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This is a prospective, multi-center, open-label, phase Ib/ II study (two parts) with patients that have locally advanced or metastatic HER2+ breast cancer. The first part (phase Ib) will investigate the MTD/ RP2D of the combination therapy of BEZ235 BID and weekly trastuzumab using a Bayesian model. Once MTD/ RP2D is established the second part (phase II) will start. Phase II will evaluate the efficacy and the safety of weekly trastuzumab plus BEZ235 BID compared to capecitabine and lapatinib.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BEZ235 + Trastuzumab (Phase l /Phase ll) | Experimental | Phase l: Eligible patients will receive increasing doses of oral BEZ235 administered on a continuous twice daily (BID) schedule + weekly trastuzumab at a fixed dose of 2 mg/kg. Treatment will be organized into cycles of 28 days. Phase ll: Eligible patients will receive weekly trastuzumab (2 mg/kg) + oral BEZ235 on a continuous twice daily (BID schedule) at the MTD or RP2D. Treatment will be organized into cycles of 21 days. |
|
| Lapatinib + Capecitabine (Phase II) | Active Comparator | Eligible patients will receive lapatinib (1250 mg given orally once daily on days 1 through 21) in combination with capecitabine (2000 mg/m2/day administered orally in 2 doses approximately 12 hours apart on days 1 through 14). Treatment will be organized into cycles of 21 days . |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| BEZ235 + Trastuzumab Phase l/Phase ll) | Drug | Phase l: Patients will receive increasing doses of oral BEZ235 (BID) together with standard weekly trastuzumab at a fixed dose. BEZ235 doses will be escalated in cohorts of 3 to 6 patients guided by an adaptive Bayesian logistic regression model with overdose control until MTD/RP2D has been established. Phase ll: If randomized to the trastuzumab + BEZ235 arm, patients will receive standard weekly trastuzumab in combination with oral BEZ235 (BID) at the MTD or RP2D and will continue on study treatment until PD, unacceptable toxicity or until other pre-defined discontinuation criteria are met. They will have regular safety assessments and will be evaluated for response to treatment according to RECIST every 2 cycles for the first 36 weeks then every 12 weeks until disease progression (or start of new anti-neoplastic therapy). |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Dose Limiting Toxicities (DLT) in the first cycle - phase lb | DLT is defined as treatment-related toxicity (classified according Common Toxicity Criteria for Adverse Events (CTCAE) Version 4) occurring during the first 28 treatment days and meeting specific protocol-predefined criteria. The information will be integrated in a Bayesian logistic regression model with overdose control to estimate the maximum tolerated dose (MTD) | First treatment cycle (28 days) |
| Progression Free Survival (PFS) based on local radiological assessment - phase ll | PFS is defined as the time from randomization until objective tumor progression or death from any cause. Radiological assessments will be performed every 6 weeks for the first 36 weeks after treatment start, then every 12 weeks. | Randomization, disease progression or start of of new anti-neoplastic therapy (expected average: 12 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Progression Free Survival (PFS) - Phase lb | Time from treatment start until objective tumor progression or death from any cause. Radiological assessments will be performed every 8 weeks for the first 32 weeks after treatment start, then every 12 weeks. | Randomization, Randomization, disease progression or start of of new anti-neoplastic therapy (expected average: 12 months) |
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Inclusion Criteria:
Additional inclusion criteria for phase II:
Exclusion Criteria:
Additional exclusion criteria for phase II:
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| Name | Affiliation | Role |
|---|---|---|
| Novartis Pharmaceuticals | Novartis Pharmaceuticals | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Novartis Investigative Site | Madrid | 28050 | Spain | |||
| Novartis Investigative Site |
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| Label | URL |
|---|---|
| Results for CBEZ235B2203 can be found on the Novartis Clinical Trials Website | View source |
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|
| Lapatinib + Capecitabine (Phase II) | Drug | If randomized to the lapatinib + capecitabine treatment arm, patients will receive standard lapatinib plus capecitabine until PD, unacceptable toxicity or until other pre-defined discontinuation criteria are met. Patients will have regular safety assessments and will be evaluated for response to treatment according to RECIST every 2 cycles for the first 36 weeks then every 12 weeks until disease progression (or start of new anti-neoplastic therapy). After progression, survival f-up will continue. All patients participating in the Phase II part of the study will be required to have available archival or fresh tumor tissue for biomarker analysis prior to treatment start |
|
| Overall Response Rate (ORR)- Phase lb | Proportion of patients with a best overall response of complete response (CR) or partial response (PR) according to RECIST 1.1 | 12 months |
| Clinical Benefit Rate (CBR) (Phase lb) | Proportion of patients with a best overall response of CR, PR or stable disease (SD) with a duration of 24 weeks or longer according to RECIST 1.1 | 12 months |
| Frequency and severity of Adverse Events - Phase lb | Incidence of adverse events (based on common terminology criteria for adverse events (CTCAE) Version 4) summarized by system organ class and/or preferred term, severity and relation to study treatment. | until 30 days after treatment discontinuation |
| BEZ235 plasma and trastuzumab serum concentrations - phase lb | BEZ235 plasma and trastuzumab serum concentrations obtained during the two sampling windows (pre-dose and post-dose). No pharmacokinetic parameters will be calculated and no formal statistical analysis will be performed. | Pre-dose (cycle 1 through 9) and 4-6 hours post-dose (cycle 1 and 2) |
| Overall Response Rate (ORR) - phase ll | Proportion of patients with a best overall response of CR or PR according to RECIST 1.1 | 12 months |
| Clinical Benefit Rate (CBR) - phase ll | Proportion of patients with a best overall response of CR, PR or SD with a duration of 24 weeks or longer according to RECIST 1.1 | 12 months |
| Time to overall response (TTR) - phase ll | Time from randomization until first documented response. | 12 months |
| Duration of overall response (DR) - phase ll | Time between the first documented response and first documented progression or death due to underlying cancer. | 12 months |
| Median overall survival (OS) (phase ll) | Time from randomization to the date of death due to any cause. | Randomization, death (expected average:24 months) |
| PFS based on central radiological assessment (phase ll) | Time from randomization until objective tumor progression or death from any cause. Radiological assessments will be performed every 6 weeks for the first 36 weeks after treatment start, then every 12 weeks, centrally collected and read. | Randomization, disease progression or start of of new anti-neoplastic therapy (expected average: 12 months) |
| Frequency and severity of adverse events (phase ll) | Incidence of adverse events (based on CTCAE Version 4) summarized by system organ class and/or preferred term, severity and relation to study treatment. | Until 30 days after treatment discontinuation |
| Efficacy in subgroups of patients with activated/non-activated PI3K pathway (phase ll) | Efficacy (e.g. PFS, ORR, CBR) according to PI3K activation and treatment group. | 12 months |
| Leicester |
| LE1 5WW |
| United Kingdom |
| Novartis Investigative Site | Manchester | M20 2BX | United Kingdom |
| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D009362 | Neoplasm Metastasis |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D009385 | Neoplastic Processes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| C531198 | dactolisib |
| D000077341 | Lapatinib |
| D000069287 | Capecitabine |
| D017322 | Clinical Trials, Phase II as Topic |
| ID | Term |
|---|---|
| D011799 | Quinazolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D005472 | Fluorouracil |
| D014498 | Uracil |
| D011744 | Pyrimidinones |
| D003853 | Deoxyribonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D002986 | Clinical Trials as Topic |
| D000068456 | Clinical Studies as Topic |
| D016020 | Epidemiologic Study Characteristics |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
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