Efficacy and Safety Study of Enzalutamide in Combination With Paclitaxel Chemotherapy or as Monotherapy Versus Placebo With Paclitaxel in Patients With Advanced, Diagnostic-Positive, Triple-Negative Breast Cancer (ENDEAR)
Primary Purpose
Breast Cancer
Status
Withdrawn
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Enzalutamide
Placebo
Paclitaxel
Sponsored by
About this trial
This is an interventional treatment trial for Breast Cancer focused on measuring metastatic, triple negative
Eligibility Criteria
Inclusion Criteria:
- Adult women and men at least 18 years of age and willing and able to provide informed consent.
- Has advanced TNBC:
- TNBC is defined as staining by immunohistochemistry (IHC) < 1% or Allred score < 2 for estrogen receptor (ER) and progesterone receptor (PgR), and 0 or 1+ by IHC for human epidermal growth factor receptor 2 (HER2) or negative for gene amplification (average HER2 copy number < 4 signals/cell; HER2:CEP17 ratio < 2.0).
- Advanced disease is defined as locally advanced or metastatic disease not amenable to curative intent surgery or radiotherapy.
- Has diagnostic-positive status as determined by a central diagnostic testing laboratory.
- Received 0 or 1 prior line of systemic therapy in the advanced disease setting.
- Patients who received 1 prior line of therapy for locally advanced or metastatic TNBC must have objective disease progression as assessed by the investigator.
- Has measurable and/or disease that is not measurable but is evaluable using RECIST 1.1 (eg, bone metastases, pathologic lymph nodes, or skin lesions).
- Patients with nonmeasurable and nonevaluable TNBC (eg, malignant effusions or bone marrow as the only manifestations of disease) are not eligible for enrollment.
- Patients with metastatic disease limited to the bone must have disease adequately visualized by computed tomography (CT) with bone windows, magnetic resonance imaging (MRI), or x-ray.
- Has an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1 at screening and a life expectancy of at least 3 months from randomization.
Exclusion Criteria:
- Received a taxane regimen ≥ 28 days in duration in the advanced disease setting.
- Prior taxane therapy for neoadjuvant and/or adjuvant disease is permitted.
- A single dose of a taxane given as part of an every-3-weeks regimen is permitted.
- Two doses of a taxane given as part of a once-weekly regimen is permitted.
- Had a disease-free interval of ≤ 12 months from the last dose of taxane when used as part of adjuvant therapy for patients who did not receive prior therapy for locally advanced or metastatic breast cancer.
- Has history of or known central nervous system (CNS) metastasis or active leptomeningeal disease; brain imaging is required for all patients during screening.
- Received any anticancer agent (commercially available or investigational) within 14 days before randomization.
- Received treatment with any of the following medications within 14 days before randomization:
- Estrogens, including hormone replacement therapy
- Androgens (eg, testosterone, dehydroepiandrosterone)
- Systemic radionuclides (eg, samarium, strontium)
- Had major surgery within 4 weeks before randomization.
- Has a history of another invasive cancer within 3 years before randomization, with the exception of fully treated cancers with a remote probability of recurrence.
- Has a history of a seizure condition or any condition that may predispose to seizure (eg, prior cortical stroke or significant brain trauma).
- Has known hypersensitivity to any of the enzalutamide/placebo capsule components.
- Had a hypersensitivity reaction to Cremophor EL (polyoxyethylated castor oil) or a drug formulated in Cremophor EL, such as paclitaxel, unless successfully treated and rechallenged with appropriate premedications.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Placebo Comparator
Experimental
Arm Label
Double-blind enzalutamide with paclitaxel
Double-blind placebo with paclitaxel
Open-label enzalutamide monotherapy followed by paclitaxel
Arm Description
At the time of disease progression, enzalutamide treatment will be discontinued and paclitaxel will be administered if considered to be an appropriate treatment by the treating physician until second disease progression.
Outcomes
Primary Outcome Measures
Progression Free Survival (PFS)
Secondary Outcome Measures
Overall survival
PFS assessed by the investigator using Response Evaluation Criteria In Solid Tumors (RECIST) 1.1
Time to treatment failure
Best overall response
Best overall response is defined as the best tumor response (complete response [CR], partial response [PR], stable disease, progressive disease, not evaluable) based on investigator assessment per RECIST 1.1 over all tumor assessments performed any time on study. Best objective response rate is defined as the proportion of patients with a best overall response of CR or PR for all patients based on investigator assessment per RECIST 1.1. The 2-sided 95% Confidence Interval (CI) will be reported for each treatment group using the Clopper-Pearson method.
