A Study of Etirinotecan Pegol (NKTR-102) Versus Treatment of Physician's Choice (TPC) in Patients With Metastatic Breast Cancer Who Have Stable Brain Metastases and Have Been Previously Treated With an Anthracycline, a Taxane, and Capecitabine (ATTAIN)
Primary Purpose
Metastasis, Breast Cancer
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
NKTR-102
Eribulin
Ixabepilone
Vinorelbine
Gemcitabine
Paclitaxel
Docetaxel
Nab-paclitaxel
Sponsored by
About this trial
This is an interventional treatment trial for Metastasis focused on measuring Breast Cancer Brain Metastases (BCBM), Carcinoma
Eligibility Criteria
Inclusion Criteria:
- Female or male, age ≥ 18 years.
- Histologically-confirmed carcinoma of the breast (either the primary or metastatic lesions) for whom single-agent cytotoxic chemotherapy is indicated. Patients may have either measurable or non-measurable disease according to RECIST version 1.1.
- Patients must have a history of brain metastases that are non-progressing.
- For triple-negative breast cancer, a minimum of 1 prior cytotoxic chemotherapy regimen must have been administered for the indication of metastatic disease.Depending on receptor status, 1 or 2 prior cytotoxic regimens are required prior to enrollment in this trial; hormonal and/or human epidermal growth factor receptor 2 (HER2) -targeted agents may be required.
- Have had prior therapy (administered in the neoadjuvant, adjuvant, and/or metastatic setting) with an anthracycline, a taxane, and capecitabine (prior anthracycline can be omitted if not medically appropriate or contraindicated for the patient).
- Last dose of anticancer therapy must have been administered within 6 months of the date of randomization into this study.
- All anticancer- and radiation therapy-related toxicities must be completely resolved or downgraded to Grade 1 or less (neuropathy may be Grade 2 or less).
- Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
- Demonstrate adequate organ function obtained within 14 days prior to randomization and analyzed by the central laboratory.
- Women of childbearing potential (WCBP) must agree to use highly effective methods of birth control throughout the duration of the study until 6 months following the last dose of study drug.
- Males with female partners of child-bearing potential must agree to use a barrier contraception (e.g., condom with spermicidal foam/gel/film/cream/suppository) throughout the duration of the study until 6 months following the last dose of study drug; in addition to their female partner using either an intrauterine device or hormonal contraception and continuing until 6 months following the last dose of study drug. Male patients should not donate sperm until 6 months following the last dose of study drug.
Exclusion Criteria:
- Last dose of anticancer therapy (including HER2-targeted therapy) within 14 days prior to randomization.
- High-dose chemotherapy followed by stem cell transplantation (autologous or allogeneic).
- Major surgery within 28 days prior to randomization.
- Concomitant use of any anticancer therapy or use of any investigational agent(s).
- Received prior treatment for cancer with a camptothecin-derived agent.
- Lesions on imaging, by cerebrospinal fluid or with neurological findings that are consistent with leptomeningeal disease or meningeal carcinomatosis.
- Chronic or acute GI disorders resulting in diarrhea of any severity grade.
- Patients who are pregnant or lactating, plan to get pregnant, or have a positive serum pregnancy test prior to randomization.
- Enzyme-inducing anti-epileptic drugs (EIAEDs) within 14 days of randomization.
- Hepatitis B or C, tuberculosis, or HIV.
- Cirrhosis.
- Prior malignancy (other than breast cancer) unless diagnosed and definitively treated more than 5 years prior to randomization.
- Daily use of oxygen supplementation.
- Significant known cardiovascular impairment.
- Prior treatment with NKTR-102.
- Psychiatric illness, social situation, or geographical situation that preclude informed consent or limit compliance.
- Known intolerance or hypersensitivity to any of the products used in this study or their excipients.
- For patients selecting vinorelbine or gemcitabine as the TPC agent, patients may not receive yellow fever vaccine in the 28 days prior to randomization.
