This phase I/II trial studies the side effects and best dose of copanlisib and how well it works when given together with eribulin in treating patients with triple negative breast cancer that has spread from where it first started (primary site) to other places in the body (metastatic). Copanlisib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as eribulin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving copanlisib and eribulin together may work better in treating advanced stage triple negative breast cancer compared to eribulin alone.
PRIMARY OBJECTIVES: I. To determine the safety, toxicity profile, dose limiting toxicity (DLT), maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of copanlisib hydrochloride (copanlisib) in combination with eribulin mesylate (eribulin) in metastatic triple negative breast cancer (TNBC). (Phase I) II. To compare progression free survival (PFS) between eribulin and eribulin plus copanlisib arms in patients with metastatic TNBC treated with prior taxane and anthracycline. (Phase II) SECONDARY OBJECTIVES: I. To determine the objective response rate (ORR) and clinical benefit rate (CBR) of the combination. (Phase I) II. To observe and record anti-tumor activity. (Phase I) III. To compare the ORR, CBR (complete response \[CR\]+partial response \[PR\]+stable disease \[SD\] \>= 24 weeks) and safety of eribulin and eribulin plus copanlisib arms. (Phase II) EXPLORATORY OBJECTIVES: I. To compare PTEN (immunohistochemistry) IHC results between paired baseline tumor biopsy versus at time of disease progression. II. Assess baseline (pre-treatment) tumor tissue mutation or gene expression profiles to correlate treatment response. III. Assess intrinsic and adaptive resistance mechanisms by analyzing pre and post treatment biopsies for gene expression and proteomic changes. IV. Determine circulating tumor DNA (ctDNA) mutation profiles at baseline and changes in mutation profile and variant allele frequencies (VAFs) on cycle 2 day 1 (C2D1) and at disease progression compared to baseline to correlate with treatment response. V. Assess circulating biomarkers predictive of treatment response. VI. Assess plasma and serum proteomics and metabolomics predictive of treatment response. VII. To compare the ORR, CBR, PFS of eribulin and eribulin plus copanlisib arms in patients with tumors harboring mutations in PIK3CA/ PTEN or with loss of PTEN expression by IHC on baseline tumor biopsy. VIII. To compare the ORR, CBR, PFS of eribulin and eribulin plus copanlisib arms in patients with tumors lacking PIK3CA/ PTEN pathway alterations. IX. To compare the ORR, CBR, PFS of eribulin and eribulin plus copanlisib arms in patients with tumors harboring loss of PTEN expression by IHC in pre-treatment metastatic site (in patients with available tissue from metastatic site). X. To compare PTEN IHC results between paired archival primary tumor versus (vs.) baseline tumor biopsies. XI. To assess targeted inhibition by copanlisib and eribulin by measuring treatment induced changes in phosphorylated (phospho)-AKT (T308), phospho-AKT (S473), phospho-histone H3, and inhibition of apoptosis (cleaved caspase 3) between post-treatment tumor (C2D1-2) versus baseline. XII. To compare the ORR, CBR, PFS of eribulin and eribulin plus copanlisib arms in patients with tumors harboring mutations in PIK3CA/PTEN by circulating tumor deoxyribonucleic acid (ctDNA) at baseline, and potential changes over time. OUTLINE: This is a phase I dose-escalation study of copanlisib and eribulin followed by a phase II study. Patients are randomized to 1 of 2 groups. Phase I, DL1: Patients receive copanlisib (45 mg) intravenously (IV) over 1 hour and eribulin (1.1 mg/m\^2) IV over 2 to 5 minutes on days 1 and 8 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Phase I, DL2: Patients receive copanlisib (45 mg) IV over 1 hour and eribulin (1.4 mg/m\^2) IV over 2 to 5 minutes on days 1 and 8 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Group I (Phase II, eribulin): Patients receive eribulin (1.4 mg/m\^2) IV over 2 to 5 minutes on days 1 and 8 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Group II (Phase II, eribulin + copanlisib, DL1): Patients receive copanlisib (45 mg) IV over 1 hour and eribulin (1.1 mg/m\^2) IV over 2 to 5 minutes on days 1 and 8 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo a computed tomography (CT) scan and/or magnetic resonance imaging (MRI) at screening, cycle 3 day 1, and every 9 weeks thereafter. Patients also undergo a biopsy at baseline, cycle 2 day 1, and at time of disease progression as well as blood sample collection at baseline, cycle 2 day 1, every 9 weeks and at time of disease progression. After completion of study treatment, patients are followed every 3 months for up to 36 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
24
Undergo biopsy
Undergo blood sample collection
Undergo CT scan
Given IV
Given IV
Undergo MRI
University of California Davis Comprehensive Cancer Center
Sacramento, California, United States
Smilow Cancer Hospital-Derby Care Center
Derby, Connecticut, United States
Smilow Cancer Hospital Care Center-Fairfield
Fairfield, Connecticut, United States
Smilow Cancer Hospital Care Center at Glastonbury
Glastonbury, Connecticut, United States
Smilow Cancer Hospital Care Center at Greenwich
Greenwich, Connecticut, United States
Maximum Tolerated Dose of Eribulin (MTD) (Phase I)
MTD is defined as the highest dose level of eribulin at which at most 1 of 6 patients experience a dose limiting toxicity during the observation window.
