E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with metastatic or locally advanced, triple-negative adenocarcinoma of the breast that have not received prior systemic therapy for metastatic breast cancer.
|
|
E.1.1.1 | Medical condition in easily understood language |
Patients with metastatic (cancer that has spread) or locally advanced (cancer that has regrown at or near the original site) triple-negative breast cancer that have not received treatment. |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
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 estimate the clinical benefit of cobimetinib plus paclitaxel relative to placebo plus paclitaxel, as measured by investigator-assessed PFS in patients with locally advanced or metastatic TNBC. |
|
E.2.2 | Secondary objectives of the trial |
- To evaluate the safety and tolerability of cobimetinib administered in combination with paclitaxel in patients with locally advanced or metastatic TNBC.
-To determine the overall response rate (ORR), ORR unconfirmed (ORR uc), and duration of response of cobimetinib plus paclitaxel and placebo plus paclitaxel
-To evaluate OS benefit of cobimetinib plus paclitaxel and placebo plus paclitaxel
-To characterize the pharmacokinetics of cobimetinib administered in combination with paclitaxel
|
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Signed Informed Consent Form
•Women and men, age ≥ 18 years
•Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
•Histologically confirmed ER negative, PR negative, and HER2-negative adenocarcinoma of the breast, with measurable metastatic or locally advanced disease
• The determination of TNBC status should, whenever possible, utilize tissue from a metastatic or recurrent lesion and where more than one biopsy source is available, priority should be given to the most recent sample.
• Patients who have not had HER2, ER, or PR testing, and thus, the HER2, ER, and PR status of the breast adenocarcinoma is unknown, are not eligible.
•Locally advanced disease must not be amenable to resection with curative intent.
•Measurable disease, according to RECIST, v1.1 (see Appendix 4)
•Adequate hematologic and end organ function, defined by the following laboratory results obtained within 14 days prior to first dose of study drug treatment:
–Absolute neutrophil count (ANC) ≥ 1.5 × 10 exp9/L
–Platelet count ≥ 100 × 10 exp9/L
–Hemoglobin ≥ 9 g/dL
–Albumin ≥ 2.5 g/dL
–Bilirubin ≤ 1.5 × the upper limit of normal (ULN)
–Aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase ≤ 3 × ULN, with the following exceptions:
-Patients with documented liver metastases: AST and/or ALT ≤ 5 × ULN
-Patients with documented liver or bone metastases: alkaline phosphatase ≤ 5 × ULN
–Serum creatinine ≤ 1.5 × ULN or creatinine clearance (CrCl) ≥ 40 mL/min on the basis of measured CrCl from a 24-hour urine collection or Cockroft-Gault glomerular filtration rate estimation:
[(140-age) x (weight in kg) x (0.85 if female)]/[72 x (serum creatinine in mg/dL)]
•Ability and capacity to comply with the study and follow-up procedure
•For female patients (and female partners of male patients) who are not postmenopausal (≥ 12 months of non-therapy-induced amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to remain abstinent or use single or combined contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 6 months after the last dose of paclitaxel and 3 months after the last dose of cobimetinib
•Men must agree not to donate sperm or have intercourse with a female partner without using appropriate barrier contraception during the treatment period and for 6 months after the last dose of paclitaxel and 3 months after the last dose of cobimetinib
•Male patients should seek advice on conserving sperm prior to treatment because of the possibility of lower fertility with paclitaxel
|
|
E.4 | Principal exclusion criteria |
•Known HER2 positive, ER positive, or PR positive breast cancer by local laboratory assessment (if more than one test result is available and not all results meet the inclusion criterion definition, all results should be discussed with the Medical Monitor to establish eligibility of the patient).
•HER2 positivity is defined as one of the following: IHC 3 positive or in situ hybridization (ISH) positive
•ER and PR positivity is defined positive for ER or PR if a finding of ≥1% of tumor cell nuclei are immunoreactive
•Patients who have not had HER2, ER, or PR testing, and thus, the HER2, ER, and PR status of the breast adenocarcinoma is unknown, are not eligible.
