Abemaciclib for Triple Negative Breast Cancer

Recruiting in Palo Alto (17 mi)

+2 other locations

Overseen by Matthew P. Goetz

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Mayo Clinic

Must not be taking: CDK 4/6 inhibitors

Disqualifiers: Active DVT/PE, Prior radiation, Others

No Placebo Group

Prior Safety Data

Breakthrough Therapy

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial studies how well abemaciclib works in patients with triple negative breast cancer that can be surgically removed but does not respond to chemotherapy. Abemaciclib is a pill that may help stop cancer cell growth by blocking certain enzymes. The trial includes patients who receive different treatments before surgery.

Will I have to stop taking my current medications?

The trial requires participants to stop using strong and moderate inducers or strong inhibitors of cytochrome P450 3A at least 7 days before registration. If you are taking these types of medications, you will need to stop them before joining the trial.

Is Abemaciclib safe for humans?

Abemaciclib has been shown to be generally safe in humans when used for certain types of breast cancer, with common side effects including diarrhea, infections, and neutropenia (low white blood cell count). ^{1 2 3 4 5}

How is the drug Abemaciclib unique for treating triple-negative breast cancer?

Abemaciclib is unique because it is a CDK4/6 inhibitor that targets the cell cycle, and while it is primarily used for ER-positive breast cancer, research suggests it may also be effective in a subset of triple-negative breast cancer when combined with other treatments, like androgen receptor-targeted agents. ^{1 2 3 6 7}

Research Team

Matthew P. Goetz

Principal Investigator

Mayo Clinic in Rochester

Eligibility Criteria

This trial is for women aged 18 or older with triple negative breast cancer that remains after chemotherapy and can be surgically removed. Participants must not be pregnant, should have completed chemo within the last 56 days, and cannot use certain drugs affecting liver enzymes. They must also provide tissue samples, swallow pills, and have no other active cancers or serious medical conditions.

Inclusion Criteria

I still have signs of cancer in my breast after chemotherapy.

I am a woman aged 18 or older.

My breast cancer is in stages 1-4, may have spread to nearby lymph nodes, but not to distant parts of the body.

Exclusion Criteria

I have had a breast biopsy for this cancer.

I have not had any other cancer within the last 3 years.

I have had a blood clot in my veins or lungs within the last year or I am currently on blood thinners for a clot.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Neoadjuvant Chemotherapy

Patients receive a neoadjuvant chemotherapy regimen, with or without pembrolizumab, to assess chemotherapy resistance.

Up to 12 weeks

Treatment with Abemaciclib

Patients receive abemaciclib orally twice daily for 14-21 days, followed by surgical resection.

3 weeks

Daily oral administration

Surgical Resection

Patients undergo standard of care surgical resection after completion of abemaciclib treatment.

1 week

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of CD8/FOXP3 ratio and other biomarkers.

30-60 days

Treatment Details

Interventions

• Abemaciclib (CDK4/6 Inhibitor)

Trial Overview The study tests abemaciclib's effectiveness on patients with resectable triple negative breast cancer resistant to chemotherapy. It examines if this drug can halt cancer cell growth by inhibiting specific enzymes needed for their proliferation. The trial includes surgery as part of the treatment process.

Participant Groups

Group I: Cohort A Group 2; Cohort B Group 4 (abemaciclib, surgery) Experimental Treatment 2 Interventions

Patients receive abemaciclib PO BID on days 1-14 or days 1-21 in the absence of disease progression or unacceptable toxicity. Patients then undergo standard of care surgical resection no later than 12 weeks after the last dose of neoadjuvant chemotherapy.

Group II: Cohort A Group 1; Cohort B Group 3 (surgery) Experimental Treatment 1 Intervention

Patients undergo standard of care surgical resection.

Who Is Running the Clinical Trial?

Mayo Clinic

Lead Sponsor

Trials

3,427

Recruited

3,221,000+

Dr. Gianrico Farrugia

Mayo Clinic

Chief Executive Officer since 2019

MD from University of Malta Medical School

Dr. Richard Afable

Mayo Clinic

Chief Medical Officer

MD from Loyola Stritch School of Medicine

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Dr. Douglas R. Lowy

National Cancer Institute (NCI)

Chief Executive Officer since 2023

MD from New York University School of Medicine

Dr. Monica Bertagnolli

National Cancer Institute (NCI)

Chief Medical Officer since 2022

MD from Harvard Medical School

Findings from Research

Interim results from the MONARCH3 study show that abemaciclib, a CDK4/6 inhibitor, is an effective first-line treatment for advanced ER-positive, HER2-negative breast cancer.

