Etude : AMBRE /



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Acronyme / Nom
Situation thérapeutique
Traitement
Cadre réglementaire
MÀJ
Présentation de l'étude
Acronyme / Nom : AMBRE

Situation thérapeutique : Métastatique ou localement avancé

Traitement : Chimiothérapie / Thérapie ciblée

Cadre réglementaire : RIPH1

Dernière MÀJ : 01/12/2021
Titre
Spécialité(s)
CIM10 - Localisation(s)
Informations principales
Titre : Etude multicentrique, randomisée, en ouvert, comparant la chimiothérapie standard à l’association standard d’une hormonothérapie avec l’abémaciclib comme traitement de première ligne métastatique chez les patientes atteintes d’un cancer du sein ER positif - HER2 négatif avec des métastases viscérales et une charge tumorale élevée

Spécialité : Seins, organes génitaux de la femme
Localisation : C50 - Tumeur maligne du sein
Schéma
Phase
Stade
Ligne(s)
Informations complémentaires
Schéma : AMBRE is a phase III study comparing two standard treatments as initial metastatic treatment in ER+/HER2- breast cancer (BC) patients with visceral metastasis and high burden disease: Chemotherapy and combination of endocrine therapy with abemaciclib.

The primary objective is to compare the efficacy of standard endocrine therapy + abemaciclib combination versus standard chemotherapy based on progression-free survival (PFS) within 24 weeks, in patients with visceral metastases of ER+/HER2- breast cancer and high tumor burden.

Patients will be randomly assigned to receive either:
- Standard Chemotherapy regimen
* Paclitaxel: administrated at the dose of 80 mg/m² as a 1-hour intravenous infusion every week (i.e., D1, D8 and D15) of a 3-week cycle.
OR
* Capecitabine: given orally at a dose of 2000 to 2500 mg/m² daily for 14 days followed by a 7-day rest period every 3 weeks.
- Standard Endocrine therapy (ET) regimen + Abemaciclib
* Letrozole: continuous orally administration of 2.5 mg/day (1 tablet/day) OR anastrozole continuous orally administration of 1 mg/day (1 tablet/day) in combination with oral abemaciclib 150 mg (BID: twice a day) continuous for patients NSAI naïve or relapsing >1 year after the end of adjuvant ET.
OR
* Fulvestrant: 500 mg intramuscular on D1-D15-D29 (loading dose). Then 500 mg every 28 days (maintenance dose) with oral abemaciclib 150 mg BID continuous for patients relapsing on adjuvant or less than one year after completion of adjuvant NSAI.
For women with a non-menopausal status at inclusion, a concomitant Luteinizing hormone-releasing hormone (LH-RH) agonist will be administered in combination with ET every 28 days. The LH-RH agonist drug to be used will be left to the investigator's choice.
Non-menopausal women will be included as soon as the reimbursement of abemaciclib in combination with ET will be approved for this population.

Phase : III

Stade : Métastatique

1
Informations libres de droit
Critères d'inclusion
Critères de non-inclusion
Informations libres de droit
Critères d'inclusion et de non-inclusion
Critères d'inclusion : 1. Patient must have signed a written informed consent form prior to any study specific procedures.
2. Female age > 18 years.
3. Performance status, ECOG 0-2.
4. Histologically confirmed adenocarcinoma of the breast.
5. Metastatic breast cancer, with liver and/or lung and/or pleural and/or peritoneal metastases with high tumor burden (according to RECIST v1.1) defined as either:
o visceral involvement of one site with more than 3 lesions,
o visceral involvement of at least 2 sites,
o symptomatic ascites or pleural effusion, defined as the need for weekly drainage with visceral measurable metastases,
o visceral involvement and LDH > N.
6. Patient considered candidate for a first line chemotherapy in metastatic setting by their physician (either capecitabine or paclitaxel) and who may receive first-line endocrine therapy combined with abemaciclib according to the marketed authorization.
7. ER-positive by IHC (>10%) on primary or metastatic disease.
8. HER2-negative by IHC (score 0 or 1+) and/or Fish/Cish negative.
9. Non-menopausal women will receive LH-RH agonists at least 1 month before starting the endocrine therapy and every 28 days thereafter.
10. Adequate renal, hepatic, and hematopoietic functions as defined by the following criteria:
o Absolute Neutrophil Count (ANC) ≥ 1,500/mm3 or ≥ 1.5 G/L
o Platelets ≥ 100,000/mm3 or ≥ 100 G/L
o Hemoglobin ≥ 8 g/dL (patients may receive erythrocyte transfusions to achieve this hemoglobin level at the discretion of the investigator. Initial treatment must not begin earlier than the day after the erythrocyte transfusion).
o Serum Aspartate Transaminase (AST) and serum Alanine Aminotransferase Transaminase (ALT) ≤ 3 x upper limit of normal (ULN) (< 5 ULN if liver metastasis)
o Total serum bilirubin ≤ 1.5 x ULN (patients with Gilbert’s syndrome with a total bilirubin ≤ 2.0 times ULN and direct bilirubin within normal limits are permitted)
o Serum creatinine ≤ 1.5 x ULN or estimated creatinine clearance > 60 mL/min as calculated using the standard method for the institution.
11. Adequate cardiac functions, including:
o 12 Lead electrocardiogram (ECG) with normal tracing or non-clinically significant changes that do not require medical intervention.
o QTcF interval ≤ 480 msec (mean of replicate values, correction per institutional standard)
o no history of Torsades de Pointes or other symptomatic QTc abnormality.
12. Women of childbearing potential agreeing to use highly effective contraception during treatment and for 3 weeks following the last dose of abemaciclib or for 6 months following the last dose of capecitabine or paclitaxel.
13. Women of childbearing potential must have a negative serum pregnancy test within 7 days and/or urine pregnancy test 48 hours prior to the administration of any study treatment.
14. Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests, and other trial procedures.
15. Health insurance coverage.

