taselisib Combined With 160mg Enzalutamide - Phase I | 0 | 0 | 0 | 0 |
The PFS time is defined as the time from treatment start to progression or death (whichever comes first), and those alive without progression were censored at the last date of follow up. PFS will be estimated using the Kaplan-Meier method. The median with 95% confidence intervals will be reported.
| months | Patients Received Both Enzalutamide and Taselisib |
|---|---|
| Overall Progression-Free Survival (PFS) of Patients Treated With Enzalutamide and Taselisib | 3.4 (2.1 to 7.2) |
Pharmacokinetic sampling will occur in the phase Ib portion and in 10 patients in the phase II portion
No measurements were reported for this outcome.
Collected over Approximately 42 months. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Taselisib 2 mg | 2/3 (66.7%) | 0/3 (0%) | 3/3 (100%) |
| Taselisib 4 mg | 4/5 (80%) | 2/5 (40%) | 5/5 (100%) |
| Taselisib 6 mg | 3/3 (100%) | 1/3 (33.3%) | 3/3 (100%) |
| Taselisib 8 mg | 2/2 (100%) | 0/2 (0%) | 2/2 (100%) |
| Enzalutamide | 2/2 (100%) | 1/2 (50%) | 2/2 (100%) |
| Enzalutamide + Taselisib | 5/12 (41.7%) | 10/12 (83.3%) | 12/12 (100%) |
| Cross-Over | 1/3 (33.3%) | 1/3 (33.3%) | 3/3 (100%) |
| Event | Taselisib 2 mg | Taselisib 4 mg | Taselisib 6 mg | Taselisib 8 mg | Enzalutamide | Enzalutamide + Taselisib | Cross-Over |
|---|---|---|---|---|---|---|---|
| Rash maculo-papularSkin and subcutaneous tissue disorders | 0/3 | 0/5 | 0/3 | 0/2 | 0/2 | 6/12 | 0/3 |
| Heart failureCardiac disorders | 0/3 | 0/5 | 0/3 | 0/2 | 1/2 | 0/12 | 1/3 |
| DyspneaRespiratory, thoracic and mediastinal disorders | 0/3 | 0/5 | 0/3 | 0/2 | 1/2 | 0/12 | 0/3 |
| FeverGeneral disorders | 0/3 | 1/5 | 0/3 | 0/2 | 0/2 | 5/12 | 0/3 |
| Pleural effusionRespiratory, thoracic and mediastinal disorders | 0/3 | 0/5 | 1/3 | 0/2 | 0/2 | 0/12 | 1/3 |
| Left ventricular systolic dysfunctionCardiac disorders | 0/3 | 0/5 | 0/3 | 0/2 | 0/2 | 0/12 | 1/3 |
| ColitisGastrointestinal disorders | 0/3 | 1/5 | 0/3 | 0/2 | 0/2 | 0/12 | 0/3 |
| ConfusionPsychiatric disorders | 0/3 | 0/5 | 0/3 | 0/2 | 0/2 | 2/12 | 0/3 |
| FatigueGeneral disorders | 0/3 | 0/5 | 0/3 | 0/2 | 0/2 | 2/12 | 0/3 |
| AnorexiaMetabolism and nutrition disorders | 0/3 | 0/5 | 0/3 | 0/2 | 0/2 | 2/12 | 0/3 |
| Event | Taselisib 2 mg | Taselisib 4 mg | Taselisib 6 mg | Taselisib 8 mg | Enzalutamide | Enzalutamide + Taselisib | Cross-Over |
|---|---|---|---|---|---|---|---|
| NauseaGastrointestinal disorders | 2/3 | 2/5 | 2/3 | 1/2 | 2/2 | 7/12 | 3/3 |
| DiarrheaGastrointestinal disorders | 1/3 | 4/5 | 1/3 | 2/2 | 0/2 | 4/12 | 1/3 |
| Gastroesophageal reflux diseaseGastrointestinal disorders | 2/3 | 5/5 | 0/3 | 1/2 | 0/2 | 0/12 | 0/3 |
| HyperglycemiaMetabolism and nutrition disorders | 0/3 | 5/5 | 3/3 | 2/2 | 0/2 | 3/12 | 1/3 |
| FatigueGeneral disorders | 2/3 | 5/5 | 3/3 | 2/2 | 2/2 | 10/12 | 3/3 |
| Rash maculo-papularSkin and subcutaneous tissue disorders | 2/3 | 2/5 | 1/3 | 2/2 | 0/2 | 4/12 | 2/3 |
| Alkaline phosphatase increasedInvestigations | 0/3 | 3/5 | 1/3 | 2/2 | 0/2 | 2/12 | 1/3 |
| AnemiaBlood and lymphatic system disorders | 1/3 | 5/5 | 3/3 | 2/2 | 0/2 | 4/12 | 2/3 |
| VomittingGastrointestinal disorders | 0/3 | 4/5 | 0/3 | 0/2 | 0/2 | 4/12 | 0/3 |
| Mucositis oralGastrointestinal disorders | 2/3 | 0/5 | 0/3 | 1/2 | 0/2 | 1/12 | 1/3 |
ER/PR+ or TNBC AR+ women with breast cancer
| Age, Categorical(Participants) | PH1b E+T - Level 1 (Cohort 1) | PH1b E+T - Level 2 (Cohort 1 and 2) | PH1b E+T - Level 3 (Cohort 1) | PH1b E+T - Level 4 (Cohort 1) | PHII Enzalutamide | Phase II E+T | Total |
|---|---|---|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 2 | 4 | 3 | 2 | 2 | 9 | 22 |
| >=65 years | 1 | 1 | 0 | 0 | 3 | 3 | 8 |
| Sex: Female, Male(Participants) | PH1b E+T - Level 1 (Cohort 1) | PH1b E+T - Level 2 (Cohort 1 and 2) | PH1b E+T - Level 3 (Cohort 1) | PH1b E+T - Level 4 (Cohort 1) | PHII Enzalutamide | Phase II E+T | Total |
|---|---|---|---|---|---|---|---|
| Female | 3 | 4 | 3 | 2 | 5 | 12 | 29 |
| Male | 0 | 1 | 0 | 0 | 0 | 0 | 1 |
| Race (NIH/OMB)(Participants) | PH1b E+T - Level 1 (Cohort 1) | PH1b E+T - Level 2 (Cohort 1 and 2) | PH1b E+T - Level 3 (Cohort 1) | PH1b E+T - Level 4 (Cohort 1) | PHII Enzalutamide | Phase II E+T | Total |
|---|---|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 1 | 0 | 0 | 0 | 0 | 0 | 1 |
| White | 2 | 5 | 3 | 2 | 5 | 11 | 28 |
| More than one race | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 | 1 | 1 |
Documents are hosted by the registry — open the source record to download them.
This study is terminated, as verified in Aug 2022. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Vanderbilt-Ingram Cancer Center