The overall rationale of this study evaluating tolerance and efficacy of LY2780301 in combination with paclitaxel in HER2-negative, inoperable locally advanced or metastatic breast cancer (MBC) is based on : * the medical need in this population with either hormonal-resistant or unsensitive and/or rapidly progressive disease * the preclinical evidences for involvement of PI3K/AKT pathway in tumor progression and drug resistance, including taxanes as well as its potential reversion by AKT inhibition * the high level of frequency of PI3K/AKT activation in HER2-negative MBC * the in vitro and in vivo preclinical activity of LY2780301, and its synergistic combination with various anticancer agents, including taxanes * the favourable profile of tolerance of LY2780301 in phase I trial Weekly paclitaxel is conventionally administered at 80 mg/m²/week and is a standard treatment in breast cancer (BC) As described above, LY2780301 500 mg once daily has been established as the RP2D in phase I single agent trial. Evidence of pharmacodynamic activity was noted at 400-500 mg QD. Conservatively, the first dose level to be explored will be LY2780301 400 mg QD and paclitaxel 70 mg/m²/week.
RATIONALE OF THE STUDY DESIGN The purpose of this study will be: 1. to determine the recommended phase 2 dose (RP2D) for LY2780301 in combination with weekly paclitaxel in HER2-negative, inoperable locally advanced or MBC patients 2. to estimate the objective response rate (ORR) of the combination in first-line treated, HER2-negative, inoperable locally advanced or MBC patients. In addition, this study will assess the role of PI3K/AKT/S6 pathway activation as potential predictive factor for response to LY2780301 in this patient population. This trial will be a phase Ib/II prospective, multicentre, open label, uncontrolled study. Phase Ib will use a continuous reassessment method (CRM) design, allowing to reach safely and quickly the MTD and the RP2D of the combination, but ensuring the treatment of at least 18 patients to secure the tolerance profile. Phase II will estimate antitumor activity in the overall patient population and in patients with activation of PI3K/AKT/S6 axis, allowing to examine its potential value as predictive biomarker
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
68
Continuous daily PO LY2780301 (400 mg, 500 mg or 300 mg) QD + weekly paclitaxel (70 or 80 mg/m²/week) for 21 days cycle until progression or toxicity
Centre Geroges François Leclerd
Dijon, France
Institut Paoli-Calmettes
Marseille, France
Phase Ib: recommended phase II dose (RP2D)
To determine the recommended phase II dose (RP2D) of daily LY2780301 when administered orally in combination with weekly intravenous (IV) paclitaxel in HER2-negative, inoperable locally advanced or MBC patients
Time frame: Day 28
Phase II: objective response rate (ORR)
To estimate the efficacy of daily LY2780301 when administered orally at the RP2D in combination with weekly intravenous (IV) paclitaxel in HER2-negative, inoperable locally advanced or MBC patients, in the overall population and in patients with activation of PI3/AKT/S6 pathway
Time frame: until progression assessed up to 18 months
safety
Type and severity of adverse events according to CTCAE v4.0 up to the end of treatment or maximum 6 months
Time frame: up to the end of treatment or maximum 6 months
clinical benefit (CB)
The Clinical benefit (CB) is defined as the addition of complete response (CR) + partial response (PR) + Stable disease (SD) \> 6 months
Time frame: until progression assessed up to 18 months
progression-free survival (PFS)
Date of progression (evaluated according to RECIST V1.1 criteria) or death up to 18 months
Time frame: until progression assessed up to 18 months
pharmacokinetics
Pharmacokinetics of LY2780301 and paclitaxel evaluated by plasma concentrations and basic PK parameters
Time frame: D1, D8, D15, D22, D28 post dose
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