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Trilaciclib, a CDK4/6 Inhibitor, in Patients With Early-Stage Triple Negative Breast Cancer

Primary Purpose

Triple Negative Breast Cancer, Breast Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Trilaciclib
Cylophosphamide
Doxorubicin
Paclitaxel
Carboplatin (Investigator discretion)
Pembrolizumab (Investigator discretion)
Sponsored by
G1 Therapeutics, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Triple Negative Breast Cancer focused on measuring Breast Cancer, Triple Negative Breast Cancer, CDK4/6 Inhibitor, trilaciclib dihydrochloride, Cosela, Immuno-oncology, Solid tumor, Chemotherapy-induced myelosuppression, Myeloprotective, Cyclin-dependent kinase 4/6 inhibitor, Neoadjuvant, HER2-negative, TNBC, Breast cancer surgery, Trilaciclib, Myeloprotection, pembrolizumab, carboplatin, doxorubicin, cyclophosphamide, Dose-dense anthracycline/cyclophosphamide, paclitaxel, Chemotherapy

Eligibility Criteria

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

Inclusion Criteria:

  • Suitability of therapy and patient intends to undergo curative surgery
  • Documented diagnosis of estrogen receptor (ER)-negative and progesterone receptor (PR)-negative tumor
  • Primary tumor ≥ 2 cm with any nodal status
  • Provide archival tissue for the baseline tissue sample
  • ECOG performance status of 0 or 1
  • Demonstrates adequate organ function
  • Research tumor biopsies including at least one on-treatment biopsy (and additional biopsy at baseline, if required)
  • Participants of child bearing potential must be willing to use 2 forms of contraception during the study and for 6 months following study treatment

Exclusion Criteria:

  • Prior systemic therapies or radiation for current breast cancer
  • History of invasive malignancy ≤3 years prior to signing informed consent except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer
  • History of breast cancer including ipsilateral ductal carcinoma in situ (DCIS) treated with radiotherapy at any time
  • Previous exposure to doxorubicin of more than 200 mg/m2 (as lifetime exposure to doxorubicin is not to exceed 450 mg/m2)
  • For patients who will receive pembrolizumab:

    • History of active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy is not considered a form of systemic treatment
    • Diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drugs
  • History of (non-infectious) pneumonitis that required steroids or current pneumonitis
  • Known history of active tuberculosis (Bacillus Tuberculosis)
  • History of severe hepatic impairment
  • Uncontrolled ischemic heart disease or uncontrolled symptomatic congestive heart failure (Class II-IV as defined by the New York Heart Association [NYHA] functional classification system)
  • Known history of stroke, cerebrovascular accident, severe/unstable angina, myocardial infarction, or coronary angioplasty/stenting/bypass grafting within 6 months prior to enrollment
  • Known serious active infection (e.g., human immunodeficiency virus [HIV], hepatitis B or C, tuberculosis).
  • Women who are pregnant or breastfeeding
  • Participation in other studies involving active treatment with investigational drug(s)
  • Prior hematopoietic stem cell or bone marrow transplantation

Sites / Locations

  • Cancer and Blood Specialty Clinic
  • UCLA Department of Medicine - Hematology/Oncology
  • PIH Health
  • Nebraska Hematology-Oncology, P.C.
  • Duke University Medical Center
  • Texas Oncology - Baylor Charles A. Sammons Cancer Center
  • Virginia Oncology Associates

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Trilaciclib plus chemotherapy

Arm Description

Trilaciclib lead-in, followed by trilaciclib plus anthracycline/cyclophosphamide, then trilaciclib plus taxane chemotherapy: Lead-in trilaciclib (240mg/m2) single dose monotherapy Trilaciclib (240mg/m2) + doxorubicin (60 mg/m2) + cyclophosphamide (600 mg/m2) + pembrolizumab (per Investigator discretion; 400mg) Trilaciclib (240mg/m2) + paclitaxel (80 mg/m2) + carboplatin (per Investigator discretion; AUC 1.5)

Outcomes

Primary Outcome Measures

Immune-based mechanism of action
Evaluated 7 days after a single-dose of trilaciclib, measured by the change in CD8 T cells/regulatory T cells (Treg) ratio in tumor tissue.

