Combination Therapy for Breast Cancer

Not currently recruiting at 22 trial locations

Overseen By Erica L. Mayer, MD MPH

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Dana-Farber Cancer Institute

Must be taking: GNRH agonists

Must not be taking: CYP3A inhibitors/inducers, QT prolongers

Disqualifiers: Active brain metastases, Uncontrolled illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 10

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests three different drug combinations for breast cancer treatment. The goal is to compare the effectiveness of these combinations to Fulvestrant alone. Participants will receive either Fulvestrant alone, Fulvestrant with Palbociclib, or Fulvestrant with Palbociclib and Avelumab (an immunotherapy drug). The trial seeks individuals with breast cancer that has spread or recurred after certain unsuccessful treatments. Those with hormone receptor-positive (HR+) and HER2-negative breast cancer, whose cancer has progressed after specific therapies, may qualify. As a Phase 2 trial, this research measures the treatment's effectiveness in an initial, smaller group, allowing participants to contribute to significant advancements in breast cancer treatment.

Will I have to stop taking my current medications?

The trial does not specify if you must stop taking your current medications, but you cannot participate if you have had endocrine, chemotherapy, or biologic therapy within 14 days before the study. Also, you cannot take medications that strongly affect certain liver enzymes (CYP3A) or drugs that prolong the QT interval (a heart rhythm measure).

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that treatment with palbociclib and fulvestrant is generally safe and well-tolerated for patients with certain types of breast cancer. Studies have found that this combination can be safely used in individuals with hormone receptor-positive metastatic breast cancer.

Regarding the combination of fulvestrant, palbociclib, and avelumab, research indicates it can delay cancer progression in many patients after one year. However, adding avelumab does not seem to offer more benefits than using fulvestrant and palbociclib alone.

Patients have found these treatments manageable, but side effects can occur. It is important to discuss potential risks and benefits with a healthcare provider to determine if this trial is suitable. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Researchers are excited about these treatments because they combine existing therapies in novel ways to target breast cancer more effectively. Fulvestrant with Palbociclib is a promising combination because Palbociclib, a CDK4/6 inhibitor, works by halting cancer cell division, which complements Fulvestrant's ability to degrade estrogen receptors. Adding Avelumab, an immune checkpoint inhibitor, could further enhance this approach by helping the immune system recognize and attack cancer cells. This multi-pronged strategy targets cancer growth at several points, potentially improving outcomes compared to standard therapies like hormone therapy alone.

What evidence suggests that this trial's treatments could be effective for breast cancer?

Research has shown that using palbociclib and fulvestrant together, one of the treatment options in this trial, effectively treats advanced breast cancer. Studies indicate that this combination extends the time patients live without their cancer worsening, with an average progression-free period of about 7.43 months and an overall survival time of around 24.70 months. Another treatment arm in this trial includes adding avelumab to the palbociclib and fulvestrant combination. Although some lab studies suggest this addition might offer benefits, real-world results do not significantly surpass those of using just palbociclib and fulvestrant. Results can vary, so these treatments may work better for some individuals than others. ^{2 3 6 7 8}

Who Is on the Research Team?

Erica L Mayer, MD MPH

Principal Investigator

Dana-Farber Cancer Institute

Are You a Good Fit for This Trial?

This trial is for adults with hormone receptor positive, HER2 negative breast cancer that has worsened on or after CDK4/6 inhibitor therapy. Participants must have good performance status, normal organ and marrow function, and no prior fulvestrant treatment in the metastatic setting. Pregnant women are excluded, and effective contraception is required.

Inclusion Criteria

Your liver enzymes should be within a certain range, unless you have cancer that has spread to your liver.

Your total bilirubin level should be below a certain limit, unless you have documented Gilbert's disease.

I am using reliable birth control methods to prevent pregnancy.

Exclusion Criteria

You have had a serious allergic reaction to the study drug or any of its ingredients in the past.

I am not taking any medications that affect my heart's rhythm.

You have a current hepatitis B or hepatitis C virus infection.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Fulvestrant, Palbociclib, and Avelumab in various combinations

12 months

Fulvestrant: 2 IM injections on Cycle 1 Days 1, 15, then monthly; Palbociclib: orally once per day for 21 days on a 28-day cycle; Avelumab: intravenously once every 2 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

5.4 months

Tumor assessments every 8 weeks until 24 weeks, then every 12 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Avelumab
• Fulvestrant
• Palbociclib

Trial Overview The study tests three drug combinations for breast cancer: Fulvestrant alone; Fulvestrant with Palbociclib; and Fulvestrant with both Palbociclib and Avelumab. It aims to find out which combination works best for patients who've seen their disease progress after previous treatments.

How Is the Trial Designed?

