E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
metastatic HER2-negative breast cancer |
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E.1.1.1 | Medical condition in easily understood language |
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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 | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10027475 |
E.1.2 | Term | Metastatic breast cancer |
E.1.2 | System Organ Class | 100000004864 |
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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 evaluate the efficacy of bavituximab in combination with taxane therapy in patients with MBC |
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E.2.2 | Secondary objectives of the trial |
To characterize the safety and tolerability of bavituximab plus taxane therapy in patients with MBC
Exploratory:
• to assess immune effects in patients treated with bavituximab in combination with taxane therapy
• serum levels of β2-GP1 |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Written informed consent obtained prior to screening.
2. Females or males at least 18 years of age.
3. Histologically or cytologically documented metastatic HER2-negative breast cancer.
4. Measurable disease per RECIST 1.1 (Phase II; Appendix 2); evaluable disease (Phase III).
5. ECOG performance status of 0 or 1 (Appendix 1).
6. Adequate hematologic function: absolute neutrophil count ≥1500 cells/μL; hemoglobin ≥9 g/dL; platelets ≥100,000/μL.
7. Adequate renal function: serum creatinine ≤1.8 mg/dL or calculated creatinine clearance >50 mL/min using the Cockcroft-Gault equation.
8. Adequate hepatic function: total bilirubin ≤ upper limit of normal (ULN), serum albumin ≥3.0 g/dL, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤1.5 × ULN. ALT and/or AST may be ≤5 × ULN if due to liver metastases. If ALT or AST is >1.5 and ≤5 × ULN in patients with liver metastases, alkaline phosphatase must be ≤2.5 × ULN. Patients with Gilbert’s syndrome are allowed if total bilirubin is ≤2 × ULN and direct bilirubin is ≤ULN.
9. Prothrombin time (PT) and/or international normalized ratio (INR) ≤1.5 × ULN and activated partial thromboplastin time (aPTT) ≤1.5 × ULN if patient is not on anticoagulant therapy (a therapeutic PT and/or INR and aPTT is acceptable if the
patient is on anticoagulants).
10. Patients must have a negative serum human chorionic gonadotropin (hCG) test within 1 week of Day 1 (pregnancy test not required for patients with bilateral oophorectomy and/or hysterectomy or for those patients who are >1 year postmenopausal).
11. All patients of reproductive potential (ie, not surgically sterile or postmenopausal) must agree to use a highly effective method of contraception (<1% failure rate per year) during and 3 months after end of study treatment (female) or during and 6 months after end of study treatment (male). |
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E.4 | Principal exclusion criteria |
1. HER2-positive breast cancer.
2. Less than 6 months since last dose of prior adjuvant non-taxane regimen.
3. Less than 12 months since last dose of prior adjuvant taxane-containing regimen.
4. Any chemotherapy regimen for MBC within 3 weeks before Day 1.
5. Known history of bleeding diathesis or coagulopathy (eg, von Willebrand disease or hemophilia).
6. Bleeding
a) Clinically significant bleeding, such as gross hematuria, gastrointestinal bleeding, and hemoptysis within the 6 months before screening, unless the cause has been identified and adequately treated (eg, cystitis, ulcer).
b) Minor biopsy-related bleeding lasting <24 hours and resolved at least 1 week before Day 1 is allowed.
7. Thromboembolic events (eg, deep vein thrombosis, pulmonary embolism, arterial thrombosis) within 6 months before screening.
8. Grade 2 or higher peripheral neuropathy (eg, numbness, tingling, and/or pain in distal extremities).
9. Radiotherapy within 1 week preceding Day 1; ongoing acute toxicity from prior radiotherapy.
10. Either symptomatic or clinically active brain metastases (ie, requiring ongoing treatment). Patients are eligible if brain metastases are adequately treated. Patients must be either off corticosteroids, or on a stable or decreasing dose of ≤10 mg daily prednisone (or equivalent).
11. Major surgery within 4 weeks of Day 1.
12. Uncontrolled intercurrent disease (eg, diabetes, hypertension, thyroid disease, active infections).
13. Autoimmune disease, being treated with immunosuppressive drugs (eg, methotrexate or biological agents), or other conditions requiring immunosuppressive therapy (eg, prior allotransplantation).
14. History of hypersensitivity to bavituximab, docetaxel, paclitaxel, or to any of their excipients.
15. Symptomatic coronary artery disease, cerebrovascular accident or transient ischemic attack, myocardial infarction, arterial embolism, or unstable angina pectoris within 6 months of screening.
16. Currently pregnant, nursing, or planning a pregnancy during the study.
17. Investigational therapy within 28 days prior to Day 1.
18. Patient has a condition or is in a situation which, in the investigator's opinion, may put the patient at significant risk, may confound the study results, or may interfere significantly with the patient’s participation in the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Phase II:
ORR: percentage of patients whose best overall response is complete or partial response (CR or PR).
Phase III:
PFS |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Tumor response will be assessed radiographically every 8 weeks (±3 days) for the first approximately 24 weeks, then every 12 weeks (±3 days) thereafter. |
|
E.5.2 | Secondary end point(s) |
Phase II efficacy:
• disease control rate (DCR): percentage of patients whose best overall response is CR, PR, or stable disease
• DOR: number of days from first CR or PR (whichever is first recorded) until the first documented tumor progression (per RECIST 1.1; Appendix 2) or death due to any cause, whichever occurs first
• PFS: number of days from randomization until the first documented tumor progression (per RECIST 1.1) or death due to any cause, whichever occurs first
• overall survival (OS): number of days from randomization until death regardless of cause
Phase III efficacy:
• ORR
• DCR
• DOR
• OS
Safety endpoints:
• AEs
• laboratory measurements: hematology (complete blood count with differential; platelets), biochemistry, and ADA
Exploratory endpoints:
• immune correlates
• serum levels of β2-GP1 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Hematology and biochemistry: Day 1 of each 3-week cycle or Days 1, 8, 15 of each 4-week cycle.
ADA: Q8W for 24W, then Q12W |
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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 | No |
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 | Yes |
E.6.13.1 | Other scope of the trial description |
Tumor tissue for ImmunoProfiling and gene expression |
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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) | Yes |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Standard Therapy Taxane without Bavituximab |
|
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 | 7 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 165 |
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 |
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E.8.7 | Trial has a data monitoring committee | Yes |
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
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Last Visit [i.e. survival assessment (can be by telephone)] Last Subject |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |