Fulvestaciclib Combined With Anti-HER2 and Endocrine Therapy for HR+/HER2+ Advanced Breast Cancer

Официальное название

Efficacy and Safety of Fulvestaciclib Combined With Anti-HER2 and Endocrine Therapy for First-line Maintenance or Upfront Chemo-Free Treatment in HR+/HER2+ Advanced Breast Cancer: A Multicenter, Open-label, Randomized Controlled Phase II Study

Обзор

This phase II, multicenter, open-label, randomized controlled trial (FACET study) evaluates the efficacy and safety of fulvestaciclib, a novel oral CDK4/6 inhibitor, combined with anti-HER2 dual blockade (trastuzumab and pertuzumab, HP) and endocrine therapy (ET) in hormone receptor-positive (HR+) and HER2-positive advanced breast cancer (ABC). Patients with HR+/HER2+ ABC without prior systemic therapy for advanced disease are randomized in a 1:1:1 ratio into three arms, stratified by visceral metastasis status (yes vs. no) and metastatic type (de novo vs. recurrent). Arm A: After 4-8 cycles of induction chemotherapy (taxane) plus HP, patients receive fulvestaciclib + HP + ET as maintenance therapy. Arm B: After 4-8 cycles of induction chemotherapy (taxane) plus HP, patients receive HP + ET alone (without fulvestaciclib) as maintenance therapy. Arm C (exploratory): Patients receive upfront fulvestaciclib + HP + ET as first-line therapy without induction chemotherapy (chemo-free). For premenopausal/perimenopausal patients, ovarian function suppression (OFS) is added in all arms. Treatment continues until disease progression, unacceptable toxicity, withdrawal of consent, or death. The primary endpoint is investigator-assessed progression-free survival (PFS) comparing Arm A versus Arm B. Secondary endpoints include PFS (Arm A vs. Arm C), overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), duration of response (DoR), cumulative incidence of central nervous system (CNS) metastases, safety, and patient-reported outcomes (PROs).

Вмешательства

• Препарат Fulvestaciclib
  Oral CDK4/6 inhibitor, 200 mg once daily, 21 days on/7 days off per 28-day cycle.
• Биопрепарат Trastuzumab
  Anti-HER2 monoclonal antibody, 8 mg/kg loading dose then 6 mg/kg IV every 21 days.
• Биопрепарат Pertuzumab
  Anti-HER2 monoclonal antibody, 840 mg loading dose then 420 mg IV every 21 days.
• Препарат Fulvestrant
  Fulvestrant
• Препарат Letrozole
  Aromatase inhibitor, 2.5 mg orally once daily.
• Препарат Anastrozole
  Aromatase inhibitor, 1 mg orally once daily.
• Препарат Taxane
  Induction chemotherapy (paclitaxel, docetaxel, or nab-paclitaxel) plus HP for 4-8 cycles prior to maintenance therapy.

Первичные конечные точки

• Progression-Free Survival (PFS) Assessed by Investigator [Срок оценки: From randomization to first documented progression per RECIST 1.1 or death, assessed every 6 weeks for 12 weeks then every 12 weeks until progression, up to 6 years.]

Вторичные конечные точки (8)

• Progression-Free Survival (PFS) Assessed by Investigator (Arm A vs Arm C) [Срок оценки: From randomization to first documented progression per RECIST 1.1 or death, assessed every 6 weeks for 12 weeks then every 12 weeks until progression, up to 6 years.]
• Overall Survival (OS) [Срок оценки: From date of randomization to date of death from any cause, assessed up to approximately 6 years.]
• Objective Response Rate (ORR) [Срок оценки: From randomization to progression or start of subsequent therapy, assessed every 6 weeks for 12 weeks then every 12 weeks, up to 6 years.]
• Clinical Benefit Rate (CBR) [Срок оценки: From randomization to progression or start of subsequent therapy, assessed every 6 weeks for 12 weeks then every 12 weeks, up to 6 years.]
• Duration of Response (DoR) [Срок оценки: From first documented CR or PR to first progression per RECIST 1.1 or death, assessed up to 6 years.]
• Cumulative Incidence of Central Nervous System (CNS) Metastases [Срок оценки: From date of randomization to date of first documented CNS metastasis, assessed up to approximately 6 years.]
• Number of Participants with Adverse Events (AEs) and Serious Adverse Events (SAEs) as Assessed by NCI-CTCAE v5.0 [Срок оценки: From informed consent through 28 days after last dose; labs/ECGs every 3 weeks, echocardiograms every 12 weeks, up to 6 years.]
• Patient-Reported Outcomes (PROs) Assessed by the Functional Assessment of Cancer Therapy - Breast (FACT-B) Questionnaire [Срок оценки: Measured at Cycle 1 Day 1 (each cycle is 28 days), every 12 weeks thereafter, and at treatment discontinuation and safety follow-up, up to 6 years.]

