ENCORE305: Phase 2 Study of Fulvestrant With and Without Entinostat in Postmenopausal Women With ER+ Advanced Breast Cancer

Sponsor

Syndax Pharmaceuticals (Industry)

Overall Status

Withdrawn

CT.gov ID

NCT02115594

Collaborator

(none)

Enrollment

Location

Arms

Duration (Months)

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Preclinical data has demonstrated that entinostat (SNDX-275) can enhance fulvestrant sensitivity in hormone receptor-positive breast cancer in animal models. The addition of entinostat to fulvestrant will provide clinical benefit to patients with locally advanced or metastatic breast when compared to fulvestrant plus placebo. Also, based on previous data, patients exposed to entinostat who demonstrate an elevated level of protein lysine acetylation will have an improved efficacy outcome.

Condition or Disease	Intervention/Treatment	Phase
Breast Cancer	Drug: Fulvestrant Drug: Entinostat Drug: Placebo	Phase 2

Detailed Description

Entinostat (SNDX-275) inhibits mechanisms of resistance to hormone therapy in breast cancer (BC) cells, thereby prolonging sensitivity of the cells to fulvestrant. Preclinical data has demonstrated that entinostat can enhance fulvestrant sensitivity in hormone receptor-positive BC in animal models. Thus, it is hypothesized that the addition of entinostat to fulvestrant will provide clinical benefit to patients with locally advanced or metastatic BC when compared to fulvestrant plus placebo.

Preliminary data from Phase 2 Study SNDX-275-0301 suggest patients with higher levels of protein lysine acetylation who receive entinostat with exemestane potentially have improved clinical outcomes (e.g., PFS, OS) when compared to patients with lower levels of protein lysine acetylation. Thus, it is hypothesized that patients exposed to entinostat and who demonstrate an elevated level of protein lysine acetylation will have an improved efficacy outcome.

Study Design

Study Type:

Interventional

Actual Enrollment :

0 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Triple (Participant, Care Provider, Investigator)

Primary Purpose:

Treatment

Official Title:

A Phase 2, Randomized, Double-Blind, Multicenter Study of Fulvestrant With and Without Entinostat in Postmenopausal Women With Hormone Receptor-Positive Advanced Breast Cancer

Study Start Date :

Apr 1, 2014

Anticipated Primary Completion Date :

Dec 1, 2015

Anticipated Study Completion Date :

Jun 1, 2016

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Fulvestrant + Entinostat Arm A: Fulvestrant (500 mg on C1D1, C1D15, C2D1, and on Day 1 of each subsequent cycle) plus entinostat (5 mg PO once weekly)	Drug: Fulvestrant Other Names: faslodex Drug: Entinostat
Active Comparator: Fulvestrant + Placebo Arm B: Fulvestrant (500 mg on C1D1, C1D15, C2D1, and on Day 1 of each subsequent cycle) plus placebo (5 mg PO once weekly)	Drug: Fulvestrant Other Names: faslodex Drug: Placebo

Arm

Intervention/Treatment

Experimental: Fulvestrant + Entinostat

Arm A: Fulvestrant (500 mg on C1D1, C1D15, C2D1, and on Day 1 of each subsequent cycle) plus entinostat (5 mg PO once weekly)

Drug: Fulvestrant

Other Names:

faslodex

Drug: Entinostat

Active Comparator: Fulvestrant + Placebo

Arm B: Fulvestrant (500 mg on C1D1, C1D15, C2D1, and on Day 1 of each subsequent cycle) plus placebo (5 mg PO once weekly)

Drug: Fulvestrant

Other Names:

faslodex

Drug: Placebo

Outcome Measures

Primary Outcome Measures

Progression Free Survival [From date of randomization until the date of 1st documented progression or date of death from any cause, whichever occurs first, assessed for up to 48 months]
Radiological disease assessments

Secondary Outcome Measures

Objective Response Rate (CR or PR) [From date of randomization until the date of 1st documented progression or date of death from any cause, whichever occurs first, for up to 48 months]
Radiological disease assessments
Clinical Benefit Rate (CR, PR, or SD for greater than or equal to 6 months from randomization) [From the date of randomization until the date of 1st documented progression or date of death, from any cause, whichever occurs first, assessed for up to 48 months]
Radiological disease assessments
Overall Survival [From the date of randomization until date of death, assessed for up to 48 months]
Clinical review of safety parameters (AEs, lab values) [From date of randomization until 30 days post the date of study treatment discontinuation]
Percent change from baseline in blood protein lysine acetylation measures [From the baseline visit through the 1st 15 days of study treatment]
Concentrations of entinostat measured in plasma (PK) [From the baseline visit through the 1st 15 days of study treatment]

