Phase 2 Window Study of SAR439859 (Amcenestrant) Versus Letrozole in Post-menopausal Patients With ER+, HER2- Pre-operative Post-menopausal Primary Breast Cancer (AMEERA-4)
Primary Purpose
Breast Cancer
Status
Terminated
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Amcenestrant (SAR439859)
Letrozole
Sponsored by

About this trial
This is an interventional treatment trial for Breast Cancer
Eligibility Criteria
Inclusion criteria :
- Histological or cytological proven diagnosis of invasive breast adenocarcinoma.
- Localized breast cancer eligible for upfront breast conservative surgery or upfront mastectomy: Stage I, Stage II or operable Stage III (excluded T4) as defined in American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition 2017.
- Postmenopausal women as defined by one of the following:
- Spontaneous cessation of menses greater than (>) 12 months.
- or who had received hormonal replacement therapy but had discontinued the treatment and had follicle stimulating hormone (FSH) level in the postmenopausal range.
- or with status post bilateral surgical oophorectomy.
- or post bilateral ovarian ablation through pelvic radiotherapy.
- Breast tumor size of at least 10 millimeters (mm) in greatest dimension measured by ultrasound.
- Primary tumor had to be positive for Estrogen Receptors (ER+) and negative for HER2 (HER2-) receptor by immunohistochemistry.
- Ki67 level of at least 15% at diagnosis from immunohistochemistry of the tumor.
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
Exclusion criteria:
- Medical history or ongoing gastrointestinal disorders potentially affecting the absorption of SAR439859 or letrozole.
- Participants unable to swallow normally and to take capsules or tablets.
- Participants with known active hepatitis A, B, C infection; or hepatic cirrhosis.
- Participant with any other cancer; adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer or any other cancer from which the participant had been disease free for >3 years were allowed.
- Evidence of metastatic spread by standard assessment according to local practice.
- Treatment with strong Cytochrome P450 3A (CYP3A) inducers or drugs that had the potential to inhibit uridine diphosphate glucuronosyltransferase (UGT) within 2 weeks before first study treatment administration or 5 elimination half-lives whichever was longest.
- Treatment with drugs that were sensitive substrates of P-glycoprotein (P-gp) or of breast cancer resistance protein (BCRP) within 2 weeks before first study treatment administration or 5 elimination half-lives whichever was longer.
- Use of any investigational agent within 4 weeks prior to randomization.
- Recent use of hormone replacement therapy (last dose less than or equal to [<=] 30 days prior to randomization).
- Prior anti-cancer treatment was not allowed unless it was then completed at least 1 year prior to inclusion into this trial.
- Previous systemic or local treatment for the new primary breast cancer currently under investigation (including surgery, radiotherapy, cytotoxic and endocrine treatments).
- Inadequate hematological or renal function.
- Prothrombin time/international normalized ratio (INR) >1.5 * upper limit of normal (ULN) or outside therapeutic range if received anticoagulation that would have had affected the prothrombin time/INR.
- Any of the following abnormal liver function test results: Aspartate aminotransferase >1.5 * ULN; Alanine aminotransferase >1.5 * ULN; Total bilirubin >1.5 * ULN.
- Participants were employees of the clinical study site or other individuals directly involved in the conduct of the study, or immediate family members of such individuals.
- Sensitivity to any of the study interventions, or components thereof, or drug or other allergy that, in the opinion of the Investigator, contraindicates participation in the study.
The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Sites / Locations
- Investigational Site Number 8400014
- Investigational Site Number 8400010
- Investigational Site Number 8400018
- Investigational Site Number 8400005
- Investigational Site Number 8400016
- Investigational Site Number 8400012
- Investigational Site Number 0560001
- Investigational Site Number 0560002
- Investigational Site Number 2500001
- Investigational Site Number 2500004
- Investigational Site Number 2500002
- Investigational Site Number 2500003
- Investigational Site Number 3800004
- Investigational Site Number 3800002
- Investigational Site Number 3800001
- Investigational Site Number 3920002
- Investigational Site Number 3920003
- Investigational Site Number 3920001
- Investigational Site Number 8400007
- Investigational Site Number 6430006
- Investigational Site Number 6430004
- Investigational Site Number 6430002
- Investigational Site Number 6430003
- Investigational Site Number 6430007
- Investigational Site Number 7240005
- Investigational Site Number 7240003
- Investigational Site Number 7240001
- Investigational Site Number 7240002
- Investigational Site Number 8040004
- Investigational Site Number 8040001
- Investigational Site Number 8040002
- Investigational Site Number 8040005
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Active Comparator
Arm Label
Amcenestrant 400 mg
Amcenestrant 200 mg
Letrozole 2.5 mg
Arm Description
Participants received 4 capsules of 100 milligrams (mg) of amcenestrant once daily (QD) from Day 1 to Day 14.
