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An Early Phase Study of Abraxane Combined With Phenelzine Sulfate in Patients With Metastatic or Advanced Breast Cancer (Epi-PRIMED)

Primary Purpose

Metastatic Breast Cancer

Status
Completed
Phase
Phase 1
Locations
Australia
Study Type
Interventional
Intervention
Nanoparticle albumin-bound paclitaxel
Phenelzine Sulfate
Sponsored by
EpiAxis Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Breast Cancer focused on measuring Nanoparticle albumin-bound paclitaxel (Abraxane), Phenelzine Sulfate, Cancer stem cells, epigenetics, LSD1

Eligibility Criteria

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

Inclusion Criteria:

  1. Patients who are 18 years or older;
  2. Fluent in written and spoken English and in a position to provide written informed consent to participate;
  3. A patient who is in a position to attend a 12-week treatment regimen and end of study visit;
  4. Metastatic Breast Cancer (MBC) or inoperable locally advanced breast cancer diagnosis based on pre-existing documented histopathology and medical imaging results, either Triple Negative Metastatic Breast Cancer (TNBC) or not;
  5. Women with metastatic breast cancer or inoperable locally advanced breast cancer who have not received any cytotoxic therapy in the last 3 weeks;
  6. Volunteers of child-bearing potential must have a negative serum pregnancy test (serum beta-human chorionic gonadotropin or ß-hCG) and have agreed to practice an effective, reliable contraceptive regimen for the duration of this clinical trial, such as an intrauterine device (IUD) or intrauterine system (IUS) with a failure rate of <1% stated on the product label or a male partner who is has been sterilised (vasectomy with documented azoospermia);
  7. ECOG Performance Status 0 or 1; and
  8. Adequate liver function as evidenced by bilirubin of <1.5 times upper limit of normal (ULN) and ALT/AST <2 times of ULN. However, AST and ALT of <5 times ULN if liver metastases are present.

Exclusion Criteria:

  1. A patient who has been diagnosed as having HER2-positive metastatic breast cancer;
  2. A concurrent condition that may limit the decision-making capabilities of the participant during the informed consent process;
  3. A previous positive diagnosis of Human Immunodeficiency Virus (HIV) and/or Hepatitis C Virus (HCV) and/or Hepatitis B Virus (HBV) infection;
  4. Women who are pregnant or lactating;
  5. Uncontrolled, untreated intra-cranial metastases. However, controlled intra-cranial metastases are allowed, i.e. stable patients with more than a month after the completion of whole brain radiotherapy and not currently on steroids or anticonvulsants;
  6. Current use of monoamine oxidase inhibitors (MOAI) or use of dextromethorphan
  7. Current use of CNS depressants such as selective serotonin re-uptake inhibitors as well as specific medication for pain management including pethidine, tramadol, dextromethorphan, fentanyl and/or methadone. This includes the concurrent use of any serotoninergic agents or buspirone hydrochloride during the week preceding phenelzine sulfate administration, the active study treatment phase and the washout period at the end of study. Serotoninergic drugs may include but are not limited to the following: dexfenfluramine, fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram and venlafaxine;
  8. Previous use of nanoparticle albumin-bound paclitaxel;
  9. Known allergy to phenelzine sulfate or similar MOAI; and
  10. Known or suspected history of alcohol abuse;

Sites / Locations

  • Canberra Region Cancer Centre
  • Liverpool Cancer Therapy Centre
  • Southern Medical Day Care Centre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cohort Group

Arm Description

There are five patient cohort groups. Each will receive a progressively higher starting dose of phenelzine sulfate, consecutively. Cohort A will start at 15mg/day and will be increased to 30mg/d by week 2 and further increased to 45mg/d for week 3, which will be maintained throughout the study. Cohort B will start at 45mg/d and will be held constant throughout the Study. Similarly, Cohort C, D & E will start at 60, 75 and 90mg/d, respectively, and will also be held on this dose throughout the study. The decision to escalate the dose for the next cohort will be made on the basis of the number of dose limiting toxicity (DLT) events observed during the first 8 weeks in the preceding cohort group. In addition, all cohort groups will receive a constant dose of Abraxane at 100mg/m2.

