A Phase I Trial of Capecitabine in Combination with Cemiplimab in Patients with Hormone Receptor Positive Metastatic Breast Cancer
This is a single-center, open-label, phase I study to assess the safety and efficacy of the oral chemotherapy capecitabine in combination with cemiplimab in patients with hormone-receptor–positive (HR+) metastatic breast cancer.
- To evaluate the safety and tolerability of capecitabine in combination with cemiplimab and to determine the recommended phase II dose (RP2D)
1. To evaluate the objective response rate (ORR)
2. To evaluate the clinical benefit rate (CBR)
3. To evaluate progression-free survival (PFS)
Able to provide a written informed consent and any locally required authorization prior to performing any protocol-related procedures,including screening evaluations.
Female or male, age 18 years or older
Eastern Cooperative Oncology Group (EGOG) performance status 0 through 2
Pathologic confirmation of noninvasive breast cancer that is Hormone-receptor positive (HR+) (ER [estrogen-receptor] and/or PR [progesterone-receptor] >/= 1%, locally advanced, or metastatic disease.
Invasive breast cancer is Human Epidermal Growth Factor Receptor 2 (HER2) negative defined as 0 or 1+ by immunohistochemistry (IHC) or with an in situ hybridization (ISH) ratio (HER2 gene copy/chromosome 17) > Measurable or non-measurable disease
Any line of prior endocrine therapy in the unresectable and /or metastatic setting
Adequate organ and marrow function as defined in protocol
Participants must be willing and able to comply with the protocol for the duration of the study. This compliance includes undergoing treatment, scheduled visits, and examinations, including follow-up.
If taking herbal or natural remedies that may have immune modulatory effects, participants must be willing to discontinue them before first dose of cemiplimab
Participation in another clinical study with an investigational product during the last 4 weeks
Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period of an interventional study.
Received prior systemic cytotoxic chemotherapy for unresectable and/or metastatic disease. Patients who received 1 cycle or fewer at least 3 months prior to enrollment, which was discontinued for reasons other than disease progression, may be enrolled at the discretion of the PI.
Any previous treatment with a PD-1 or PD-L1 inhibitor, including cemiplimab.
Nontreated brain metastasis. Treated brain metastasis is allowed if patients are stable and off steroids for at least 2 months prior to enrollment.
History of another primary malignancy, except for malignancy treated with curative intent; no known active disease for ≥2 years; adequately treated non-melanoma skin cancer or lentigo maligna (without evidence of disease); or adequately treated carcinoma in situ without evidence of disease (eg, cervical cancer in situ).
Current or prior use of immunosuppressive medication within 14 days before the first dose of cemiplimab, with the exceptions of intranasal, inhaled, topical steroids, or local steroid injections (eg, intra-articular injection); systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone or an equivalent corticosteroid; or steroids as premedication for hypersensitivity reactions (eg, CT scan premedication).
Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [eg, colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, pneumonitis etc]). The following are exceptions to this criterion: (a) Patients with vitiligo or alopecia. (b) Patients with hypothyroidism (eg, following Hashimoto syndrome) who are stable on hormone replacement. (c) Any chronic skin condition that does not require systemic therapy. (d) Patients without active disease in the last 5 years may be included but only after consultation with the study physician. (e) Patients with celiac disease controlled by diet alone.
Prior treatment with other immune-modulating agents that was (a) within fewer than 4 weeks (28 days) prior to the first dose of cemiplimab or (b) associated with immune-mediated AEs that were ≥ grade 1 within 90 days prior to the first dose of cemiplimab or (c) associated with toxicity that resulted in discontinuation of the immune-modulating agent
Prior treatment with idelalisib. The decision to treat with cemiplimab tumor types for which cemiplimab and/or other anti-PD-1/ PD-L1 agents have demonstrated efficacy, such as advanced CSCC, merits an individualized risk:benefit assessment by the treating physician in discussion with the patient, in the event that a patient had prior exposure to idelalisib.
History of primary immunodeficiency.
History of allogeneic organ transplant.
Known allergy or history of hypersensitivity to cemiplimab or any excipient.
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, active bleeding diatheses, or psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the subject to give written informed consent.
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