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    Clinical Trial Results:
    A Phase 2, Multicenter Study of the Effect of the Addition of SNDX-275 to Continued Aromatase Inhibitor (AI) Therapy in Postmenopausal Women with ER+ Breast Cancer Whose Disease is Progressing

    Summary
    EudraCT number
    2007-006415-23
    Trial protocol
    GB   IE  
    Global end of trial date
    24 Nov 2009

    Results information
    Results version number
    v1(current)
    This version publication date
    25 Jun 2022
    First version publication date
    25 Jun 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SNDX-275-0303
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00828854
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Syndax Pharmaceuticals, Inc.
    Sponsor organisation address
    35 Gatehouse Drive, Building D, Floor 3, Waltham, MA, United States, 02451
    Public contact
    Main Telephone Number, Syndax Pharmaceuticals, Inc., +1 781-419-1400, clinicaltrials@syndax.com
    Scientific contact
    Main Telephone Number, Syndax Pharmaceuticals, Inc., +1 781-419-1400, clinicaltrials@syndax.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    24 Nov 2009
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Nov 2009
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the tumor responses to SNDX-275 in combination with continued AI therapy as measured by clinical benefit rate (CBR) during the first 6 cycles of study treatment, that is, complete response (CR), partial response (PR), or stable disease (SD) for at least 6 months.
    Protection of trial subjects
    This study was conducted in accordance with International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Good Clinical Practice, and the principles of the Declaration of Helsinki, in addition to following the laws and regulations of the country or countries in which a study is conducted.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Oct 2008
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 18
    Country: Number of subjects enrolled
    Ireland: 9
    Worldwide total number of subjects
    27
    EEA total number of subjects
    9
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    7
    From 65 to 84 years
    20
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Participants took part in the study at 8 investigative sites in the United Kingdom (UK) and Ireland from 1 October 2008 to 24 November 2009.

    Pre-assignment
    Screening details
    Participants with a diagnosis of estrogen receptor-positive (ER+) breast cancer whose disease was progressing were enrolled to receive entinostat 5 milligrams (mg) in combination with continued AI therapy.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    This was an open-label study.

    Arms
    Arm title
    Entinostat 5 mg + AI
    Arm description
    Entinostat 5 mg tablet orally every week on Days 1, 8, 15 and 22 of each 28-day treatment cycle in combination with continued treatment with AI therapy at labeled dose and schedule until disease progression or unacceptable toxicity.
    Arm type
    Experimental

    Investigational medicinal product name
    Entinostat
    Investigational medicinal product code
    Other name
    SNDX-275
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Entinostat 5 mg per oral (PO) every week

    Investigational medicinal product name
    Aromatase Inhibitor Therapy
    Investigational medicinal product code
    Other name
    AI Therapy
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    AI therapy at labeled dose and schedule as prescribed in clinical practice. AI therapies included: Arimidex (anastrozole) 1 mg/day PO, Fermara (letrozole) 2.5 mg/day PO, Aromasin (exemestane) 25 mg/day PO.

    Number of subjects in period 1
    Entinostat 5 mg + AI
    Started
    27
    Completed
    0
    Not completed
    27
         Adverse event, non-fatal
    9
         Reason Not Specified
    1
         Disease Progression
    17

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Entinostat 5 mg + AI
    Reporting group description
    Entinostat 5 mg tablet orally every week on Days 1, 8, 15 and 22 of each 28-day treatment cycle in combination with continued treatment with AI therapy at labeled dose and schedule until disease progression or unacceptable toxicity.

    Reporting group values
    Entinostat 5 mg + AI Total
    Number of subjects
    27 27
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    7 7
        From 65-84 years
    20 20
        85 years and over
    0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    68 ± 7.0 -
    Gender categorical
    Units: Subjects
        Female
    27 27
        Male
    0 0
    Eastern Cooperative Oncology Group (ECOG) Status
    ECOG performance status is an assessment of a participant’s general well-being and activities of daily of life. Scores range from 0=perfect health (asymptomatic; able to carry out activities without restriction) to 5=death.
    Units: Subjects
        Score=0
    9 9
        Score=1
    18 18
    Age, Customized
    Units: Subjects
        45 to 64 years
    7 7
        65 to 74 years
    15 15
        75 years and older
    5 5
    Race (National Institutes of Health/Office of Management and Budget)
    Units: Subjects
        American Indian or Alaska Native
    0 0
        Asian
    0 0
        Native Hawaiian or Other Pacific Islander
    0 0
        Black or African American
    1 1
        White
    26 26
        More than one race
    0 0
        Unknown or Not Reported
    0 0

    End points

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    End points reporting groups
    Reporting group title
    Entinostat 5 mg + AI
    Reporting group description
    Entinostat 5 mg tablet orally every week on Days 1, 8, 15 and 22 of each 28-day treatment cycle in combination with continued treatment with AI therapy at labeled dose and schedule until disease progression or unacceptable toxicity.