•Any prior chemotherapy, hormonal, or targeted therapy, for inoperable locally advanced or mTNBC
•Prior chemotherapy (including taxanes) and/or radiation in the neoadjuvant or adjuvant setting is allowable if treatment occurred ≥ 6 mos prior to initiation of study treatment (Cycle 1 Day1)
•Any systemic anti-cancer therapy within 3 weeks prior to Cycle 1,
Day 1
•Any radiation treatment to metastatic site within 28 days of Cycle 1, Day 1
•Major surgical procedure, open biopsy, or significant traumatic injury within 30 days prior to Cycle 1, Day 1, or anticipation of need for major surgical procedure during the course of the study
•Prior therapy with bevacizumab, sorafenib, sunitinib, or other putative vascular endothelial growth factor pathway−targeted therapy within 2 years of start of study treatment
•Prior exposure to experimental treatment targeting Raf, MEK, or the MAPK pathway
•Previous therapy with Akt, PI3K, and/or mTOR inhibitors
•Prior therapy with trastuzumab
•Grade ≥ 2 peripheral neuropathy
•Brain metastases (symptomatic or non-symptomatic) that have not been treated previously, are progressive, or require any type of therapy (e.g. radiation,surgery or steroids) to control symptoms from brain metastases within 30 days prior to first study treatment dose
•History of or evidence of retinal pathology on ophthalmologic examination that is considered a risk factor for neurosensory retinal detachment / central serous chorioretinopathy (CSCR), retinal vein occlusion (RVO), or neovascular macular degeneration
•Patients will be excluded if they currently have the following risk factors for RVO:
-Uncontrolled glaucoma with intra-ocular pressures ≥ 21mmHg
-Serum cholesterol ≥ Grade 2
-Hypertriglyceridemia ≥ Grade 2
-Hyperglycemia (fasting) ≥ Grade 2
•Cobimetinib is metabolized by the hepatic cytochrome CYP3A4 enzyme. The drugs listed below should be avoided. If use of one of these drugs is necessary, the risks and benefits and potential alternatives should be discussed with the Medical Monitor prior to its concomitant use with cobimetinib
-Strong CYP3A4/5 inhibitors such as, but not limited to, atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin, and voriconazole
-Strong CYP3A4/5 inducers such as, but not limited to, rifampin, carbamazepine, rifapentine, phenytoin, and phenobarbital
-The following foods/supplements are prohibited at least 7 days prior to initiation of and during study treatment:
-St. John’s wort or hyperforin (potent CYP3A4 enzyme inducer)
-Grapefruit juice (potent cytochrome P450 CYP3A4 enzyme inhibitor)
•History of clinically significant cardiac dysfunction, including the following
–Significant cardiovascular disease, such as symptomatic congestive heart failure, defined as New York Heart Association Class II or higher; see Appendix 7
–Unstable angina, or new-onset angina within 3 months prior to initiation of study treatment
–Myocardial infarction within 3 months prior to initiation of study treatment
–Unstable arrhythmia
–History of congenital long QT syndrome
•QTc interval at screening > 480 msec (average of triplicate screening measurements)
•Left ventricular ejection fraction (LVEF) below institutional lower limit of normal (LLN) or below 50%, whichever is lower
-Pregnancy (positive serum pregnancy test) or lactation
-Uncontrolled serious medical or psychiatric illness
-Active infection requiring intravenous (IV) antibiotics on Cycle 1 Day 1
•Patients who have a history of hypersensitivity reactions to paclitaxel or other drugs formulated in Cremophor® EL (polyoxyethylated castor oil)
•No other history of or ongoing malignancy that would potentially interfere with the interpretation of the PD or efficacy assays
|
|
E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is PFS, defined as the time from randomization to the first occurrence of disease progression, as determined by investigator per RECIST v1.1, or death on study from any cause, whichever occurs first. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
The PFS analysis will be performed after approximately 60 investigator-assessed PFS events (estimated to be approximately 21 months after the first patient is enrolled). |
|
E.5.2 | Secondary end point(s) |
Overall survival, defined as the time from randomization to death from any cause, regardless of whether the death occurs during the study or following treatment discontinuation. For patients who have not died, OS will be censored at the date of last contact. OS will be analyzed similarly to the primary endpoint. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
To be done at time of primary analysis |
|
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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
study start with an open label safety run in stage prior to a random. placebo controlled expansion. |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 51 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Belgium |
Czech Republic |
France |
Italy |
Korea, Republic of |
Spain |
Taiwan |
United Kingdom |
United States |
|
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 | 5 |
E.8.9.1 | In the Member State concerned months | 5 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 0 |