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Breast NeoplasmsPhase 2NCT02115048

Clinical Study for the Treatment of Breast Cancer: the Patient Will Receive Afatinib Plus Letrozole or Letrozole Alone

A Phase 2 study testing Letrozole and Afatinib in people with Breast Neoplasms, run by Translational Research in Oncology at 26 sites in 4 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
Search all trials

Trial summary

The purpose of the study is to compare the efficacy of treatment with afatinib plus letrozole to treatment with letrozole alone in women diagnosed with a specific type of breast cancer. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Breast Neoplasms
What is being tested?
Letrozole and Afatinib
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
44 participants
Where
26 sitesin 4 countries
Study dates
Jul 2014to Nov 2018
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Signed and dated informed consent.
  • Postmenopausal females, 18 years of age or older.
  • Histologically or cytologically proven diagnosis of adenocarcinoma of the breast with evidence of locally recurrent disease not amenable to resection or radiation therapy with curative intent, or metastatic disease.
  • HER2 negative breast cancer. Central testing (required for all subjects) must demonstrate that the tumor is HER2 negative by FISH or Immunohistochemistry (IHC).
  • ER positive breast cancer. Central testing (required for all subjects) must demonstrate that the tumor is ER+ with low expression (H-score [1-159]).
  • Paraffin-embedded tumor block(s) or 15 to 20 unstained slides available for centralized assessment of ER, PR, and HER2.
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  • Measurable disease according to Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 or bone-only non measurable disease.
  • Eastern Cooperative Oncology Group (ECOG) Performance status 0 or 1.
  • Adequate hematological, hepatic and renal functions.
  • Baseline left ventricular ejection fraction (LVEF) 50%.
  • Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests, and other trial procedures.

Who cannot join

  • Brain metastases, spinal cord compression, carcinomatous meningitis, or leptomeningeal disease.
  • Prior treatment with any type of systemic therapy for advanced disease.
  • Prior treatment with letrozole in (neo)adjuvant setting with disease-free interval ≤ 12 months from completion of treatment until randomization.
  • Prior treatment with any anti HER-family targeted therapy in (neo)adjuvant setting.
  • Any concurrent or previous malignancy within 5 years prior to randomization, except for adequately and radically treated basal or squamous skin cancer, or carcinoma in situ of the cervix, or other non-invasive/in-situ neoplasm.
  • Non-measurable disease according to RECIST 1.1, with the exception of bone-only non-measurable disease.
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  • Known pre-existing interstitial lung disease.
  • Significant or recent acute gastrointestinal disorders with diarrhea as a major symptom.
  • History or presence of clinically relevant cardiovascular abnormalities as per investigator assessment.
  • Any other concomitant serious illness or organ system dysfunction as per investigator assessment
  • Any contraindication to oral agents.
  • Active hepatitis B infection, active hepatitis C infection or known HIV carrier.
  • Known or suspected active drug or alcohol abuse.
  • Known hypersensitivity to afatinib or letrozole or the excipients of any of the trial drugs.
  • Concomitant treatment with strong inhibitor of P-gp.
  • Any ongoing acute clinically significant toxic effect of prior anticancer therapy or any persisting complication of prior surgery.
  • Subjects with known history of keratitis, ulcerative keratitis or severe dry eye.
  • Participation in the active phase of other clinical trials of investigational agents in which last study treatment was administered within 2 weeks prior to randomization

Trial locations and contacts

26 sites in 4 countries.

26 sites in 4 countries

United States9 sites
  • Hope Women's Cancer Centers

    Asheville, North Carolina, 28806

  • St. Jude Heritage Healthcare

    Fullerton, California, 92835

  • Comprehensive Cancer Centers of Nevada

    Las Vegas, Nevada, 89169

  • University of California Los Angeles Hematology Oncology

    Los Angeles, California, 90095

  • West Valley Hematology Oncology Medical Group

    Northridge, California, 91328

  • Orlando Health, Inc.