Patients receiving abemaciclib in combination with letrozole experienced significantly improved progression-free survival compared to those receiving a placebo with endocrine therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

First-Line Abemaciclib Effective in ER+ Breast Cancer. [2019]

In a phase III trial, abemaciclib combined with endocrine therapy significantly reduced the risk of breast cancer recurrence in patients with hormone receptor positive (HR+), HER2-negative, node-positive early breast cancer, regardless of prior chemotherapy or tumor characteristics.

The combination treatment was generally well-tolerated, with manageable side effects such as diarrhea, infections, and neutropenia, making it a valuable option for high-risk patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Abemaciclib: A Review in Early Breast Cancer with a High Risk of Recurrence. Fung, S., Blair, HA.[2023]

The combination of the CDK4/6 inhibitor abemaciclib and the androgen receptor-targeting agent seviteronel showed synergistic effects in treating androgen receptor-positive triple-negative breast cancer (TNBC) in preclinical models, suggesting a new potential therapy for this aggressive cancer subtype.

Single-cell RNA sequencing revealed variability in androgen receptor levels among TNBC cells, indicating that targeting the androgen receptor alongside cell cycle inhibition could enhance treatment efficacy in AR-positive TNBC patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Activity of Combined Androgen Receptor Antagonism and Cell Cycle Inhibition in Androgen Receptor Positive Triple Negative Breast Cancer. Christenson, JL., O'Neill, KI., Williams, MM., et al.[2022]

The combination of the CDK4/6 inhibitor abemaciclib and the PARP inhibitor talazoparib (TAL) showed a synergistic effect in suppressing the growth of BRCA-mutated, RB-deficient triple negative breast cancer (TNBC) cells, indicating a promising treatment strategy.

This combination therapy not only effectively inhibited cell growth but also overcame resistance to TAL by inducing cell cycle arrest and activating apoptotic pathways, suggesting it could be a viable option for patients with challenging TNBC cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Novel combination treatment of CDK 4/6 inhibitors with PARP inhibitors in triple negative breast cancer cells. Guney Eskiler, G., Ozman, Z., Haciefendi, A., et al.[2023]

Triple-negative breast cancer (TNBC) is a challenging subtype with limited treatment options and a poor prognosis, often leading to a median survival of only 13 months after standard therapies fail.

The newly approved drug eribulin has demonstrated a survival benefit for patients with previously treated TNBC, highlighting the need for more effective targeted therapies and the potential of biomarker-driven approaches to improve treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimal strategies for the treatment of metastatic triple-negative breast cancer with currently approved agents. André, F., Zielinski, CC.[2020]

In phase III clinical trials (MONARCH 2 and MONARCH 3), abemaciclib, a CDK4 & 6 inhibitor, significantly improved progression-free survival and overall survival in women with hormone receptor positive (HR+) and HER2-negative advanced breast cancer when used in combination with endocrine therapy.

Abemaciclib demonstrated a tolerable safety profile, making it a promising treatment option for patients who have progressed after previous endocrine therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Development of CDK4 & 6 Inhibitor Abemaciclib in Breast Cancer]. Masuda, N., Saji, S., Kawaguchi, T., et al.[2021]

Abemaciclib, a CDK4/6 inhibitor, shows significant effectiveness in treating various breast cancer subtypes, particularly ER+/HER2- and ER+/HER2+, as well as some triple-negative breast cancers with intact Rb signaling, based on studies using 44 breast cancer cell lines and xenograft models.

The combination of abemaciclib with hormonal therapies or HER2-targeted treatments enhances its antitumor activity without reducing the effectiveness of either treatment, suggesting a promising strategy for improving breast cancer therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preclinical Activity of Abemaciclib Alone or in Combination with Antimitotic and Targeted Therapies in Breast Cancer. O'Brien, N., Conklin, D., Beckmann, R., et al.[2020]

References

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

First-Line Abemaciclib Effective in ER+ Breast Cancer. [2019]

2. France pubmed.ncbi.nlm.nih.gov

Abemaciclib: A Review in Early Breast Cancer with a High Risk of Recurrence. [2023]

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

Activity of Combined Androgen Receptor Antagonism and Cell Cycle Inhibition in Androgen Receptor Positive Triple Negative Breast Cancer. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

Novel combination treatment of CDK 4/6 inhibitors with PARP inhibitors in triple negative breast cancer cells. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Optimal strategies for the treatment of metastatic triple-negative breast cancer with currently approved agents. [2020]

6. Japan pubmed.ncbi.nlm.nih.gov

[Development of CDK4 & 6 Inhibitor Abemaciclib in Breast Cancer]. [2021]

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

Preclinical Activity of Abemaciclib Alone or in Combination with Antimitotic and Targeted Therapies in Breast Cancer. [2020]