Secondary Outcome Measures

Pathologic Complete Response (pCR) rate
Rate of pCR using the definition of ypT0/Tis ypN0 (i.e., no invasive residual tumor in breast or nodes; noninvasive breast residuals allowed) as assessed by the local pathologist.
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Safety/tolerability as per CTCAE version 5.0

Full Information

First Posted
October 6, 2021
Last Updated
March 23, 2023
Sponsor
G1 Therapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05112536
Brief Title
Trilaciclib, a CDK4/6 Inhibitor, in Patients With Early-Stage Triple Negative Breast Cancer
Official Title
A Phase 2, Open-Label, Single-Arm Study of Single-Dose Lead-In and Neoadjuvant Trilaciclib and Chemotherapy in Patients With Early-Stage Triple Negative Breast Cancer (TNBC)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
November 19, 2021 (Actual)
Primary Completion Date
October 31, 2022 (Actual)
Study Completion Date
March 13, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
G1 Therapeutics, Inc.

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
The purpose of this study is to evaluate the mechanism of action, as well as the safety and efficacy of trilaciclib in combination with standard of care treatment in the neoadjuvant setting of early-stage triple negative breast cancer (TNBC). This study will have four phases: 1) Screening Phase, 2) Trilaciclib Lead-In Phase, 3) Treatment Phase, and 4) Surgery and Follow-Up Phase. After a screening phase of up to 21 day, each participant will receive trilaciclib single-dose monotherapy during the lead-in phase, followed by a tumor biopsy. During the treatment phase, each participant will receive trilaciclib with standard of care chemotherapy. Immunotherapy may be included during the treatment phase, per standard of care. 3-5 weeks following conclusion of the treatment phase, each participant will undergo definitive surgery. A 30-day Safety Follow-up Visit will occur 30 days after the last dose of trilaciclib and an End of Study Visit will occur within 14 days after definitive surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Triple Negative Breast Cancer, Breast Cancer
Keywords
Breast Cancer, Triple Negative Breast Cancer, CDK4/6 Inhibitor, trilaciclib dihydrochloride, Cosela, Immuno-oncology, Solid tumor, Chemotherapy-induced myelosuppression, Myeloprotective, Cyclin-dependent kinase 4/6 inhibitor, Neoadjuvant, HER2-negative, TNBC, Breast cancer surgery, Trilaciclib, Myeloprotection, pembrolizumab, carboplatin, doxorubicin, cyclophosphamide, Dose-dense anthracycline/cyclophosphamide, paclitaxel, Chemotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Trilaciclib plus chemotherapy
Arm Type
Experimental
Arm Description
Trilaciclib lead-in, followed by trilaciclib plus anthracycline/cyclophosphamide, then trilaciclib plus taxane chemotherapy: Lead-in trilaciclib (240mg/m2) single dose monotherapy Trilaciclib (240mg/m2) + doxorubicin (60 mg/m2) + cyclophosphamide (600 mg/m2) + pembrolizumab (per Investigator discretion; 400mg) Trilaciclib (240mg/m2) + paclitaxel (80 mg/m2) + carboplatin (per Investigator discretion; AUC 1.5)
Intervention Type
Drug
Intervention Name(s)
Trilaciclib
Other Intervention Name(s)
COSELA®, G1T28
Intervention Description
Trilaciclib is administered IV as monotherapy during the lead-in phase and administered prior to chemotherapy on each day chemotherapy is administered during the treatment phase.
Intervention Type
Drug
Intervention Name(s)
Cylophosphamide
Other Intervention Name(s)
CYTOXAN®
Intervention Description
Cyclophosphamide administered IV every 2 weeks for the first 4 cycles (1-4), each cycle 2 weeks in length.
Intervention Type
Drug
Intervention Name(s)
Doxorubicin
Other Intervention Name(s)
ADRIAMYCIN®
Intervention Description
Doxorubicin administered as an IV bolus every 2 weeks for the first 4 cycles (1-4), each cycle 2 weeks in length.
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Other Intervention Name(s)
TAXOL®
Intervention Description
Paclitaxel administered weekly for the last 12 cycles (cycles 5-16), each cycle 1 week in length.
Intervention Type
Drug
Intervention Name(s)
Carboplatin (Investigator discretion)
Other Intervention Name(s)
PARAPLATIN®
Intervention Description
Carboplatin, if given, is administered IV weekly at the start of paclitaxel administration, for the last 12 cycles (cycles 5-16).
Intervention Type
Biological
Intervention Name(s)
Pembrolizumab (Investigator discretion)
Other Intervention Name(s)
KEYTRUDA®
Intervention Description
Pembrolizumab, if given, is administered IV every 6 weeks throughout the treatment phase (cycles 1, 4, 9, 15).
Primary Outcome Measure Information:
Title
Immune-based mechanism of action
Description
Evaluated 7 days after a single-dose of trilaciclib, measured by the change in CD8 T cells/regulatory T cells (Treg) ratio in tumor tissue.
Time Frame
Up to 8 days
Secondary Outcome Measure Information:
Title
Pathologic Complete Response (pCR) rate
Description
Rate of pCR using the definition of ypT0/Tis ypN0 (i.e., no invasive residual tumor in breast or nodes; noninvasive breast residuals allowed) as assessed by the local pathologist.
Time Frame
Up to 26 weeks
Title
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability)
Description
Safety/tolerability as per CTCAE version 5.0
Time Frame
Up to 28 weeks
Other Pre-specified Outcome Measures:
Title
Intratumoral immune profile characterization following trilaciclib
Description
Characterization of molecular and immune changes based on CD8+ T cell and Treg infiltration, quantified by RNA profiling of tumor tissue before study treatment, during study treatment, and at definitive surgery.
Time Frame
Up to 26 weeks
Title
Kinetics of the immune response in peripheral blood
Description
Longitudinal immune changes in peripheral blood, measured by frequency of immune subsets and profiling of activation, maturation, and exhaustion status.
Time Frame
Up to 26 weeks
Title
Kinetics of T cell function and polyfunctionality
Description
Ex-vivo measurement of cytokine production to determine T cell function and polyfunctionality.
Time Frame
Up to 26 weeks
Title
Molecular biomarkers for clinical responsiveness
Description
pCR in patients by gene signatures determined in the tumor at baseline.
Time Frame
Up to 26 weeks
Title
CDK4/6 dependence for clinical responsiveness
Description
pCR in patients by subgroups according to CDK4/6 dependence signatures.
Time Frame
Up to 26 weeks
Title
PD-L1 status and clinical responsiveness
Description
pCR in patients by subgroups according to PD-L1 status, as measured by IHC.
Time Frame
Up to 26 weeks
Title
Immune response and clinical responsiveness
Description
pCR in patients by frequency of immune subsets, immunological markers, and cytokines.
Time Frame
Up to 26 weeks