    Orlando, Florida, 32806

  • DBA Torrance Memorial Physician Network/Cancer Care Associates

    Redondo Beach, California, 90277

  • Coastal Integrative Cancer Care

    San Luis Obispo, California, 93401

  • Central Coast Medical Oncology Corporation

    Santa Maria, California, 93454

Other trials in United States

Spain8 sites
  • Complexo Hospitalario Universitario A Coruña

    A Coruña, 15006

  • Complejo Hospitalario Universitario de Albacete

    Albacete, 02006

  • Hospital General Universitario de Alicante

    Alicante, 03010

  • Hospital de Especialidades de Jerez de La Frontera

    Jerez de la Frontera, 11408

  • Hospital Clínico Universitario Virgen de La Arrixaca

    Murcia, 30120

  • Hospital Son Llatzer

    Palma de Mallorca, 07198

  • Hospital Universitari de Sant Joan de Reus

    Reus, 43204

  • Hospital Universitario Miguel Servet

    Zaragoza, 50009

Other trials in Spain

Romania6 sites
  • Filantropia Clinical Hospital

    Bucharest

  • County Emergency Clinical Hospital Cluj-Napoca Oncology Department

    Cluj-Napoca, 400006

  • SC Medisprof SRL

    Cluj-Napoca, 400058

  • County Hospital Ploiesti

    Ploieşti, 100337

  • County Emergency Hospital "Sf Ioan cel Nou"

    Suceava, 720237

  • Oncomed SRL Timisoara

    Timișoara

Other trials in Romania

Bosnia and Herzegovina3 sites
  • University Hospital Clinical Center Banja Luka, Oncology Clinic

    Banja Luka, 78000

  • Clinical Center of University in Sarajevo, Clinic for Oncology

    Sarajevo, 71000

  • University Clinical Center Tuzla Clinic for Oncology, Hematology and Radiotherapy

    Tuzla, 75000

Other trials in Bosnia and Herzegovina

About this study

Official title: A Randomized Open-label Phase II Study of Letrozole Plus Afatinib Versus Letrozole Alone in First-line Treatment of Advanced ER+, HER2- Postmenopausal Breast Cancer With Low ER Expression

The purpose of the study is to compare the efficacy of treatment with afatinib plus letrozole to treatment with letrozole alone in women diagnosed with a specific type of breast cancer.

Read the detailed description

This is an open-label, multicenter, international, randomized, Phase II clinical trial that will assess the efficacy and safety of letrozole in combination with afatinib(oral epidermal growth factor receptor (EGFR ) inhibitor) versus letrozole monotherapy for the first-line treatment of postmenopausal women with ER+, Human Epidermal Growth Factor Receptor 2 (HER2) negative advanced breast cancer with low ER expression.

In order to assess the level of estrogen receptor (ER) expression we will use a semi-quantitative scoring system (McClelland, 1990) defined as :

H-score = (% of cells stained at intensity category 1x1) + (% of cells stained at intensity category 2x2) + (% of cells stained at intensity category 3x3).

This formula results in an H-score in the range of 0-300 where 300 equals 100% of tumor cells stained strongly (i.e., 3+). Low ER expression will be defined as tumor sample with H-score below 160 (Finn, 2009).

All subjects who consented for the study must submit a tumor sample to the designated central laboratory for central confirmation of ER / Progesterone receptor (PR) and HER2 statuses and determination of the H-score. This will be assessed prior to randomization.

Subjects with HER2 negative, ER+ advanced breast cancer with low ER expression defined as H-score between 1 and 159 will enter screening phase and perform the required screening assessments.

Eligible subjects will be randomly assigned in a 1:1 ratio and stratified according to sites of disease (bone only disease vs. other) and prior administration of hormonal therapy in neo/adjuvant setting (Yes vs. No) to either:

Arm A : Continuous regimen of oral letrozole 2.5 mg until progression of disease or any other study treatment discontinuation criteria.

or Arm B : Continuous regimen of oral letrozole 2.5 mg daily plus oral afatinib 30 mg daily until progression of disease or any other study treatment discontinuation criteria.

IN ADDITION the following applies whichever comes first:

  • If the patients treated with the combination of afatinib and letrozole (arm B) discontinue the trial treatment (whatever the reason) before 30 November 2018, the patients from the other arm (arm A, letrozole alone) still on treatment will also be discontinued from the trial at the same time. They may continue receiving letrozole using commercial drug as standard of care according to their treating physician discretion.
  • If the patients treated with afatinib and letrozole (arm B) have not discontinued the trial treatment by 30 November 2018, all patients currently on treatment in the trial (including the ones only treated by letrozole alone (arm A)) will be discontinued from the trial at that time. They may continue receiving their treatment if in alignment with their treating physician judgment as follows:
  • Patients in arm A: may continue receiving letrozole using commercial drug as standard of care according to their treating physician discretion.
  • Patients in arm B: may continue receiving afatinib in the context of alternative drug supply outside the clinical trial as appropriate according to local legislation. Additionally, they may continue receiving letrozole using commercial drug as standard of care according to their treating physician discretion.

Once the patient is discontinued from trial treatment and has undergone the End of Treatment Visit, she will be permanently discontinued from the trial and treated as per local clinical practice.

