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Trastuzumab Deruxtecan With Nivolumab in Advanced Breast and Urothelial Cancer

Primary Purpose

Breast Cancer, Urothelial Carcinoma

Status
Unknown status
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Trastuzumab deruxtecan
Nivolumab
Sponsored by
Daiichi Sankyo, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

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

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

Inclusion Criteria:

  1. Is the age of majority (adulthood) in their country
  2. Has an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 to 1
  3. 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
  4. Has an adequate archival tumor sample available for the central laboratory to determine eligibility to participate
  5. Has at least 1 measurable lesion per RECIST version 1.1
  6. Has cardiac, bone marrow, kidney, liver, blood and clotting test results required per protocol
  7. Has had an adequate washout period before enrollment since previous surgery and other treatment
  8. 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
  9. 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
  10. Has a life expectancy of at least 3 months

Exclusion Criteria:

  1. Has received prior treatment with nivolumab or trastuzumab deruxtecan
  2. 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.
  3. 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
  4. 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
  5. 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
  6. Is pregnant or breastfeeding, or planning to become pregnant
  7. 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
  8. Has received a live vaccine within 30 days before the first dose of study drug
  9. Is related to the investigator or another employee of the sponsor or the study site
  10. Is pregnant, breastfeeding, or planning to become pregnant
  11. 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:

    1. safety or well-being of the participant or offspring
    2. safety of study staff
    3. 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

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Dose Escalation

Dose Expansion - Cohort 1

Dose Expansion - Cohort 2

Dose Expansion - Cohort 3

Dose Expansion - Cohort 4

Arm Description

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.

Outcomes

Primary Outcome Measures

Part 1: Number of participants with dose-limiting toxicity at each dose level
Categories: Low Dose, High Dose
Part 2: Dose expansion - Objective response rate (ORR) as assessed by Central Imaging Review
ORR is defined as the percentage of participants with tumor size reduction of a predefined amount and for a minimum time period. ORR includes partial response (PR) and complete response (CR). ORR will be assessed by Central Imaging Review based on Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.

Secondary Outcome Measures

Duration of Response (DoR)
Disease Control Rate (DCR)
Progression Free Survival (PFS)
PFS is defined as the time from randomization until objective tumor progression or death, whichever occurs first.
Time to Response based on central review
Overall Survival (OS)
Overall survival is defined as the time from randomization until death from any cause and is measured in the intent-to-treat population.
ORR
ORR, as assessed by the investigator based on RECIST Version 1.1.
Number of participants with treatment emergent adverse events (TEAEs) during the trial
Total number of participants in the safety analysis set with TEAEs collected during the trial (including follow-up periods), for inclusion in the database

Full Information

First Posted
April 30, 2018
Last Updated
August 11, 2021
Sponsor
Daiichi Sankyo, Inc.
Collaborators
Bristol-Myers Squibb, AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT03523572
Brief Title
Trastuzumab Deruxtecan With Nivolumab in Advanced Breast and Urothelial Cancer
Official Title
A Phase 1b, Multicenter, Two-Part, Open-Label Study of Trastuzumab Deruxtecan, an Anti-Human Epidermal Growth Factor Receptor-2 (HER2)-Antibody Drug Conjugate (ADC), in Combination With Nivolumab, an Anti-PD-1 Antibody, for Subjects With HER2-expressing Advanced Breast and Urothelial Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Unknown status
Study Start Date
June 20, 2018 (Actual)
Primary Completion Date
July 22, 2021 (Actual)
Study Completion Date
July 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Daiichi Sankyo, Inc.
Collaborators
Bristol-Myers Squibb, AstraZeneca