Time frame: Up to 28 days
Recommended Phase 2 Dose of Eribulin (RP2D) (Phase I)
RP2D is the maximum tolerated dose of eribulin at which at most 1 of 6 patients experience a dose limiting toxicity during the observation window.
Time frame: Up to 28 days
Maximum Tolerated Dose of Copanlisib (MTD) (Phase I)
MTD is defined as the highest dose level of copanlisib at which at most 1 of 6 patients experience a dose limiting toxicity during the observation window.
Time frame: Up to 28 days
Recommended Phase 2 Dose of Copanlisib (RP2D) (Phase I)
RP2D is the maximum tolerated dose of copanlisib at which at most 1 of 6 patients experience a dose limiting toxicity during the observation window.
Time frame: Up to 28 days
Progression Free Survival (PFS) (Phase II)
Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of measurable target lesions, a measurable increase in a non-target lesion, or the appearance of new lesions. Patients who have not experienced progression or death will be censored at last follow up. PFS will be estimated using the Kaplan-Meier product limit estimator.
Time frame: From date of treatment start to date of progression or death, assessed up to 36 months
Objective Response Rate (ORR) (Phase I)
ORR is defined as the proportion of patients with complete response, partial response by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1. Per RECIST 1.1, target lesions and assessed by CT/MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions. Overall Response (OR) = CR + PR.
Time frame: Up to 36 months
Clinical Benefit Rate (CBR) (Phase I)
CBR defined as the proportion of patients with clinical benefit (complete response, partial response and stable disease lasting \> 24 weeks) per RECIST v1.1 in the overall population, and by PTEN/PIK3CA mutation status based on archival tumor tissue next generation sequencing. Per RECIST 1.1, target lesions and assessed by CT/MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Stable Disease (SD), Neither 30% shrinkage of longest diameter of target lesions to qualify for PR nor 20% increase in longest diameter of target lesion to qualify for PD, for a period of time greater than 24 weeks.
Time frame: Up to 36 months
ORR (Phase II)
ORR is defined as the proportion of patients with complete response, partial response by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1. Per RECIST 1.1, target lesions and assessed by CT/MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions. Overall Response (OR) = CR + PR.
Time frame: Up to 36 months
CBR (Phase II)
CBR is defined as the proportion of patients with clinical benefit (complete response, partial response, and stable disease lasting ≥ 24 weeks) per RECIST v1.1 in each arm. Per RECIST 1.1, target lesions and assessed by CT/MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Stable Disease (SD), Neither 30% shrinkage of longest diameter of target lesions to qualify for PR nor 20% increase in longest diameter of target lesion to qualify for PD, for a period of time greater than 24 weeks.
Time frame: Up to 36 months
PFS (Phase I)
PFS is defined from date of treatment start to date of progression or death. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of measurable target lesions, a measurable increase in a non-target lesion, or the appearance of new lesions. Patients who have not experienced progression or death will be censored at last follow up. PFS will be estimated using the Kaplan-Meier product limit estimator.
Time frame: From start of treatment to time of progression or death, whichever occurs first, assessed up to 36 months
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