A Study of Multiple Immunotherapy-Based Treatment Combinations in Hormone Receptor (HR)-Positive Human Epidermal Growth Factor Receptor 2 (HER2)-Negative Breast Cancer (MORPHEUS HR+BC)
Breast Neoplasms
About this trial
This is an interventional treatment trial for Breast Neoplasms
Eligibility Criteria
Inclusion Criteria for Both Stages:
- Measurable disease per RECIST v1.1
- Adequate hematologic and end organ function
- Disease progression during or after first- or second-line hormonal therapy with CDK4/6 inhibitor
Inclusion Criteria for Stage 1:
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Metastatic or inoperable, locally advanced, histologically or cytologically confirmed invasive HR-positive HER2-negative breast cancer
- Recommended for endocrine therapy, and cytotoxic chemotherapy not indicated at study entry
- Recurrence or progression following most recent systemic breast cancer therapy
- Disease progression during or after first- or second-line hormonal therapy for locally advanced or metastatic disease
- Postmenopausal according to protocol-defined criteria
- Life expectancy >3 months
- Available tumor specimen for determination of PD-L1 status
Inclusion Criteria for Stage 2:
- ECOG performance status of 0-2
- Ability to initiate treatment within 3 months after disease progression or unacceptable toxicity on a Stage 1 regimen
Exclusion Criteria for Both Stages:
- Significant or uncontrolled comorbid disease as specified in the protocol
- Uncontrolled tumor-related pain
- Autoimmune disease except for stable/controlled hypothyroidism, Type 1 diabetes mellitus, or certain dermatologic conditions
- Positive human immunodeficiency virus test
- Active hepatitis B or C
- Active tuberculosis
- Severe infection within 4 weeks and/or antibiotics within 2 weeks prior to study treatment
- Prior allogeneic stem cell or solid organ transplantation
- History of malignancy other than breast cancer within 2 years prior to screening except those with negligible risk of metastasis/death
- History of or known hypersensitivity to study drug or excipients
- For patients entering Stage 2, recovery from all immunotherapy-related adverse events to Grade 1 or better or to baseline at the time of consent
Exclusion Criteria for Stage 1:
- Prior fulvestrant or cytotoxic chemotherapy for metastatic breast cancer, or certain other agents as specified in the protocol
- Unresolved AEs from prior anti-cancer therapy
- Eligibility only for the control arm
- Prior treatment with inhibitors as specified in the protocol
Exclusion Criteria for Stage 2:
- Unacceptable toxicity with atezolizumab during Stage 1
- Uncontrolled cardiovascular disease or coagulation disorder, including use of anticoagulants as specified in the protocol
- Significant abdominal or intestinal manifestations within 6 months prior to treatment
- Grade 2 or higher proteinuria
Sites / Locations
- University of Alabama at Birmingham
- Cedars-Sinai Medical Center
- UCSF Helen Diller Family CCC
- Stanford Cancer Institute
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
- Wellness Oncology and Hematology - Main Office
- Northwest Georgia Oncology Centers PC - Marietta
- Rush University Medical Center - Chicago
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
- Memorial Sloan Kettering Cancer Center
- Levine Cancer Institute
- The Ohio State University Comprehensive Cancer Center
- Providence Cancer Center
- UPMC Pinnacle Health System
- Thomas Jefferson University Hospital
- Univ of Pittsburgh Sch of Med; Magee-Womens Hospital
- Sarah Cannon Research Institute
- Houston Methodist Hospital; Department of Pharmacy
- Northwest Medical Specialties, PLLC; Research Department
- Rambam Medical Center
- Shaare Zedek Medical Center
- Rabin Medical Center-Beilinson Campus; Davidof Institute
- Sheba Medical Center
- Tel Aviv Sourasky Medical Center; Pharmacy
- National Cancer Center
- Seoul National University Hospital
- University of Ulsan College of Medicine - Asan Medical Center
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm 7
Arm 8
Active Comparator
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Stage 1: Fulvestrant
Stage 1: Atezolizumab + Entinostat
Stage 1: Atezolizumab + Fulvestrant
Stage 1: Atezolizumab + Ipatasertib
Stage 1: Atezolizumab + Ipatasertib + Fulvestrant
Stage 2: Atezolizumab + Bevacizumab + Endocrine Therapy
Stage 1: Mandatory On-Treatment Biopsy
Stage 1: Atezolizumab + Abemaciclib + Fulvestrant
Participants will receive fulvestrant until unacceptable toxicity or disease progression according to RECIST v1.1.
Participants will receive doublet combination treatment with atezolizumab plus entinostat until unacceptable toxicity or loss of clinical benefit as determined by the investigator.
Participants will receive doublet combination treatment with atezolizumab plus fulvestrant until unacceptable toxicity or loss of clinical benefit as determined by the investigator.
Participants will receive doublet combination treatment with atezolizumab plus ipatasertib until unacceptable toxicity or loss of clinical benefit as determined by the investigator. Prior to enrollment into this arm, the first 6 participants in the study will complete a safety run-in with atezolizumab plus ipatasertib.
Participants will receive triplet combination treatment with atezolizumab plus ipatasertib plus fulvestrant until unacceptable toxicity or loss of clinical benefit as determined by the investigator. Prior to enrollment into this arm, the first 6 participants in the study will complete a safety run-in with atezolizumab plus ipatasertib.
Those who progress or experience unacceptable toxicity during treatment in Stage 1 may be eligible to enter Stage 2. Participants will receive triplet combination therapy with atezolizumab plus bevacizumab plus one of three endocrine therapies (fulvestrant, exemestane, or tamoxifen) selected by the physician. Treatment in Stage 2 will continue until unacceptable toxicity or loss of clinical benefit as determined by the investigator.
For experimental combination arms that demonstrate clinical activity during the preliminary phase, the Sponsor may open enrollment into a separate mandatory on-treatment biopsy cohort for that combination.
Participants will receive triplet combination treatment with atezolizumab plus abemaciclib plus fulvestrant until unacceptable toxicity or loss of clinical benefit as determined by the investigator.