10. Eligibility

Sex
Female
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Suitability of therapy and patient intends to undergo curative surgery Documented diagnosis of estrogen receptor (ER)-negative and progesterone receptor (PR)-negative tumor Primary tumor ≥ 1.5 cm with any nodal status Provide archival tissue for the baseline tissue sample ECOG performance status of 0 or 1 Demonstrates adequate organ function Research tumor biopsies including at least one on-treatment biopsy (and additional biopsy at baseline, if required) Participants of child bearing potential must be willing to use 2 forms of contraception during the study and for 6 months following study treatment Exclusion Criteria: Prior systemic therapies or radiation for current breast cancer History of invasive malignancy ≤3 years prior to signing informed consent except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer History of breast cancer including ipsilateral ductal carcinoma in situ (DCIS) treated with radiotherapy at any time Previous exposure to doxorubicin of more than 200 mg/m2 (as lifetime exposure to doxorubicin is not to exceed 450 mg/m2) For patients who will receive pembrolizumab: History of active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy is not considered a form of systemic treatment Diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drugs History of (non-infectious) pneumonitis that required steroids or current pneumonitis Known history of active tuberculosis (Bacillus Tuberculosis) History of severe hepatic impairment Uncontrolled ischemic heart disease or uncontrolled symptomatic congestive heart failure (Class II-IV as defined by the New York Heart Association [NYHA] functional classification system) Known history of stroke, cerebrovascular accident, severe/unstable angina, myocardial infarction, or coronary angioplasty/stenting/bypass grafting within 6 months prior to enrollment Known serious active infection (e.g., human immunodeficiency virus [HIV], hepatitis B or C, tuberculosis). Women who are pregnant or breastfeeding Participation in other studies involving active treatment with investigational drug(s) Prior hematopoietic stem cell or bone marrow transplantation
Facility Information:
Facility Name
Cancer and Blood Specialty Clinic
City
Los Alamitos
State/Province
California
ZIP/Postal Code
90720
Country
United States
Facility Name
UCLA Department of Medicine - Hematology/Oncology
City
Santa Monica
State/Province
California
ZIP/Postal Code
90404
Country
United States
Facility Name
PIH Health
City
Whittier
State/Province
California
ZIP/Postal Code
90602
Country
United States
Facility Name
Nebraska Hematology-Oncology, P.C.
City
Lincoln
State/Province
Nebraska
ZIP/Postal Code
68506
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Texas Oncology - Baylor Charles A. Sammons Cancer Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75246
Country
United States
Facility Name
Virginia Oncology Associates
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23502
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Trilaciclib, a CDK4/6 Inhibitor, in Patients With Early-Stage Triple Negative Breast Cancer

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