Group I: Fulvestrant with Palbociclib and Avelumab Experimental Treatment 3 Interventions

-Palbociclib should be taken orally, once per day for 21 days on a 28 days cyclye -Fulvestrant will be administered in the clinic as two IM injections on Cycle 1 Days 1, 15, then monthly -Avelumab will be administered intravebously once every 2 weeks

Group II: Fulvestrant with Palbociclib Experimental Treatment 2 Interventions

-Palbociclib should be taken orally, once per day for 21 days on a 28 days cyclye -Fulvestrant will be administered in the clinic as two IM injections on Cycle 1 Days 1, 15, then monthly

Group III: Fulvestrant Active Control 1 Intervention

-Fulvestrant will be administered in the clinic as two IM injections on Cycle 1 Days 1, 15, then monthly

Fulvestrant is already approved in European Union, United States, Canada, Japan for the following indications:

Approved in European Union as Faslodex for:

• Hormone receptor-positive metastatic breast cancer
• Locally advanced breast cancer

Approved in United States as Faslodex for:

• Hormone receptor-positive metastatic breast cancer
• Locally advanced breast cancer

Approved in Canada as Faslodex for:

• Hormone receptor-positive metastatic breast cancer
• Locally advanced breast cancer

Approved in Japan as Faslodex for:

• Hormone receptor-positive metastatic breast cancer
• Locally advanced breast cancer

Who Is Running the Clinical Trial?

Dana-Farber Cancer Institute

Lead Sponsor

Trials

1,128

Recruited

382,000+

Pfizer

Industry Sponsor

Trials

4,712

Recruited

50,980,000+

Known For

Vaccine Innovations

Top Products

Viagra, Zoloft, Lipitor, Prevnar 13

Albert Bourla

Pfizer

Chief Executive Officer since 2019

PhD in Biotechnology of Reproduction, Aristotle University of Thessaloniki

Patrizia Cavazzoni

Pfizer

Chief Medical Officer

MD from McGill University

Published Research Related to This Trial

Fulvestrant, an estrogen receptor antagonist, was effective in treating advanced breast cancer in postmenopausal women, showing an overall clinical benefit in 39% of the 339 patients studied, with better outcomes when used as a first-line treatment.

The treatment was well tolerated, with only 5% of patients experiencing adverse events, and it was particularly beneficial for patients with tumors expressing both estrogen and progesterone receptors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fulvestrant ("Faslodex"): clinical experience from the Compassionate Use Programme. Steger, GG., Gips, M., Simon, SD., et al.[2018]

Oral palbociclib is an effective treatment for HR-positive, HER2-negative advanced or metastatic breast cancer, significantly prolonging progression-free survival when used with letrozole or fulvestrant in clinical trials involving postmenopausal women.

The most common side effect was neutropenia, which was manageable and rarely led to serious complications, indicating that palbociclib can be safely administered without significantly compromising its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Palbociclib: A Review in HR-Positive, HER2-Negative, Advanced or Metastatic Breast Cancer. Kim, ES., Scott, LJ.[2022]

In a phase II study involving 190 postmenopausal women with hormone receptor-positive, HER2-negative advanced breast cancer, the combination of palbociclib and fulvestrant significantly improved one-year progression-free survival (PFS-1y) rates (83.5% vs. 71.9% for placebo) and median PFS (31.8 months vs. 22.0 months).

While the palbociclib/fulvestrant combination showed better efficacy, it was associated with higher rates of grade 3-4 adverse events, particularly neutropenia (68.1% vs. 0% in the placebo group), indicating a need for careful monitoring of side effects in patients receiving this treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized phase II study of fulvestrant plus palbociclib or placebo in endocrine-sensitive, hormone receptor-positive/HER2-advanced breast cancer: GEICAM/2014-12 (FLIPPER). Albanell, J., Martínez, MT., Ramos, M., et al.[2022]

Palbociclib, when combined with fulvestrant, significantly improves progression-free survival in women with hormone receptor-positive, HER2-negative advanced breast cancer, showing a median PFS of 9.5 months compared to 4.6 months with placebo, based on a study of 521 women.

The safety profile of palbociclib includes common adverse reactions such as neutropenia and infections, which were observed in over 20% of patients, confirming its known side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

FDA Approval of Palbociclib in Combination with Fulvestrant for the Treatment of Hormone Receptor-Positive, HER2-Negative Metastatic Breast Cancer. Walker, AJ., Wedam, S., Amiri-Kordestani, L., et al.[2022]

In the FLIPPER trial, the combination of palbociclib and fulvestrant significantly improved progression-free survival (PFS) in postmenopausal women with HR+/HER2- advanced breast cancer compared to placebo and fulvestrant.

Patient-reported outcomes indicated that while global health status and quality of life (QoL) were maintained during treatment with palbociclib/fulvestrant, the time to deterioration in QoL was longer with placebo/fulvestrant, suggesting that palbociclib/fulvestrant is a beneficial treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quality of life with palbociclib plus fulvestrant versus placebo plus fulvestrant in postmenopausal women with endocrine-sensitive hormone receptor-positive and HER2-negative advanced breast cancer: patient-reported outcomes from the FLIPPER trial. Tibau, A., Martínez, MT., Ramos, M., et al.[2023]

In a study of 191 patients with metastatic breast cancer receiving palbociclib, the median progression-free survival was 22.8 months for first-line treatment, indicating significant efficacy of the drug in delaying disease progression.