Participants received 2 capsules of 100 mg of amcenestrant QD from Day 1 to Day 14.
Participants received 2.5 mg of letrozole tablet QD from Day 1 to Day 14.
Outcomes
Primary Outcome Measures
Percent Change From Baseline in Ki67 Level at Day 15
Tumor tissue collected through a core-cut biopsy at Baseline and Day 15 was used to determine Ki67 expression. Ki67 expression was defined as the percentage of positive tumor cells assessed by central reading. Ki67 percent change from Baseline for a given participant was defined as 100*(Ki67pre - Ki67post) / Ki67pre, where Ki67pre and Ki67post were pre-treatment and post-treatment Ki67 value of the participant. Adjusted geometric least square (LS) means and 95 percentage (%) confidence interval (CI) for the percent change were obtained from analysis of covariance (ANCOVA) model of the log proportional change i.e., log (Ki67post/ki67pre) with treatment and log-Ki67pre as fixed effect and converted by antilog transformation.
Secondary Outcome Measures
Percentage of Participants With Percent Change From Baseline in Ki67 Greater Than or Equal to (>=) 50 Percent at Day 15
Tumor tissue collected through a core-cut biopsy at Baseline and Day 15 was used to determine Ki67 expression. Ki67 expression was defined as the percentage of positive tumor cells assessed by central reading. Ki67 percent change from Baseline for a given participant was defined as 100*(Ki67pre - Ki67post) / Ki67pre, where Ki67pre and Ki67post were pre-treatment and post-treatment Ki67 value of the participant.
Change From Baseline in Estrogen Receptor (ER) Expression as Measured by H-Score at Day 15
Change from Baseline in ER expression was measured by H-Score. The H-score was calculated as the sum of the percent of cells staining positive (0 to 100) multiplied staining intensity level from 0 to 3 (0=none, 1=low, 2=moderate, 3=high). Total ER expression H-score ranged from 0 to 300, where higher score indicated stronger ER expression. Change from Baseline in H-Score equals H-scorepost minus H-scorepre; where H-scorepost and H-scorepre denoted post-treatment and pre-treatment H-scores, respectively. LS-means and 95% CI were obtained from an ANCOVA model for change from baseline with treatment and baseline as fixed effect.
Number of Participants With Abnormalities: Hematological Parameters
Hematology parameters covered by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) and included: Hemoglobin, Lymphocyte, Neutrophils, Leukocytes (white blood cells), Anemia, Platelets, Eosinophils, and international normalized ratio (INR). An NCI-CTCAE Grades 1 to 5 were described as: Grade 1-Mild; asymptomatic/mild symptoms; Grade 2-Moderate; minimal, local or noninvasive intervention indicated; limiting age appropriate instrumental daily activities. Grade 3-Severe/medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; Grade 4-Life-threatening consequences; Grade 5-Death. Data for 'All Grades' were reported in this outcome measure.
