Trastuzumab Deruxtecan With Nivolumab in Advanced Breast and Urothelial Cancer
Breast Cancer, Urothelial Carcinoma
About this trial
This is an interventional treatment trial for Breast Cancer focused on measuring Human epidermal growth factor receptor-2, HER2, Refractory, Metastatic, Urothelial cancer, Breast Cancer
Eligibility Criteria
Inclusion Criteria:
- Is the age of majority (adulthood) in their country
- Has an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 to 1
- Has pathologically documented breast cancer or urothelial cancer that is unresectable or metastatic, and refractory to or intolerant of existing therapy(ies) known to provide clinical benefit, and as specified in each study cohort
- Has an adequate archival tumor sample available for the central laboratory to determine eligibility to participate
- Has at least 1 measurable lesion per RECIST version 1.1
- Has cardiac, bone marrow, kidney, liver, blood and clotting test results required per protocol
- Has had an adequate washout period before enrollment since previous surgery and other treatment
- If reproduction is possible, agrees to use protocol-defined methods of contraception (or completely abstain from heterosexual intercourse) from screening to at least 7 months for females and males after the last dose of study drug
- Agrees to avoid harvesting sperm or ova for any reason from screening to at least 7 months for females and males after the last dose of study drug
- Has a life expectancy of at least 3 months
Exclusion Criteria:
- Has received prior treatment with nivolumab or trastuzumab deruxtecan
- Has medical history of myocardial infarction (MI) within 6 months before enrollment, symptomatic congestive heart failure (CHF) (New York Heart Association classes II-IV). Troponin levels above upper limit of normal (ULN) at screening (as defined by the manufacturer) and without any MI-related symptoms should have a cardiologic consultation before enrollment to rule out MI.
- Has a corrected QT interval by Fredericia (QTcF) prolongation to > 470 ms (females) or > 450 ms (males) based on an average of the screening triplicate 12-lead electrocardiogram
- Has history of non-infectious interstitial lung disease (ILD/pneumonitis) (that required steroids), has ILD/pneumonitis currently, or it cannot be ruled out by imaging at screening
- Has a condition (other than active autoimmune disease) that requires systemic treatment with either corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of starting study treatment
- Is pregnant or breastfeeding, or planning to become pregnant
- Is suspected to have certain other protocol-defined diseases based on past medical history, physical exam, blood tests, eye test and imaging at screening period
- Has received a live vaccine within 30 days before the first dose of study drug
- Is related to the investigator or another employee of the sponsor or the study site
- Is pregnant, breastfeeding, or planning to become pregnant
Has or had any disease, psychiatric or medical condition, metastatic condition, drug/medication use or other condition that might, per protocol or in the opinion of the investigator, compromise:
- safety or well-being of the participant or offspring
- safety of study staff
- analysis of results
Sites / Locations
- UCLA - Medical Center
- Yale University
- University of Miami Hospital & Clinics/Sylvester Comprehensive Cancer Center
- Norton Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Levine Cancer Institute Carolinas Healthcare System
- Gabrail Cancer Center Research
- Tennessee Oncology - Sara Cannon Research Institute
- Huntsman Cancer Institute
- University of Washington Medical Center
- AZ Groeninge
- Cliniques Universitaires Saint-Luc
- GZA Hospital Campus Sint-Augustinus
- Institut de Cancerologie de L'Ouest
- Centre Georges Francois Leclerc
- ICO Rene Gauducheau
- Charite Campus Benjamin Franklin
- University Hospital Frankfurt
- University Cancer Center
- Ospedale San Raffaele
- Fondazione IRCCS Istituto Nazionale dei Tumori
- Azienda Ospedaliera Universitaria Senese U.O.C. Immunoterapia Oncologica
- Hospital Gregorio Maranon Madrid Spain
- MD Anderson Cancer Center Madrid
- Hospital Universitario Ramon y Cajal Madrid
- Fundacion Jimenez Diaz
- START Madrid CIOCC
- Sarah Cannon Research Institute UK
- Royal Marsden Hospital (Surrey)
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Experimental
Experimental
Experimental
Experimental
Experimental
Dose Escalation
Dose Expansion - Cohort 1
Dose Expansion - Cohort 2
Dose Expansion - Cohort 3
Dose Expansion - Cohort 4
Part 1 will enroll participants meeting the eligibility criteria set up for any of the 4 cohorts of Part 2 specified below using a 3 + 3 + 3 design. Escalating/de-escalating doses of trastuzumab deruxtecan in combination with a flat dose of nivolumab will be administered on Day 1 of each 21-day cycle. The recommended dose for expansion (RDE) will be calculated using data collected from this population in the first two cycles. These participants may continue to receive study treatment in subsequent cycles.
Cohort 1 (n=30): Participants with pathologically documented advanced/metastatic breast cancer that has centrally-determined positive HER2 expression (IHC 3+ or IHC 2+/ISH+) [as defined by American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines]. These participants have received prior ado-trastuzumab emtansine (T-DM1). Participants will receive the RDE of trastuzumab deruxtecan and the flat dose of nivolumab.
Cohort 2 (n=15): Participants with pathologically documented advanced/metastatic breast cancer that has centrally-determined low HER2 expression (IHC 1+ or IHC 2+/ISH-), who have exhausted treatments that can confer any clinically meaningful benefit (eg, other therapies such as hormonal therapy for patients who are hormone receptor positive). Participants will receive the RDE of trastuzumab deruxtecan and the flat dose of nivolumab.
Cohort 3 (n=30): Participants with pathologically documented advanced/metastatic urothelial carcinoma that has centrally-determined HER2 expression of IHC 2+ or 3+, who received prior platinum-based therapy with documented progression. Participants will receive the RDE of trastuzumab deruxtecan and the flat dose of nivolumab.
Cohort 4 (n=15): Participants with pathologically documented advanced/metastatic urothelial carcinoma that has centrally-determined HER2 expression of IHC 1+, who received prior platinum-based therapy with documented progression. Participants will receive the RDE of trastuzumab deruxtecan and the flat dose of nivolumab.