Critères de non-inclusion : 1. Bone lesion only or non-measurable lesion (RECIST V1.1).
2. Patients with all target lesions in a previously irradiated region, except if clear progression has been observed prior to study in at least one of them.
3. Spinal cord compression and/or symptomatic or progressive brain metastases (Brain metastasis are not acceptable unless asymptomatic or treated and stable off steroids for at least 30 days prior to start of study drug).
4. Patient with visceral crisis as defined in the 4th ESO–ESMO International Consensus Guidelines (severe organ dysfunction as assessed by signs and symptoms, laboratory studies and rapid progression of disease).
5. Patient has received one line of chemotherapy for metastatic disease.
6. Patient has received endocrine therapy for metastatic disease.
7. Inability to swallow orally administered medication.
8. Patients who received radiotherapy must have completed and fully recovered from the acute effects of radiotherapy. A washout period of at least 14 days is required between end of radiotherapy and randomization.
9. Major problem with intestinal absorption.
10. Previous or current malignancies of other histologies within the last 5 years, with the exception of in situ carcinoma of the cervix or the breast, and adequately treated basal cell or squamous cell carcinoma of the skin.
11. Patient has active systemic bacterial infection (requiring intravenous [IV] antibiotics at time of initiating study treatment), fungal infection, or detectable viral infection (such as known human immunodeficiency virus positivity or with known active hepatitis B or C [for example, hepatitis B surface antigen positive]. Screening is not required for enrollment.
12. Patient has a personal history of any of the following conditions: syncope of cardiovascular etiology, ventricular arrhythmia of pathological origin (including, but not limited to, ventricular tachycardia and ventricular fibrillation), or sudden cardiac arrest.
13. Patient has any serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance < 30 mL/min], history of major surgical resection involving the stomach or small bowel, or preexisting Crohn’s disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea).
14. Any drug or plant derivative that may interact with abemaciclib.
15. Episode of pulmonary thromboembolism (PTE) in the last six months. Patients with deep vein thrombosis previously treated with a low-molecular-weight heparin for more than two months prior enrolment in the study will be eligible.
16. Patients with previously documented total/partial dihydropyrimidine dehydrogenase (DPD) deficiency or with DPD deficiency identified at baseline visit (plasma uracil concentration ≥ 16 ng/mL). These patients will be not eligible for chemotherapy by capecitabine.
17. Pregnant or breast feeding women.
18. Patients enrolled in another therapeutic study within 30 days prior inclusion.
19. Individuals deprived of liberty or placed under the authority of a tutor.
NCT
Promoteur
Coordonnateur
Informations relatives au promoteur
NCT :
NCT04158362
Promoteur :
Unicancer
Type de sponsor : Institutionnel
3, avenue du Général Harris
14000 CAEN

Coordonnateur :
Dr Véronique DIERAS
v.dieras@rennes.unicancer.fr
Tél : + 33 (0)2 99 25 32 80
Centre investigateur
Investigateur
TEC / ARC / IDE
État
MÀJ
Informations relatives aux investigateurs
Centre investigateur :
Centre François BACLESSE - 3 avenue du Général Harris - 14000 CAEN
Apicrypt : essaitherapeutiquecfb@baclesse.unicancer.fr

Investigateur :
Christelle LEVY

TEC / ARC / IDE :
Sara GROSSI
s.grossi@
baclesse.unicancer.fr

Statut de l'essai : OUVERT

MAJ : 21/10/2020