Number of Participants With Abnormalities: Clinical Chemistry
Clinical chemistry laboratory parameters covered by NCI-CTCAE and included: Glucose, Potassium, Sodium, Creatinine. An NCI-CTCAE Grades 1 to 5 were described as: Grade 1-Mild; asymptomatic or mild symptoms; Grade 2- Moderate; minimal, local or noninvasive intervention indicated; limiting age appropriate instrumental daily activities; Grade 3-Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; Grade 4-Life-threatening consequences; Grade 5-Death. Data for 'All Grades' were reported in this outcome measure.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04191382
Brief Title
Phase 2 Window Study of SAR439859 (Amcenestrant) Versus Letrozole in Post-menopausal Patients With ER+, HER2- Pre-operative Post-menopausal Primary Breast Cancer
Acronym
AMEERA-4
Official Title
Phase 2 Window Study of Two Dose Levels of Amcenestrant [SAR439859] (SERD) Versus Letrozole in Newly Diagnosed Pre-operative Post-menopausal Patients With ER Positive, HER2 Negative Primary Breast Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
June 2022
Overall Recruitment Status
Terminated
Why Stopped
early discontinuation based on strategic sponsor decision not driven by any safety concerns
Study Start Date
February 4, 2020 (Actual)
Primary Completion Date
April 30, 2021 (Actual)
Study Completion Date
May 28, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sanofi
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Primary Objective:
To determine whether amcenestrant given at 2 different doses improved the antiproliferative activity when compared to letrozole.
Secondary Objectives:
To assess the proportion of participants with a relative decrease from Baseline in percentage of positive tumor cells tested by immunohistochemistry greater than or equal to (>=) 50 percent (%) (Ki67 >=50%) in the three treatment arms.
To assess estrogen receptor (ER) degradation in biopsies in participants in the three treatment arms.
To assess safety in the three treatment arms.
Detailed Description
Duration of the study, per participant, would include screening period of up to 14 days before randomization, treatment period of 14 days and post-treatment safety follow-up period of 30±7 days after last investigational medicinal product (IMP) intake.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
105 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Amcenestrant 400 mg
Arm Type
Experimental
Arm Description
Participants received 4 capsules of 100 milligrams (mg) of amcenestrant once daily (QD) from Day 1 to Day 14.
Arm Title
Amcenestrant 200 mg
Arm Type
Experimental
Arm Description
Participants received 2 capsules of 100 mg of amcenestrant QD from Day 1 to Day 14.
Arm Title
Letrozole 2.5 mg
Arm Type
Active Comparator
Arm Description
Participants received 2.5 mg of letrozole tablet QD from Day 1 to Day 14.
Intervention Type
Drug
Intervention Name(s)
Amcenestrant (SAR439859)
Intervention Description
Pharmaceutical form: Capsules, Route of administration: Oral
Intervention Type
Drug
Intervention Name(s)
Letrozole
Intervention Description
Pharmaceutical form: Tablets, Route of administration: Oral
Primary Outcome Measure Information:
Title
Percent Change From Baseline in Ki67 Level at Day 15
Description
Tumor tissue collected through a core-cut biopsy at Baseline and Day 15 was used to determine Ki67 expression. Ki67 expression was defined as the percentage of positive tumor cells assessed by central reading. Ki67 percent change from Baseline for a given participant was defined as 100*(Ki67pre - Ki67post) / Ki67pre, where Ki67pre and Ki67post were pre-treatment and post-treatment Ki67 value of the participant. Adjusted geometric least square (LS) means and 95 percentage (%) confidence interval (CI) for the percent change were obtained from analysis of covariance (ANCOVA) model of the log proportional change i.e., log (Ki67post/ki67pre) with treatment and log-Ki67pre as fixed effect and converted by antilog transformation.
Time Frame
Baseline, Day 15
Secondary Outcome Measure Information:
Title
Percentage of Participants With Percent Change From Baseline in Ki67 Greater Than or Equal to (>=) 50 Percent at Day 15
Description
Tumor tissue collected through a core-cut biopsy at Baseline and Day 15 was used to determine Ki67 expression. Ki67 expression was defined as the percentage of positive tumor cells assessed by central reading. Ki67 percent change from Baseline for a given participant was defined as 100*(Ki67pre - Ki67post) / Ki67pre, where Ki67pre and Ki67post were pre-treatment and post-treatment Ki67 value of the participant.
Time Frame
Baseline, Day 15
Title
Change From Baseline in Estrogen Receptor (ER) Expression as Measured by H-Score at Day 15
Description
Change from Baseline in ER expression was measured by H-Score. The H-score was calculated as the sum of the percent of cells staining positive (0 to 100) multiplied staining intensity level from 0 to 3 (0=none, 1=low, 2=moderate, 3=high). Total ER expression H-score ranged from 0 to 300, where higher score indicated stronger ER expression. Change from Baseline in H-Score equals H-scorepost minus H-scorepre; where H-scorepost and H-scorepre denoted post-treatment and pre-treatment H-scores, respectively. LS-means and 95% CI were obtained from an ANCOVA model for change from baseline with treatment and baseline as fixed effect.