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a study of trastuzumab deruxtecan, which was approved by the FDA (in December 2019) for the treatment of HER2-positive unresectable or metastatic breast cancer following two or more prior anti-HER2 based regimens. Participants will receive this study drug along with a cancer drug, an immune checkpoint inhibitor, anti-PD1, called nivolumab. The study will be done in two parts: Part 1 is to identify the recommended dose to use for treatment. Part 2 is to find out how well the combination works, and how safe and tolerable it is.
Detailed Description
The purpose of this phase 1b (Part 1, Part 2) study is to assess the combination of a test drug (trastuzumab deruxtecan) with nivolumab in participants with HER2-expressing breast and urothelial cancer who had disease progression during or after prior therapies, did not respond to standard therapies, or for whom no standard therapy is available. The study will be performed in 2 parts. Part 1 is to test different doses of trastuzumab deruxtecan when given along with a fixed dose of nivolumab, and establish the most effective and the maximum/recommended tolerated dose, when used in combination with nivolumab Part 2 is to assess the efficacy and safety of this dose combination.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer, Urothelial Carcinoma
Keywords
Human epidermal growth factor receptor-2, HER2, Refractory, Metastatic, Urothelial cancer, Breast Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
Part 1 will be a sequential dose-finding (dose escalation) study, Part 2 will consist of a single group of four cohorts who receive the recommended dose (determined during Part 1)
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
99 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dose Escalation
Arm Type
Experimental
Arm Description
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.
Arm Title
Dose Expansion - Cohort 1
Arm Type
Experimental
Arm Description
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.
Arm Title
Dose Expansion - Cohort 2
Arm Type
Experimental
Arm Description
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.
Arm Title
Dose Expansion - Cohort 3
Arm Type
Experimental
Arm Description
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.
Arm Title
Dose Expansion - Cohort 4
Arm Type
Experimental
Arm Description
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.
Intervention Type
Drug
Intervention Name(s)
Trastuzumab deruxtecan
Other Intervention Name(s)
Enhertu
Intervention Description
The investigational product is a sterile lyophilized powder, which is made into solution for intravenous administration.
Intervention Type
Drug
Intervention Name(s)
Nivolumab
Other Intervention Name(s)
Opdivo
Intervention Description
Nivolumab is an aqueous solution formulated at 10 mg/mL to be administered at a flat dose of 360 mg IV over 30 minutes. Protocol-defined thyroid testing is required while taking nivolumab.
Primary Outcome Measure Information:
Title
Part 1: Number of participants with dose-limiting toxicity at each dose level
Description
Categories: Low Dose, High Dose
Time Frame
2 cycles (within 2 months; each cycle is 21 days)
Title
Part 2: Dose expansion - Objective response rate (ORR) as assessed by Central Imaging Review
Description
ORR is defined as the percentage of participants with tumor size reduction of a predefined amount and for a minimum time period. ORR includes partial response (PR) and complete response (CR). ORR will be assessed by Central Imaging Review based on Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Time Frame
6 months after the last participant is enrolled, or when 80% of participants have experienced disease progression or discontinued study treatment, whichever occurs first (within 24 months)
Secondary Outcome Measure Information:
Title
Duration of Response (DoR)
Time Frame
within 24 months
Title
Disease Control Rate (DCR)
Time Frame
within 24 months
Title
Progression Free Survival (PFS)
Description
PFS is defined as the time from randomization until objective tumor progression or death, whichever occurs first.
Time Frame
within 24 months
Title
Time to Response based on central review
Time Frame
within 24 months
Title
Overall Survival (OS)
Description
Overall survival is defined as the time from randomization until death from any cause and is measured in the intent-to-treat population.
Time Frame
within 24 months
Title
ORR
Description
ORR, as assessed by the investigator based on RECIST Version 1.1.
Time Frame
within 24 months
Title
Number of participants with treatment emergent adverse events (TEAEs) during the trial
Description
Total number of participants in the safety analysis set with TEAEs collected during the trial (including follow-up periods), for inclusion in the database
Time Frame
