Evexomostat + Alpelisib + Fulvestrant for Breast Cancer

(Amelia-1 Trial)

Recruiting in Palo Alto (17 mi)

+7 other locations

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1 & 2

Recruiting

Sponsor: SynDevRx, Inc.

Must be taking: Alpelisib, Capivasertib, Fulvestrant

Must not be taking: Insulin, Corticosteroids, Sulfonylureas, others

Disqualifiers: Inflammatory breast cancer, Brain metastasis, Type 1 diabetes, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial tests a new drug combination for post-menopausal women with a specific type of advanced breast cancer. It aims to see if the new drug can reduce side effects and improve the effectiveness of existing treatments. The treatment works by blocking proteins and hormones that help cancer grow and by managing side effects like high blood sugar.

Will I have to stop taking my current medications?

The trial requires that you stop taking certain medications at least 7 days before starting the treatment, specifically strong CYP3A4 inducers, inhibitors of BCRP, and sulfonylureas. If you are on these medications, you will need to discuss alternatives with your doctor.

What data supports the effectiveness of the drug combination Evexomostat + Alpelisib + Fulvestrant for breast cancer?

The combination of alpelisib and fulvestrant has been shown to improve progression-free survival in patients with hormone receptor-positive, PIK3CA-mutant metastatic breast cancer, according to the SOLAR-1 study. Additionally, alpelisib has demonstrated promising activity when combined with other treatments in similar breast cancer settings. ^{1 2 3 4 5}

Is the combination of Evexomostat, Alpelisib, and Fulvestrant safe for humans?

The combination of Alpelisib and Fulvestrant has been associated with high rates of side effects like high blood sugar, rash, and diarrhea, which sometimes required hospital treatment. While this combination is approved for certain types of breast cancer, its safety profile shows significant concerns, especially in real-world settings. ^{1 2 5 6 7}

What makes the drug combination of Evexomostat, Alpelisib, and Fulvestrant unique for breast cancer treatment?

This drug combination is unique because it combines Evexomostat, a novel component, with Alpelisib and Fulvestrant, which are already used for hormone receptor-positive, HER2-negative advanced breast cancer. Alpelisib targets a specific mutation (PIK3CA) in cancer cells, while Fulvestrant blocks estrogen receptors, and the addition of Evexomostat may offer a new approach to enhance treatment effectiveness. ^{1 7 8 9 10}

Research Team

Medical Team

Principal Investigator

SynDevRx, Inc.

Eligibility Criteria

This trial is for adult women with advanced HR+/HER2- breast cancer, specifically those who have a PIK3CA mutation and are postmenopausal. Participants should not have brain malignancies or sensitivities to the drugs being tested, nor should they have uncontrolled diabetes or previous treatments with similar drugs.

Inclusion Criteria

My cancer has a PIK3CA mutation confirmed by an FDA-approved test.

I am postmenopausal.

I am fully active or can carry out light work.

Exclusion Criteria

I have been treated with PI3K/Akt/mTOR inhibitors or fulvestrant.

I have been diagnosed with inflammatory breast cancer.

You are allergic to evexomostat, fulvestrant, or alpelisib or any of their ingredients.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-treatment

14-day pre-treatment phase of evexomostat plus fulvestrant before adding either alpelisib or capivasertib

2 weeks

1 visit (in-person)

Treatment

Participants receive the triplet therapy consisting of evexomostat, alpelisib or capivasertib, and fulvestrant for up to 7 cycles

6 months

Monthly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

Treatment Details

Interventions

• Evexomostat (MetAP2 inhibitor)

Trial Overview The study tests a combination of three drugs: Evexomostat, Alpelisib, and Fulvestrant in women with a specific gene mutation linked to aggressive breast cancer. It aims to see if Evexomostat can reduce high blood sugar caused by Alpelisib and improve its effectiveness against tumors.

Participant Groups

Group I: Evexomostat Experimental Treatment 1 Intervention

Each subject will receive repeat doses (C1, C2...) for 28-day cycles. Participants may continue on study drug until disease progression, unacceptable toxicity, or other withdrawal criteria is met.

Who Is Running the Clinical Trial?

SynDevRx, Inc.

Lead Sponsor

Trials

3

Recruited

140+

Findings from Research

In a study of 76 women with hormone receptor-positive, HER2-negative metastatic breast cancer, alpelisib combined with endocrine therapy demonstrated a median progression-free survival of 5.2 months, indicating its effectiveness in a real-world setting.

However, about 31.6% of patients had to permanently discontinue alpelisib due to adverse events, with hyperglycemia being the most common serious side effect, highlighting the need for careful monitoring of patients on this treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Cohort Study of the Antitumor Efficacy and Toxicity Profile of Alpelisib for Metastatic or Locally Advanced HR+, HER2- Breast Cancer: A Single-Institution Experience. Sarfraz, H., Bari, S., Whiting, J., et al.[2023]

In the NEO-ORB study involving 257 postmenopausal women with HR+ early breast cancer, the addition of alpelisib to letrozole did not significantly improve the objective response rate compared to placebo, with rates of 43% for alpelisib versus 45% for placebo in the PIK3CA-mutant cohort.