Sites / Locations
- Investigator Site - Tucson
- Investigator Site - Orange
- Investigator Site - San Francisco
- Investigator Site - Miami
- Investigator Site - Plantation
- Investigator Site - West Palm Beach
- Investigator Site - Athens
- Investigator Site - Baltimore
- Investigator Site - Boston
- Investigator Site - Minneapolis
- Investigator Site - Saint Louis
- Investigator Site - New York
- Investigator Site - Chapel Hill
- Investigator Site - Columbus
- Investigator Site - Germantown
- Investigator Site - Fort Worth
- Investigator Site - Houston
- Investigator Site - Salt Lake City
- Investigator Site - Seattle
- Investigatory Site - Albury
- Investigator Site - Darlinghurst
- Investigator Site - Wollongong
- Investigator Site - Subiaco
- Investigator Site - Box Hill
- Investigator Site - Nedlands
- Investigator Site - Brussels
- Investigator Site - Brussels
- Investigator Site - Brussels
- Investigator Site - Charleroi
- Investigator Site - Edegem
- Investigator Site - Liege
- Investigator Site - Woluwe- Saint-Lambert
- Investigator Site - Montreal
- Investigator Site - Le Mans
- Investigator Site - Nimes
- Investigator Site - Paris
- Investigator Site - Rennes
- Investigator Site - Rouen
- Investigator Site - Strasbourg
- Investigator Site - Beersheba
- Investigator Site - Haifa
- Investigator Site - Tel Aviv
- Investigator Site - Milano
- Investigator Site - Milan
- Investigator Site - Napoli
- Investigator Site - Roma
- Investigator Site - Lisboa
- Investigator Site - Porto
- Investigator Site - Barcelona
- Investigator Site - Barcelona
- Investigator Site - Madrid
- Investigator Site - Santa Cruz de Tenerife
- Investigator Site - Sevilla
- Investigator Site - Bradford
- Investigator Site - Manchester
- Investigator Site - Nottingham
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
NKTR-102
Treatment of Physician's Choice (TPC)
Arm Description
In Group A, NKTR-102 will be administered at a dose level of 145 mg/m2 on a q21d schedule as a 90-minute intravenous (IV) infusion on Day 1 of each treatment cycle.
In Group B, TPC will be administered per standard of care. Patients randomized to TPC will receive single-agent IV chemotherapy, limited to choice of one of the following 7 agents: eribulin, ixabepilone, vinorelbine, gemcitabine, paclitaxel, docetaxel, or nab-paclitaxel.
Outcomes
Primary Outcome Measures
Overall Survival (OS) of Patients
To compare Overall Survival (OS) of patients who receive 145 mg/m2 NKTR-102 given once every 21 days (q21d) with OS of patients who receive Treatment of Physician's Choice (TPC). Overall survival is defined as the time from the date of randomization to the date of death from any cause. Patients will be followed until their date of death or until final database closure. Patients who are lost-to-follow-up or are alive at the time of analysis will be censored at the time they were last known to be alive or at the date of event cut-off for OS analysis.
Secondary Outcome Measures
Progression-Free Survival (Outside the Central Nervous System)
Progression-Free Survival (PFS) is defined as the time from the date of randomization to the earliest evidence of documented Progressive Disease (PD) or of death from any cause. The date of global deterioration or symptomatic deterioration will not be used as the date of PD. The assessment of PFS outside the CNS will utilize RECIST criteria v1.1.
Progression-Free Survival in Brain Metastasis (PFS-BM)
Progression-Free Survival in Brain Metastasis (PFS-BM) is defined as the time from the date of randomization to the earliest evidence of documented Progressive Disease (PD) per Response Assessment in Neuro-Oncology-Brain Metastases (RANO-BM) in brain metastases or death from any cause. The PD will also be determined by the investigator's assessments. Progressive Disease (PD) is defined as at least a 20% increase in the sum of longest diameters of CNS target lesions, taking as reference the smallest sum on study. This included the baseline sum if that was the smallest on study. In addition to the relative increase of 20%, at least 1 lesion had to increase by an absolute value of 5 mm or more to be considered progression.
Progression-Free Survival (Overall)
Progression-free survival (CNS and peripheral) is defined as the time from the date of randomization to the earliest evidence of documented PD in either the CNS or peripheral (using RANO-BM) or death from any cause. The PD will be determined by both the investigator's and the central imaging facility assessments. The same statistical methods that were used for PFS and PFS-BM will be used for PFS (Overall). Progressive Disease (PD) is defined as at least a 20% increase in the sum of longest diameters of CNS target lesions, taking as reference the smallest sum on study. This included the baseline sum if that was the smallest on study. In addition to the relative increase of 20%, at least 1 lesion had to increase by an absolute value of 5 mm or more to be considered progression.