at the time of final database lock (anticipated within three years)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Global Team Leader
Organizational Affiliation
Daiichi Sankyo, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
UCLA - Medical Center
City
Santa Monica
State/Province
California
ZIP/Postal Code
90404-2125
Country
United States
Facility Name
Yale University
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06520
Country
United States
Facility Name
University of Miami Hospital & Clinics/Sylvester Comprehensive Cancer Center
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Norton Cancer Institute
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202-3700
Country
United States
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029-6504
Country
United States
Facility Name
Levine Cancer Institute Carolinas Healthcare System
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28204
Country
United States
Facility Name
Gabrail Cancer Center Research
City
Canton
State/Province
Ohio
ZIP/Postal Code
44718-2566
Country
United States
Facility Name
Tennessee Oncology - Sara Cannon Research Institute
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37203-1619
Country
United States
Facility Name
Huntsman Cancer Institute
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84112
Country
United States
Facility Name
University of Washington Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
Facility Name
AZ Groeninge
City
Kortrijk
State/Province
West-Vlaanderen
ZIP/Postal Code
8500
Country
Belgium
Facility Name
Cliniques Universitaires Saint-Luc
City
Brussels
ZIP/Postal Code
1200
Country
Belgium
Facility Name
GZA Hospital Campus Sint-Augustinus
City
Wilrijk
ZIP/Postal Code
2610
Country
Belgium
Facility Name
Institut de Cancerologie de L'Ouest
City
Angers
ZIP/Postal Code
49055
Country
France
Facility Name
Centre Georges Francois Leclerc
City
Dijon
ZIP/Postal Code
21079
Country
France
Facility Name
ICO Rene Gauducheau
City
Saint-Herblain
ZIP/Postal Code
44805
Country
France
Facility Name
Charite Campus Benjamin Franklin
City
Berlin
State/Province
Brandenburg
ZIP/Postal Code
12200
Country
Germany
Facility Name
University Hospital Frankfurt
City
Frankfurt
State/Province
Hessen
ZIP/Postal Code
60590
Country
Germany
Facility Name
University Cancer Center
City
Dresden
State/Province
Sachsen
ZIP/Postal Code
01307
Country
Germany
Facility Name
Ospedale San Raffaele
City
Milano
ZIP/Postal Code
20132
Country
Italy
Facility Name
Fondazione IRCCS Istituto Nazionale dei Tumori
City
Milano
ZIP/Postal Code
20133
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Senese U.O.C. Immunoterapia Oncologica
City
Siena
ZIP/Postal Code
53100
Country
Italy
Facility Name
Hospital Gregorio Maranon Madrid Spain
City
Madrid
ZIP/Postal Code
28007
Country
Spain
Facility Name
MD Anderson Cancer Center Madrid
City
Madrid
ZIP/Postal Code
28033
Country
Spain
Facility Name
Hospital Universitario Ramon y Cajal Madrid
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Fundacion Jimenez Diaz
City
Madrid
ZIP/Postal Code
28040
Country
Spain
Facility Name
START Madrid CIOCC
City
Madrid
ZIP/Postal Code
28050
Country
Spain
Facility Name
Sarah Cannon Research Institute UK
City
London
State/Province
England
ZIP/Postal Code
W1G6AD
Country
United Kingdom
Facility Name
Royal Marsden Hospital (Surrey)
City
London Borough of Sutton
ZIP/Postal Code
SM25PT
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
De-identified individual participant data (IPD) and applicable supporting clinical trial documents may be available upon request at https://vivli.org/. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. Details on data sharing criteria and the procedure for requesting access can be found at this web address: https://vivli.org/ourmember/daiichi-sankyo/
IPD Sharing Time Frame
Studies for which the medicine and indication have received European Union (EU) and United States (US), and/or Japan (JP) marketing approval on or after 01 January 2014 or by the US or EU or JP Health Authorities when regulatory submissions in all regions are not planned and after the primary study results have been accepted for publication.
IPD Sharing Access Criteria
Formal request from qualified scientific and medical researchers on IPD and clinical study documents from clinical trials supporting products submitted and licensed in the United States, the European Union and/or Japan from 01 January 2014 and beyond for the purpose of conducting legitimate research. This must be consistent with the principle of safeguarding study participants' privacy and consistent with provision of informed consent.
IPD Sharing URL
https://vivli.org/ourmember/daiichi-sankyo/

Learn more about this trial

Trastuzumab Deruxtecan With Nivolumab in Advanced Breast and Urothelial Cancer

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