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A Pilot and Phase II Study of Entinostat and Anastrozole/Tamoxifen in Women With Triple Negative Breast Cancer to Evaluate Biomarkers and Surrogates for Response


Phase 2
18 Years
N/A
Open (Enrolling)
Female
Estrogen Receptor-negative Breast Cancer, HER2-negative Breast Cancer, Progesterone Receptor-negative Breast Cancer, Stage I Breast Cancer, Stage II Breast Cancer, Stage IIIA Breast Cancer, Triple-negative Breast Cancer

Thank you

Trial Information

A Pilot and Phase II Study of Entinostat and Anastrozole/Tamoxifen in Women With Triple Negative Breast Cancer to Evaluate Biomarkers and Surrogates for Response


PRIMARY OBJECTIVES:

I. To evaluate the safety and tolerability of entinostat in combination with anastrozole or
tamoxifen. (Pilot) II. To determine the optimal dose of entinostat in combination with
anastrozole or tamoxifen for phase II. (Pilot) III. To determine baseline and percentage
change in proliferative index (Ki67) before and after treatment with entinostat and
anastrozole/tamoxifen in triple negative breast cancer (TNBC). (Phase II) IV. To determine
the estrogen receptor (ER) expression after treatment with entinostat and
anastrozole/tamoxifen in TNBC. (Phase II)

SECONDARY OBJECTIVES:

I. To evaluate baseline and change in the expression levels of progesterone receptor (PR),
human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR),
cytokeratin 5/6 (CK5/6), and aromatase before and after treatment with entinostat and
anastrozole/tamoxifen.

II. To assess baseline and change in tumor tissue histone H3 and H4 acetylation before and
after treatment with entinostat and anastrozole/tamoxifen.

III. To assess the clinical and pathological response to preoperative combination of
entinostat and anastrozole/tamoxifen in TNBC.

TERTIARY OBJECTIVES:

I. To correlate the levels of histone H3 and H4 acetylation in tumors with the changes in
Ki67 and ER.

II. To evaluate baseline and change in gene methylation silencing and expression of
candidate genes in tissues and in circulating DNA, including estrogen receptor (ER)-alpha,
ER-beta, RAR-beta, cyclin D2, Twist, RASSF1A, and HIN-1.

III. To correlate entinostat trough concentrations with histone H3 and H4 acetylation in
tumors as well as the change in Ki67 and ER.

IV. To evaluate baseline and change in the global gene expression profile before and after
treatment with entinostat and anastrozole/tamoxifen.

OUTLINE: This is a multicenter, pilot study followed by a phase II study.

Patients receive entinostat orally (PO) once daily on days 1, 8, 15, 22, and 29 and
anastrozole PO once daily on days 4-29. Patients then undergo mastectomy or lumpectomy.

Tumor tissue samples are collected at baseline or from original diagnosis, and during
surgery for correlative studies by IHC and RT-PCR. Blood samples are also collected at
baseline, on days 1 and 15, and during surgery for correlative studies.

After completion of study therapy, patients are followed up for 30 days.


Inclusion Criteria:



- Histologically confirmed adenocarcinoma of the breast

- Unresected breast cancer amenable to surgery

- Clinical stage

- T1c, T2, or T3

- Any N

- M0 (no distant metastasis)

- Hormone insensitivity

- Evidence of hormone insensitivity (ER and PR negative) of primary tumor
tissue; ER negative is define as ER 0 or < 1% staining by
immunohistochemistry; PR negativity is defined as PR =< 10% staining by
immunohistochemistry

- HER2 negative in the primary tumor tissue by:

- Grade 0 or 1+ staining intensity (on a scale of 0 to 3) by IHC analysis

- Grade 2+ staining intensity by IHC with gene amplification on fluorescent
in situ hybridization (FISH) < 2.2

- Patients must have adequate tumor tissue sample prior to the enrolment available for
correlative studies as defined below:

- Core needle biopsy or incisional biopsy samples that can provide >= 3 unstained
sections of 5 micron thickness; fine needle aspiration (FNA) sample alone is not
sufficient except in the second cohort

- Additional core needle biopsy needs to be performed in the patients who agree to
participate in this study and do not have adequate tumor tissue sample