Objective Response Rates (ORR) of the NKTR-102 Treatment and the Treatment of Physician's Choice (TPC)
RECIST criteria for lesions outside the Central Nervous System (CNS); RANO-BM criteria for CNS lesions) based upon the best response as assessed by the central imaging facility. CR is defined as disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) had to have reduction in short axis to < 10 mm. PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. ORR is calculated as the sum of CR and PR. Progressive Disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this included the baseline sum if that was the smallest on study). Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Clinical Benefit Rate (CBR)
Clinical Benefit Rate will be defined as the proportion of patients having a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) for at least 4 months (≥ 120 days). CR is defined as disappearance of all target lesions for at least 4 weeks with no new lesions, not use of corticosteroids, and patient was stable or improved clinically. PR is defined as at least a 30% decrease in the sum of longest diameters sustained for at least 4 weeks, no new lesions; stable to decreased corticosteroid dose; stable or improved clinically. Progressive Disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this included the baseline sum if that was the smallest on study). Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Duration of Response (DoR)
Duration of response (DoR) outside the CNS will be defined as the time from first documented CR or PR until the earliest evidence of disease progression per RECIST v1.1 or death from any cause. CR is defined as disappearance of all target lesions for at least 4 weeks with no new lesions, not use of corticosteroids, and patient was stable or improved clinically. PR is defined as at least a 30% decrease in the sum of longest diameters sustained for at least 4 weeks, no new lesions; stable to decreased corticosteroid dose; stable or improved clinically. Progressive Disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this included the baseline sum if that was the smallest on study). Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Compare Health-Related Quality of Life (HRQoL) Using the European Organisation for Treatment of Cancer (EORTC) Quality of Life Core 30 (QLQ-C30) Module With the Brain Neoplasms 20-question (BN-20) Subscale.
The EORTC QLQ-BN20 Scale has a series of 20 questions each of which involve reporting a scale from 1-4. It is an increasing scale where a score of one indicates "not at all" while a score of four indicates "very much". The minimum score is 20 and the maximum score is 80. The higher the score the worse the outcome.
Compare Health-Related Quality of Life (HRQoL) Using the the EuroQoL 5D (EQ-5D-5L™)
The EQ-5D-5L scale is used to measure health by having a patient answer a series of questions. There are a series of 5 questions each of which is scaled from a score of 4-20 in increasing increments of 4. The scale is numbered from 0 to 100 where 100 means the beast health you can imagine and 0 means the worst health.
Compare Health-Related Quality of Life (HRQoL) Using the Brief Fatigue Inventory (BFI)
The Brief Fatigue Inventory scale utilizes a series of 4 questions. The first three are scored with a scale from 1-10. The fourth question has 6 six sub components each of which are scored with a scale of 1-10. For every scale, a score of 0 indicates no fatigue/interference where a score of 10 indicates as bad as you can imagine. A patient's score can range from 0 to 100 where 0 indicates the best outcome and 100 indicates the worst.
Magnitude of Clinical Benefit Assessed by ESMO-MCBS Derived From Overall Survival
The magnitude of clinical benefit of NKTR-102 is assessed by the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) (v1.0). The scale is graded 5, 4, 3, 2, 1, where grades 5 and 4 represent a high level of proven clinical benefit, and grade 1 represents no clinical benefit. To determine the magnitude of clinical benefit when the median OS with the standard of treatment is ≤ 1 year, the score is derived from the Hazard Ratio (HR) of Overall Survival, overall survival gain, and QoL improvement between two treatment arms. Values reported in the data table are Overall Survival values.