    Subject analysis set title
    Per-protocol Set
    Subject analysis set type
    Per protocol
    Subject analysis set description
    Participants from the full analysis who met eligibility criteria, completed at least 2 cycles and who had baseline and post-baseline tumor assessments.

    Subject analysis set title
    Full Analysis Set
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All eligible participants who signed informed consent.

    Subject analysis set title
    Safety Analysis Set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All participants who received at least 1 dose of study drug.

    Primary: Clinical Benefit Rate

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    End point title
    Clinical Benefit Rate [1]
    End point description
    CBR is defined as the percentage of participants who achieved CR or PR or SD for 6 months as assessed by the investigator based on Response Evaluation Criteria in Solid Tumors (RECIST), version 1.0. CR is defined as the disappearance of all target lesions. PR is defined as at least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD. SD is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease (PD), taking as reference the smallest sum LD since the treatment started.
    End point type
    Primary
    End point timeframe
    6 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Only the 95% confidence interval is reported for this end point.
    End point values
    Per-protocol Set
    Number of subjects analysed
    26
    Units: Percentage of Participants
        number (confidence interval 95%)
    15.4 (4.4 to 34.9)
    No statistical analyses for this end point

    Secondary: Progression-free Survival (PFS)

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    End point title
    Progression-free Survival (PFS)
    End point description
    PFS is defined as the number of months from the date of randomization to the earlier of PD or death due to any cause.
    End point type
    Secondary
    End point timeframe
    From date of randomization to discontinuation due to disease progression or death up to primary completion date (Median follow-up 7.4 months)
    End point values
    Per-protocol Set
    Number of subjects analysed
    26
    Units: Months
        median (confidence interval 95%)
    3.9 (1.9 to 5.6)
    No statistical analyses for this end point

    Secondary: Objective Response Rate (ORR) During the First 6 Cycles of Study Treatment

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    End point title
    Objective Response Rate (ORR) During the First 6 Cycles of Study Treatment
    End point description
    ORR is defined as the percentage of participants with response during treatment classified as CR or PR, as assessed by the investigator based on RECIST, version 1.0. CR is defined as the disappearance of all target lesions. PR is defined as at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD.
    End point type
    Secondary
    End point timeframe
    From date of randomization to discontinuation due to disease progression or intolerable adverse event (AE) up to primary completion date (Median follow-up 7.4 months)
    End point values
    Per-protocol Set
    Number of subjects analysed
    26
    Units: Percentage of Participants
        number (confidence interval 95%)
    3.9 (0.1 to 19.6)
    No statistical analyses for this end point

    Secondary: Number of Participants With AEs

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    End point title
    Number of Participants With AEs
    End point description
    An AE is defined as any untoward medical occurrence in a participant or clinical investigation participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. Worsening of a pre-existing medical condition was considered an AE if there was either an increase in severity, frequency, or duration of the condition or an association with significantly worse outcomes. Abnormal clinical laboratory findings determined by the investigator to be clinically significant were recorded as AEs.
    End point type
    Secondary
    End point timeframe
    Up to 8, 28-day cycles + 30 days (approximately 254 days)
    End point values
    Safety Analysis Set
    Number of subjects analysed
    27
    Units: Participants
    27
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Up to 8, 28-day cycles + 30 days (Approximately 254 days)
    Adverse event reporting additional description
    Safety Set included all participants who received at least 1 dose of study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    10.1
    Reporting groups
    Reporting group title
    Entinostat 5 mg + AI
    Reporting group description
    Entinostat 5 mg tablet orally every week on Days 1, 8, 15 and 22 of each 28-day treatment cycle in combination with continued treatment with AI therapy at labeled dose and schedule until disease progression or unacceptable toxicity.