Duration of response
Time to second disease progression in patients randomly assigned to enzalutamide monotherapy who subsequently receive paclitaxel
Clinical benefit rate at 24 weeks (CBR24): From the start of treatment D1 assessed every 8 weeks +/- 1 week while on study treatment
CBR (complete, partial response, or stable disease lasting 24 weeks or longer) assessed per RECIST 1.1
Safety as assessed by percentage of patients with any Adverse Event (AE), AE leading to Study Drug Discontinuation, AE leading to death, Serious Adverse Event (SAE), AE related to study drug, SAE related to study drug
Time to functional status deterioration using the Functional Assessment of Cancer Therapy-Breast (FACT-B) trial outcome index (physical, functional, breast) (TOI-PFB)
Pharmacokinetics of enzalutamide as assessed by trough plasma concentrations
Pharmacokinetics of the active metabolite N-desmethyl enzalutamide as assessed by trough plasma concentrations
Full Information
NCT ID
NCT02929576
First Posted
September 7, 2016
Last Updated
October 19, 2018
Sponsor
Pfizer
Collaborators
Astellas Pharma Inc, Medivation, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT02929576
Brief Title
Efficacy and Safety Study of Enzalutamide in Combination With Paclitaxel Chemotherapy or as Monotherapy Versus Placebo With Paclitaxel in Patients With Advanced, Diagnostic-Positive, Triple-Negative Breast Cancer
Acronym
ENDEAR
Official Title
A Phase 3, Randomized, International Study Comparing the Efficacy and Safety of Enzalutamide in Combination With Paclitaxel Chemotherapy or as Monotherapy Versus Placebo With Paclitaxel in Patients With Advanced, Diagnostic-Positive, Triple-Negative Breast Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
October 2018
Overall Recruitment Status
Withdrawn
Why Stopped
Further understanding about the role of androgen signaling in TNBC was required
Study Start Date
September 2016 (undefined)
Primary Completion Date
April 2019 (Anticipated)
Study Completion Date
undefined (undefined)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Pfizer
Collaborators
Astellas Pharma Inc, Medivation, Inc.
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to evaluate and compare the clinical benefit and safety of treatment with enzalutamide in combination with paclitaxel chemotherapy or as monotherapy versus placebo with paclitaxel in patients with locally advanced or metastatic, diagnostic-positive, triple-negative breast cancer (TNBC).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
metastatic, triple negative
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Double-blind enzalutamide with paclitaxel
Arm Type
Experimental
Arm Title
Double-blind placebo with paclitaxel
Arm Type
Placebo Comparator
Arm Title
Open-label enzalutamide monotherapy followed by paclitaxel
Arm Type
Experimental
Arm Description
At the time of disease progression, enzalutamide treatment will be discontinued and paclitaxel will be administered if considered to be an appropriate treatment by the treating physician until second disease progression.
Intervention Type
Drug
Intervention Name(s)
Enzalutamide
Other Intervention Name(s)
Xtandi, MDV3100
Intervention Description
Enzalutamide will be administered as four 40-mg capsules once daily (160 mg/day).
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Intervention Description
Paclitaxel (90 mg/m2) will be administered by constant-rate intravenous infusion of ≤ 1 hour once weekly for 16 weeks. Dose reductions or alterations to the schedule are allowed to maintain patient safety.
Primary Outcome Measure Information:
Title
Progression Free Survival (PFS)
Time Frame
Anticipated in about 31 months following first patient enrolled
Secondary Outcome Measure Information:
Title
Overall survival
Time Frame
Anticipated in about 40 months following first patient enrolled
Title
PFS assessed by the investigator using Response Evaluation Criteria In Solid Tumors (RECIST) 1.1
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Time to treatment failure
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Best overall response
Description
Best overall response is defined as the best tumor response (complete response [CR], partial response [PR], stable disease, progressive disease, not evaluable) based on investigator assessment per RECIST 1.1 over all tumor assessments performed any time on study. Best objective response rate is defined as the proportion of patients with a best overall response of CR or PR for all patients based on investigator assessment per RECIST 1.1. The 2-sided 95% Confidence Interval (CI) will be reported for each treatment group using the Clopper-Pearson method.