Outcomes

Primary Outcome Measures

Dose-Limiting Toxicity (DLT) events
The number of DLT events for nanoparticle albumin-bound paclitaxel and phenelzine sulfate combined, with the following events assessed using the NCI's CTCAE v4.3 toxicity criteria: Grade 3 Febrile neutropenia; Grade ≥2 peripheral neuropathy; Any Grade 3 non-haematological toxicity except alopecia; nausea, vomiting, or diarrhoea for 72 hrs due to inadequate use of prophylaxis; Grade 3 fatigue for > 7 days; Non-hematologic Grade 3 or 4 laboratory AE that do not return to baseline or to Grade 1 within 7 days; Grade 3 thrombocytopenia with signs of significant bleeding or platelet count Grade 4; Blood bilirubin (total) Grade ≥3 for 72 hrs, AST or ALT Grade 3 for >7 consecutive days, AST or ALT Grade 4; Persistent Grade 3 hypertension for >7 days & not responding to antihypertensive therapy or Grade 4 hypertension; An inability to administer treatment (with >7 day delay) during Cycle 1 and Cycle 2 for toxicity reason; & Any other treatment emergent SAE.

Secondary Outcome Measures

Abraxane Cmax
To assess maximum plasma concentration (ng/ml) of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate.
Abraxane Tmax
To assess the time after infusion of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate to achieve peak maximum plasma concentration (minutes).
Abraxane Half-life
To assess the terminal half-life (minutes) of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate.
Abraxane AUC
To assess the area under nanoparticle albumin-bound paclitaxel concentration time curve from 0 to infinity (ng minutes / ml) and when combined with phenelzine sulfate.
Nardil Cmax
To assess maximum plasma concentration (ng/ml) of phenelzine sulfate when combined with nanoparticle albumin-bound paclitaxel.
Nardil Tmax
To assess the time after ingestion of phenelzine sulfate, when combined with nanoparticle albumin-bound paclitaxel, to achieve peak maximum plasma concentration (minutes).
Nardil Half-life
To assess the terminal half-life (minutes) after ingestion of phenelzine sulfate, when combined with nanoparticle albumin-bound paclitaxel.
Nardil AUC
To assess the area under Phenelzine Sulfate concentration time curve from 0 to infinity (ng minutes / ml) when combined with nanoparticle albumin-bound paclitaxel.
Circulating Tumour Cell (CTC) burden
The CTC burden is expressed as the number of tumour cells observed per 30ml of blood.
PDL1 expressing Circulating Tumour Cell (CTC) burden
The PDL1 expressing CTC burden is expressed as the number of CTC observed per 30ml of blood with PDL1 expression.
HER2 expressing Circulating Tumour Cell (CTC) burden
The HER2 expressing CTC burden is expressed as the number of CTC observed per 30ml of blood with PDL1 expression.
FFPE Tumour cells burden
The number of tumour cells observed per FFPE slide.
FFPE Stoma cells burden
The number of stoma cells observed per FFPE slide.
FFPE Cancer Stem Cells (CSC) burden
The number of CSC observed per FFPE slide.

Full Information

First Posted
March 4, 2018
Last Updated
November 12, 2019
Sponsor
EpiAxis Therapeutics
Collaborators
The Canberra Hospital, Southern Medical Day Care Centre, Liverpool Cancer Therapy Centre
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1. Study Identification

Unique Protocol Identification Number
NCT03505528
Brief Title
An Early Phase Study of Abraxane Combined With Phenelzine Sulfate in Patients With Metastatic or Advanced Breast Cancer
Acronym
Epi-PRIMED
Official Title
A Phase Ib Safety and Pharmacokinetics (PK)/ Pharmacodynamics (PD) Study to Determine the Dosage of Abraxane in Combination With Phenelzine Sulfate in Metastatic or Inoperable Locally Advanced Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
August 17, 2017 (Actual)
Primary Completion Date
October 30, 2019 (Actual)
Study Completion Date
October 30, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
EpiAxis Therapeutics
Collaborators
The Canberra Hospital, Southern Medical Day Care Centre, Liverpool Cancer Therapy Centre