Критерии участия

Критерии включения

• Age ≥ 18 years, with inoperable locally advanced or recurrent/metastatic breast cancer not amenable to curative-intent therapy.
• Histologically or cytologically confirmed hormone receptor-positive (HR+) and HER2-positive (HER2+) breast cancer. HR+ is defined as estrogen receptor (ER) and/or progesterone receptor (PR) positivity with ≥1% of invasive tumor cells positive by immunohistochemistry (IHC). HER2+ is defined as IHC 3+ or IHC 2+ with in situ hybridization (ISH) positivity.
• No prior systemic therapy for advanced breast cancer, including endocrine therapy, chemotherapy, anti-HER2 therapy, or any CDK4/6 inhibitor.
• Patients may have received neoadjuvant or adjuvant therapy. If prior endocrine therapy was received in the neoadjuvant/adjuvant setting, the disease-free interval from completion of endocrine therapy to randomization must be ≥12 months. If prior anti-HER2 therapy was received, the disease-free interval from completion of anti-HER2 therapy to randomization must be ≥6 months.
• Patients with stable central nervous system (CNS) metastases (meeting all the following criteria: no disease progression on screening imaging after local therapy; at least 3 weeks from completion of local CNS therapy to Cycle 1 Day 1; no requirement for medication to control symptoms) or asymptomatic CNS metastases are eligible.
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
• Any menopausal status. Postmenopausal status is defined as: a. bilateral oophorectomy; b. age ≥60 years; c. age <60 years with amenorrhea for >1 year in the absence of chemotherapy, tamoxifen, toremifene, or ovarian function suppression, and with serum FSH and estradiol levels within the postmenopausal range. For patients <60 years on tamoxifen or toremifene with amenorrhea, serum FSH and estradiol levels must be within the postmenopausal range on consecutive measurements.
• At least one evaluable lesion per RECIST 1.1 (measurable and/or non-measurable lesion).
• For women of childbearing potential: negative serum or urine pregnancy test within 7 days prior to randomization, and agreement to use adequate contraception during study treatment and for 6 months after the last dose of fulvestaciclib.
• Voluntarily sign the informed consent form (ICF), understand the study, and be willing to comply with all study procedures and follow-up.
• Adequate bone marrow and organ function defined as:

Absolute neutrophil count (ANC) ≥1.5 × 10⁹/L; Hemoglobin ≥90 g/L (no red blood cell transfusion within 14 days prior to randomization); Platelet count ≥75 × 10⁹/L; Serum total bilirubin ≤1.5 × upper limit of normal (ULN); AST and ALT ≤3 × ULN (or ≤5 × ULN in the presence of liver metastases); Serum creatinine ≤1 × ULN or calculated creatinine clearance >50 mL/min (Cockcroft-Gault formula); Baseline left ventricular ejection fraction (LVEF) ≥50%.

Критерии исключения

• Inflammatory breast cancer.
• Leptomeningeal disease.
• Active brain metastases (patients with asymptomatic brain metastases, or clinically stable and not requiring steroids or other CNS-directed therapy for ≥4 weeks are eligible).
• Diagnosis of any other malignancy, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ of the cervix that has been definitively treated.
• Known severe hypersensitivity to any component of the study drugs.
• Myocardial infarction within 6 months prior to first dose; uncontrolled cardiac arrhythmias (QTc interval ≥470 ms by Fridericia's formula); New York Heart Association (NYHA) Class III-IV cardiac insufficiency; LVEF <50% on echocardiography; or clinically significant pleural effusion, pericardial effusion, or ascites requiring intervention.
• Dysphagia, active gastrointestinal disease, major gastrointestinal surgery, malabsorption syndrome, or any other condition that may interfere with the absorption of study drugs.
• Known active infection, including hepatitis B (HBsAg positive with HBV DNA ≥1×10⁴ copies/mL or ≥2000 IU/mL), hepatitis C, syphilis, or human immunodeficiency virus (HIV) infection.
• Major surgery, radiotherapy, tumor immunotherapy, monoclonal antibody therapy, or other systemic antitumor therapy within 30 days prior to the first dose, or any therapy that the investigator considers may interfere with the efficacy of study drugs.
• Concurrent use of other investigational drugs or therapies.
• Planned or prior organ or bone marrow transplantation.
• Known history of substance abuse or drug addiction.
• Any other condition that, in the investigator's judgment, makes the patient unsuitable for participation in this study.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Идентификаторы

NCT: NCT07716046 · HLX902-IIT-MA-BC02

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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