A Phase III, Multicenter, Randomized, Open-Label Study Evaluating the Efficacy and Safety of Inavolisib Plus Fulvestrant Versus Alpelisib Plus Fulvestrant in Patients with Hormone Receptor-Positive, Her2-Negative, Pik3ca Mutated, Locally Advanced or Metastatic Breast Cancer Who Progressed During Or After Cdk4/6 Inhibitor And Endocrine Combination Therapy

Cancer Categories

Breast

Karmanos Trial ID

2023-057

NCT ID

NCT05646862

Age Group

Adult

Scope

National

Phase

Phase III

Principal Investigator

Hadeel
Assad, M.D.
Oncology - Medical View Profile

Objective:

Primary Objective:

To evaluate the efficacy of inavolisib plus fulvestrant compared with alpelisib plus fulvestrant.

Secondary Objectives:

To evaluate patient-reported pain, functioning, and HRQoL among participants treated with inavolisib plus fulvestrant compared with alpelisib plus fulvestrant
To evaluate the safety and tolerability of inavolisib plus fulvestrant compared with alpelisib plus fulvestrant
To characterize the pharmacokinetics of inavolisib in the inavolisib plus fulvestrant arm

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Eligibility

Inclusion Criteria:

If pre/perimenopausal women and men treatment with luteinizing hormone-releasing hormone (LHRH) agonist therapy beginning at least 2 weeks prior to Day 1 of Cycle 1
Histologically or cytologically confirmed adenocarcinoma of the breast that is locally advanced or metastatic and is not amenable to surgical or radiation therapy with curative intent
Documented HR +/ HER2- tumor according to American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines
Confirmation of biomarker eligibility: detection of specified mutation(s) of PIK3CA via specified test
Disease progression after or during treatment with a combination of CDK4/6i and endocrine therapy: <= 2 prior lines of systemic therapy in mBC setting; CDK4/6i based therapy does not need to be the last one received prior study entry; one line of chemotherapy in mBC setting allowed
Measurable or evaluable disease per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1)
Participants for whom endocrine-based therapy is recommended and treatment with cytotoxic chemotherapy is not indicated at time of entry into the study, as per national or local treatment guidelines
Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1, or 2
Life expectancy of > 6 months
Adequate hematologic and organ function prior to initiation of study treatment

Exclusion Criteria:

Metaplastic breast cancer
Prior treatment in locally advanced or metastatic setting with any PI3K, AKT, or mTOR inhibitor or any agent whose mechanism of action is to inhibit the PI3K/-AKT/-mTOR pathway
Participant who relapsed with documented evidence of progression > 12 months from completion of adjuvant CDK4/6i based therapy with no treatment for metastatic disease
Pregnant, lactating, or breastfeeding, or intending to become pregnant during the study or at least 60 days after the final dose of study treatment
Type 2 diabetes requiring ongoing systemic treatment at the time of study entry; or any history of Type 1 diabetes
Inability or unwillingness to swallow pills
Malabsorption syndrome or other condition that would interfere with enteral absorption
Any history of leptomeningeal disease or carcinomatous meningitis
Known and untreated, or active central nervous system (CNS) metastases. Participants with a history of treated CNS metastases are eligible if they meet specific certain criteria
Known active, systemic infection at study enrollment, or any major episode of infection requiring treatment with intravenous antibiotics or hospitalization within 7 days prior to Day 1 of Cycle 1
Any concurrent ocular or intraocular condition that, in the opinion of the investigator, would require medical or surgical intervention during the study period to prevent or treat vision loss that might result from that condition
Active inflammatory or infectious conditions in either eye or history of idiopathic or autoimmune-associated uveitis in either eye
Requirement for daily supplemental oxygen
Symptomatic active lung disease, including pneumonitis
History of or active inflammatory bowel disease
Any active bowel inflammation
Clinically significant and active liver disease, including severe liver impairment, viral or other hepatitis, current alcohol abuse, or cirrhosis
Participants with known human immunodeficiency virus infection that meet specific criteria
Investigational drug(s) within 4 weeks before randomization or within 5 half-lives of the investigational drug(s), whichever is longer
History of other malignancy within 5 years prior to screening, except for cancers with very low risk of recurrence
Chronic therapy of >= 10 mg of prednisone per day or an equivalent dose of other anti-inflammatory corticosteroids or immunosuppressants for a chronic disease
Allergy or hypersensitivity to components or excipients of the inavolisib, fulvestrant, or alpelisib formulations
History of severe cutaneous reactions like Stevens-Johnson Syndrome, Erythema Multiforme, Toxic Epidermal Necrolysis, or Drug Reaction with Eosinphilia and Systemic Symptoms
Active ongoing osteonecrosis of the jaw

Locations

Karmanos Cancer Institute - Detroit Headquarters

4100 John R
Detroit, MI 48201
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Phone: 800-527-6266

Karmanos Cancer Institute at Weisberg Cancer Center - Farmington Hills

31995 Northwestern Hwy
Farmington Hills, MI 48334
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Phone: 800-527-6266

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