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This phase 1b study will determine the safety and efficacy of combined treatment of Abraxane and phenelzine sulfate (Nardil) for metastatic or locally advanced breast cancer. Participants may be eligible to join this study if they are aged 18 years or above and have been diagnosed with metastatic breast cancer or inoperable locally advanced breast cancer. All participants will receive a combination of intravenous Abraxane and an oral dose of phenelzine sulfate. Abraxane will be administered weekly for the first 3 weeks of a 4-week cycle for 3 consecutive cycles. Phenelzine sulfate will be taken daily for the duration of the 3 cycles. Five patient cohort groups will receive a progressively increasing dose of phenelzine sulfate. Safety and efficacy will be assessed weekly over the 3 cycles of treatment. Although both drugs have been used in clinical care for more than a decade, they have not been intentionally combined together in a cancer therapy setting. This means that the combined effect of these two drugs has not been documented. This is being addressed in this study.
Detailed Description
Nanoparticle albumin-bound paclitaxel (Abraxane) will be administered intravenously over 3 cycles at a fixed dosage of 100mg/m2 to each study participant. This dose will be administered weekly for the first 3 consecutive weeks, over the 4 week cycle, before commencing the second and third cycles. In addition to the fixed dose of nanoparticle albumin-bound paclitaxel, all patients will receive a continuous daily oral dose of phenelzine sulfate across all three cycles, Each of the five patient cohort groups will receive a progressively higher starting dose of phenelzine sulfate, consecutively. Cohort A will start at 15mg/day and will be increased to 30mg/d by week 2 and further increased to 45mg/d for week 3, which will be maintained throughout the study. Cohort B will start at 45mg/d and will be held constant throughout the Study. Similarly, Cohort C, D & E will start at 60, 75 and 90mg/d, respectively, and will also be held on this dose throughout the study. The decision to escalate the dose for the next cohort will be made on the basis of the number of dose limiting toxicity (DLT) events observed during the first 8 weeks in the preceding cohort group. Phenelzine sulfate compliance will be monitored weekly based on drug tablet returns.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Breast Cancer
Keywords
Nanoparticle albumin-bound paclitaxel (Abraxane), Phenelzine Sulfate, Cancer stem cells, epigenetics, LSD1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
An open, non-randomised, cumulative cohort group design (across 5 groups) with a target toxicity fraction of 30% and a margin of 10%. This means that a dose will be escalated between groups when the observed toxicity rate is < 20%, de-escalated when > 40% and maintained otherwise. The toxicity fraction is the number of participants receiving that dose who experience a DLT.
Masking
None (Open Label)
Enrollment
8 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort Group
Arm Type
Experimental
Arm Description
There are five patient cohort groups. Each will receive a progressively higher starting dose of phenelzine sulfate, consecutively. Cohort A will start at 15mg/day and will be increased to 30mg/d by week 2 and further increased to 45mg/d for week 3, which will be maintained throughout the study. Cohort B will start at 45mg/d and will be held constant throughout the Study. Similarly, Cohort C, D & E will start at 60, 75 and 90mg/d, respectively, and will also be held on this dose throughout the study. The decision to escalate the dose for the next cohort will be made on the basis of the number of dose limiting toxicity (DLT) events observed during the first 8 weeks in the preceding cohort group. In addition, all cohort groups will receive a constant dose of Abraxane at 100mg/m2.
Intervention Type
Drug
Intervention Name(s)
Nanoparticle albumin-bound paclitaxel
Other Intervention Name(s)
Abraxane
Intervention Description
Abraxane is administered intravenous at a constant dose of 100mg/m2
Intervention Type
Drug
Intervention Name(s)
Phenelzine Sulfate
Other Intervention Name(s)
Nardil
Intervention Description
Nardil is administered orally from a starting dose of 15mg/d to a maximum of 90mg/d
Primary Outcome Measure Information:
Title
Dose-Limiting Toxicity (DLT) events
Description
The number of DLT events for nanoparticle albumin-bound paclitaxel and phenelzine sulfate combined, with the following events assessed using the NCI's CTCAE v4.3 toxicity criteria: Grade 3 Febrile neutropenia; Grade ≥2 peripheral neuropathy; Any Grade 3 non-haematological toxicity except alopecia; nausea, vomiting, or diarrhoea for 72 hrs due to inadequate use of prophylaxis; Grade 3 fatigue for > 7 days; Non-hematologic Grade 3 or 4 laboratory AE that do not return to baseline or to Grade 1 within 7 days; Grade 3 thrombocytopenia with signs of significant bleeding or platelet count Grade 4; Blood bilirubin (total) Grade ≥3 for 72 hrs, AST or ALT Grade 3 for >7 consecutive days, AST or ALT Grade 4; Persistent Grade 3 hypertension for >7 days & not responding to antihypertensive therapy or Grade 4 hypertension; An inability to administer treatment (with >7 day delay) during Cycle 1 and Cycle 2 for toxicity reason; & Any other treatment emergent SAE.
Time Frame
Assessed throughout the first 56 days
Secondary Outcome Measure Information:
Title
Abraxane Cmax
Description
To assess maximum plasma concentration (ng/ml) of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate.
Time Frame
Cmax will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate.
Title
Abraxane Tmax
Description
To assess the time after infusion of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate to achieve peak maximum plasma concentration (minutes).
Time Frame
Tmax will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate.
Title
Abraxane Half-life
Description
To assess the terminal half-life (minutes) of nanoparticle albumin-bound paclitaxel alone and when combined with phenelzine sulfate.
Time Frame
Half-life will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate.
Title
Abraxane AUC
Description
To assess the area under nanoparticle albumin-bound paclitaxel concentration time curve from 0 to infinity (ng minutes / ml) and when combined with phenelzine sulfate.
Time Frame
AUC will be assessed on two separate occasions. The first is at day 1 and is for the effect of nanoparticle albumin-bound paclitaxel alone. The second is at day 57 and is for the combined effect with phenelzine sulfate.
Title
Nardil Cmax
Description
To assess maximum plasma concentration (ng/ml) of phenelzine sulfate when combined with nanoparticle albumin-bound paclitaxel.
Time Frame
Cmax will be assessed on day 57.
Title
Nardil Tmax
Description
To assess the time after ingestion of phenelzine sulfate, when combined with nanoparticle albumin-bound paclitaxel, to achieve peak maximum plasma concentration (minutes).
Time Frame
Tmax will be assessed on day 57.
Title
Nardil Half-life
Description
To assess the terminal half-life (minutes) after ingestion of phenelzine sulfate, when combined with nanoparticle albumin-bound paclitaxel.
Time Frame
Half-life will be assessed on day 57.
Title
Nardil AUC
Description
To assess the area under Phenelzine Sulfate concentration time curve from 0 to infinity (ng minutes / ml) when combined with nanoparticle albumin-bound paclitaxel.
Time Frame
AUC will be assessed on day 57.
Title
Circulating Tumour Cell (CTC) burden
Description
The CTC burden is expressed as the number of tumour cells observed per 30ml of blood.
Time Frame
CTC burden will assessed be at baseline and again at day 29, 57 and 85, whereas the CSC burden will assessed only at baseline and again at day 85.
Title
PDL1 expressing Circulating Tumour Cell (CTC) burden
Description
The PDL1 expressing CTC burden is expressed as the number of CTC observed per 30ml of blood with PDL1 expression.
Time Frame
The PDL1 CTC expression burden will be assessed at baseline and again at day 29, 57 and 85, whereas the CSC burden will assessed only at baseline and again at day 85.
Title
HER2 expressing Circulating Tumour Cell (CTC) burden
Description
The HER2 expressing CTC burden is expressed as the number of CTC observed per 30ml of blood with PDL1 expression.
Time Frame
The HER2 CTC expression burden will be assessed at baseline and again at day 29, 57 and 85, whereas the CSC burden will assessed only at baseline and again at day 85.
Title
FFPE Tumour cells burden
Description
The number of tumour cells observed per FFPE slide.
Time Frame
Then burden will be assessed at baseline and again at day 85.
Title
FFPE Stoma cells burden
Description
The number of stoma cells observed per FFPE slide.
Time Frame
Then burden will be assessed at baseline and again at day 85.
Title
FFPE Cancer Stem Cells (CSC) burden
Description
The number of CSC observed per FFPE slide.
Time Frame
Then burden will be assessed at baseline and again at day 85.