Other Outcome Measures

Analysis of biopsy tumor tissue (fresh optional, archival required) [Screening (fresh tissue) and post 1st dose, between Days 15-18 of study treatment]
molecular classification of breast cancer (BC) subtypes, DNA methylation, e-cadherin levels, protein lysine acetylation levels, and changes in proteins associated with estrogen signaling and fulvestrant resistance

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Inclusion Criteria:

Patient is a female who is: Postmenopausal OR Pre/perimenopausal and: Received at least one prior hormone therapy in combination with a luteinizing hormone-releasing hormone (LHRH) agonist prior to study entry. Initiated on an LHRH agonist at least 28 days prior to study entry. Demonstrated ovarian estradiol suppression, defined as an estradiol level within postmenopausal ranges per institutional guidelines, within 28 days immediately prior to study entry
Patient has histologically or cytologically confirmed ER+ and/or progesterone receptor-positive (PR+) BC at initial diagnosis or on subsequent biopsy. With regard to hormone receptor status, staining of ≥1% cells is considered positive. Receptor status may have been determined at any time prior to randomization and from any site (i.e., primary, recurrent, or metastatic)
Patient experienced PD within 28 days before initiating study treatment and has been deemed eligible for treatment with fulvestrant
Patient has evidence of locally advanced or metastatic disease, based on imaging studies (bone scan, CT, MRI) within 28 days before initiating study treatment
Patient completed any prior radiotherapy ≥2 weeks prior to receiving the first dose of study treatment and has recovered from any radiation-related toxicity
Patient may have received 1 prior chemotherapy regimen for metastatic disease provided treatment was completed ≥3 weeks prior to randomization. Prior chemotherapy in the adjuvant or neoadjuvant setting is also allowed
Patient is willing and able to provide or assist study personnel in accessing slides from prior biopsies
Patient has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Patient has the following laboratory parameters: a. Hemoglobin (Hgb) ≥9.0 g/dL; unsupported platelet count ≥100×10P9P/L; and absolute neutrophil count (ANC) ≥1.5×10P9P/L without the use of hematopoietic growth factors; b. Creatinine ≤2.0 mg/dL; c. Total bilirubin <1.5 x institutional upper limit normal (≤3 mg/dL in case of Gilbert's syndrome); d. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2 x institutional upper limit of normal; unless elevation is due to metastatic disease to the liver, in which case ALT and AST must be within 5.0 x institutional upper limit of normal
Patient is able to swallow tablets
Patient is able to understand and give written informed consent and comply with study procedures

Exclusion Criteria:

Patient has rapidly progressive or life-threatening metastases (visceral crisis)
Patient has HER2-positive (HER2+) disease, as defined by the 2013 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) recommendations for HER2 testing in BC (see http://www.asco.org/quality-guidelines/recommendations-human-epidermal-growth-factor-r eceptor-2-testing-breast-cancer), or has unknown HER2 status
Patient previously received treatment with entinostat or any other HDAC inhibitor, including valproic acid
Patient has had previous treatment with fulvestrant or other selective estrogen receptor down-regulator (SERD) in the metastatic setting; such treatment may have been given in the adjuvant setting
Patient has an allergy to benzamide or inactive components of the study drug
Patient has a history of allergies to any active or inactive ingredients of fulvestrant
Patient has a concomitant medical condition that precludes adequate study treatment compliance or assessment, or increases patient risk, in the opinion of the

Investigator, such as but not limited to:

Myocardial infarction or arterial thromboembolic event within 6 months prior to Baseline or severe or unstable angina, New York Heart Association (NYHA) Class III or IV disease (see Appendix 2), or a QTc interval >470 msec.
Uncontrolled heart failure or hypertension, uncontrolled diabetes mellitus, or uncontrolled systemic infection
Another active cancer (excluding adequately treated basal cell carcinoma or cervical intraepithelial neoplasia [CIN] / cervical carcinoma in situ or melanoma in situ). Prior history of other cancer is allowed, as long as there is no active disease within the prior 5 years

Patient is currently receiving treatment with any agent listed on the prohibited medication list such as valproic acid or other systemic cancer agents
Patient initiated oral bisphosphonates within 7 days prior to study drug
Patient has moderate or severe hepatic impairment (i.e., Child-Pugh score B or C)
Patient has brain or leptomeningeal metastases