Number of Participants With Adverse Events as Assessed by Common Terminology Criteria for Adverse Events (CTCAE) v4.3
The number of participants with adverse events as assessed by Common Terminology Criteria for Adverse Events (CTCAE) v4.3
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02915744
Brief Title
A Study of Etirinotecan Pegol (NKTR-102) Versus Treatment of Physician's Choice (TPC) in Patients With Metastatic Breast Cancer Who Have Stable Brain Metastases and Have Been Previously Treated With an Anthracycline, a Taxane, and Capecitabine
Acronym
ATTAIN
Official Title
A Phase 3 Open-Label, Randomized, Multicenter Study of NKTR-102 Versus Treatment of Physician's Choice (TPC) in Patients With Metastatic Breast Cancer Who Have Stable Brain Metastases and Have Been Previously Treated With an Anthracycline, a Taxane, and Capecitabine
Study Type
Interventional
2. Study Status
Record Verification Date
April 2023
Overall Recruitment Status
Completed
Study Start Date
November 2016 (undefined)
Primary Completion Date
July 2020 (Actual)
Study Completion Date
July 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nektar Therapeutics
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This is an open-label, randomized, active comparator, multicenter, international Phase 3 study of NKTR-102 versus TPC in patients with metastatic breast cancer who have stable brain metastases and have been previously treated with an anthracycline, a taxane, and capecitabine in either the adjuvant or metastatic setting (prior anthracycline may be omitted if medically appropriate or contraindicated for the patient).
Detailed Description
This is an open-label, randomized, active comparator, multicenter, international Phase 3 study of NKTR-102 versus TPC in patients with metastatic breast cancer who have stable brain metastases and have been previously treated with an anthracycline, a taxane, and capecitabine in either the adjuvant or metastatic setting (prior anthracycline may be omitted if medically appropriate or contraindicated for the patient).
In Group A, NKTR-102 will be administered at a dose level of 145 mg/m2 on a q21d schedule as a 90-minute intravenous (IV) infusion on Day 1 of each treatment cycle. In Group B, TPC will be administered per standard of care. Patients randomized to TPC will receive single-agent IV chemotherapy, limited to choice of one of the following 7 agents: eribulin, ixabepilone, vinorelbine, gemcitabine, paclitaxel, docetaxel, or nab-paclitaxel.
This study will randomize approximately 220 patients using a 1:1 randomization ratio and stratification based on geographic region, tumor receptor status, and Eastern Cooperative Oncology Group (ECOG) status. At Screening, the Investigator must determine which TPC will be offered to the patient.
Data will be collected on subsequent anticancer therapies in both treatment groups from the time patients come off the study treatment until the time of primary data analysis for Overall Survival (OS).
An independent data monitoring committee (DMC) will assess interim safety and efficacy data and determine final number of death events needed to provide 80% conditional power based on the zone adaptive design.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastasis, Breast Cancer
Keywords
Breast Cancer Brain Metastases (BCBM), Carcinoma
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
178 (Actual)
8. Arms, Groups, and Interventions
Arm Title
NKTR-102
Arm Type
Experimental
Arm Description
In Group A, NKTR-102 will be administered at a dose level of 145 mg/m2 on a q21d schedule as a 90-minute intravenous (IV) infusion on Day 1 of each treatment cycle.
Arm Title
Treatment of Physician's Choice (TPC)
Arm Type
Active Comparator
Arm Description
In Group B, TPC will be administered per standard of care. Patients randomized to TPC will receive single-agent IV chemotherapy, limited to choice of one of the following 7 agents: eribulin, ixabepilone, vinorelbine, gemcitabine, paclitaxel, docetaxel, or nab-paclitaxel.
Intervention Type
Drug
Intervention Name(s)
NKTR-102
Intervention Type
Drug
Intervention Name(s)
Eribulin
Intervention Type
Drug
Intervention Name(s)
Ixabepilone
Intervention Type
Drug
Intervention Name(s)
Vinorelbine
Intervention Type
Drug
Intervention Name(s)
Gemcitabine
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Intervention Type
Drug
Intervention Name(s)
Docetaxel
Intervention Type
Drug
Intervention Name(s)
Nab-paclitaxel
Primary Outcome Measure Information:
Title
Overall Survival (OS) of Patients
Description
To compare Overall Survival (OS) of patients who receive 145 mg/m2 NKTR-102 given once every 21 days (q21d) with OS of patients who receive Treatment of Physician's Choice (TPC). Overall survival is defined as the time from the date of randomization to the date of death from any cause. Patients will be followed until their date of death or until final database closure. Patients who are lost-to-follow-up or are alive at the time of analysis will be censored at the time they were last known to be alive or at the date of event cut-off for OS analysis.