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients who are 18 years or older; Fluent in written and spoken English and in a position to provide written informed consent to participate; A patient who is in a position to attend a 12-week treatment regimen and end of study visit; Metastatic Breast Cancer (MBC) or inoperable locally advanced breast cancer diagnosis based on pre-existing documented histopathology and medical imaging results, either Triple Negative Metastatic Breast Cancer (TNBC) or not; Women with metastatic breast cancer or inoperable locally advanced breast cancer who have not received any cytotoxic therapy in the last 3 weeks; Volunteers of child-bearing potential must have a negative serum pregnancy test (serum beta-human chorionic gonadotropin or ß-hCG) and have agreed to practice an effective, reliable contraceptive regimen for the duration of this clinical trial, such as an intrauterine device (IUD) or intrauterine system (IUS) with a failure rate of <1% stated on the product label or a male partner who is has been sterilised (vasectomy with documented azoospermia); ECOG Performance Status 0 or 1; and Adequate liver function as evidenced by bilirubin of <1.5 times upper limit of normal (ULN) and ALT/AST <2 times of ULN. However, AST and ALT of <5 times ULN if liver metastases are present. Exclusion Criteria: A patient who has been diagnosed as having HER2-positive metastatic breast cancer; A concurrent condition that may limit the decision-making capabilities of the participant during the informed consent process; A previous positive diagnosis of Human Immunodeficiency Virus (HIV) and/or Hepatitis C Virus (HCV) and/or Hepatitis B Virus (HBV) infection; Women who are pregnant or lactating; Uncontrolled, untreated intra-cranial metastases. However, controlled intra-cranial metastases are allowed, i.e. stable patients with more than a month after the completion of whole brain radiotherapy and not currently on steroids or anticonvulsants; Current use of monoamine oxidase inhibitors (MOAI) or use of dextromethorphan Current use of CNS depressants such as selective serotonin re-uptake inhibitors as well as specific medication for pain management including pethidine, tramadol, dextromethorphan, fentanyl and/or methadone. This includes the concurrent use of any serotoninergic agents or buspirone hydrochloride during the week preceding phenelzine sulfate administration, the active study treatment phase and the washout period at the end of study. Serotoninergic drugs may include but are not limited to the following: dexfenfluramine, fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram and venlafaxine; Previous use of nanoparticle albumin-bound paclitaxel; Known allergy to phenelzine sulfate or similar MOAI; and Known or suspected history of alcohol abuse;
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Desmond Yip, MBBS
Organizational Affiliation
ACT Health
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Laeeq Malik, MBBS
Organizational Affiliation
ACT Health
Official's Role
Principal Investigator
Facility Information:
Facility Name
Canberra Region Cancer Centre
City
Canberra
State/Province
Australian Capital Territory
ZIP/Postal Code
260
Country
Australia
Facility Name
Liverpool Cancer Therapy Centre
City
Sydney
State/Province
New South Wales
ZIP/Postal Code
2170
Country
Australia
Facility Name
Southern Medical Day Care Centre
City
Wollongong
State/Province
New South Wales
ZIP/Postal Code
2500
Country
Australia

