The main hypothesis of the study is that enzalutamide induces a significant proliferative arrest in HR+/HER2-negative breast cancer falling into the PAM50 HER2-E subtype. Currently, enzalutamide clinical development is ongoing in different prostate cancer indications but the breast cancer development program has been discontinued. As the role of the AR in HR-positive breast cancer and the predictive value of previously identified biomarker are still unclear, further research is needed to effectively utilize enzalutamide in this disease.
A strong rationale accumulated over the years suggests that within HR+/HER2-negative breast cancer, tumors falling into the PAM50 HER2-enriched subtype have androgen receptor (AR)-dependency. To test this hypothesis directly in patients' tumors, we propose an exploratory, open-label, non-randomized, two-cohort, multicenter, prospective, phase II study which evaluates the effect of enzalutamide on proliferation after 2 weeks (14-21 days) of treatment in patients with endocrine-resistant, locally advanced or metastatic HR+/HER2-negative breast cancer. After 2 weeks (14-21 days) of treatment, patients will continue enzalutamide. Exemestane will be allowed to be added to enzalutamide per investigator discretion and will be administered until progression or unacceptable toxicity.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
34
Patients will be dispensed with oral enzalutamide 160 mg (four 40 mg capsules) as a self-administered single oral daily dose, continuously.
ICO Badalona
Badalona, Barcelona, Spain
Institut Català d'Oncologia Hospitalet
L'Hospitalet de Llobregat, Barcelona, Spain
Hospital Clinic de Barcelona
Barcelona, Spain
Hospital Universitari Vall d' Hebrón
Barcelona, Spain
Hospital Universitario 12 de Octubre
Madrid, Spain
Hospital Universitario Fundación de Alcorcón
Madrid, Spain
Hospital Universitario Virgen del Rocio
Seville, Spain
Fundación Instituto Valenciano de Oncología
Valencia, Spain
changes of the PAM50 11-gene proliferation signature
Relative changes of the PAM50 11-gene proliferation signature after 2 weeks (14-21 days) of treatment with enzalutamide. These changes will be analyzed according to the formula: Mean suppression = 100 - \[geometric mean (post-treatment / pretreatment · 100)\].
Time frame: after 2 weeks (14-21 days) of treatment with enzalutamide
Incidence, duration and severity of Adverse Events
Incidence, duration and severity of Adverse Events (AEs) assessed by the NCI Common Terminology for Classification of Adverse Events (CTCAE) version 5, including dose reductions, delays and treatment discontinuations.
Time frame: during and after 2 weeks (14-21 days) of treatment with enzalutamide
Relative changes of 33 gene signatures
Relative changes of 33 gene signatures and 770 genes after 2 weeks (14-21 days) of treatment with enzalutamide and from week 3 to progression (in those patients who consent for optional biopsy). This study will be performed using the nCounter Breast 360TM panel. Relative changes of 33 gene signatures and 770 genes after 2 weeks (14-21 days) of treatment with enzalutamide and from week 3 to progression (in those patients who consent for optional biopsy). This study will be performed using the nCounter Breast 360TM panel.
Time frame: after 2 weeks (14-21 days) of treatment with enzalutamide
somatic mutations
Proportion of somatic mutations in samples from both cohorts using a targeted gene sequencing panel.
Time frame: after 2 weeks (14-21 days) of treatment with enzalutamide
AR expression by IHC
Analysis of AR expression by IHC (% nuclear expression in tumoral cell)
Time frame: before and after 21 days of treatment in Cohorts A and B.
changes in percentage of cells expressing Ki67 by IHC
Relative changes in percentage of cells expressing Ki67
Time frame: after 21 days of enzalutamide in HER2-E and Luminal A/B tumors.
changes of It-TIL and Str-TIL
Analysis of lymphocyte infiltrate on hematoxylin and eosin-stained FFPE-sections. Percentage (%) change in It-TILs and Str-TILs infiltration
Time frame: pre- and after 2 weeks (14-21 days) of treatment with enzalutamide and progression
ctDNA levels
Quantification of baseline ctDNA levels and 2 weeks (14-21 days) post-treatment. Determination of quantitative changes at day 21, at progression or at the end of trial due to other reasons
Time frame: during and after 2 weeks (14-21 days) of treatment with enzalutamide
tumor ORR
Proportion of patients who have a partial (PR) or complete response (CR) to therapy.
Time frame: after 2 weeks (14-21 days) of treatment with enzalutamide
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