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Trial of Chidamide in Combination With Exemestane in Patients With Advanced Breast Cancer

Primary Purpose

Breast Cancer

Status
Completed
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
Chidamide
exemestane
placebo
Sponsored by
Chipscreen Biosciences, Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer focused on measuring Chidamide, breast cancer, exemestane, Estrogen Receptor

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. 18 ~ 75 years old, postmenopausal women;
  2. Histological or cytological confirmation of hormone receptor-positive [estrogen receptor (ER) positive and progesterone receptors (PgR) positive or negative] breast cancer;
  3. Disease progression or recurrence after at least one endocrine therapy (either in advanced/metastatic setting or adjuvant setting);
  4. ≤4 prior therapies (either in advanced/metastatic setting or adjuvant setting), patients may have received one prior chemotherapy;
  5. The disease condition is inoperable, stage III or stage IV, at least one measurable lesion or simple bone metastases with no measurable lesions;
  6. Last prior therapy intervals: (a) if the last treatment was endocrine therapy, the interval must ≥ 2 weeks; (b) if the last treatment was chemotherapy therapy, the interval must ≥ 4 weeks;
  7. Eastern Cooperative Oncology Group Performance Status: 0~1;
  8. Absolute neutrophil count ≥ 1.5×109 / L, platelet count ≥ 100×109 / L, hemoglobin ≥ 90 g/L;
  9. Life expectancy ≥ 3 months;
  10. Have signed informed consent.

Exclusion Criteria:

  1. Patients have known central nervous system (CNS) metastases or a history of CNS metastases , or with leptomeningeal disease;
  2. Patients with human epidermal growth factor receptor-2 (Her-2) positive;
  3. Patients previously received treatment with exemestane;
  4. Patients received radiotherapy ≤ 4 weeks prior to study entry;
  5. Patients with no measurable lesion (except simple bone metastasis), such as pleural or pericardial effusion, ascites, et al;
  6. Patients have uncontrolled or significant cardiovascular disease, including:

    1. Myocardial infarction (< the last 12 months)
    2. Uncontrolled angina (< the last 6 months)
    3. Congestive heart failure (< the last 6 months), or Left Ventricular Ejection Fraction (LVEF) < 50% prior to study entry
    4. History of any significant ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, or TdP)
    5. History of significant QT interval prolongation, or Corrected QT Interval (QTc) > 450 ms prior to study entry
    6. History of cerebrovascular accident
    7. Symptomatic coronary heart disease requiring treatment with agents
  7. The size of fluid area detected by cardiac ultrasonography in cavum pericardium is ≥10mm during diastolic period;
  8. History of organ transplantation;
  9. Patients have not recovered from all clinically relevant toxicities to grade 1 due to prior therapies;
  10. Patients have clinical significant gastrointestinal abnormality, e.g., unable to swallow, chronic diarrhea, ileus, that would interfere the ingestion,transportation or absorption of oral agents;
  11. Active infection [Suffered from active infection of bacteria, virus, fungi, mycobacteria, parasites, or other infections (excluding nail bed fungal infections), or require intravenous antibiotic therapy, or antiviral therapy, or hospitalization due to any significant infection events], or persistent fever within 14 days prior to study entry;
  12. Patients had organ surgery < 6 weeks prior to study entry;
  13. Abnormal liver function [total bilirubin > 1.5×upper limit of normal (> 3×upper limit of normal in case of Gilbert syndrome); Transaminases (ALT, AST) >2.5×upper limit of normal (>5x upper limit of normal patients with liver metastases), abnormal renal function (serum creatinine > 1.5×upper limit of normal);
  14. Patients with prior invasive malignancies with the exception of curatively-treated basal cell or squamous cell carcinoma of the skin or cervical carcinoma in situ, unless received curative treatment and with documented evidence of no recurrence in the past five years;
  15. Any mental or cognitive disorder, that would interfere the ability to understand the informed consent document or the operation and compliance of study;
  16. Patients are currently enrolled in another investigational drug study, or completed within 4 weeks prior to study entry, with the exception of patients only in overall survival follow-up;
  17. Any other condition which is inappropriate for the study in the opinion of the investigators.

