FASN Inhibitor TVB-2640 and Trastuzumab in Combination With Paclitaxel or Endocrine Therapy for the Treatment of HER2 Positive Metastatic Breast Cancer

  • STATUS
    Recruiting
  • End date
    Jul 30, 2024
  • participants needed
    80
  • sponsor
    Mayo Clinic
Updated on 14 June 2022
ct scan
platelet count
paclitaxel
cancer
ejection fraction
measurable disease
breast cancer
direct bilirubin
endocrine therapy
MRI
metastasis
neutrophil count
hormone therapy
pertuzumab
advanced breast cancer
tumor cells
HER2
chemotherapy regimen
biomarker analysis
trastuzumab
solid tumors
cancer chemotherapy
her2/neu-positive breast cancer
taxane
her2 positive breast cancer
immunological adjuvant

Summary

This phase II trial studies how well FASN inhibitor TVB-2640, paclitaxel, and trastuzumab work in treating patients with HER2 positive breast cancer that has spread to other places in the body (metastatic). FASN inhibitor TVB-2640 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Trastuzumab is a form of targeted therapy because it attaches itself to specific molecules (receptors) on the surface of cancer cells, known as HER2 receptors. When trastuzumab attaches to HER2 receptors, the signals that tell the cells to grow are blocked and the cancer cell may be marked for destruction by the body's immune system. Drugs used in chemotherapy, such as paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Estrogen can cause the growth of breast cancer cells. Drugs used in endocrine therapy either lower the amount of estrogen made by the body or blocks the use of estrogen by the tumor cells. This may help stop the growth of tumor cells that need estrogen to grow. Giving FASN inhibitor TVB-2640 and trastuzumab in combination with paclitaxel or endocrine therapy may help control the disease in patients with HER2 positive breast cancer.

Description

PRIMARY OBJECTIVES:

I. To estimate the overall tumor response rate (ORR i.e. complete response [CR]+partial response [PR]) of the combination of FASN inhibitor TVB-2640 [TVB-2640] with paclitaxel and trastuzumab in patients with taxane and trastuzumab-resistant, advanced HER2-positive breast cancer.

II. To estimate the ORR of the combination of TVB-2640 with paclitaxel and trastuzumab in patients with endocrine and trastuzumab-resistant, advanced HER2-positive breast cancer

SECONDARY OBJECTIVES:

I. For each patient cohort, to evaluate the safety profile of the combination of TVB-2640 with paclitaxel and trastuzumab.

II. For each patient cohort, to assess the clinical benefit rate (CBR), duration of response, and progression free survival of the combination of TVB-2640 with paclitaxel and trastuzumab.

III. To obtain a point and interval estimate of the difference in RR as well as the difference in CBR between cohort A and cohort B.

CORRELATIVE RESEARCH OBJECTIVES:

I. For each patient cohort, to assess the changes in FASN, phosphorylation (p)AKT, and pS6 expression in tumor tissue after the first cycle of the combination of TVB-2640 with paclitaxel and trastuzumab from pre-treatment levels.

II. For each patient cohort, to assess the changes in levels of cellular apoptosis in tumor tissue after the first cycle of the combination of TVB-2640 with paclitaxel and trastuzumab from pre-treatment levels.

III. For each patient cohort, to assess the changes in serum FASN after the first cycle of the combination of TVB-2640 with paclitaxel and trastuzumab from pre-treatment levels.

OUTLINE: Patients are assigned to 1 of 2 cohorts.

COHORT A: Patients receive FASN inhibitor TVB-2640 orally (PO) once daily (QD) on days 1-28, paclitaxel intravenously (IV) over 1-96 hours on days 1, 8, and 15, and trastuzumab IV over 30-90 minutes on days 1, 8, 15, and 22. Cycles repeat every 28 days in the absence of disease progression or unexpected toxicity.

COHORT B: Patients receive FASN inhibitor TVB-2640 PO QD on days 1-28 and trastuzumab IV over 30-90 minutes on days 1, 8, 15, and 22. Patients also continue endocrine therapy of either anastrozole PO QD, exemestane PO QD, fulvestrant intramuscularly (IM) on days 1 and 14 of cycle 1 and day 1 of subsequent cycles, or letrozole PO QD. Cycles repeat every 28 days in the absence of disease progression or unexpected toxicity.

After completion of study treatment, patients are followed up every 6 months for up to 3 years.

