Selecting Advanced Breast Cancer Patients for Talazoparib Treatment Using the RECAP Test

FUnctional Selection of Advanced Breast Cancer Patients for Talazoparib Treatment Using the REpair Capacity (RECAP) Test: The FUTURE Trial

This study is testing if a new test can help find advanced breast cancer patients who will benefit from a specific treatment called talazoparib.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 66 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Erasmus Medical Center (Academic / other)
• Drugs / interventions: chemotherapy, radiation
• Locations: 3 sites (Leiden, South Holland and 2 other locations)
• Trial ID: NCT06193525 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to determine the effectiveness of the RECAP test in identifying advanced breast cancer patients who are likely to respond to talazoparib, a PARP inhibitor. Participants will undergo biopsies and blood tests to assess their homologous recombination deficiency (HRD) status. Those identified as HRD will receive talazoparib treatment, while HR proficient patients will receive alternative therapies. The study will evaluate progression-free survival and overall response rates over a four-month period.

Who should consider this trial

Good fit: Ideal candidates include patients with advanced breast cancer who have a proven HRD phenotype or BRCA mutations.

Not a fit: Patients with HR proficient tumors or those who do not meet the specific eligibility criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could lead to more personalized and effective treatment options for patients with advanced breast cancer.

How similar studies have performed: Other studies have shown promise in using genetic testing to guide treatment decisions in cancer, suggesting this approach may be effective.

Eligibility criteria

Inclusion Criteria:

* WHO performance status 0-2
* Locally advanced breast cancer without options for treatment with curative intent or metastatic breast cancer
* Objective progressive disease (PD) according to RECIST within 4 months prior to study entry
* The breast cancer must be either

  * high grade (Bloom \& Richardson grade 3) ER positive (\>10%) and HER2 negative primary breast cancer, or
  * triple negative (ER\<10%, PR\<10% and HER2 negative), or
  * any Bloom \& Richardson grading and receptor status and also

    * at least one metastatic lesion must have a proven HRD phenotype based on a RECAP test not treated with anticancer therapy thereafter or
    * the patient must have a proven germline or somatic BRCA1 and/or BRCA2 mutation The Bloom \& Richardson grading is always based on the primary tumor. The receptor status can be based on the primary tumor or a metastatic lesion whichever comes latest.
* The site of the metastatic lesion (or primary tumor in case it is still in situ) should be easily amendable for biopsy. NB lung metastases (high risk of hemato/pneumo-thorax) and bone metastases (not suitable for RECAP test because calcifications interfere with experimental procedures) are excluded. The local guidelines will be used for stopping and r estarting of anticoagulation. Bilirubin \<1.5 ULN (except elevated bilirubin due to Gilbert's disease or a similar syndrome involving slow conjugation of bilirubin) and both AST and ALT \<5x ULN in case a liver biopsy is planned.
* The tumor must be HRD, defined as HRD identified by the RECAP test determined just before the start of potential Talazoparib treatment within this study (also in case a proven germline BRCA1/2 mutation is present).
* Maximum of four prior lines of chemotherapy for advanced disease; Patients who received platinum compounds are eligible if they have had at least a progression free interval of four months.
* Measurable or evaluable disease according to RECIST 1.1 criteria (appendix 2)
* Life expectancy ≥ 3 months
* Hemoglobin ≥ 10 g/dL (6,2 mmol/L) and ANC of ≥ 1.5 x 109 /L
* Platelets \>100 x 10e9/L
* Hepatic function as defined by total serum bilirubin ≤ 1. 5 x ULN (except elevated bilirubin due to Gilbert's disease or a similar syndrome involving slow conjugation of bilirubin), ASAT and ALAT \< 3 x ULN or \<5 x ULN in case of liver metastasis
* Adequate renal function as defined by either serum creatinine ≤ 1.5 x ULN or creatinine clearance ≥ 50 mL/min (by Cockcroft-Gault formula)
* Negative pregnancy test (urine/serum) for female patients with childbearing potential
* Written informed consent

Exclusion Criteria:

* Any psychological condition potentially hampering compliance with the study protocol
* Any treatment with investigational antitumor drugs within 28 days prior to receiving the first dose of investigational treatment; or within 21 days for standard chemotherapy; or within 14 days for weekly scheduled chemotherapeutic regimens or endocrine therapy
* Radiotherapy within the last four weeks prior to receiving the first dose of investigational treatment; except 1 or 2 x 8 Gy for pain palliation, then seven days interval after the last radiation should be maintained
* Known persistent (\>4 weeks) ≥ Grade 2 toxicity from prior cancer therapy (except for alopecia grade 2)
* Symptomatic brain or leptomeningeal metastases. Patients completely free of symptoms and without corticosteroids for at least four weeks after adequate treatment by resection and/or irradiation could be eligible (consult PI).
* Women who have a positive pregnancy test (urine/serum) and/or who are breastfeeding
* Unreliable contraceptive methods. Women and men enrolled in this trial must agree to use a reliable contraceptive method throughout the study (adequate contraceptive methods are: intra-uterine devices or systems, condom or other barrier contraceptive measures, sterilization and true abstinence)
* Concomitant use of P-gp inhibitors or inducers or BCRP inhibitors (see Appendix A)
* Any known history of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML)
* Uncontrolled infectious disease (such as Human Immunodeficiency Virus HIV-1 or HIV-2 infection) or known active hepatitis B or C
* Recent myocardial infarction (\< six months) or unstable angina

Where this trial is running

Leiden, South Holland and 2 other locations

• Leiden University Medical Center — Leiden, South Holland, Netherlands (Recruiting)
• Erasmus Medical Center — Rotterdam, South Holland, Netherlands (Recruiting)
• Groningen University Medical Center — Groningen, Netherlands (Recruiting)

Study contacts

• Principal investigator: Agnes Jager, MD, PhD — Erasmus Medical Center
• Study coordinator: Clinical Trial Center

Conditions Advanced Breast Cancer; Metastatic Breast Cancer