Sites / Locations

  • Anhui Provincial Hospital
  • The First Affiliated Hospital of Anhui Medical University
  • The 307th Hospital of Chinese people's Liberation Army
  • Beijing Cancer Hospital
  • Sun Yat-sen University Cancer Center
  • Peking University Shenzhen Hospital
  • Cangzhou Central Hospital
  • Tumor Hospital of Hebei Province
  • Harbin Medical University Cancer Hospital
  • Henan Cancer Hospital
  • Hunan Cancer Hospital
  • Zhejiang Cancer Hospital
  • Jiangsu Cancer Hospital
  • Jiangsu Province Hospital
  • The Third Hospital of Nanchang
  • Jilin Cancer Hospital
  • The First Hospital of Jilin University
  • Liaoning Cancer Hospital & Institute
  • Jinan Central Hospital
  • Fudan University Shanghai Cancer Center
  • Fudan University ZhongShan Hospital
  • Tianjin Medical University Cancer Institute and Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

Chidamide + exemestane, open-label

Chidamide + exemestane, double-blinded

placebo + exemestane, double-blinded

Arm Description

Patients receive 30 mg Chidamide per week and 25 mg exemestane QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

Patients receive 30 mg Chidamide twice per week and 25 mg exemestane QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

Patients receive placebo twice per week and 25 mg exemestane PO QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

progression-free survival (PFS), double-blinded period
PFS is measured from the date of randomization until progression or death, whichever is first met
pharmacokinetic profiles of Chidamide, open-label period
The pharmacokinetic parameters include Area under the plasma concentration versus time curve (AUC) , Peak Plasma Concentration (Cmax), time to reach Cmax (Tmax), mean concentration at steady state (Css)
pharmacokinetic profiles of exemestane, open-label period
The pharmacokinetic parameters include Area under the plasma concentration versus time curve (AUC) , Peak Plasma Concentration (Cmax), time to reach Cmax (Tmax), mean concentration at steady state (Css)
acetylation level of histone H3, open-label period
The acetylation level of histone H3 is assayed by enzyme-linked immuno sorbent assay (ELISA).

Secondary Outcome Measures

overall survival, double-blinded period
OS is measured from the date of randomization until death
duration of response (DOR), double-blinded period
DOR is measured from the first date when criteria for response is met until the first date when the criteria for progression is met
objective response rate (ORR), open-label period and double-blinded period
ORR is defined as percentage of participants with Complete Response and Partial Response, assessed by the investigators according to the Response Evaluation Criteria in Solid Tumors (RECIST)
clinical benefit rate (CBR), open-label period and double-blinded period
ORR is defined as percentage of participants with Complete Response, Partial Response or Stable Disease ≥ 24 weeks, assessed by the investigators according to the Response Evaluation Criteria in Solid Tumors (RECIST)
PFS, open-label period
PFS is measured from the start of treatment until progression or death, whichever is first met

