A Phase 1 Trial of MK-2206 in Combination With Anastrozole, Fulvestrant, or Anastrozole Plus Fulvestrant in Postmenopausal Women With Estrogen Receptor Positive Metastatic Breast Cancer
PRIMARY OBJECTIVES:
I. To determine the maximum tolerated dose (MTD) of MK-2206 in combination with anastrozole
based on toxicities observed during cycle 1 therapy. (Phase IA) II. To evaluate the
tolerability of prolonged administration (3 months) of MK-2206 in combination with
anastrozole at the MTD defined in Phase IA. (Phase IB) III. To determine the recommended
phase II treatment dosing (RPTD) of MK-2206 in combination with anastrozole based on
toxicities observed with prolonged drug administration. (Phase IB) IV. To determine the
tolerability of fulvestrant (Arm C), or fulvestrant plus anastrozole (Arm D), respectively,
in combination with MK-2206 (at the RPTD defined in Phase 1B). (Arms C and D) V. To
determine the recommended phase II treatment dose (RPTD) of fulvestrant (Arm C) or
fulvestrant plus anastrozole (Arm D), respectively, in combination with MK-2206 based on
toxicities observed with prolonged drug administration (3 months). (Arms C and D) VI. To
evaluate the toxicity profile of MK-2206 in combination with fulvestrant (Arm C) or
fulvestrant plus anastrozole (Arm D), respectively, with prolonged drug administration.
(Arms C and D)
SECONDARY OBJECTIVES:
I. To evaluate the toxicity profile of MK-2206 in combination with anastrozole, or
fulvestrant, or anastrozole plus fulvestrant.
II. To evaluate the Clinical Benefit Rate (CBR: complete response [CR]+partial response
[PR]+stable disease [SD] > 6 months), Response Rate (CR+PR), and Percent of Patients
Progression Free at 6 months with the treatment of MK-2206 in combination with anastrozole,
or fulvestrant or anastrozole plus fulvestrant in patients with estrogen receptor positive
(ER+) metastatic breast cancer.
III. To examine serum levels of estradiol prior to and following 1 cycle of MK-2206 therapy.
TERTIARY OBJECTIVES:
I. To examine baseline tumor specimens for PI3K pathway abnormalities and to explore its
relationship with treatment response.
II. To evaluate the effect of MK-2206 on tumor cell AKT signaling, proliferation, and
apoptosis using serially collected tumor samples in available cases.
III. To examine changes in tumor cell glucose uptake by positron emission tomography (PET)
with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) at baseline and 24 h post day 1 MK-2206. (Phase
IA) IV. To examine the PIK3CA mutation status in circulating deoxribonucleic acid (DNA) at
baseline and following study therapy and to correlate with tumor tissue PIK3CA status and
treatment response.
OUTLINE: This is a phase I, dose-escalation study of Akt inhibitor MK2206 (MK-2206) followed
by a recommended phase II dose (RPTD) study. Patients are assigned to the treatment arm that
is currently open.
ARM A: Patients receive anastrozole orally (PO) on days 1-28. Beginning in course 2,
patients receive MK-2206 PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the
absence of disease progression or unacceptable toxicity.
ARM B: The RPTD of MK-2206 with anastrozole is determined after 4 courses, administered as
in arm A.
ARM C: Patients receive letrozole PO on days 1-28. Beginning in course 2, patients receive
MK-2206 PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease
progression or unacceptable toxicity.
ARM D: Patients receive exemestane PO on days 1-28. Beginning in course 2, patients receive
MK-2206 PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease
progression or unacceptable toxicity.
ARM E: For patients who have not been started on fulvestrant, fulvestrant will be
administered intramuscularly (IM) on day 1 and day 15 on course 1 and then on day 1 of
course 2 and each subsequent course of the study. MK2206 is added on day 1 of course 2 of
the study. For patients who have completed at least 2 doses of fulvestrant, MK2206 will
start on day 1 of the scheduled monthly fulvestrant injection at course 1 of the study.
Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study therapy, patients are followed up for 30 days.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Maximum tolerated dose (MTD) of MK-2206 in combination with anastrozole determined according to dose-limiting toxicities (DLTs) graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0) (Phase IA)
4 weeks
Yes
Cynthia Ma
Principal Investigator
Washington University School of Medicine
United States: Food and Drug Administration
NCI-2011-02586
NCT01344031
April 2011
Name | Location |
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Washington University School of Medicine | Saint Louis, Missouri 63110 |