Time Frame
Within 3 years from study start
Secondary Outcome Measure Information:
Title
Progression-Free Survival (Outside the Central Nervous System)
Description
Progression-Free Survival (PFS) is defined as the time from the date of randomization to the earliest evidence of documented Progressive Disease (PD) or of death from any cause. The date of global deterioration or symptomatic deterioration will not be used as the date of PD. The assessment of PFS outside the CNS will utilize RECIST criteria v1.1.
Time Frame
Through study completion, an expected average of 1 year
Title
Progression-Free Survival in Brain Metastasis (PFS-BM)
Description
Progression-Free Survival in Brain Metastasis (PFS-BM) is defined as the time from the date of randomization to the earliest evidence of documented Progressive Disease (PD) per Response Assessment in Neuro-Oncology-Brain Metastases (RANO-BM) in brain metastases or death from any cause. The PD will also be determined by the investigator's assessments. Progressive Disease (PD) is defined as at least a 20% increase in the sum of longest diameters of CNS target lesions, taking as reference the smallest sum on study. This included the baseline sum if that was the smallest on study. In addition to the relative increase of 20%, at least 1 lesion had to increase by an absolute value of 5 mm or more to be considered progression.
Time Frame
Through study completion, an expected average of 1 year
Title
Progression-Free Survival (Overall)
Description
Progression-free survival (CNS and peripheral) is defined as the time from the date of randomization to the earliest evidence of documented PD in either the CNS or peripheral (using RANO-BM) or death from any cause. The PD will be determined by both the investigator's and the central imaging facility assessments. The same statistical methods that were used for PFS and PFS-BM will be used for PFS (Overall). Progressive Disease (PD) is defined as at least a 20% increase in the sum of longest diameters of CNS target lesions, taking as reference the smallest sum on study. This included the baseline sum if that was the smallest on study. In addition to the relative increase of 20%, at least 1 lesion had to increase by an absolute value of 5 mm or more to be considered progression.
Time Frame
Through study completion, an expected average of 1 year
Title
Objective Response Rates (ORR) of the NKTR-102 Treatment and the Treatment of Physician's Choice (TPC)
Description
RECIST criteria for lesions outside the Central Nervous System (CNS); RANO-BM criteria for CNS lesions) based upon the best response as assessed by the central imaging facility. CR is defined as disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) had to have reduction in short axis to < 10 mm. PR is defined as at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. ORR is calculated as the sum of CR and PR. Progressive Disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this included the baseline sum if that was the smallest on study). Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time Frame
Through study completion, an expected average of 1 year
Title
Clinical Benefit Rate (CBR)
Description
Clinical Benefit Rate will be defined as the proportion of patients having a Complete Response (CR), Partial Response (PR), or Stable Disease (SD) for at least 4 months (≥ 120 days). CR is defined as disappearance of all target lesions for at least 4 weeks with no new lesions, not use of corticosteroids, and patient was stable or improved clinically. PR is defined as at least a 30% decrease in the sum of longest diameters sustained for at least 4 weeks, no new lesions; stable to decreased corticosteroid dose; stable or improved clinically. Progressive Disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this included the baseline sum if that was the smallest on study). Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time Frame
For at least 4 months, with an expected average of 1 year
Title
Duration of Response (DoR)
Description
Duration of response (DoR) outside the CNS will be defined as the time from first documented CR or PR until the earliest evidence of disease progression per RECIST v1.1 or death from any cause. CR is defined as disappearance of all target lesions for at least 4 weeks with no new lesions, not use of corticosteroids, and patient was stable or improved clinically. PR is defined as at least a 30% decrease in the sum of longest diameters sustained for at least 4 weeks, no new lesions; stable to decreased corticosteroid dose; stable or improved clinically. Progressive Disease (PD) is defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this included the baseline sum if that was the smallest on study). Stable Disease (SD) is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time Frame
Through study completion, an expected average of 1 year
Title
Compare Health-Related Quality of Life (HRQoL) Using the European Organisation for Treatment of Cancer (EORTC) Quality of Life Core 30 (QLQ-C30) Module With the Brain Neoplasms 20-question (BN-20) Subscale.
