This study is designed to determine the RP2D of gedatolisib in combination with talazoparib and to evaluate the efficacy of this combination in advanced HER2 negative breast cancer that is triple negative or BRCA1/2 positive (deficient).
Triple negative breast cancers (TNBC) are tumors that lack the hormone receptors and the human epidermal growth factor receptor-2 (HER2). TNBC represents about 15% of all invasive breast cancers diagnosed in the United States each year. This aggressive breast cancer subtype has the lowest overall survival rate of all advanced breast cancers with median survival of 12-13 months. Due to the lack of expression of the hormone receptors and HER2,chemotherapy remains the current treatment for women with advanced TNBC. A subset of breast cancers have defects in homologous recombination (HR) DNA repair due to germline BRCA mutations, and these cases are often triple negative. Poly(ADP-ribose) polymerase (PARP) enzymes are involved in DNA repair and are activated by DNA strand breaks. PARP function is particularly critical in tumors with BRCA1/2 mutations, making PARP inhibition a rationale therapeutic strategy. Two PARP inhibitors, Talazoparib and Olaparib, were approved by the FDA in 2018 for patients who have advanced HER2 negative breast cancer and a germline BRCA 1/2 mutation. These approvals were based on results from the EMBRACA and OLYMPIAD trials, respectively, which both showed an improvement in progression-free survival (PFS) versus physician choice chemotherapy. Gedatolisib is an intravenously administered PI3K and mTOR inhibitor which has been shown to be safe in patients with metastatic breast cancer, either alone or in combination with oral therapies. Previous research has shown that PI3K inhibitors lower nucleotide pools required for DNA synthesis and S-phase progression. Additionally, inhibition of PI3K/mTOR could impede PI3K interaction with the homologous recombination complex, increasing dependency on PARP enzymes for DNA repair. Based on this data, the combination of a PI3K inhibitor and PARP inhibitor could potentially lead to a new, non-chemotherapy treatment option for TNBC with wild-type BRCA and improve the modest PFS seen with the PARP inhibitors as single agents in BRCA1/2 mutant advanced breast cancer. The hypothesis for this trial is that the gedatolisib will sensitize advanced TNBC or BRCA1/2 mutant breast cancers to PARP inhibition with talazoparib. This study is thus designed to determine the recommended phase 2 dose of gedatolisib in combination with talazoparib and to evaluate the efficacy of this combination in advanced HER2 negative breast cancer that is triple negative or BRCA1/2 positive (mutated/deficient).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Gedatolisib, 150-180MG IV
.75-1.00mg
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
University of Illinois Cancer Center
Chicago, Illinois, United States
Indiana University Melvin and Bren Simon Comprehensive Cancer Center
Indianapolis, Indiana, United States
University of Iowa Hospital and Clinics
Iowa City, Iowa, United States
Maximum Tolerated Dose (MTD) of talazoparib in combination with gedatolisib (Phase I)
Determine the recommended Phase 2 dose (RP2D) of talazoparib in combination with gedatolisib in patients with advanced human epidermal growth factor receptor 2 (HER2) negative (triple negative or BRCA1/2 deficient) breast cancer.
Time frame: 28 days
Objective Response Rate (ORR) (Phase II)
Calculate ORR, which will include confirmed complete response (CR) + confirmed partial response (PR) determined as per RECIST1.1 on treatment with talazoparib in combination with gedatolisib in patients with BRCA1/2 deficient advanced HER2 negative breast cancer.
Time frame: 24 Months
Duration of Response (DOR)
Duration of Response (DoR) on treatment with talazoparib in combination with gedatolisib in all patients (Phase I run-in, Cohort A). DoR is defined as the time that measurement criteria are met for complete or partial response (whichever status is recorded first) until the date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since treatment started).
Time frame: 24 Months
Clinical Benefit Rate (CBR) at 16 weeks
Clinical Benefit Rate (CBR) at 16 weeks; this will include sum of confirmed complete plus partial responses plus stable disease at 16 weeks on treatment with talazoparib in combination with gedatolisib in patients with BRCA1/2 negative, or unknown, advanced TNBC (Cohort A) by RECIST 1.1.
Time frame: 16 Weeks
Overall Survival
Overall Survival (OS) defined as the time from treatment initiation with talazoparib in combination with gedatolisib until death as a result of any cause in patients with BRCA1/2 negative, or unknown, advanced TNBC (Cohort A).
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University of Wisconsin
Madison, Wisconsin, United States
Time frame: 24 Months
Rates of Adverse Events
Rates of adverse events by NCI Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 5 on treatment with talazoparib in combination with gedatolisib in patients with BRCA1/2 negative, or unknown, advanced TNBC (Cohorts A).
Time frame: 24 Months