Although the primary objective was not met, the combination treatment did show a greater decrease in phosphorylated AKT levels in PIK3CA-mutant tumors, suggesting some biological activity, but overall pathologic complete response rates remained low across all groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Phase II Randomized Study of Neoadjuvant Letrozole Plus Alpelisib for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer (NEO-ORB). Mayer, IA., Prat, A., Egle, D., et al.[2023]

In a study involving 451 postmenopausal women with advanced breast cancer, fulvestrant was found to be as effective as anastrozole in terms of time to progression, with median times of 5.5 months for fulvestrant and 5.1 months for anastrozole.

Both treatments were well tolerated, with low withdrawal rates due to adverse events (3.2% for fulvestrant and 1.3% for anastrozole), indicating that fulvestrant is a safe and effective option for patients who have progressed on prior endocrine therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fulvestrant, formerly ICI 182,780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. Howell, A., Robertson, JF., Quaresma Albano, J., et al.[2022]

In a study of 247 patients with metastatic hormone receptor-positive, PIK3CA-mutant breast cancer, 61.5% developed any-grade hyperglycemia after treatment with alpelisib, with a median onset time of just 16 days.

Patients receiving alpelisib as standard care experienced significantly higher rates of hyperglycemia compared to those in clinical trials, highlighting the importance of monitoring and optimizing glycemic status before starting treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer. Shen, S., Chen, Y., Carpio, A., et al.[2023]

Alpelisib, when combined with fulvestrant, significantly improves progression-free survival (PFS) in postmenopausal women and men with hormone receptor-positive, HER2-negative, PIK3CA-mutated advanced breast cancer, showing a median PFS of 11 months compared to 5.7 months with placebo.

The treatment is specifically effective for patients with PIK3CA mutations, as no PFS benefit was observed in those without these mutations, highlighting the importance of genetic testing in treatment decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

FDA Approval Summary: Alpelisib Plus Fulvestrant for Patients with HR-positive, HER2-negative, PIK3CA-mutated, Advanced or Metastatic Breast Cancer. Narayan, P., Prowell, TM., Gao, JJ., et al.[2022]

In the phase III SOLAR-1 trial involving 571 patients, alpelisib combined with fulvestrant showed significant efficacy in treating PIK3CA-mutated advanced breast cancer, with a median progression-free survival of 12.5 months at higher dose intensities compared to 5.8 months with placebo.

Common adverse events included hyperglycemia and rash, which were effectively managed through early identification and preventive measures, leading to reduced severity and lower treatment discontinuation rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Time course and management of key adverse events during the randomized phase III SOLAR-1 study of PI3K inhibitor alpelisib plus fulvestrant in patients with HR-positive advanced breast cancer. Rugo, HS., André, F., Yamashita, T., et al.[2022]

In a study of 54 postmenopausal women with metastatic breast cancer, fulvestrant demonstrated clinical benefit in 38.9% of patients, with a median time to progression of 6.4 months, indicating its efficacy even after multiple prior treatments.

Fulvestrant was well tolerated, with no severe toxicities (grade 3/4) reported, suggesting it is a safe option for patients with advanced breast cancer who have limited treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fulvestrant ('Faslodex') in heavily pretreated postmenopausal patients with advanced breast cancer: single centre clinical experience from the compassionate use programme. Mlineritsch, B., Psenak, O., Mayer, P., et al.[2018]

Fulvestrant was well tolerated and provided clinical benefit to 21% of heavily pre-treated postmenopausal women with advanced breast cancer, with 42% achieving stable disease for at least 12 weeks.

The efficacy of fulvestrant was similar whether given after disease progression or as maintenance therapy, with a median time to progression of 3 months and no significant toxicities reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fulvestrant in heavily pre-treated patients with advanced breast cancer: results from a single compassionate use programme centre. Catania, C., Ascione, G., Adamoli, L., et al.[2018]

Fulvestrant is an effective estrogen receptor antagonist for postmenopausal women with advanced breast cancer who have progressed after previous endocrine therapies, as demonstrated in a Compassionate Use Programme with diverse patient cases.

Clinical experience from the Compassionate Use Programme aligns with clinical trial data, indicating that fulvestrant is a valuable treatment option even for patients with challenging disease characteristics, such as visceral metastases and HER2-positive breast cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case studies of fulvestrant ("Faslodex") in postmenopausal women with advanced breast cancer. Abram, P., Maass, N., Rea, D., et al.[2018]

References

1. England pubmed.ncbi.nlm.nih.gov

The efficacy and safety of alpelisib in breast cancer: A real-world analysis. [2023]

2. Switzerland pubmed.ncbi.nlm.nih.gov

A Cohort Study of the Antitumor Efficacy and Toxicity Profile of Alpelisib for Metastatic or Locally Advanced HR+, HER2- Breast Cancer: A Single-Institution Experience. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

A Phase II Randomized Study of Neoadjuvant Letrozole Plus Alpelisib for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer (NEO-ORB). [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Fulvestrant, formerly ICI 182,780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

FDA Approval Summary: Alpelisib Plus Fulvestrant for Patients with HR-positive, HER2-negative, PIK3CA-mutated, Advanced or Metastatic Breast Cancer. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Time course and management of key adverse events during the randomized phase III SOLAR-1 study of PI3K inhibitor alpelisib plus fulvestrant in patients with HR-positive advanced breast cancer. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Fulvestrant ('Faslodex') in heavily pretreated postmenopausal patients with advanced breast cancer: single centre clinical experience from the compassionate use programme. [2018]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Fulvestrant in heavily pre-treated patients with advanced breast cancer: results from a single compassionate use programme centre. [2018]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Case studies of fulvestrant ("Faslodex") in postmenopausal women with advanced breast cancer. [2018]