Description
The EORTC QLQ-BN20 Scale has a series of 20 questions each of which involve reporting a scale from 1-4. It is an increasing scale where a score of one indicates "not at all" while a score of four indicates "very much". The minimum score is 20 and the maximum score is 80. The higher the score the worse the outcome.
Time Frame
Baseline (prior to first dose of study treatment in Cycle 1 [cycle length = 21 for NKTR-102 or 28 days for TPC] and end of Cycle 44.
Title
Compare Health-Related Quality of Life (HRQoL) Using the the EuroQoL 5D (EQ-5D-5L™)
Description
The EQ-5D-5L scale is used to measure health by having a patient answer a series of questions. There are a series of 5 questions each of which is scaled from a score of 4-20 in increasing increments of 4. The scale is numbered from 0 to 100 where 100 means the beast health you can imagine and 0 means the worst health.
Time Frame
Baseline (prior to first dose of study treatment in Cycle 1 [cycle length = 21 for NKTR-102 or 28 days for TPC] and end of Cycle 44
Title
Compare Health-Related Quality of Life (HRQoL) Using the Brief Fatigue Inventory (BFI)
Description
The Brief Fatigue Inventory scale utilizes a series of 4 questions. The first three are scored with a scale from 1-10. The fourth question has 6 six sub components each of which are scored with a scale of 1-10. For every scale, a score of 0 indicates no fatigue/interference where a score of 10 indicates as bad as you can imagine. A patient's score can range from 0 to 100 where 0 indicates the best outcome and 100 indicates the worst.
Time Frame
Baseline (prior to first dose of study treatment in Cycle 1 [cycle length = 21 for NKTR-102 or 28 days for TPC] and end of Cycle 44
Title
Magnitude of Clinical Benefit Assessed by ESMO-MCBS Derived From Overall Survival
Description
The magnitude of clinical benefit of NKTR-102 is assessed by the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) (v1.0). The scale is graded 5, 4, 3, 2, 1, where grades 5 and 4 represent a high level of proven clinical benefit, and grade 1 represents no clinical benefit. To determine the magnitude of clinical benefit when the median OS with the standard of treatment is ≤ 1 year, the score is derived from the Hazard Ratio (HR) of Overall Survival, overall survival gain, and QoL improvement between two treatment arms. Values reported in the data table are Overall Survival values.
Time Frame
Through study completion, within 3 years from study start
Title
Number of Participants With Adverse Events as Assessed by Common Terminology Criteria for Adverse Events (CTCAE) v4.3
Description
The number of participants with adverse events as assessed by Common Terminology Criteria for Adverse Events (CTCAE) v4.3
Time Frame
Through study completion, an expected average of 1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Female or male, age ≥ 18 years.
Histologically-confirmed carcinoma of the breast (either the primary or metastatic lesions) for whom single-agent cytotoxic chemotherapy is indicated. Patients may have either measurable or non-measurable disease according to RECIST version 1.1.
Patients must have a history of brain metastases that are non-progressing.
For triple-negative breast cancer, a minimum of 1 prior cytotoxic chemotherapy regimen must have been administered for the indication of metastatic disease.Depending on receptor status, 1 or 2 prior cytotoxic regimens are required prior to enrollment in this trial; hormonal and/or human epidermal growth factor receptor 2 (HER2) -targeted agents may be required.
Have had prior therapy (administered in the neoadjuvant, adjuvant, and/or metastatic setting) with an anthracycline, a taxane, and capecitabine (prior anthracycline can be omitted if not medically appropriate or contraindicated for the patient).
Last dose of anticancer therapy must have been administered within 6 months of the date of randomization into this study.
All anticancer- and radiation therapy-related toxicities must be completely resolved or downgraded to Grade 1 or less (neuropathy may be Grade 2 or less).
Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
Demonstrate adequate organ function obtained within 14 days prior to randomization and analyzed by the central laboratory.
Women of childbearing potential (WCBP) must agree to use highly effective methods of birth control throughout the duration of the study until 6 months following the last dose of study drug.