Full Information

First Posted
June 17, 2015
Last Updated
January 10, 2022
Sponsor
Chipscreen Biosciences, Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02482753
Brief Title
Trial of Chidamide in Combination With Exemestane in Patients With Advanced Breast Cancer
Official Title
A Phase III Trial of Chidamide in Combination With Exemestane in Patients With Hormone Receptor-Positive Advanced Breast Cancer (ACE)
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Completed
Study Start Date
July 2015 (Actual)
Primary Completion Date
March 2018 (Actual)
Study Completion Date
February 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Chipscreen Biosciences, Ltd.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study was to evaluate the efficacy and safety of Chidamide in combination with exemestane in postmenopausal patients with hormone-receptor positive advanced breast cancer.
Detailed Description
This study including two parts: (1) Part A, open-label design, 20 patients will be enrolled and receive 30 mg Chidamide BIW and 25 mg exemestane QD. The main object of part A is to evaluate the pharmacokinetic and pharmacodynamic profile of Chidamide when in combination with exemestane. (2) Part B, randomized and double-blinded design, 328 patients will be assigned randomly in a 2:1 ratio to experiment group (30 mg Chidamide BIW + 25 mg exemestane QD) and control group (placebo BIW + 25 mg exemestane QD), to evaluate the efficacy and safety of Chidamide when in combination with exemestane in patients with locally advanced or metastatic estrogen receptor-positive breast cancer progressing on endocrine therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
Chidamide, breast cancer, exemestane, Estrogen Receptor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
365 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Chidamide + exemestane, open-label
Arm Type
Experimental
Arm Description
Patients receive 30 mg Chidamide per week and 25 mg exemestane QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Arm Title
Chidamide + exemestane, double-blinded
Arm Type
Experimental
Arm Description
Patients receive 30 mg Chidamide twice per week and 25 mg exemestane QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Arm Title
placebo + exemestane, double-blinded
Arm Type
Placebo Comparator
Arm Description
Patients receive placebo twice per week and 25 mg exemestane PO QD. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Chidamide
Other Intervention Name(s)
CS055
Intervention Description
30 mg, administered orally twice per week (BIW)
Intervention Type
Drug
Intervention Name(s)
exemestane
Other Intervention Name(s)
Aromasin
Intervention Description
25 mg, PO daily
Intervention Type
Drug
Intervention Name(s)
placebo
Other Intervention Name(s)
Simulation tablet of Chidamide
Intervention Description
Administered orally twice per week (BIW)
Primary Outcome Measure Information:
Title
progression-free survival (PFS), double-blinded period
Description
PFS is measured from the date of randomization until progression or death, whichever is first met
Time Frame
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 3 years
Title
pharmacokinetic profiles of Chidamide, open-label period
Description
The pharmacokinetic parameters include Area under the plasma concentration versus time curve (AUC) , Peak Plasma Concentration (Cmax), time to reach Cmax (Tmax), mean concentration at steady state (Css)
Time Frame
0,1,2,4,8,12,24,48,72 hours after the first dose of Chidamide on day 2 at induced stage (4 days in total); 0,1,2,4,8,12,24,48,72 hours post-dose on day 1 of cycle 1 at combination treatment stage
Title
pharmacokinetic profiles of exemestane, open-label period
Description
The pharmacokinetic parameters include Area under the plasma concentration versus time curve (AUC) , Peak Plasma Concentration (Cmax), time to reach Cmax (Tmax), mean concentration at steady state (Css)
Time Frame
0,1,2,4,8,12,24 hours after the first dose of exemestane on day 1 at induced stage (4 days in total); 0,1,2,4,8,12,24,48,72 hours post-dose on day 1 of cycle 1 at combination treatment stage
Title
acetylation level of histone H3, open-label period
Description
The acetylation level of histone H3 is assayed by enzyme-linked immuno sorbent assay (ELISA).
Time Frame
pre-dose of Chidamide on day 2 at induced stage (4 days in total); pre-dose of Chidamide on day 1 of cycle 2 at combination treatment stage
Secondary Outcome Measure Information:
Title
overall survival, double-blinded period
Description
OS is measured from the date of randomization until death
Time Frame
Time from randomization to death from any cause, assessed up to 6 years
Title
duration of response (DOR), double-blinded period
Description
DOR is measured from the first date when criteria for response is met until the first date when the criteria for progression is met
Time Frame
From the first date of response until the date of first documented progression, assessed up to 3years
Title
objective response rate (ORR), open-label period and double-blinded period
Description
ORR is defined as percentage of participants with Complete Response and Partial Response, assessed by the investigators according to the Response Evaluation Criteria in Solid Tumors (RECIST)
Time Frame
Response is assessed once every 6 weeks, assessed up to 3 years
Title
clinical benefit rate (CBR), open-label period and double-blinded period
Description
ORR is defined as percentage of participants with Complete Response, Partial Response or Stable Disease ≥ 24 weeks, assessed by the investigators according to the Response Evaluation Criteria in Solid Tumors (RECIST)
Time Frame
Response is assessed once every 6 weeks, assessed up to 3 years
Title
PFS, open-label period
Description
PFS is measured from the start of treatment until progression or death, whichever is first met
Time Frame
Time from the start of treatment to the earliest of documented disease progression, or death, assessed up to 3 years

