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Metastatic Breast CancerPhase 1NCT03238196

Fulvestrant, Palbociclib and Erdafitinib in ER+/HER2-/FGFR-amplified Metastatic Breast Cancer

A Phase 1 study testing Erdafitinib, Palbociclib and Fulvestrant in people with Metastatic Breast Cancer, run by Vanderbilt-Ingram Cancer Center at 6 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is an open-label, multi-institution, phase Ib trial that evaluates the safety and tolerability and preliminary anti-tumor activity of fulvestrant, palbociclib and erdafitinib in patients with ER+/HER2-/FGFR-amplified metastatic breast cancer. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Metastatic Breast Cancer
What is being tested?
Erdafitinib, Palbociclib and Fulvestrant
Could I receive a placebo?
No, everyone receives an active treatment
How many people
35 participants
Where
6 sitesUnited States
Study dates
18 Aug 2017to 20 Mar 2024
Phase
Phase 1
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients must be able to swallow and retain oral medication
  • Patients must be ≥ 18 years of age
  • Female patients of no childbearing potential must be post-menopausal. Postmenopausal female subjects should be defined prior to protocol enrollment by any of the following:
  • Participants at least 60 years of age; OR
  • Participants under 60 years of age and naturally (spontaneous, no alternative pathologic or physiological cause) amenorrhea for at least 12 months; OR
  • Medical ovarian failure confirmed by follicle-stimulating hormone (FSH) and estradiol levels in the post menopausal range per local institutional normal range; OR
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  • Prior bilateral oophorectomy; OR
  • Prior radiation castration with amenorrhea for at least 6 months; OR
  • Treatment with a luteinizing hormone-releasing hormone (LH-RH) agonist (such as goserelin acetate or leuprolide acetate) is permitted for induction of ovarian suppression as long as it has been initiated at least 28 days prior to study enrollment
  • Patients must have ECOG performance status 0 - 1
  • Patients must have clinical stage IV or inoperable locoregional recurrent invasive mammary carcinoma that is:
  • ER+ and/or PgR+ (≥ 1% positive stained cells) by immunohistochemistry (IHC)
  • HER2-negative (by IHC or FISH, per ASCO guidelines)
  • FGFR1 - 4 amplified
  • Patients must have evaluable (may have either measurable or non-measurable) disease
  • Patients must have available tissue for FGFR determination
  • Patients must have had at least one line of therapy in the metastatic setting
  • Current use of any of the drugs listed on the Cautionary Concomitant Med list has to be approved by the Study Chair
  • Patients must have adequate hematologic, hepatic and renal function. All laboratory tests must be obtained within 2 weeks from study drug initiation. These include:
  • ANC ≥ 1,500/mm3
  • Platelet count ≥ 100,000/mm3
  • HgB ≥ 9.0 g/dL
  • Creatinine clearance ≥ 40 mL/min/1.73 m2
  • SGOT, SGPT ≤ 2.5 x ULN if no liver metastasis present; SGOT, SGPT ≤ 4 x ULN if liver metastasis present
  • Albumin ≥ 2.0 g/dL
  • Total serum bilirubin ≤ 1.5 x ULN (≤ 3 x ULN or direct bilirubin ≤ 1.5 x ULN if known Gilbert's syndrome)
  • Potassium within institutional normal limits
  • Phosphorus ≤ institutional upper limit of normal

