This is an international, open-label, non-controlled, multicenter phase II clinical trial with two different primary objectives: a biological and a clinical objective. From a clinical point of view, the objective is to assess the clinical benefit of the combination of palbociclib and hormonotherapy in patients with advance breast cancer that had previously received endocrine therapy in combination with palbociclib and had achieved clinical benefit during palbociclib treatment with subsequent disease progression. From a biological point of view, the challenge is to define a molecular profile that allow identifying patients that could benefit more from continuing on palbociclib after progression on a prior palbociclib-containing regimen
Eligible patients will receive palbociclib capsules orally for 21 days every four weeks in combination with endocrine therapy (physician's choice based on prior administered agent including tamoxifen, exemestane, fulvestrant, anastrozole, or letrozole). Patients will receive treatment until disease progression (with the exception of patients who develop isolated progression in the brain), unacceptable toxicity, death, or discontinuation from the study treatment for any other reason. Patients discontinuing the study treatment period will enter a post-treatment follow-up period during which survival and new anti-cancer therapy information will be collected every six months (± 14 days) from the last dose of investigational product. The treatment follow-up period will conclude at six months after the last patient has received first treatment dose in the study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
33
palbociclib in combination with endocrine therapy (investigator's choice)
Endocrine therapy (physician's choice based on prior administered agent including tamoxifen, exemestane, fulvestrant, anastrozole, or letrozole). Endocrine therapy must be different from previous treatment line.
Istituto Europeo di Oncologia
Milan, Italy
Azienda Sanitaria Universitaria Integrata di Udine
Udine, Italy
ICO Badalona
Badalona, Barcelona, Spain
ICO l'Hospitalet
L'Hospitalet de Llobregat, Barcelona, Spain
Clinico Universitario A Coruña
A Coruña, Spain
Hospital del Mar
Barcelona, Spain
Hospital Universitari Vall d'Hebron
Barcelona, Spain
Hospital Provincial de Castellón
Castellon, Spain
Hospital Reina Sofia
Córdoba, Spain
Hospital La Paz
Madrid, Spain
...and 5 more locations
molecular patterns of resistance [with a special focus on retinoblastoma (Rb) status] upon progression to palbociclib plus endocrine therapy in patients who previously achieved clinical benefit with the combination
the percentage of patients with Rb loss \[as defined by loss of expression, copy number variation (CNV), somatic mutation, or methylation dependent silencing\]. The evaluation criteria will be the characterization of the molecular patterns of resistance with greater than 20% prevalence.
Time frame: Baseline-Up to 24 months
clinical activity of the combination of palbociclib and endocrine therapy after prior progression to palbociclib in endocrine-sensitive patients.
percentage of patients that achieve clinical benefit (CBR) defined as complete response, partial response, or stable disease for at least 24 weeks per RECIST v.1.1.
Time frame: Baseline-Up to 24 months
Compare clinical activity with molecular patterns of resistance.
Patients with molecular patterns of resistance (Rb loss, biomarkers significant inhibition), mutations and expression profiles will be compared against patients without.
Time frame: Baseline-Up to 24 months
Measure changes of immunostaining of Rb targets (E2F, DNMT, HIF1alpha, and SKP2) as a result of CDK4 and CDK6 inhibition and the potential predictive value of cyclin D, cyclin E, p16, p18, p21, and p27, in CDK4, and CDK6 inhibition
measure histoscore (Hscore) levels of the above targets
Time frame: Baseline-Up to 24 months
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