Using Abemaciclib and Hydroxychloroquine to Target Residual Breast Cancer Cells
A Phase II Pilot Trial of ABemacicliB or Abemaciclib and HydroxYchloroquine to Target Minimal Residual Disease in Breast Cancer Patients ("ABBY")
This study is testing if a combination of two approved medications, abemaciclib and hydroxychloroquine, can help reduce leftover breast cancer cells in patients' bone marrow.
Quick facts
| Phase | Phase 2 |
|---|---|
| Study type | Interventional |
| Enrollment | 66 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Abramson Cancer Center at Penn Medicine Academic / other |
| Drugs / interventions | chemotherapy, immunotherapy, radiation |
| Locations | 1 site (Philadelphia, Pennsylvania) |
| Trial ID | NCT04523857 on ClinicalTrials.gov |
What this trial studies
This Phase II clinical trial is designed to evaluate the effectiveness of abemaciclib and hydroxychloroquine in targeting minimal residual disease in patients with breast cancer. A total of 66 participants will be enrolled, and the study will involve administering these FDA-approved medications twice daily to assess their ability to reduce or eliminate disseminated tumor cells in the bone marrow. The trial is randomized and controlled, ensuring a robust methodology to evaluate the outcomes of the treatment.
Who should consider this trial
Good fit: Ideal candidates include patients with histologically-confirmed invasive breast cancer diagnosed within the last five years and specific risk factors as outlined in the eligibility criteria.
Not a fit: Patients who have not completed all primary therapy or do not meet the specific inclusion criteria may not benefit from this study.
Why it matters
Potential benefit: If successful, this approach could significantly improve outcomes for breast cancer patients by effectively targeting and reducing residual cancer cells.
How similar studies have performed: While the combination of these specific drugs is being tested in this trial, similar approaches targeting minimal residual disease in cancer have shown promise in other studies.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Histologically-confirmed, primary, invasive breast cancer diagnosed within 5 years of entry into the companion DTC screening protocol UPCC 28115 * Qualifying risk status, at diagnosis utilizing receptor testing by ASCO/CAP guidelines, meting at least one of the following: (i) Histologically positive axillary lymph nodes, regardless of receptors (ii) Primary tumor that is ER/PR/Her2 negative: estrogen receptor (ER) \< 10%, progesterone receptor (PR) \< 10% and negative for Her2-overexpression by ASCO-CAP guidelines, regardless of lymph nodes status (iii) Primary tumor that is ER+/Her2 negative/Lymph node negative with Breast Cancer Recurrence Score of \>/= 25 per the Genomic Health Oncotype DX breast cancer test and/or high risk MammaPrint (iv) Evidence of residual disease in the breast on pathologic assessment after neoadjuvant chemotherapy * Patients must have completed all primary therapy (definitive surgery, (neo)adjuvant chemotherapy adjuvant radiation and/or Her2-directed therapy) for the index malignancy at least 4 weeks prior to study entry. Prior treatment-related toxicity must be resolved or improving to Grade 1 with the exception of alopecia, Grade 2 endocrine disorders (e.g. adrenal insufficiency or thyroid disorders from prior immunotherapy) controlled on stable replacement therapy for \> 1 year, and up to Grade 3 peripheral neuropathy, prior to study enrollment. Concurrent receipt of adjuvant endocrine and bone modifying agents is allowed per standard of care guidelines. Tamoxifen is not allowed due to drug-drug interactions with HCQ. * Bone marrow aspirate obtained via research trial UPCC 28115 after completion of therapy (except endocrine therapy) demonstrates detectable DTCs (via IHC) * No evidence of recurrent local or distant breast cancer by physical examination, blood tests (CBC, LFTs, Alk Phos), or imaging. Assessment for overt metastatic disease by radiologic testing per institutional guidelines (CT Chest, Abdomen and Pelvis, bone scan, MRI and/or PET/CT) will only be done in patients with DTCs detected on bone marrow aspirate who are being screened for this trial. * Age \>/= 18 years * ECOG performance status =/\< 2 * Ability to swallow oral medications * No contraindications to the study medications or uncontrolled medical illness. * Adequate bone marrow function as shown by: ANC \>/= 1.5 x 10\^9/L, Platelets \>/= 100 x 10\^9/L, Hb \>9 g/dL * Adequate liver function as shown by: Serum bilirubin \</= 1.5 x ULN, ALT and AST \</= 3.0 x ULN, and INR \</=1.5 * Adequate renal function: serum creatinine \</= 1.5 x ULN * Adequate muscle function: creatinine phosphokinase (CPK) \</= 2.5 x ULN * Anticoagulation is allowed if target INR =/\< 1.5 on a stable dose of warfarin or on a stable dose of anticoagulant for \>2 weeks at time of randomization * Ability to provide informed consent Exclusion Criteria * Concurrent enrollment on another investigational therapy * Patient has received an experimental treatment in a clinical trial within the last 30 days or 5 half-lives, whichever is longer, prior to randomization (or treatment assignment), or is currently enrolled in any other type of medical research (for example: medical device) judged by the sponsor not to be scientifically or medically compatible with this study. * Prior treatment with a CDK 4/6 inhibitor * Known hypersensitivity to hydroxychloroquine or any of its derivatives * Prior hydroxychloroquine exposure for a duration of \> 1 month since the completion of the patient's primary therapy (definitive surgery, (neo)adjuvant chemotherapy, adjuvant radiation, and/or Her2-directed therapy) for the index malignancy. * Patients with hormone-receptor positive breast cancer may not be receiving tamoxifen due to drug-drug interactions with hydroxychloroquine * Patients who have initiated bone modifying agents within 3 months prior to the start of study treatment * Patients who have had major surgery within 14 days prior to randomization (or treatment assignment) * Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study * Female patients who are pregnant or breast feeding, or adults of reproductive potential who are not using effective birth control methods. * Women of childbearing potential must have a negative serum pregnancy test within 7 days prior to the first dose of Abema
Where this trial is running
Philadelphia, Pennsylvania
- Abramson Cancer Center of the University of Pennsylvania — Philadelphia, Pennsylvania, United States (Recruiting)
Study contacts
- Principal investigator: Amy Clark, MD — Abramson Cancer Center at Penn Medicine
- Study coordinator: Lauren Bayne, PhD
- Email: breastcancerclinicaltrials@pennmedicine.upenn.edu
- Phone: 215-615-2367
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.