Apatinib Combined With cdk4/6i in First-line Treatment for HR+/HER2- SNF4 Subtype Breast Cancer

Advanced Breast Cancer Clinical Trial

Official title:

Study of Efficacy of Apatinib Combined With cdk4/6i in First-line Treatment for HR+/HER2- SNF4 Subtype Advanced Breast Cancer (Open, Randomized, Phase III)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06447623
• Other study ID #: SCHBCC-N068
• Status: Recruiting
• Phase: Phase 3
• Start date: February 1, 2024
• Est. completion date: February 1, 2029

Study information

• Verified date: June 2024
• Source: Fudan University
• Contact: Zhimin Shao, MD, PhD
• Phone: 86-021-64175590
• Email: zhimingshao[@]yahoo.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a randomized, controlled, open-label, phase III study to explore the efficacy and safety of Apatinib in combination with standard first-line endocrine therapy for the HR+/ HER2-SNF4 subtype of advanced breast cancer. The study was used to explore the efficacy of Apatinib in combination with standard endocrine therapy.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 184
• Est. completion date: February 1, 2029
• Est. primary completion date: February 1, 2027
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Inclusion Criteria:
• Patients need to meet all of the following conditions
• Patients must be =18 and = 75 years of age;
• Pathologically confirmed breast cancer is HR+/HER2- breast cancer (IHC ER >10%, or/and PR>10%, HER 0 OR +, if HER2++, FISH negative);
• SNF4 subtype definition: SNF4 subtype confirmed by digital pathology of H&E sections;
• Locally advanced breast cancer (radical local therapy is not possible) or metastatic breast cancer (without using adjuvant CDK4/6 inhibitors in the past, or one year after adjuvant CDK4/6 inhibitor therapy has ended);
• No prior therapy (chemotherapy, targeted therapy, etc.) for advanced or metastatic breast cancer;
• Patients with at least one measurable lesion that has not previously received radiation therapy and can be evaluated repeatedly according to RECIST 1.1;
• The functions of the main organs are basically normal, and the following

conditions are met:

1. Blood routine examination standards should meet: HB=90g/L (no blood transfusion within 14 days); ANC=1.5×109/L; PLT=75×109/L;

2. Biochemical examination shall meet the following standards: TBIL=1.5×ULN (upper limit of normal value); ALT and AST=3 x ULN; In case of liver metastasis, ALT and AST=5×ULN; Serum Cr =1.5×ULN, endogenous creatinine clearance > 50ml/min (Cockcroft-Gault formula);

• ECOG performance status 0 or 1; The expected survival is more than 3 months;
• Fertile female is required to use a medically approved contraceptive during study treatment and for at least 3 months after the last use of the study drug;
• Patients voluntarily join the study, sign the informed consent, have good compliance, and cooperate with follow-up.

Exclusion Criteria:

• Patients with any of the following conditions were excluded from the study
• Patients with central nervous system metastasis out of control (symptoms need to use glucocorticoids or mannitol).
• A history of clinically significant or uncontrolled heart disease, including congestive heart failure, angina pectoris, myocardial infarction within the last 6 months, or ventricular arrhythmia;
• Radiotherapy, chemotherapy, surgery, other targeted therapy, and immunotherapy for advanced HR+/HER2- breast cancer within 4 weeks before the first administration of drugs used in this study.
• Pregnant or lactating patients;
• Other malignancies within the previous 3 years, excluding cured skin basal cell carcinoma and cervical carcinoma in situ;
• Significant comorbid medical conditions, including mental illnesses that the investigator or sponsor believes would adversely affect the patient's participation in the study;
• Allergic physique, or known allergic history of the drug components of this program; Or allergic to other monoclonal antibodies;
• The investigator does not consider the patient suitable for participation in any other circumstances of the study.

Related Conditions & MeSH terms

• Advanced Breast Cancer
• Breast Neoplasms

Intervention

Drug:
• Apatinib
Apatinib is a kind of TKI inhibitor.
• CDK4/6 Inhibitor
Dalpiciclib (SHR6390) is a kind of CDK4/6 inhibitor that has demonstrated tolerability and preliminary clinical activity in patients with heavily pretreated hormone receptor-positive, HER2-negative advanced breast cancer.
• Aromatase inhibitor and Fulvestrant
Endocrine therapy combined with CDK4/6 inhibitors is the standard first-line therapy for advanced luminal breast cancer. Investigators choose endocrine therapy including Letrozole, Anastrozole, Exemestane, and Fulvestrant. Postmenopausal participants should use Goserelin.

Locations

Country	Name	City	State
China	Fudan University Shanghai Cancer Center	Shanghai	Shanghai

Sponsors (1)

Lead Sponsor	Collaborator
Fudan University

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Progression Free Survival (PFS)	The interval from randomization until the first occurrence of disease progression (according to RECIST 1.1) or death from any cause, which ever occurs first.	Approximately 5 years
Secondary	Clinical Benefit Rate (CBR)	CBR is the total percentage of participants who achieved a complete response, partial response, or had stable disease for 6 months or more.	Approximately 5 years
Secondary	Objective Response Rate (ORR)	ORR is defined as the proportion of participants who have a complete response (CR) or partial response (PR) based on BICR and investigator assessment using RECIST 1.1.	Approximately 5 years
Secondary	Overall Survival (OS)	OS is defined as the time from randomisation until the date of death due to any cause.	Approximately 5 years
Secondary	Safety and tolerability	Number of adverse events according to NCI-CTCAE Version 5.0 per each treatment arm.	Approximately 5 years