Details
Condition Advanced Breast Carcinoma, HER2 Positive Breast Carcinoma, Stage III Breast Cancer AJCC v7, Stage IIIA Breast Cancer AJCC v7, Stage IIIB Breast Cancer AJCC v7, Stage IIIC Breast Cancer AJCC v7, Stage IV Breast Cancer AJCC v6 and v7
Treatment laboratory biomarker analysis, Paclitaxel, Trastuzumab, Letrozole, anastrozole, exemestane, fulvestrant, FASN Inhibitor TVB-2640
Clinical Study IdentifierNCT03179904
SponsorMayo Clinic
Last Modified on14 June 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

PRE-REGISTRATION INCLUSION CRITERIA
Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) criteria that is
A non-nodal lesion is considered measurable if its longest diameter can be accurately measured as >= 1.0 cm with computed tomography (CT) scan, CT component of a positron emission tomography (PET)/CT, or magnetic resonance imaging (MRI) and/or
A malignant lymph node is considered measurable if its short axis is > 1.5 cm when assessed by CT scan (CT scan slice thickness recommended to be no greater than 5 mm)
Note: tumor lesions in a previously irradiated area are not considered measurable disease; disease that is measurable by physical examination only is not eligible
Received =< four (4) prior chemotherapy regimens in the metastatic setting
Cohort A one of the following must be true
Distant disease progression during administration of combination therapy with taxane based chemotherapy and anti-HER2 therapy (trastuzumab or pertuzumab) for metastatic disease
Note: patients who began treatment with this combination and discontinued taxane-based chemotherapy due to intolerability before distant disease progression are eligible
Distant disease progression during administration or within 180 days of
Note: patients who began treatment with this combination and discontinued taxane-based chemotherapy due to intolerability before distant disease progression are eligible
discontinuing combination therapy with taxane based chemotherapy and anti-HER2
therapy (trastuzumab or pertuzumab) in the adjuvant disease
Cohort B (one of the following must be true)
Willingness to provide mandatory tumor tissue specimens for correlative research
Distant disease progression during administration of combination therapy with endocrine therapy and anti-HER2 therapy (trastuzumab or pertuzumab) for metastatic disease; permissible endocrine therapies include an aromatase inhibitor or fulvestrant
For patient who received taxane based chemotherapy and anti-HER2 therapy
REGISTRATION INCLUSION CRITERIA
NOTE: Tamoxifen is not permissible
(trastuzumab or pertuzumab) in the neo-adjuvant setting and underwent surgical
Registration must be completed =< 28 days of pre-registration
resection of primary breast disease: distant disease progression during or
Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
Hemoglobin >= 9.0 g/dL (obtained =< 14 days prior to registration)
NOTE: Tamoxifen is not permissible
within 180 days of discontinuing anti-HER2 therapy (trastuzumab or pertuzumab)
Histological confirmation of HER2-positive advanced breast cancer; HER2+ is defined by 2013 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines
Absolute neutrophil count (ANC) >= 1500/mm^3 (obtained =< 14 days prior to registration)
in the adjuvant setting
Platelet count >= 100,000/mm^3 (obtained =< 14 days prior to registration)
NOTE: If insufficient or no tissue is obtained by the pre-registration biopsy, an archival tissue specimen (preferably from a metastatic site) from procedure performed =< 2 years prior to pre-registration must be available to submit for Central Laboratory review prior to registration
Direct bilirubin =< 1.5 x upper limit of normal (ULN) (obtained =< 14 days prior to registration)
Exception: If there is no medically safe site for biopsy, Study Chair (Dr. Haddad) may waive this requirement
Aspartate transaminase (AST) =< 3 x ULN (=< 5 x ULN for patients with liver involvement) (obtained =< 14 days prior to registration)
Calculated creatinine clearance >= 45 ml/min using the Cockcroft-Gault formula (obtained =< 14 days prior to registration)
Distant disease progression during administration of combination therapy with
Cardiac ejection fraction (left ventricular ejection fraction [LVEF]) >= 50% by echocardiogram =< 28 days prior to registration
endocrine therapy and anti-HER2 therapy (trastuzumab or pertuzumab) in the
adjuvant setting; permissible endocrine therapies include an aromatase
For Cohort B only: Histologic confirmation of ERalpha positive disease (>= 1% expression)
inhibitor or fulvestrant
Provide written informed consent
Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
Negative urine pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
For women: Compliant with a medically-approved contraceptive regimen during and for 3 months after the treatment period or documented to be surgically sterile or postmenopausal
For men: Compliant with a medically-approved contraceptive regimen during and for 3 months after the treatment period or documented to be surgically sterile; men whose sexual partners are of child-bearing potential must agree to use 2 methods of contraception prior to study entry, during the study, and for 3 months after the treatment period
Patient and his/her partner agree to use adequate contraception after providing
written informed consent through 3 months after the last dose of TVB-2640, as
follows
Willingness to provide mandatory tumor tissue and/or blood specimens for correlative
research

