This phase II trial studies how well Akt/ERK inhibitor ONC201 (ONC201) with a methionine-restricted (MR) diet works in treating participants with triple negative breast cancer that has spread to other places in the body or cannot be removed by surgery. ONC201 activates a process that leads to the death of a cell. ONC201 is able to target tumor cells to get rid of them, but does not affect normal cells. MR diet is a methionine-free amino acid modified medical food. The addition of an intermittent MR diet may enhance the activity of ONC201. Giving ONC201 and an MR diet may work better in treating participants with breast cancer.
PRIMARY OBJECTIVES: I. To determine objective response rate (ORR) to ONC201 with a methionine-restricted diet in patients with metastatic triple negative breast cancer (TNBC). SECONDARY OBJECTIVES: I. To determine progression-free survival (PFS) to ONC201 with a methionine-restricted diet in patients with metastatic TNBC. II. To determine clinical benefit rate (complete or partial response plus stable disease) (CBR) at 4 months to ONC201 with a methionine-restricted diet in patients with metastatic TNBC. III. To determine overall survival (OS) to ONC201 with a methionine-restricted diet in patients with metastatic TNBC. IV. To assess metabolic indices in patients with metastatic TNBC treated with ONC201 and a methionine-restricted diet. V. To assess the expression of TRAIL receptor in circulating tumor cells (CTCs) prior, during and upon progression in patients with metastatic TNBC treated with ONC201 with a methionine-restricted diet. EXPLORATORY OBJECTIVES: I. To determine time to development of brain metastases or worsening of brain metastases in patients with metastatic TNBC treated with ONC201 with a methionine-restricted diet. STUDY DESIGN Patients with metastatic TNBC will be enrolled in a single-arm study evaluating ONC201 with a methionine-restricted diet. After completion of study treatment, participants are followed up every 3 months for 2 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
4
Given PO
Given PO
University of Wisconsin Carbone Cancer Center
Madison, Wisconsin, United States
Overall Response Rate (ORR) - Number of Participants Who Responded to Treatment
ORR will be estimated according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, by dividing the total number of responders (complete plus partial responses plus CR or PR) or (CR or PR), respectively, by number of subjects with measurable disease and the exact 95% confidence interval will be provided. Due to early termination with few participants, only the counts of events have been reported.
Time frame: maximum follow up time was 1 year
Progression-free Survival (PFS) - Number of Participants With PFS
Will be summarized using Kaplan-Meier estimates of the median survival times. Point estimates as well as 95% confidence intervals will be provided. Due to early termination with few participants, only the counts of events have been reported.
Time frame: maximum follow up time was 1 year
Overall Survival (OS) - Number of Participants Who Survived the Study Period
Will be summarized using Kaplan-Meier estimates of the median survival times. Point estimates as well as 95% confidence intervals will be provided. Due to early termination with few participants, only the counts of events have been reported.
Time frame: maximum follow up time was 1 year
Clinical Benefit Rate (CBR) - Number of Participants Who Experienced Clinical Benefit
CBR will be estimated according to RECIST 1.1, by dividing the total number of responders (complete plus partial responses plus CR or PR or stable disease \[SD\]), by number of subjects with measurable disease and the exact 95% confidence interval will be provided. Due to early termination with few participants, only the counts of events have been reported.
Time frame: At 4 months
Duration of Response (DOR)
Will be measured using Kaplan-Meier methodology. A 95% confidence interval will be provided for the median duration of response.
Time frame: Up to 2 years
Incidence of Adverse Events - Number of Participants Who Experienced Adverse Events
Incidence of adverse events as measured by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) 5.0. Safety and tolerability will be assessed by frequency tables. Also, metabolic indices in patients with metastatic triple negative breast cancer (TNBC) treated with ONC-201 and a methionine-restricted diet will be assessed by frequency tables and descriptive statistics.
Time frame: 30 days after last dose of study drug, up to 4 months on study
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