Being tested
Letrozole, Afatinib
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT02115048
Study groupRoleWhat they receive
Arm AActive comparatorContinuous regimen of oral Letrozole 2.5 mg daily
Receives: Drug: Letrozole
Arm BExperimentalContinuous regimen of oral Letrozole 2.5 mg daily plus oral Afatinib 30 mg daily
Receives: Drug: Letrozole; Drug: Afatinib

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Progression Free Survival (PFS)

    Progression Free Survival (PFS) is defined as the time from randomization until date of progression (assessed by Response Evaluation Criteria in Solid Tumors - RECIST) or death due to any cause, whichever occurs first. For evaluation of PFS, the randomization date for each patient was the "start date". If the status at the last assessment date was "Non-complete response/ Non-progressive disease" or "Complete response", then the patient was considered "censored". If the status at the last assessment for any tumor was "Progressive disease", then the patient was considered as having an event.

    Progressive disease is defined using RECIST v1 .1 as a ≥ 20% increase in the sum of the longest diameter of target lesions compared with the smallest-sum longest diameter recorded or the appearance of one or more target or non-target new lesions and/or unequivocal progression of existing non-target lesions.

    Measured: Tumor assessments were every 12 weeks up to 9 months (average) for subjects in Arm A or up to 14 months (average) for subjects in Arm B.

Secondary outcomes (4)
  1. Overall Survival (OS)

    Overall Survival is defined as the time from randomization until death to any cause.

    For subjects in which treatment is discontinued for reasons different than Progression Disease: after treatment and up to documentation of disease progression: Overall Survival is assessed every 12 weeks

    Measured: Under treatment: every 4 wks up to 9 months (average) for subject in the Arm A or up to 14 months (average) for subjects in Arm B. After documentation of disease progression up to the end of the study: every 6 months up to 42 months

  2. Objective Response Rate (ORR)

    Objective response rate (ORR) is defined as the proportion of randomized subjects achieving a best overall response of complete response (CR) or partial response (PR) as per Response Evaluation Criteria In Solid Tumors (RECIST). As per RECIST (version 1.1):

    CR is defined as disappearance of all target and non target lesions - lymph node (LN) <10mm.

    PR is defined as at least a 30% decrease in the Sum of Diameters, taking as reference the Baseline Sum of Diameters

    Measured: Tumor assessment: every 12 weeks up to 9 months (average) for subjects in Arm A or up to 14 months (average) for subjects in Arm B.

  3. Time to Tumor Progression (TTP)

    As per Response Evaluation Criteria In Solid Tumors (RECIST). Time to progression (TTP) is defined as the time interval from date of randomization to date of the first documented objective tumor progression.

    Measured: Tumor assessments: every 12 weeks up to 9 months (average) for subjects in Arm A or up to 14 months (average) for subjects in Arm B.

  4. Number of Participants With Adverse Events

    Participants who experienced at least one Treatment Emergent Adverse Event (TEAE) are presented. Participants with at least one serious TEAE, those who had at least one TEAE related to letrozole or afatinib (serious/non-serious), including participants who experienced a grade 3/4 TEAE, or who discontinued/died as a result of their TEAE are listed by treatment arm. Adverse events were tabulated by system organ class, preferred term and toxicity grade by treatment arm. For subjects in which treatment was discontinued for reasons different than progression of disease, the assessment was conducted every 12 weeks following treatment, and up to documentation of disease progression.

    ** Enrollment was closed prematurely due to low recruitment (only 44 participants enrolled) compared to what was initially planned (150 participants), therefore no statistical evaluations were completed. Adverse event data collected are described per arm but no statistical comparison was made.

    Measured: Under treatment: every 4 wks up to 9 months (average) for subjects in Arm A or up to 14 months (average) for subjects in Arm B. After documentation of disease progression up to the end of the study: every 6 months up to 42 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Apr 2014 (estimated)
  2. Study startJul 2014
  3. Primary completionNov 2018
  4. Study completionNov 2018

Why it stopped: Study was completed as per amended protocol. Protocol was amended to close enrollment earlier than initially planned (study continued as per plan).

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
44 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02115048
Sponsor's protocol ID
TRIO 020
Status last verified
Dec 2019
First submitted
9 Apr 2014
Last updated
26 Dec 2019
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Letrozole and Afatinib in people with Breast Neoplasms, run by Translational Research in Oncology at 26 sites in 4 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 26 Dec 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 26 sites in United States, Spain, Romania, Bosnia and Herzegovina. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Dec 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Progression Free Survival (PFS) (time frame: Tumor assessments were every 12 weeks up to 9 months (average) for subjects in Arm A or up to 14 months (average) for subjects in Arm B.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Dec 2019.

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