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 18 ~ 75 years old, postmenopausal women; Histological or cytological confirmation of hormone receptor-positive [estrogen receptor (ER) positive and progesterone receptors (PgR) positive or negative] breast cancer; Disease progression or recurrence after at least one endocrine therapy (either in advanced/metastatic setting or adjuvant setting); ≤4 prior therapies (either in advanced/metastatic setting or adjuvant setting), patients may have received one prior chemotherapy; The disease condition is inoperable, stage III or stage IV, at least one measurable lesion or simple bone metastases with no measurable lesions; Last prior therapy intervals: (a) if the last treatment was endocrine therapy, the interval must ≥ 2 weeks; (b) if the last treatment was chemotherapy therapy, the interval must ≥ 4 weeks; Eastern Cooperative Oncology Group Performance Status: 0~1; Absolute neutrophil count ≥ 1.5×109 / L, platelet count ≥ 100×109 / L, hemoglobin ≥ 90 g/L; Life expectancy ≥ 3 months; Have signed informed consent. Exclusion Criteria: Patients have known central nervous system (CNS) metastases or a history of CNS metastases , or with leptomeningeal disease; Patients with human epidermal growth factor receptor-2 (Her-2) positive; Patients previously received treatment with exemestane; Patients received radiotherapy ≤ 4 weeks prior to study entry; Patients with no measurable lesion (except simple bone metastasis), such as pleural or pericardial effusion, ascites, et al; Patients have uncontrolled or significant cardiovascular disease, including: Myocardial infarction (< the last 12 months) Uncontrolled angina (< the last 6 months) Congestive heart failure (< the last 6 months), or Left Ventricular Ejection Fraction (LVEF) < 50% prior to study entry History of any significant ventricular arrhythmias (e.g., ventricular tachycardia, ventricular fibrillation, or TdP) History of significant QT interval prolongation, or Corrected QT Interval (QTc) > 450 ms prior to study entry History of cerebrovascular accident Symptomatic coronary heart disease requiring treatment with agents The size of fluid area detected by cardiac ultrasonography in cavum pericardium is ≥10mm during diastolic period; History of organ transplantation; Patients have not recovered from all clinically relevant toxicities to grade 1 due to prior therapies; Patients have clinical significant gastrointestinal abnormality, e.g., unable to swallow, chronic diarrhea, ileus, that would interfere the ingestion,transportation or absorption of oral agents; Active infection [Suffered from active infection of bacteria, virus, fungi, mycobacteria, parasites, or other infections (excluding nail bed fungal infections), or require intravenous antibiotic therapy, or antiviral therapy, or hospitalization due to any significant infection events], or persistent fever within 14 days prior to study entry; Patients had organ surgery < 6 weeks prior to study entry; Abnormal liver function [total bilirubin > 1.5×upper limit of normal (> 3×upper limit of normal in case of Gilbert syndrome); Transaminases (ALT, AST) >2.5×upper limit of normal (>5x upper limit of normal patients with liver metastases), abnormal renal function (serum creatinine > 1.5×upper limit of normal); Patients with prior invasive malignancies with the exception of curatively-treated basal cell or squamous cell carcinoma of the skin or cervical carcinoma in situ, unless received curative treatment and with documented evidence of no recurrence in the past five years; Any mental or cognitive disorder, that would interfere the ability to understand the informed consent document or the operation and compliance of study; Patients are currently enrolled in another investigational drug study, or completed within 4 weeks prior to study entry, with the exception of patients only in overall survival follow-up; Any other condition which is inappropriate for the study in the opinion of the investigators.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Zefei Jiang
