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This is an open-label, multicenter, randomized, Phase 2/3 study in patients with locally recurrent or metastatic triple-negative breast cancer (TNBC) with no more than one prior systemic therapy for locally recurrent or metastatic disease.
The study will consist of 2 parts:
Part 1 is the focus of the current protocol, with a primary endpoint of DCR. DCR data as determined by an IRR will determine whether or not proceeding to Part 2 is warranted. If so, Part 2 will be implemented via a major amendment to the protocol. Meanwhile, sites will remain open with the expectation that Part 2 will be activated
After providing informed consent and completing the screening assessments, patients who meet all inclusion and no exclusion criteria will be randomized in a 1:1 ratio to one of the following treatment arms:
Treatment will continue until objective disease progression, unacceptable toxicity, or the patient's withdrawal of consent.
A survival follow-up period will include the collection of survival, progression of disease if applicable, subsequent anti-cancer therapy every 12 weeks (± 1 week)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Eryaspase plus Chemotherapy | Experimental | eryaspase 100 U/kg dosed at Day 1 and Day 8 of each 3-week cycle in combination with
|
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| Chemotherapy alone | Active Comparator | Gemcitabine plus carboplatin dosed at Day 1 and Day 8 of each 3-week cycle |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| eryaspase (L-asparaginase encapsulated in red blood cells) | Drug | IV infusion 100 U/kg |
|
| Measure | Description | Time Frame |
|---|---|---|
| Disease Control Rate (DCR) | To determine whether the addition of eryaspase to gemcitabine and carboplatin improves the disease control rate (DCR) by modified Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) as determined by an independent radiological review (IRR) in patients with locally recurrent or metastatic triple-negative breast cancer (TNBC) compared with chemotherapy alone. | 1 year after last patient randomized |
| Measure | Description | Time Frame |
|---|---|---|
| Disease Control Rate (DCR) | To compare the DCR between the two treatment arms as determined by the Investigator's assessment. | 1 year after last patient randomized |
| Objective response rate (ORR) |
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Inclusion Criteria:
Female or male, 18 years of age or older.
Histologically or cytologically confirmed diagnosis of invasive breast cancer.
Metastatic or locally recurrent inoperable breast cancer with no more than one prior systemic therapy.
Diagnosis (original primary tumor or subsequent relapse) of triple negative breast cancer, defined as the absence of expression of the following receptors in the primary and/or metastatic tumor tissue:
Measurable lesion(s) per RECIST 1.1.
Available archival or fresh tumor tissue.
Adequate performance status (PS) score.
Life expectancy of >12 weeks according to the Investigator's clinical judgment.
Females of childbearing potential must have a negative pregnancy test at screening and an additional pregnancy test prior to first dose. Females of childbearing potential must agree to use a highly effective method of contraception during treatment and for at least 6 months after the last dose of study treatment.
Adequate laboratory parameters at baseline (obtained <14 days prior to randomization)
Patients must be able to understand and comply with the conditions of the protocol and must have read and understood the consent form and provided written informed consent.
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| ZNA Middelheim | Antwerp | Belgium | ||||
| Institut Jules Bordet |
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| Gemcitabine | Drug | IV infusion 1000 mg/m2 |
|
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| Carboplatin | Drug | IV infusion AUC2 |
|
|
To compare the objective response rate (ORR) between the two treatment arms as determined by the independent radiological review (IRR).
| 1 year after last patient randomized. |
| Progression-Free Survival (PFS) | To compare progression-free survival (PFS) between the two treatment arms. | 1 year after last patient randomized. |
| Duration of Response (DoR) | To compare the duration of response (DoR) between the two treatment arms. | 1 year after last patient randomized. |
| Overall Survival (OS) | To compare overall survival (OS) between the two treatment arms. | 1 year after last patient randomized. |
| Incidence of treatment emergent adverse events as assessed by CTCAE v5.0 | To evaluate the safety and tolerability of eryaspase in combination with chemotherapy versus chemotherapy alone by assessing the number of patients with treatment emergent adverse events per CTCAE v5.0. | Collected from time of informed consent until 30 days after last study treatment. |
| Clinical response assessed by F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging | To evaluate the change in F-18 fluorodeoxyglucose (FDG) tumor uptake as a predictor of clinical response following one cycle of treatment with eryaspase and chemotherapy. | Collected at baseline and within 3 days of the end of Cycle 1 in all patients. |
| Eryaspase induced immunogenecity | To determine the anti-asparaginase antibodies titer. | Samples will be collected pre-dose at Cycle 1 Day 1 and pre-dose at Cycle 3 Day 1 (each Cycle is 21 days) |
| Biomarkers potentials in predicting eryaspase activity. | To determine DNA, RNA and protein levels present in tumor tissues and blood samples. | Tissue samples will be collected at baseline. Blood samples for biomarker analysis will be collected during screening, at Cycle 1 Day 1 and Day 8, and at Day 1 of every second cycle ( each is 21 days) until End of Treatment (EOT) visit. |
| Pharmacokinetics of eryaspase | To determine total and plasma asparaginase activity (U/L) | Samples will be collected the first day (D1) and the eight day (D8) of Cycle 1 and Cycle 3 treatment (each Cycle is 21 days) and at End of treatment (EOT) |
| Pharmacodynamics of eryaspase | To determine plasma concentrations of asparagine and glutamine (µmol/L) | Samples will be collected the first day (D1) and the eight day (D8) of Cycle 1 and Cycle 3 treatment (each Cycle is 21 days) and at End of treatment (EOT) |
| Brussels |
| Belgium |
| UZ Brussel | Brussels | Belgium |
| Grand Hôpital de Charleroi asbl | Charleroi | Belgium |
| Clinique Sainte-Elisabeth | Namur | Belgium |
| Debreceni Egyetem - Klinikai Kozpont - Onkologiai Klinika | Debrecen | Hungary |
| Bacs Kiskun Megyei Korhaz | Kecskemét | 6000 | Hungary |
| Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet | Szolnok | 5000 | Hungary |
| Complejo Hospitalario Universitario A Coruña | A Coruña | Spain |
| Hospital Universitario Germans Trias i Pujol | Badalona | Spain |
| Hospital Universitario Arnau Vilanova | Lleida | Spain |
| Fundacion Jimenez Diaz | Madrid | Spain |
| Hospital Clinico San Carlos | Madrid | Spain |
| Hospital Universitario Quirón Madrid | Madrid | Spain |
| Hospital Universitario Ramon y Cajal | Madrid | Spain |
| Hospital Universitario Virgen del Rocio | Seville | Spain |
| ID | Term |
|---|---|
| D064726 | Triple Negative Breast Neoplasms |
| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
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| ID | Term |
|---|---|
| C000708079 | eryaspase |
| D004906 | Erythrocyte Count |
| D000093542 | Gemcitabine |
| D016190 | Carboplatin |
| ID | Term |
|---|---|
| D001772 | Blood Cell Count |
| D002452 | Cell Count |
| D003584 | Cytological Techniques |
| D019411 | Clinical Laboratory Techniques |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D006403 | Hematologic Tests |
| D008919 | Investigative Techniques |
| D002468 | Cell Physiological Phenomena |
| D001790 | Blood Physiological Phenomena |
| D002943 | Circulatory and Respiratory Physiological Phenomena |
| D006571 | Heterocyclic Compounds |
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D056831 | Coordination Complexes |
| D009930 | Organic Chemicals |
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