Time Frame
Baseline, Day 15
Title
Number of Participants With Abnormalities: Hematological Parameters
Description
Hematology parameters covered by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) and included: Hemoglobin, Lymphocyte, Neutrophils, Leukocytes (white blood cells), Anemia, Platelets, Eosinophils, and international normalized ratio (INR). An NCI-CTCAE Grades 1 to 5 were described as: Grade 1-Mild; asymptomatic/mild symptoms; Grade 2-Moderate; minimal, local or noninvasive intervention indicated; limiting age appropriate instrumental daily activities. Grade 3-Severe/medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; Grade 4-Life-threatening consequences; Grade 5-Death. Data for 'All Grades' were reported in this outcome measure.
Time Frame
From first dose of study drug up to Day 14
Title
Number of Participants With Abnormalities: Clinical Chemistry
Description
Clinical chemistry laboratory parameters covered by NCI-CTCAE and included: Glucose, Potassium, Sodium, Creatinine. An NCI-CTCAE Grades 1 to 5 were described as: Grade 1-Mild; asymptomatic or mild symptoms; Grade 2- Moderate; minimal, local or noninvasive intervention indicated; limiting age appropriate instrumental daily activities; Grade 3-Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; Grade 4-Life-threatening consequences; Grade 5-Death. Data for 'All Grades' were reported in this outcome measure.
Time Frame
From first dose of study drug up to Day 14
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria :
Histological or cytological proven diagnosis of invasive breast adenocarcinoma.
Localized breast cancer eligible for upfront breast conservative surgery or upfront mastectomy: Stage I, Stage II or operable Stage III (excluded T4) as defined in American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition 2017.
Postmenopausal women as defined by one of the following:
Spontaneous cessation of menses greater than (>) 12 months.
or who had received hormonal replacement therapy but had discontinued the treatment and had follicle stimulating hormone (FSH) level in the postmenopausal range.
or with status post bilateral surgical oophorectomy.
or post bilateral ovarian ablation through pelvic radiotherapy.
Breast tumor size of at least 10 millimeters (mm) in greatest dimension measured by ultrasound.
Primary tumor had to be positive for Estrogen Receptors (ER+) and negative for HER2 (HER2-) receptor by immunohistochemistry.
Ki67 level of at least 15% at diagnosis from immunohistochemistry of the tumor.
Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
Exclusion criteria:
Medical history or ongoing gastrointestinal disorders potentially affecting the absorption of SAR439859 or letrozole.
Participants unable to swallow normally and to take capsules or tablets.
Participants with known active hepatitis A, B, C infection; or hepatic cirrhosis.
Participant with any other cancer; adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer or any other cancer from which the participant had been disease free for >3 years were allowed.
Evidence of metastatic spread by standard assessment according to local practice.
Treatment with strong Cytochrome P450 3A (CYP3A) inducers or drugs that had the potential to inhibit uridine diphosphate glucuronosyltransferase (UGT) within 2 weeks before first study treatment administration or 5 elimination half-lives whichever was longest.
Treatment with drugs that were sensitive substrates of P-glycoprotein (P-gp) or of breast cancer resistance protein (BCRP) within 2 weeks before first study treatment administration or 5 elimination half-lives whichever was longer.
Use of any investigational agent within 4 weeks prior to randomization.
Recent use of hormone replacement therapy (last dose less than or equal to [<=] 30 days prior to randomization).
Prior anti-cancer treatment was not allowed unless it was then completed at least 1 year prior to inclusion into this trial.
Previous systemic or local treatment for the new primary breast cancer currently under investigation (including surgery, radiotherapy, cytotoxic and endocrine treatments).
Inadequate hematological or renal function.
Prothrombin time/international normalized ratio (INR) >1.5 * upper limit of normal (ULN) or outside therapeutic range if received anticoagulation that would have had affected the prothrombin time/INR.
Any of the following abnormal liver function test results: Aspartate aminotransferase >1.5 * ULN; Alanine aminotransferase >1.5 * ULN; Total bilirubin >1.5 * ULN.