Exclusion Criteria

PRE-REGISTRATION EXCLUSION CRITERIA
Patients with a history of LVEF decline to below 50% during or after prior trastuzumab or other HER2 directed therapy =< 6 months prior to pre-registration
Patients who previously discontinued trastuzumab due to unacceptable cardiac toxicity
Patients with any class of New York Heart Association (NYHA) congestive heart failure (CHF) or heart failure with preserved ejection fraction (HFPEF)
Patients with a history of known coronary artery disease or a myocardial infarction within 12 months prior to pre-registration
Patients with persistently uncontrolled hypertension (systolic blood pressure [BP] > 160 mm Hg or diastolic BP > 100 mm Hg) despite optimal medical therapy
Patients with known unstable angina pectoris
Patients with a known history of serious cardiac arrhythmias requiring treatment (exception: controlled atrial fibrillation, paroxysmal supraventricular tachycardia)
Patients with a prolonged corrected QT interval (QTc) interval (>= 450 ms)
NOTE: Metastases treated by surgery and/or radiotherapy such that patient is neurologically stable and off steroids >= 4 weeks prior to preregistration are eligible
Leptomeningeal disease or uncontrolled brain metastasis
EXCEPTION: Grade 1 peripheral (sensory) neuropathy that has been stable for at least 3 months since completion of prior treatment
Tumors involving spinal cord or heart
Visceral crisis or lymphangitic spread
NOTE: Visceral crisis is not the mere presence of visceral metastases, but implies severe organ dysfunction as assessed by symptoms and signs, laboratory studies, and rapid progression of disease
Uncontrolled intercurrent non-cardiac illness including, but not limited to
Ongoing or active infection
Psychiatric illness/social situations
Dyspnea at rest due to complications of advanced malignancy or other disease that requires continuous oxygen therapy
Or any other conditions that would limit compliance with study requirements
NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
History of myocardial infarction =< 6 months, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
Patient is unable to swallow oral medications or has impairment of gastrointestinal (GI) function or GI disease that may significantly alter drug absorption (e.g. active inflammatory bowel disease, uncontrolled nausea, vomiting, diarrhea, or malabsorption syndrome); note: concomitant therapy with proton pump inhibitors and/or H2-receptor antagonists is permissible
Prior history of hypersensitivity, drug or radiation-induced, or other immune-mediated pneumonitis
Patient has a history of clinically significant dry eye (xerophthalmia) or other corneal abnormality, or if a contact lens wearer, does not agree to abstain from contact lens use from baseline through the last TVB-2640 dose
Other invasive malignancy =< 3 years prior to pre-registration
Patients with a history of intolerance to trastuzumab (i.e. a grade 3 or 4 infusion reaction) are excluded; Note: patients with a history of mild infusion reaction to trastuzumab who have previously been successfully re-challenged after an infusion reaction with or without prophylactic medication are allowed
EXCEPTIONS: Non-melanoma skin cancer, papillary thyroid cancer, or carcinoma-in-situ of the cervix which has been adequately treated
Failure to recover from acute, reversible effects of prior therapy regardless of
NOTE: If there is a history of prior malignancy, patients must not be receiving other treatment for their cancer and the disease must be inactive/stable
interval since last treatment
REGISTRATION EXCLUSION CRITERIA
Any of the following
Pregnant women
Nursing women
Men or women of childbearing potential who are unwilling to employ adequate contraception
Any of the following therapies prior to registration
Chemotherapy =< 3 weeks
Immunotherapy =< 3 weeks
Biologic therapy =< 3 weeks
Immunocompromised patients and patients known to be human immunodeficiency virus (HIV)
Monoclonal antibodies =< 3 weeks
positive and currently receiving antiretroviral therapy
Radiation therapy =< 2 weeks
CDK 4/6 inhibitors =< 4 weeks
Receiving any other investigational agent which would be considered as a treatment for
mTOR inhibitors =< 4 weeks
the primary neoplasm
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