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
It is the sponsors intention to publish the aggregated study results after the completion of the study.
Citations:
PubMed Identifier
29311580
Citation
Boulding T, McCuaig RD, Tan A, Hardy K, Wu F, Dunn J, Kalimutho M, Sutton CR, Forwood JK, Bert AG, Goodall GJ, Malik L, Yip D, Dahlstrom JE, Zafar A, Khanna KK, Rao S. LSD1 activation promotes inducible EMT programs and modulates the tumour microenvironment in breast cancer. Sci Rep. 2018 Jan 8;8(1):73. doi: 10.1038/s41598-017-17913-x. Erratum In: Sci Rep. 2019 Dec 5;9(1):18771.
Results Reference
background
PubMed Identifier
31249575
Citation
Tan AHY, Tu W, McCuaig R, Hardy K, Donovan T, Tsimbalyuk S, Forwood JK, Rao S. Lysine-Specific Histone Demethylase 1A Regulates Macrophage Polarization and Checkpoint Molecules in the Tumor Microenvironment of Triple-Negative Breast Cancer. Front Immunol. 2019 Jun 12;10:1351. doi: 10.3389/fimmu.2019.01351. eCollection 2019.
Results Reference
background
PubMed Identifier
35719960
Citation
Prasanna T, Malik L, McCuaig RD, Tu WJ, Wu F, Lim PS, Tan AHY, Dahlstrom JE, Clingan P, Moylan E, Chrisp J, Fuller D, Rao S, Yip D. A Phase 1 Proof of Concept Study Evaluating the Addition of an LSD1 Inhibitor to Nab-Paclitaxel in Advanced or Metastatic Breast Cancer (EPI-PRIMED). Front Oncol. 2022 Jun 3;12:862427. doi: 10.3389/fonc.2022.862427. eCollection 2022.
Results Reference
derived
Links:
URL
https://www.epiaxistherapeutics.com
Description
Sponsor's website

Learn more about this trial

An Early Phase Study of Abraxane Combined With Phenelzine Sulfate in Patients With Metastatic or Advanced Breast Cancer

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