Males with female partners of child-bearing potential must agree to use a barrier contraception (e.g., condom with spermicidal foam/gel/film/cream/suppository) throughout the duration of the study until 6 months following the last dose of study drug; in addition to their female partner using either an intrauterine device or hormonal contraception and continuing until 6 months following the last dose of study drug. Male patients should not donate sperm until 6 months following the last dose of study drug.
Exclusion Criteria:
Last dose of anticancer therapy (including HER2-targeted therapy) within 14 days prior to randomization.
High-dose chemotherapy followed by stem cell transplantation (autologous or allogeneic).
Major surgery within 28 days prior to randomization.
Concomitant use of any anticancer therapy or use of any investigational agent(s).
Received prior treatment for cancer with a camptothecin-derived agent.
Lesions on imaging, by cerebrospinal fluid or with neurological findings that are consistent with leptomeningeal disease or meningeal carcinomatosis.
Chronic or acute GI disorders resulting in diarrhea of any severity grade.
Patients who are pregnant or lactating, plan to get pregnant, or have a positive serum pregnancy test prior to randomization.
Enzyme-inducing anti-epileptic drugs (EIAEDs) within 14 days of randomization.
Hepatitis B or C, tuberculosis, or HIV.
Cirrhosis.
Prior malignancy (other than breast cancer) unless diagnosed and definitively treated more than 5 years prior to randomization.
Daily use of oxygen supplementation.
Significant known cardiovascular impairment.
Prior treatment with NKTR-102.
Psychiatric illness, social situation, or geographical situation that preclude informed consent or limit compliance.
Known intolerance or hypersensitivity to any of the products used in this study or their excipients.
For patients selecting vinorelbine or gemcitabine as the TPC agent, patients may not receive yellow fever vaccine in the 28 days prior to randomization.
Facility Information:
Facility Name
Investigator Site - Tucson
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
Investigator Site - Orange
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Investigator Site - San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States
Facility Name
Investigator Site - Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Investigator Site - Plantation
City
Plantation
State/Province
Florida
ZIP/Postal Code
33324
Country
United States
Facility Name
Investigator Site - West Palm Beach
City
West Palm Beach
State/Province
Florida
ZIP/Postal Code
33401
Country
United States
Facility Name
Investigator Site - Athens
City
Athens
State/Province
Georgia
ZIP/Postal Code
30607
Country
United States
Facility Name
Investigator Site - Baltimore
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Investigator Site - Boston
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Investigator Site - Minneapolis
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
Investigator Site - Saint Louis
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Investigator Site - New York
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
Investigator Site - Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Investigator Site - Columbus
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Investigator Site - Germantown
City
Germantown
State/Province
Tennessee
ZIP/Postal Code
38138
Country
United States
Facility Name
Investigator Site - Fort Worth
City
Fort Worth
State/Province
Texas
ZIP/Postal Code
76104
Country
United States
Facility Name
Investigator Site - Houston
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Investigator Site - Salt Lake City
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84106
Country
United States
Facility Name
Investigator Site - Seattle
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
Facility Name
Investigatory Site - Albury
City
Albury
State/Province
New South Wales
ZIP/Postal Code
2640
Country
Australia
Facility Name
Investigator Site - Darlinghurst
City
Darlinghurst
State/Province
New South Wales
ZIP/Postal Code
2010
Country
Australia
Facility Name
Investigator Site - Wollongong
City
Wollongong
State/Province
New South Wales
ZIP/Postal Code
2500
Country
Australia
Facility Name