Organizational Affiliation
307 Hospital of PLA
Official's Role
Principal Investigator
Facility Information:
Facility Name
Anhui Provincial Hospital
City
Hefei
State/Province
Anhui
ZIP/Postal Code
230001
Country
China
Facility Name
The First Affiliated Hospital of Anhui Medical University
City
Hefei
State/Province
Anhui
ZIP/Postal Code
230022
Country
China
Facility Name
The 307th Hospital of Chinese people's Liberation Army
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100021
Country
China
Facility Name
Beijing Cancer Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100036
Country
China
Facility Name
Sun Yat-sen University Cancer Center
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510060
Country
China
Facility Name
Peking University Shenzhen Hospital
City
Shenzhen
State/Province
Guangdong
ZIP/Postal Code
518036
Country
China
Facility Name
Cangzhou Central Hospital
City
Cangzhou
State/Province
Hebei
ZIP/Postal Code
061001
Country
China
Facility Name
Tumor Hospital of Hebei Province
City
Shijiazhuang
State/Province
Hebei
ZIP/Postal Code
050019
Country
China
Facility Name
Harbin Medical University Cancer Hospital
City
Ha'erbin
State/Province
Heilongjiang
ZIP/Postal Code
150081
Country
China
Facility Name
Henan Cancer Hospital
City
Zhengzhou
State/Province
Henan
ZIP/Postal Code
450008
Country
China
Facility Name
Hunan Cancer Hospital
City
Changsha
State/Province
Hunan
Country
China
Facility Name
Zhejiang Cancer Hospital
City
Hangzhou
State/Province
Jiangsu
ZIP/Postal Code
310022
Country
China
Facility Name
Jiangsu Cancer Hospital
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210009
Country
China
Facility Name
Jiangsu Province Hospital
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210029
Country
China
Facility Name
The Third Hospital of Nanchang
City
Nanchang
State/Province
Jiangxi
ZIP/Postal Code
330009
Country
China
Facility Name
Jilin Cancer Hospital
City
Changchun
State/Province
Jilin
ZIP/Postal Code
130012
Country
China
Facility Name
The First Hospital of Jilin University
City
Changchun
State/Province
Jilin
ZIP/Postal Code
130021
Country
China
Facility Name
Liaoning Cancer Hospital & Institute
City
Shenyang
State/Province
Liaoning
ZIP/Postal Code
110042
Country
China
Facility Name
Jinan Central Hospital
City
Jinan
State/Province
Shandong
ZIP/Postal Code
250013
Country
China
Facility Name
Fudan University Shanghai Cancer Center
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200032
Country
China
Facility Name
Fudan University ZhongShan Hospital
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200032
Country
China
Facility Name
Tianjin Medical University Cancer Institute and Hospital
City
Tianjin
State/Province
Tianjin
ZIP/Postal Code
300060
Country
China

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31036468
Citation
Jiang Z, Li W, Hu X, Zhang Q, Sun T, Cui S, Wang S, Ouyang Q, Yin Y, Geng C, Tong Z, Cheng Y, Pan Y, Sun Y, Wang H, Ouyang T, Gu K, Feng J, Wang X, Wang S, Liu T, Gao J, Cristofanilli M, Ning Z, Lu X. Tucidinostat plus exemestane for postmenopausal patients with advanced, hormone receptor-positive breast cancer (ACE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019 Jun;20(6):806-815. doi: 10.1016/S1470-2045(19)30164-0. Epub 2019 Apr 27.
Results Reference
derived

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Trial of Chidamide in Combination With Exemestane in Patients With Advanced Breast Cancer

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