    Serious adverse events
    Entinostat 5 mg + AI
    Total subjects affected by serious adverse events
         subjects affected / exposed
    15 / 27 (55.56%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Malignant neoplasm progression
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Hip fracture
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypotension
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac failure congestive
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Convulsion
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Spinal cord compression
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    VIth nerve paralysis
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancytopenia
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Adverse drug reaction
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnea
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    3 / 27 (11.11%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Bone pain
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Respiratory tract infection
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypokalemia
         subjects affected / exposed
    1 / 27 (3.70%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Entinostat 5 mg + AI
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    27 / 27 (100.00%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    3
    Aspartate aminotransferase increased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Blood albumin decreased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    3
    Blood lactate dehydrogenase increased
         subjects affected / exposed
    3 / 27 (11.11%)
         occurrences all number
    3
    Blood potassium increased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Blood urea increased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    3
    Haemoglobin decreased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    6
    Lymphocyte count decreased
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Neutrophil count decreased
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    5
    Platelet count decreased
         subjects affected / exposed
    5 / 27 (18.52%)
         occurrences all number
    8
    Weight decreased
         subjects affected / exposed
    11 / 27 (40.74%)
         occurrences all number
    15
    White blood cell count decreased
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    8
    Cardiac disorders
    Palpitations
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Nervous system disorders
    Lethargy
         subjects affected / exposed
    8 / 27 (29.63%)
         occurrences all number
    11
    Dizziness
         subjects affected / exposed
    3 / 27 (11.11%)
         occurrences all number
    3
    Paraesthesia
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    4
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    10
    Thrombocytopenia
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    4
    Fatigue
         subjects affected / exposed
    15 / 27 (55.56%)
         occurrences all number
    33
    Pain
         subjects affected / exposed
    6 / 27 (22.22%)
         occurrences all number
    8
    Oedema peripheral
         subjects affected / exposed
    10 / 27 (37.04%)
         occurrences all number
    11
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    6
    Abdominal pain upper
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Constipation
         subjects affected / exposed
    5 / 27 (18.52%)
         occurrences all number
    8
    Diarrhoea
         subjects affected / exposed
    13 / 27 (48.15%)
         occurrences all number
    22
    Dyspepsia
         subjects affected / exposed
    5 / 27 (18.52%)
         occurrences all number
    9
    Eructation
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Flatulence
         subjects affected / exposed
    5 / 27 (18.52%)
         occurrences all number
    6
    Lip dry
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Nausea
         subjects affected / exposed
    15 / 27 (55.56%)
         occurrences all number
    26
    Vomiting
         subjects affected / exposed
    7 / 27 (25.93%)
         occurrences all number
    9
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    7 / 27 (25.93%)
         occurrences all number
    7
    Cough
         subjects affected / exposed
    7 / 27 (25.93%)
         occurrences all number
    8
    Pleural effusion
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Skin and subcutaneous tissue disorders
    Dry skin
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Purpura
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Rash
         subjects affected / exposed
    3 / 27 (11.11%)
         occurrences all number
    3
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    3
    Depression
         subjects affected / exposed
    3 / 27 (11.11%)
         occurrences all number
    5
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    4
    Muscle spasms
         subjects affected / exposed
    5 / 27 (18.52%)
         occurrences all number
    6
    Myalgia
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Pain in extremity
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Infections and infestations
    Cellulitis
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Lower respiratory tract infection
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Respiratory tract infection
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2
    Urinary tract infection
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    4
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    5
    Decreased appetite
         subjects affected / exposed
    4 / 27 (14.81%)
         occurrences all number
    4
    Hypokalaemia
         subjects affected / exposed
    2 / 27 (7.41%)
         occurrences all number
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    23 Jun 2008
    • The number of participating sites was increased from 6 in the UK to between 10 and 13 in the UK and Ireland. • Physical examination was added to the Day 1 visit assessments. • Compliance assessments were added to the schedule of observations.
    08 Oct 2008
    • Ancillary study of markers of bone turnover was restricted to participants who had never received a bisphosphonate. • Inclusion criterion relating to a measurable lesion was amended as follows: if the only measurable lesion was located in a previously irradiated area, the lesion must have demonstrated progression according to RECIST criteria. • Exclusion criterion addressing concurrent medical conditions was expanded to include myocardial infarction or thromboembolic events and specificity relating to prior malignancies. • The maximum treatment duration of 6 cycles was removed. • Overall survival was added as an exploratory endpoint. • 12-lead electrocardiogram was added at each cycle and end-of-treatment. • Sampling times for serum marker of bone turnover, urine marker of bone turnover, and tumor markers were expanded. • Independent Data Monitoring Board provision was added to monitor safety and efficacy on an ongoing basis. • Provision for a planned interim analysis of efficacy was added (but with no early stopping contingency).

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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