Investigator Site - Subiaco
City
Subiaco
State/Province
Western Australia
ZIP/Postal Code
6008
Country
Australia
Facility Name
Investigator Site - Box Hill
City
Box Hill
ZIP/Postal Code
3128
Country
Australia
Facility Name
Investigator Site - Nedlands
City
Nedlands
ZIP/Postal Code
6009
Country
Australia
Facility Name
Investigator Site - Brussels
City
Brussels
ZIP/Postal Code
1000
Country
Belgium
Facility Name
Investigator Site - Brussels
City
Brussels
ZIP/Postal Code
1180
Country
Belgium
Facility Name
Investigator Site - Brussels
City
Brussels
ZIP/Postal Code
1200
Country
Belgium
Facility Name
Investigator Site - Charleroi
City
Charleroi
ZIP/Postal Code
6000
Country
Belgium
Facility Name
Investigator Site - Edegem
City
Edegem
ZIP/Postal Code
2650
Country
Belgium
Facility Name
Investigator Site - Liege
City
Liège
ZIP/Postal Code
4000
Country
Belgium
Facility Name
Investigator Site - Woluwe- Saint-Lambert
City
Woluwe-Saint-Lambert
ZIP/Postal Code
1200
Country
Belgium
Facility Name
Investigator Site - Montreal
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H4A 3J1
Country
Canada
Facility Name
Investigator Site - Le Mans
City
Le Mans
ZIP/Postal Code
72000
Country
France
Facility Name
Investigator Site - Nimes
City
Nîmes
ZIP/Postal Code
30029
Country
France
Facility Name
Investigator Site - Paris
City
Paris
ZIP/Postal Code
75248
Country
France
Facility Name
Investigator Site - Rennes
City
Rennes
ZIP/Postal Code
35042
Country
France
Facility Name
Investigator Site - Rouen
City
Rouen
ZIP/Postal Code
76038
Country
France
Facility Name
Investigator Site - Strasbourg
City
Strasbourg
ZIP/Postal Code
67091
Country
France
Facility Name
Investigator Site - Beersheba
City
Beersheba
ZIP/Postal Code
84101
Country
Israel
Facility Name
Investigator Site - Haifa
City
Haifa
ZIP/Postal Code
31096
Country
Israel
Facility Name
Investigator Site - Tel Aviv
City
Tel Aviv
ZIP/Postal Code
64239
Country
Israel
Facility Name
Investigator Site - Milano
City
Milano
ZIP/Postal Code
20141
Country
Italy
Facility Name
Investigator Site - Milan
City
Milan
ZIP/Postal Code
20132
Country
Italy
Facility Name
Investigator Site - Napoli
City
Napoli
ZIP/Postal Code
80131
Country
Italy
Facility Name
Investigator Site - Roma
City
Roma
ZIP/Postal Code
144
Country
Italy
Facility Name
Investigator Site - Lisboa
City
Lisboa
ZIP/Postal Code
1649-035
Country
Portugal
Facility Name
Investigator Site - Porto
City
Porto
ZIP/Postal Code
4200-072
Country
Portugal
Facility Name
Investigator Site - Barcelona
City
Barcelona
ZIP/Postal Code
8023
Country
Spain
Facility Name
Investigator Site - Barcelona
City
Barcelona
ZIP/Postal Code
8035
Country
Spain
Facility Name
Investigator Site - Madrid
City
Madrid
ZIP/Postal Code
28040
Country
Spain
Facility Name
Investigator Site - Santa Cruz de Tenerife
City
Santa Cruz de Tenerife
ZIP/Postal Code
38320
Country
Spain
Facility Name
Investigator Site - Sevilla
City
Sevilla
ZIP/Postal Code
41013
Country
Spain
Facility Name
Investigator Site - Bradford
City
Bradford
ZIP/Postal Code
BD7 1DP
Country
United Kingdom
Facility Name
Investigator Site - Manchester
City
Manchester
ZIP/Postal Code
M20 4BX
Country
United Kingdom
Facility Name
Investigator Site - Nottingham
City
Nottingham
ZIP/Postal Code
NG5 1PB
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
35552364
Citation
Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Dieras V, Muller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortes J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. doi: 10.1001/jamaoncol.2022.0514.
Results Reference
derived
PubMed Identifier
31074641
Citation
Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Dieras V, Muller V, Tagliaferri M, Hannah AL, Cortes J. ATTAIN: Phase III study of etirinotecan pegol versus treatment of physician's choice in patients with metastatic breast cancer and brain metastases. Future Oncol. 2019 Jul;15(19):2211-2225. doi: 10.2217/fon-2019-0180. Epub 2019 May 10.
Results Reference
derived
Learn more about this trial
A Study of Etirinotecan Pegol (NKTR-102) Versus Treatment of Physician's Choice (TPC) in Patients With Metastatic Breast Cancer Who Have Stable Brain Metastases and Have Been Previously Treated With an Anthracycline, a Taxane, and Capecitabine
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