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Duration of response
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Time to second disease progression in patients randomly assigned to enzalutamide monotherapy who subsequently receive paclitaxel
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Clinical benefit rate at 24 weeks (CBR24): From the start of treatment D1 assessed every 8 weeks +/- 1 week while on study treatment
Description
CBR (complete, partial response, or stable disease lasting 24 weeks or longer) assessed per RECIST 1.1
Time Frame
24 weeks
Title
Safety as assessed by percentage of patients with any Adverse Event (AE), AE leading to Study Drug Discontinuation, AE leading to death, Serious Adverse Event (SAE), AE related to study drug, SAE related to study drug
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Time to functional status deterioration using the Functional Assessment of Cancer Therapy-Breast (FACT-B) trial outcome index (physical, functional, breast) (TOI-PFB)
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Pharmacokinetics of enzalutamide as assessed by trough plasma concentrations
Time Frame
Anticipated in about 31 months following first patient enrolled
Title
Pharmacokinetics of the active metabolite N-desmethyl enzalutamide as assessed by trough plasma concentrations
Time Frame
Anticipated in about 31 months following first patient enrolled
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Adult women and men at least 18 years of age and willing and able to provide informed consent.
Has advanced TNBC:
TNBC is defined as staining by immunohistochemistry (IHC) < 1% or Allred score < 2 for estrogen receptor (ER) and progesterone receptor (PgR), and 0 or 1+ by IHC for human epidermal growth factor receptor 2 (HER2) or negative for gene amplification (average HER2 copy number < 4 signals/cell; HER2:CEP17 ratio < 2.0).
Advanced disease is defined as locally advanced or metastatic disease not amenable to curative intent surgery or radiotherapy.
Has diagnostic-positive status as determined by a central diagnostic testing laboratory.
Received 0 or 1 prior line of systemic therapy in the advanced disease setting.
Patients who received 1 prior line of therapy for locally advanced or metastatic TNBC must have objective disease progression as assessed by the investigator.
Has measurable and/or disease that is not measurable but is evaluable using RECIST 1.1 (eg, bone metastases, pathologic lymph nodes, or skin lesions).
Patients with nonmeasurable and nonevaluable TNBC (eg, malignant effusions or bone marrow as the only manifestations of disease) are not eligible for enrollment.
Patients with metastatic disease limited to the bone must have disease adequately visualized by computed tomography (CT) with bone windows, magnetic resonance imaging (MRI), or x-ray.
Has an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1 at screening and a life expectancy of at least 3 months from randomization.
Exclusion Criteria:
Received a taxane regimen ≥ 28 days in duration in the advanced disease setting.
Prior taxane therapy for neoadjuvant and/or adjuvant disease is permitted.
A single dose of a taxane given as part of an every-3-weeks regimen is permitted.
Two doses of a taxane given as part of a once-weekly regimen is permitted.
Had a disease-free interval of ≤ 12 months from the last dose of taxane when used as part of adjuvant therapy for patients who did not receive prior therapy for locally advanced or metastatic breast cancer.
Has history of or known central nervous system (CNS) metastasis or active leptomeningeal disease; brain imaging is required for all patients during screening.
Received any anticancer agent (commercially available or investigational) within 14 days before randomization.
Received treatment with any of the following medications within 14 days before randomization:
Estrogens, including hormone replacement therapy
Androgens (eg, testosterone, dehydroepiandrosterone)
Systemic radionuclides (eg, samarium, strontium)
Had major surgery within 4 weeks before randomization.
Has a history of another invasive cancer within 3 years before randomization, with the exception of fully treated cancers with a remote probability of recurrence.
Has a history of a seizure condition or any condition that may predispose to seizure (eg, prior cortical stroke or significant brain trauma).
Has known hypersensitivity to any of the enzalutamide/placebo capsule components.
Had a hypersensitivity reaction to Cremophor EL (polyoxyethylated castor oil) or a drug formulated in Cremophor EL, such as paclitaxel, unless successfully treated and rechallenged with appropriate premedications.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pfizer CT.gov Call Center
Organizational Affiliation
Pfizer
Official's Role
Study Director
Facility Information:
City
Topeka
State/Province
Kansas
ZIP/Postal Code
66606
Country
United States
City
Metairie
State/Province
Louisiana
ZIP/Postal Code
70006
Country
United States
City
Bronx
State/Province
New York
ZIP/Postal Code
10469
Country
United States
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
City
Tacoma
State/Province
Washington
ZIP/Postal Code
98405
Country
United States
City
Wenatchee
State/Province
Washington
ZIP/Postal Code
98801
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Efficacy and Safety Study of Enzalutamide in Combination With Paclitaxel Chemotherapy or as Monotherapy Versus Placebo With Paclitaxel in Patients With Advanced, Diagnostic-Positive, Triple-Negative Breast Cancer
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