RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using fulvestrant may fight breast cancer by blocking the use of estrogen by the tumor cells. AZD6244 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether fulvestrant is more effective with or without AZD6244 in treating patients with advanced breast cancer. PURPOSE: This randomized phase II trial is studying how well fulvestrant works with or without AZD6244 in treating patients with advanced breast cancer that progressed after aromatase inhibitor therapy.
OBJECTIVES: Primary * To assess the efficacy of fulvestrant with versus without MEK inhibitor AZD6244 in patients with advanced stage, endocrine-sensitive breast cancer that progressed after aromatase inhibitor therapy. Secondary * To assess the safety and tolerability of this regimen in these patients. * To examine other outcome parameters. * To develop a virtual tissue bank for future translational research. OUTLINE: This is a multicenter study. Patients are stratified according to center, prior treatment with tamoxifen citrate (yes vs no), the setting in which prior aromatase inhibitor was given (adjuvant treatment vs advanced stage treatment), HER-2 disease (positive vs negative), visceral metastasis (present vs absent), performance status (0 vs 1 or 2), and disease (measurable disease vs bone-only disease or small but unequivocal liver or lung metastases). Patients are randomized to 1 of 2 treatment arms. * Arm I (experimental): Patients receive fulvestrant intramuscularly (IM) on days 1 and 15 of course 1 and on day 1 of each subsequent course. Patients also receive oral AZD6244 twice daily on days 1-28. Treatment repeats every 28 days for 12 courses in the absence of disease progression or unacceptable toxicity. * Arm II (control): Patients receive fulvestrant as in arm I. Patients also receive oral placebo twice daily on days 1-28. Treatment repeats every 28 days for 12 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed every 3 months for 1 year and then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
46
Arm A: Fulvestrant 500mg i.m. day 1, 15, day 1 of cycle 2, then every 28 +/- 3 days Arm B: Fulvestrant 500mg i.m. day 1, 15, day 1 of cycle 2, then every 28 +/- 3 days
AZD6244 75 mg p.o. bid
Universitair Ziekenhuis Gent
Ghent, Belgium
U.Z. Gasthuisberg
Leuven, Belgium
Kantonsspital Aarau
Aarau, Switzerland
Kantonsspital Baden
Baden, Switzerland
Universitaetsspital-Basel
Basel, Switzerland
Inselspital Bern
Bern, Switzerland
Spitalzentrum Biel
Biel, Switzerland
Kantonsspital Graubuenden
Chur, Switzerland
Brustzentrum Thurgau at Kantonsspital Frauenfeld
Frauenfeld, Switzerland
Hopitaux Universitaires de Geneve
Geneva, Switzerland
...and 7 more locations
Disease control (sum of complete response, partial response, and stable disease) at 24 weeks or more according to RECIST 1.1 criteria
Time frame: at 24 weeks or more according to RECIST 1.1 criteria
Adverse events
Time frame: according to NCI CTCAE v 4.0
Overall response
Time frame: according to RECIST 1.1
Progression-free survival
Time frame: will be calculated from randomization until documented tumor progression or death, whichever occurs first.
Time to treatment failure
Time frame: will be calculated from randomization to discontinuation of all trial treatment due to any reason
Duration of response
Time frame: will be calculated from the time that measurement criteria are met for the first time until documented tumor progression.
Overall survival
Time frame: Overall survival will be calculated from registration until death
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