Who cannot join

  • Prior use of an FGFR inhibitor
  • More than 2 lines of chemotherapy in the metastatic setting. No limit on endocrine therapy lines. Prior exposure to CDK4/6 inhibitor acceptable.
  • Radiation therapy ≤ 2 weeks prior to study entry. Patients who have received prior radiotherapy must have recovered from toxicity (≤ grade 1) induced by this treatment (except for alopecia)
  • Prior cancer therapy (except for endocrine therapy) must have been discontinued for 1 week prior to initiation of study drugs
  • Concurrent anti-cancer therapy other than the ones specified in the protocol is not permitted during study participation. Bisphosphonates or denosumab are allowed
  • Major surgery within 4 weeks of enrollment
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  • Herbal preparations are not allowed throughout the study, and should be discontinued 14 days prior to initiation of study treatment
  • Any corneal or retinal abnormality likely to increase the risk of eye toxicity, such as:
  • Current corneal pathology such as keratitis, keratoconjunctivitis, keratopathy, corneal abrasion, inflammation or ulceration
  • Uncontrolled glaucoma despite standard of care therapy
  • Diabetic retinopathy with macular edema
  • Known active wet, age-related macular degeneration (AMD)
  • Known central serous retinopathy (CSR) or retinal vascular occlusion (RVO)
  • Uncontrolled intercurrent illness including, but not limited to:
  • Malabsorption syndrome significantly affecting gastrointestinal function
  • Ongoing or active infection requiring antibiotics/antivirals
  • Impairment of lung function (COPD > grade 2, lung conditions requiring oxygen therapy)
  • Symptomatic congestive heart failure
  • Unstable angina pectoris, angioplasty, stenting, or myocardial infarction within 6 months
  • Clinically significant cardiac arrhythmia (multifocal premature ventricular contractions, bigeminy, trigeminy, ventricular tachycardia that is symptomatic or requires treatment [National Cancer Institute -Common Terminology Criteria for Adverse Events, Version 4.03, grade 3]
  • QTcF ≥ 480 msec on screening EKG
  • Known history of clinically significant QT/QTc prolongation or Torsades de Pointes(TdP)
  • ST depression or elevation of ≥ 1.5 mm in 2 or more leads
  • Diarrhea of any cause ≥ CTCAE grade 2 that does not resolve within a few days when adequately treated with anti-diarrhea medications
  • Psychiatric illness/social situations that would compromise patient safety or limit compliance with study requirements including maintenance of a compliance/pill diary
  • Symptomatic brain metastases (patients with a history of brain metastases must be clinically stable for more than 4 weeks from completion of radiation treatment and be off steroids)
  • Known history of chronic liver or chronic renal failure
  • Poor wound healing capacity

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

United States6 sites
  • University of Alabama

    Birmingham, Alabama, 35233

  • University of Texas Southwestern Simmons Comprehensive Cancer Center

    Dallas, Texas, 75235

  • Baptist Memorial Hospital MEMPHIS

    Memphis, Tennessee, 38120

  • Vanderbilt-Ingram Cancer Center

    Nashville, Tennessee, 37232

  • Memorial Sloan-Kettering Cancer Center

    New York, New York, 10065

  • University of Pittsburgh Medical Center

    Pittsburgh, Pennsylvania, 15213

Other trials in United States

About this study

Official title: A Phase Ib Trial of Fulvestrant, Palbociclib (CDK4/6 Inhibitor) and Erdafitinib (JNJ- 42756493,Pan-FGFR Tyrosine Kinase Inhibitor) in ER+/HER2-/FGFR-Amplified Metastatic Breast Cancer (MBC)

This is an open-label, multi-institution, phase Ib trial that evaluates the safety and tolerability and preliminary anti-tumor activity of fulvestrant, palbociclib and erdafitinib in patients with ER+/HER2-/FGFR-amplified metastatic breast cancer.

Read the detailed description

Primary Objectives

To determine the safety and tolerability of fulvestrant, palbociclib and erdafitinib in patients with ER+/HER2-/FGFR-amplified MBC.

Secondary Objectives

  • To determine the anti-tumor effect of fulvestrant, palbociclib and erdafitinib in patients with ER+/HER2-/FGFR-amplified MBC.
  • Pharmacokinetic assessments of erdafitinib

Correlative Objectives

  • To determine the therapeutic predictive role of FGFR1-4, CCND1-2, CDK4 and CDK6 amplifications, and RB1 and ESR1 mutations on clinical outcome
  • To determine if the FGFR1 amplification levels is an early surrogate of response
  • To determine if the cfDNA results at disease progression show new genomic alterations potentially associated with resistance to CDK4/6 and FGFR inhibition
  • To determine pharmacodynamic biomarkers of FGFR inhibition
Being tested
Erdafitinib, Palbociclib, Fulvestrant
Keywords
FGFR inhibitor, ER+ metastatic breast cancer, CDK4/6 inhibitor, Endocrine therapy
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ErdafitinibDrug

    Also called JNJ-42756493

    4mg - 8mg

  • PalbociclibDrug

    Also called Ibrance

    125 mg

  • FulvestrantDrug

    Also called Faslodex

    500 mg

Study groups in NCT03238196
Study groupRoleWhat they receive
EscalationExperimentalFulvestrant - injection into muscle 1 time per month Palbociclib capsule taken by mouth 1 time per day every 21 days followed by 1 week of rest (no drug taken) Erdafitinib tablet taken by mouth 1 time per day
Receives: Drug: Erdafitinib; Drug: Palbociclib; Drug: Fulvestrant
ExpansionExperimentalFulvestrant - injection into muscle 1 time per month Palbociclib capsule taken by mouth 1 time per day every 21 days followed by 1 week of rest (no drug taken) Erdafitinib tablet taken by mouth 1 time per day
Receives: Drug: Erdafitinib; Drug: Palbociclib; Drug: Fulvestrant

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With Dose Limiting Toxicities (DLT) in the First Cycle for the Determination of the Maximum Tolerated Dose (MTD)

    Number of participants with DLT in the first cycle for the determination of the MTD.

