E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Metastatic breast cancer |
Tumore della mammella metastatico |
|
E.1.1.1 | Medical condition in easily understood language |
Metastatic breast cancer |
Tumore della mammella metastatico |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10055113 |
E.1.2 | Term | Breast cancer metastatic |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess safety and efficacy of the combination |
Valutare l'efficacia e sicurezza della combinazione |
|
E.2.2 | Secondary objectives of the trial |
To assess the efficacy of VEX combination in terms of overall clinical benefit, defined as the objective response rate plus the rate of stable disease lasting longer than 24 weeks. |
Valutare l’efficacia in termini di Overall Clinical Benefit definito come Objective Response Rate (ORR) + SD superiori a 24 settimane. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Pre- or post-menopausal women (age ≥18 years) with histologically or citologically (cell block) proven, locally advanced (inoperable) or metastatic breast carcinoma. Immunohistochemical evaluation of ER, PgR, HER2, and EGFR according to EIO (European Institute of oncology) guidelines is mandatory.
- Patients with ER>1% and/or PgR >1%
- Patients with HER-2/neu overexpressed tumors, are eligible if they had received previous trastuzumab therapy for advanced disease, and/or a treatment with anti HER2 targeted therapy.
- Patients fulfilling one of the following criteria:
- Patients with measurable disease as per RECIST 1.1 criteria. This is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 20 mm with conventional techniques or as ≥ 10 mm with spiral CT scan
- Patients with bone lesions, lytic or mixed (lytic + sclerotic), in the absence of measurable disease as defined by RECIST 1.1 criteria. Bone lesions must be evaluable by plain CT or MRI. Patients with lesions identified only on radionucleotide bone scan are not eligible.
- Patients may have received any primary and/or adjuvant therapies, as any previous lines of chemotherapy and endocrine therapy for advanced disease. Patients may have received metronomic capecitabine, methotrexate and cyclophosphamide in adjuvant setting at least 12 months before study entry
- Previous treatment with capecitabine, cyclophosphamide and vinorelbine not in metronomic schedule for advanced disease is allowed, provided that the patient has progressive disease at study entry and the patients should not be defined as “refractory” to treatments (PR or CR or SD > 6 months).
- Patients may have had previous hormonal therapy as treatment of metastatic disease provided that the patient has progressive disease at study entry. Hormonal therapy must be discontinued prior to study entry, excluding LH-RH analogue
- Life expectancy greater than 6 months.
- ECOG performance status ≤2
- Patients must have normal organ and marrow function |
Donne in pre o post-menopausa (età ≥ 18 anni) con diagnosi istologica documentata di carcinoma mammario localmente avanzato o metastatico. Valutazione immunoistochimica di ER, PgR, HER2 e EGFR in accordo alle linee guida IEO
- Pazienti con valori di ER>1% e/o PgR>1%
- Pazienti con overespressione di HER-2/neu sono eleggibili se hanno ricevuto precedenti trattamenti con trastuzumab per la malattia avanzata, e/o trattamenti anti HER2
- Pazienti che soddisfino uno dei seguenti criteri:
- pazienti con malattia misurabile secondo i criteri RECIST 1.1, definita come almeno una lesione accuratamente misurabile in almeno una dimensione (registrare il diametro più lungo) di diametro > 20 mm con tecnica convenzionale o > 10 mm con tac spirale
- pazienti con lesioni ossee, litiche o miste (litiche + sclerotiche), in assenza di malattia misurabile secondo i criteri RECIST 1.1. Le lesioni ossee devono essere valutate tramite TAC o Risonanza Magnetica. Pazienti con lesioni identificate solo da scintigrafia globale scheletrica non sono eleggibili.
- Le pazienti possono aver ricevuto qualsiasi terapia in prima linea, in terapia adiuvante e qualsiasi linea di chemioterapia ed endocrino terapia per la malattia avanzata. Le pazienti possono aver ricevuto capecitabina metronomica, metotrexate e ciclofosfamide in setting adiuvante almeno 12 mesi dall’inizio studio.
- Precedenti trattamenti con capecitabina, ciclofosfamide e vinorelbina in schedula non metronomica per la malattia avanzata sono consentiti a condizione che le pazienti non siano in progressione di malattia all’entrata dello studio e che non siano definite come “refrattarie” al trattamento (PR o CR o SD > 6 mesi).
- Le pazienti posso essere state trattate con precedenti terapie ormonali per la malattia metastatica a condizione che siano in progressione di malattia all’entrata dello studio. L’ormonoterapia deve essere interrotta all’entrata dello studio, ad esclusione dell’ LH-RH analogo.
- Aspettativa di vita superiore ai 6 mesi.
- ECOG performance status ≤ 2
- Adeguata funzionalità d’organo e midollare |
|
E.4 | Principal exclusion criteria |
Previous metronomic chemotherapy for advanced disease with capecitabine, cyclophosphamide and vinorelbine
- Triple negative subtypes (ER: 0% PgR:0% Her2: negative)
- Patients defined as “refractory” to capecitabine, cyclophosphamide and vinorelbine (PD or SD < 6 months).
- Presence of sintomatic cerebral or leptomeningeal involvement.
- Previous or concomitant other malignancy except basal or squamous cell carcinoma of the skin or adequately treated in situ carcinoma of the cervix.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- Malabsorption syndrome or disease affecting significantly gastrointestinal function or major resection of the stomach or proximal small bowel that could affect absorption of oral vinorelbine
- Concurrent treatment with any other anti-cancer therapy except LHRH analogue.
- Patients with pre-existing motor or sensory peripheral neuropathy grade 2 according to NCI criteria |
Precedente chemioterapia metronomica per la malattia avanzata con capecitabina, ciclofosfamide e vinorelbina.
- Sottotipi triplo negativi (ER: 0% PgR: 0% Her2: negativo)
- Pazienti definite “refrattarie” alla capecitabina, alla ciclofosfamide ed alla vinorelbina (PD o SD < di 6 mesi)
- Presenza di sintomatologia cerebrale o leptomeningea
- Storia di altre neoplasie maligne eccetto per il carcinoma a cellule squamose o basali, o carcinoma in situ della cervice adeguatamente trattati
- Malattia sistemica severa non controllata in atto incluse, ma non limitate a, infezioni, insufficienza cardiaca congestizia, angina instabile in corso, aritmia cardiaca, o malattie psichiatriche e sociali che possano compromettere la compliance della paziente a partecipare al protocollo di studio
- Sindrome da malassorbimento, altre patologie che interessano in modo significativo il tratto
gastroenterico, resezione dello stomaco, resezione prossimale del piccolo intestino che possano compromettere l’assorbimento orale della vinorelbina, capecitabina e ciclofosfamide
- Concomitante trattamento antitumorale ad eccezione dell’LH-RH analogo
- Preesistente neuropatia di grado ≥ 2 in accordo ai criteri NCI |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Time To Progression |
tempo alla progressione |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
at 3 and 5 months |
a 3 e 5 mesi |
|
E.5.2 | Secondary end point(s) |
To assess the efficacy in terms of overall clinical benefit, defined as the objective response rate plus the rate of stable disease lasting longer than 24 weeks. |
Valutare l’efficacia in termini di Overall Clinical Benefit definito come Objective Response Rate (ORR) + SD (malattia stabile) superiore a 24 settimane. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 36 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 36 |
E.8.9.2 | In all countries concerned by the trial days | 0 |