While 47% of patients experienced severe neutropenia, the overall survival rate at 24 months was 74.2% for first-line treatment, suggesting that palbociclib is effective but requires monitoring for potential adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A real-world study of the first use of palbociclib for the treatment of advanced breast cancer within the UK National Health Service as part of the novel Ibrance® Patient Program. Palmieri, C., Musson, A., Harper-Wynne, C., et al.[2023]

In a study involving 1723 women with HR+/HER2- advanced or metastatic breast cancer, palbociclib combined with aromatase inhibitors or fulvestrant showed low dose-reduction rates (18.9% and 12.3%, respectively), indicating good tolerability.

The treatment demonstrated favorable progression-free rates (PFR) at 12 months, with 88.1% for palbociclib + AI and 79.8% for palbociclib + fulvestrant, along with high survival rates (97.3% and 97.5%, respectively), suggesting its effectiveness in real-world clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Real-world treatment of patients with palbociclib for HR+/HER2-advanced/metastatic breast cancer: the Europe IRIS study. Mycock, K., Zhan, L., Hart, K., et al.[2022]

In a study of 521 premenopausal and postmenopausal patients with endocrine-resistant metastatic breast cancer, those treated with palbociclib and fulvestrant showed a higher rate of prolonged benefit (29%) compared to those on placebo and fulvestrant (15%).

Long-term responders to palbociclib-fulvestrant tended to have less disease burden at baseline and lower rates of certain mutations, but no specific molecular or clinical factors were identified as predictors of long-term benefit.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of prolonged benefit from palbociclib plus fulvestrant in women with endocrine-resistant hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer in PALOMA-3. Cristofanilli, M., DeMichele, A., Giorgetti, C., et al.[2022]

The FDA approved palbociclib (IBRANCE) for use in men with hormone receptor-positive, HER2-negative advanced or metastatic breast cancer, expanding its indications beyond women, based on data from the PALOMA-2 and PALOMA-3 trials.

The approval was supported by safety data from phase I studies and real-world evidence, confirming that palbociclib is a viable treatment option for male patients with this type of breast cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

FDA Approval Summary: Palbociclib for Male Patients with Metastatic Breast Cancer. Wedam, S., Fashoyin-Aje, L., Bloomquist, E., et al.[2021]

Palbociclib is the first CDK4/6 inhibitor approved for treating estrogen receptor-positive, HER2-negative metastatic breast cancer, and it works by selectively inhibiting CDK4 and CDK6, enhancing the effects of anti-estrogens like letrozole and fulvestrant.

Clinical trials show that palbociclib significantly doubles the treatment efficacy of letrozole and fulvestrant while maintaining a manageable safety profile, positively impacting patients' quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The safety and efficacy of palbociclib in the treatment of metastatic breast cancer. Ettl, J., Harbeck, N.[2017]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S0149291822003794

Real-world Treatment Patterns and Clinical Outcomes ... The 12-month progression-free rate was 88% for palbociclib plus an AI and 79% for palbociclib plus fulvestrant; the 12-month survival rate was 96% in both ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8859011/

Real-world effectiveness of palbociclib plus fulvestrant in ... Palbociclib plus fulvestrant seems to be an effective therapy for ABC in real-world. · Median rwPFS and rwOS were estimated at 7.43 and 24.70 months, ...

3. nejm.org nejm.org/doi/full/10.1056/NEJMoa1810527

Overall Survival with Palbociclib and Fulvestrant in ... Palbociclib, in combination with fulvestrant therapy, prolongs progression-free survival among patients with hormone-receptor–positive, human epidermal growth ...

4. breastcancer.org breastcancer.org/research-news/ibrance-faslodex-combo-continues-to-improve-overal-survival-in-advanced-hr-positive

Ibrance-Faslodex Combo Continues To Improve Overall ... “An improvement in [overall survival] with palbociclib plus fulvestrant continues to be observed with more than 6 years of median follow up in ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/30391832/

Treatment patterns and clinical outcomes among patients ... Treatment with palbociclib in combination with AI or fulvestrant demonstrated favorable effectiveness in terms of progression-free and survival rates.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5061543/

Palbociclib in Combination With Fulvestrant in Women ... Treatment with palbociclib in combination with fulvestrant was generally safe and well-tolerated in patients with hormone receptor (HR)-positive metastatic ...

7. lbbc.org lbbc.org/news/ibrance-adds-no-benefit-over-faslodex-alone

Ibrance adds no benefit over Faslodex alone After one year, this triple-drug combination worked to hold off cancer in 35.6% of people, compared to 17.5% in the fulvestrant only group and ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S0960977625005867

Palbociclib treatment in patients with HR+/HER2− ... Utilizing Surveillance, Epidemiology, and End Results (SEER) registry data, Brufsky et al. reported a 48-month breast cancer-specific survival rate of 44.5 % in ...