    Measured: From the time of randomization up to 4 weeks of treatment (cycle 1), for each patient

Secondary outcomes (8)
  1. Progression-free Survival

    Assessment of clinical impact [anti-tumor effect] of the combination of erdafitinib, palbociclib and fulvestrant in patients with ER+/ FGFR amplified metastatic breast cancer will be assessed by measuring the interval (in months) between treatment initiation and disease progression. Progression-free survival (PFS) time is defined as the time from treatment initiation to progression date or death (whichever comes first). Those alive without prpgression is censored at the last date of known alive. Median PFS time and 95% confidence intervals are obtained using Kaplan-meier method.

    Measured: Imaging studies will be performed every 8 weeks from date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 48 months

  2. Overall Response Rate

    Assessment of clinical impact [anti-tumor effect] of the combination of erdafitinib, palbociclib and fulvestrant in patients with ER+/ FGFR amplified metastatic breast cancer by measure the rate (%) of complete and partial responses seen in patients with measurable disease. The response of a patient will be evaluated using Solid Tumor Response Criteria RECIST v1.1.

    Measured: Imaging studies will be performed every 8 weeks from date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 48 months

  3. Clinical Benefit Rate (CBR; Complete Response + Partial Response + Stable Disease Without Disease Progression at 6 Months)

    Assessment of clinical impact [anti-tumor effect] of the combination of erdafitinib, palbociclib and fulvestrant in patients with ER+/ FGFR amplified metastatic breast cancer by measure the rate (%) of complete and partial responses + stability of disease at 6 months seen in patients with measurable disease. Response of a patient was evaluated using Solid Tumor Response Criteria -RECIST v1.1.

    Measured: From the time of randomization up to 6 months for each patient

  4. Pharmacokinetic Assessment of Erdafitinib - Area Under the Curve (AUC)

    The area under the plasma concentration-time curve from time zero to the last measurable concentration

    Measured: From the time of randomization up to 4 weeks of treatment for each patient

  5. Pharmacokinetic Assessment of Erdafitinib - Cmax (Maximum Plasma Concentration)

    The maximum (peak) observed plasma drug concentration after oral dose administration

    Measured: From the time of randomization up to 4 weeks of treatment for each patient

  6. Pharmacokinetic Assessment of Erdafitinib - Tmax

    Time to reach maximum (Cmax) plasma drug concentration after oral dose administration (time)

    Measured: From the time of randomization up to 4 weeks of treatment for each patient

  7. Pharmacokinetic Assessment of Erdafitinib - CL/F

    Apparent total body clearance of drug from the plasma after oral administration

    Measured: From the time of randomization up to 4 weeks of treatment for each patient

  8. Incidence of Treatment-Emergent Adverse Events [Tolerability]

    Assessment of adverse events throughout the study. The number of patients who had any grade of adverse events were reported.

    Measured: From date of randomization until 28 days post treatment discontinuation from any cause, assessed up to 48 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Aug 2017
  2. Study start18 Aug 2017
  3. Primary completion30 Apr 2021
  4. Study completion20 Mar 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Sequential
Masking
None (open label)
Enrolment
35 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03238196
Sponsor's protocol ID
VICC BRE 16126
Status last verified
Oct 2024
First submitted
24 Jul 2017
Last updated
14 Nov 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Gonzalez-Ericsson PI, Unni N, Jhaveri K, Stringer-Reasor E, Liu Q, Wang Y, Sanchez V, Garcia G, Sanders ME, Lehmann BD, Balko JM, Park B, Rexer BN, Mayer IA, Arteaga CL. Phase Ib Trial of Fulvestrant, Palbociclib, and Erdafitinib, a pan-FGFR Tyrosine Kinase Inhibitor, in HR+/HER2- Metastatic Breast Cancer. Clin Cancer Res. 2025 Sep 2;31(17):3652-3661. doi: 10.1158/1078-0432.CCR-24-3803.

    PubMed 40627530

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Erdafitinib, Palbociclib and Fulvestrant in people with Metastatic Breast Cancer, run by Vanderbilt-Ingram Cancer Center at 6 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 28 inclusion and 28 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 16 Feb 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With Dose Limiting Toxicities (DLT) in the First Cycle for the Determination of the Maximum Tolerated Dose (MTD) (time frame: From the time of randomization up to 4 weeks of treatment (cycle 1), for each patient). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03238196, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Nov 2024.

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