Phase II Trial of Carboplatin +/- Tocilizumab for Metastatic Triple Negative and ER-low Breast Cancers
Study Details
Study Description
Brief Summary
This is a randomized Phase II study of carboplatin monotherapy vs. carboplatin combined with tocilizumab in in Black and non-Black patients with metastatic triple negative or ER low breast cancer.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
Phase 2 |
Detailed Description
Randomized phase II using a two-stage Bayesian optimal phase II two-arm design (BOP2). Patients are randomized 1:1 to either the monotherapy or combination arms. This requires 42 patients (21 per treatment arm) in stage I for each race-based cohort. If the no. of response in experimental - no. of response in control is no greater than -1, the trial is early stopped at stage I for futility. Otherwise, additional 42 patients for each race-based cohort will be enrolled and randomized to the study in stage II.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: Black Monotherapy
|
Drug: Carboplatin
Carboplatin will be given AUC 6 IV q3 weeks for a maximum of 9 infusions.
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Experimental: Black Combination treatment
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Drug: Carboplatin
Carboplatin will be given AUC 6 IV q3 weeks for a maximum of 9 infusions.
Drug: Tocilizumab
Tocilizimab 8 mg/ actual body weight in kg IV q4 weeks
|
Active Comparator: Non-Black Monotherapy
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Drug: Carboplatin
Carboplatin will be given AUC 6 IV q3 weeks for a maximum of 9 infusions.
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Experimental: Non-Black Combination treatment
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Drug: Carboplatin
Carboplatin will be given AUC 6 IV q3 weeks for a maximum of 9 infusions.
Drug: Tocilizumab
Tocilizimab 8 mg/ actual body weight in kg IV q4 weeks
|
Outcome Measures
Primary Outcome Measures
- Overall response rate [through study completion (i.e. up to 2 years)]
- Efficacy of tocilizumab in Black and non-Black patients [through study completion (i.e. up to 2 years)]
efficacy defined as using the difference in difference approach across race based cohorts
- Progression-free survival [through study completion (i.e. up to 2 years)]
Secondary Outcome Measures
- Safety of carboplatin monotherapy compared to carboplatin combined with tocilizumab using National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v 5.0 [through study completion (i.e. up to 2 years)]
- Evaluate the differences in inflammatory pathways between Black and non-Black patients [Baseline]
Tumor PZP, IL-6, and phosphoSTAT3
- Evaluate the impact of Duffy genotype on efficacy in Black patients [Baseline]
Tumor PZP, IL-6, and phosphoSTAT3 between Duffy-null, Duffy-heterozygous, and Duffy-wild type
Eligibility Criteria
Criteria
Inclusion Criteria:
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≥ 18 years old at the time of informed consent
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Ability to provide written informed consent and HIPAA authorization
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Locally recurrent (not amenable to local therapy with curative intent) or metastatic breast cancer that is triple negative or ER-low (ER and PR ≤ 9% weak staining)
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No prior chemotherapy for metastatic disease
- Prior (neo)adjuvant therapy must have been completed at least 12 months from diagnosis of unresectable locally recurrent or metastatic disease.
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Measurable disease based on RECIST 1.1 criteria.
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Disease amenable to and consent for study-specific biopsy
- NOTE: If no disease amenable to biopsy is present at the time of second biopsy, subjects may continue participation in the study and further study specific biopsies will not be required.
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ECOG PS 0 or 1
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Patients with treated, asymptomatic CNS disease may participate if the patient is > 4 weeks from completion of CNS therapy (radiation and/or surgery), is clinically stable at the time of study entry, and is receiving a stable or decreasing dose of corticosteroid therapy. Brain MRI or head CT is required at screening for patients with known brain metastases.
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Adequate organ function as indicated by:
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Total bilirubin < ULN (except in patients with documented Gilbert's disease, who must have a total bilirubin < 3.0 mg/dL)
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Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 5.0 x ULN
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Creatinine clearance of > 50 mL/min using the Cockcroft-Gault formula
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Absolute neutrophil count (ANC) > 1.5 K/mm3
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Platelets > 100 K/ mm3
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Hgb > 9.0 g/dL
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Women of childbearing potential must have a negative pregnancy test within 14 days of protocol registration. Women are considered to have childbearing potential (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) unless they meet one of the following criteria:
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Has undergone a hysterectomy or bilateral oophorectomy; or
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Has been naturally amenorrheic for at least 24 consecutive months.
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Women of childbearing potential and men must agree to use effective contraception throughout the study and for 6 months after the last study treatment.
Note: Acceptable methods of birth control include abstinence, partner with previous vasectomy, placement of an intrauterine device (IUD), condom with spermicidal foam/gel/film/cream/suppository, diaphragm or cervical vault cap, or hormonal birth control (pills or injections).
Exclusion Criteria:
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Prior treatment with or known contraindication to treatment with tocilizumab or other IL-6/IL-6R targeted agent
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Patients who are PD-L1 positive (CPS ≥ 10), unless they have a clear contraindication to pembrolizumab therapy.
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Active infection requiring parenteral antibiotics
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Concurrent use of methotrexate or systemic corticosteroids
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Active or symptomatic CNS disease
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Patients with HER2+ disease HER2 will be considered positive if scored 3+ by immunohistochemistry (IHC) or 2+ by IHC associated with a fluorescence in situ hybridization (FISH) ratio of > 2.0 or > 6 total HER2 gene copies per cell.
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Patients with active malignancy other than breast cancer. Patients with prior malignancies without recurrence after standard treatment will not be excluded
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Radiation therapy within 2 weeks of registration
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Hormone therapy within 2 weeks of registration
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | IU Health Joe and Shelly Schwarz Cancer Center | Carmel | Indiana | United States | 46032 |
2 | Indiana University Melvin and Bren Simon Comprehensive Cancer Center | Indianapolis | Indiana | United States | 46202 |
3 | Sidney and Lois Eskenazi Hospital | Indianapolis | Indiana | United States | 46202 |
Sponsors and Collaborators
- Kathy Miller
- Genentech, Inc.
Investigators
- Principal Investigator: Kathy Miller, MD, Indiana University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- CTO-IUSCCC-0817