Participants were employees of the clinical study site or other individuals directly involved in the conduct of the study, or immediate family members of such individuals.
Sensitivity to any of the study interventions, or components thereof, or drug or other allergy that, in the opinion of the Investigator, contraindicates participation in the study.
The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Sciences & Operations
Organizational Affiliation
Sanofi
Official's Role
Study Director
Facility Information:
Facility Name
Investigational Site Number 8400014
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
Investigational Site Number 8400010
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
Investigational Site Number 8400018
City
Fort Wayne
State/Province
Indiana
ZIP/Postal Code
46804
Country
United States
Facility Name
Investigational Site Number 8400005
City
Lincoln
State/Province
Nebraska
ZIP/Postal Code
68506
Country
United States
Facility Name
Investigational Site Number 8400016
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Facility Name
Investigational Site Number 8400012
City
Tacoma
State/Province
Washington
ZIP/Postal Code
98405
Country
United States
Facility Name
Investigational Site Number 0560001
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
Investigational Site Number 0560002
City
Namur
ZIP/Postal Code
5000
Country
Belgium
Facility Name
Investigational Site Number 2500001
City
Nantes
ZIP/Postal Code
44093
Country
France
Facility Name
Investigational Site Number 2500004
City
Paris
ZIP/Postal Code
75010
Country
France
Facility Name
Investigational Site Number 2500002
City
Saint Cloud
ZIP/Postal Code
92210
Country
France
Facility Name
Investigational Site Number 2500003
City
Toulouse Cedex 9
ZIP/Postal Code
31059
Country
France
Facility Name
Investigational Site Number 3800004
City
Meldola
ZIP/Postal Code
47014
Country
Italy
Facility Name
Investigational Site Number 3800002
City
Milano
ZIP/Postal Code
20132
Country
Italy
Facility Name
Investigational Site Number 3800001
City
Milano
ZIP/Postal Code
20141
Country
Italy
Facility Name
Investigational Site Number 3920002
City
Osaka-Shi
Country
Japan
Facility Name
Investigational Site Number 3920003
City
Sapporo-Shi
Country
Japan
Facility Name
Investigational Site Number 3920001
City
Yokohama-Shi
Country
Japan
Facility Name
Investigational Site Number 8400007
City
Hato Rey
ZIP/Postal Code
00917
Country
Puerto Rico
Facility Name
Investigational Site Number 6430006
City
Moscow
ZIP/Postal Code
117186
Country
Russian Federation
Facility Name
Investigational Site Number 6430004
City
Moscow
ZIP/Postal Code
119991
Country
Russian Federation
Facility Name
Investigational Site Number 6430002
City
Saint -Petersburg
ZIP/Postal Code
197758
Country
Russian Federation
Facility Name
Investigational Site Number 6430003
City
Saint-Petersburg
ZIP/Postal Code
194156
Country
Russian Federation
Facility Name
Investigational Site Number 6430007
City
St.Petersburg
ZIP/Postal Code
195271
Country
Russian Federation
Facility Name
Investigational Site Number 7240005
City
Barcelona
ZIP/Postal Code
08003
Country
Spain
Facility Name
Investigational Site Number 7240003
City
Córdoba
ZIP/Postal Code
14004
Country
Spain
Facility Name
Investigational Site Number 7240001
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
Investigational Site Number 7240002
City
Valencia / Valencia
ZIP/Postal Code
46010
Country
Spain
Facility Name
Investigational Site Number 8040004
City
Kharkiv
ZIP/Postal Code
61166
Country
Ukraine
Facility Name
Investigational Site Number 8040001
City
Uzhgorod
ZIP/Postal Code
88000
Country
Ukraine
Facility Name
Investigational Site Number 8040002
City
Vinnytsia
ZIP/Postal Code
21029
Country
Ukraine
Facility Name
Investigational Site Number 8040005
City
Zaporizhzhya
ZIP/Postal Code
69040
Country
Ukraine
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org
Learn more about this trial
Phase 2 Window Study of SAR439859 (Amcenestrant) Versus Letrozole in Post-menopausal Patients With ER+, HER2- Pre-operative Post-menopausal Primary Breast Cancer
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