- Patients must have an accessible tumor lesion from which a fine needle aspirate
or preferably a core biopsy specimen can be obtained; patients with FNA only
samples are allowed in this cohort; ascites or pleural/pericardial effusion
alone is not sufficient

- Patients must be willing to provide consents for 2 research biopsies; however,
the pretreatment biopsy can be omitted in patients who have recent biopsy but
have not been started on breast cancer treatment within 12 weeks prior to the
registration and there is adequate tumor tissue sample

- Postmenopausal

- ECOG performance status 0-2

- WBC ≥ 2,500/mm³

- ANC ≥ 1,100/mm³

- Platelet count ≥ 100,000/mm³

- Hemoglobin ≥ 9.0 g/dL

- Total bilirubin normal

- AST and ALT ≤ 2.5 times upper limit of normal

- Creatinine normal OR creatinine clearance ≥ 60 mL/min

- No history of allergic reactions or hypersensitivity to compounds of similar chemical
or biologic composition to entinostat, benzamide, or anastrozole

- No medical conditions that, in the opinion of the investigator, puts the patient at
risk of potentially serious complications while on this study, including any of the
following:

- HIV infection

- Unstable angina

- Uncontrolled heart failure or hypertension

- Hyperlipidemia

- Diabetes mellitus

- Systemic infection

- No systemic malignancy within the past 3 years except adequately treated cervical
carcinoma in situ or basal/squamous cell carcinoma of the skin

- No other concurrent anticancer agents including approved luteinizing-hormone
releasing-hormone agonists (e.g., goserelin or leuprolide)

- No prior histone deacetylase inhibitors (HDACs)

- Prior valproic acid allowed provided patient has ≥ 30 days wash-out period

- No prior chemotherapy, radiotherapy, or endocrine therapy for the current breast
cancer

- Prior tamoxifen, raloxifene, or another agent for the prevention of breast
cancer allowed provided patient has discontinued treatment within the past 30
days prior to baseline study biopsy.

- No bisphosphonates initiated within 4 weeks of study start

- No other concurrent investigational agents

- No concurrent valproic acid, vorinostat, or other HDAC inhibitor

- No concurrent DNA methyltransferase inhibitors

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Recommended phase II dose of entinostat in combination with anastrozole (pilot)

Outcome Time Frame:

29 days

Safety Issue:

Yes

Principal Investigator

Saranya Chumsri

Investigator Role:

Principal Investigator

Investigator Affiliation:

University of Chicago Comprehensive Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-02542

NCT ID:

NCT01234532

Start Date:

October 2010

Completion Date:

Related Keywords:

  • Estrogen Receptor-negative Breast Cancer
  • HER2-negative Breast Cancer
  • Progesterone Receptor-negative Breast Cancer
  • Stage I Breast Cancer
  • Stage II Breast Cancer
  • Stage IIIA Breast Cancer
  • Triple-negative Breast Cancer
  • Breast Neoplasms

Name

Location

Johns Hopkins University Baltimore, Maryland  21205
University of Michigan Ann Arbor, Michigan  48109-0624
Indiana University Cancer Center Indianapolis, Indiana  46202-5265
Northwestern Memorial Hospital Chicago, Illinois  60611
Ingalls Memorial Hospital Harvey, Illinois  60426
Central Illinois Hematology Oncology Center Springfield, Illinois  62701
City of Hope Duarte, California  91010
USC Norris Comprehensive Cancer Center Los Angeles, California  90089
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
Penn State Milton S Hershey Medical Center Hershey, Pennsylvania  17033
Evanston CCOP-NorthShore University HealthSystem Evanston, Illinois  60201
Illinois CancerCare-Peoria Peoria, Illinois  61615
Fort Wayne Medical Oncology and Hematology Inc - State Boulevard Fort Wayne, Indiana  46845
City of Hope Medical Group Inc Pasadena, California  91105
Magee-Womens Hospital - University of Pittsburgh Medical Center Pittsburgh, Pennsylvania  15213
University of Maryland Baltimore Baltimore, Maryland  21201
University of California Davis Phase 2 Consortium Sacramento, California  95817