A Study of Targeted Agents for Patients With Recurrent or Persistent Endometrial Cancer (EndoMAP)

• ClinicalTrials.gov Identifier: NCT04486352
• Recruitment Status: Recruiting
• First Posted: July 24, 2020
• Last Update Posted: December 26, 2023
• Sponsor: Alliance Foundation Trials, LLC.
• Collaborators: Genentech, Inc.; Foundation Medicine; Pfizer; Eli Lilly and Company
• Information provided by (Responsible Party): Alliance Foundation Trials, LLC.

Study Description

Brief Summary:

This is a Phase IB/II multi-cohort study designed to evaluate the efficacy and safety of targeted agents with or without cancer immune checkpoint therapy with atezolizumab in participant with recurrent and/or persistent endometrial cancer. The main protocol provides a platform for genomic screening with homogeneous basic eligibility criteria in order to direct study participants into biomarker-matched study cohorts consisting of testing targeted agents.

Condition or disease	Intervention/treatment	Phase
Endometrial Cancer	Drug: Atezolizumab - 28 Day Cycle; Drug: Bevacizumab; Drug: Ipatasertib; Drug: Talazoparib; Drug: Trastuzumab emtansine; Drug: Tiragolumab; Drug: Atezolizumab - 21 Day Cycle; Drug: Inavolisib; Drug: Letrozole; Drug: Giredestrant; Drug: Abemaciclib	Phase 1; Phase 2

Detailed Description:

This is a Phase IB/II multi-cohort study designed to evaluate the efficacy and safety of targeted agents with or without cancer immune checkpoint therapy with atezolizumab in participants with recurrent and/or persistent endometrial cancer.

This biomarker-driven study provides a platform whereby participants with persistent/recurrent endometrial cancer will be placed into study cohorts evaluating targeted agents selected on the basis of the tumor's specific genomic profile. Prospective participants with persistent and/or recurrent endometrial cancer will be prescreened within 60 days of treatment assignment to have a tumor tissue sample submitted for next-generation sequencing (NGS) using FoundationOne® companion diagnostic (CDx) testing prior to entering screening. If a participant has FoundationOne® CDx testing within five years of enrollment, the previous tumor tissue may be re-analyzed for use in the study.

Depending on the cohort assignment per the tumor's biomarker profile, participants will be assigned to the AFT-50A Protocol (atezolizumab+targeted agent) or the AFT-50B Protocol (non-atezolizumab targeted agents). The current study cohorts are as follows:

AFT-50A Cohorts

• Atezolizumab + Bevacizumab doublet
• Atezolizumab + Ipatasertib doublet
• Atezolizumab + Talazoparib doublet
• Atezolizumab + Trastuzumab emtansine (TDM-1) doublet
• Atezolizumab + Tiragolumab doublet

AFT-50B Cohorts

• Inavolisib + Letrozole doublet
• Giredestrant + Abemaciclib doublet

It is anticipated that approximately 20 participants will be enrolled in each study cohort in AFT-50A and 24 participants in each study cohort in AFT-50B, unless otherwise specified for a given cohort due to statistical considerations. Each study cohort will open/close independently of other study cohorts. Once a study cohort reaches the prespecified number of participants, it will be closed to further enrollment, unless an expansion phase is planned.

The study is structured to allow for additional cohorts to be added as the study progresses. These additional study cohorts may be proposed by investigators, but requires approval by the Steering Committee in order to be added to the protocol.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 148 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase IB/II Multi-Cohort Study of Targeted Agents and/or Immunotherapy With Atezolizumab for Patients With Recurrent or Persistent Endometrial Cancer
• Actual Study Start Date: October 20, 2021
• Estimated Primary Completion Date: October 1, 2025
• Estimated Study Completion Date: October 2026

Arms and Interventions

Arm	Intervention/treatment
Experimental: Atezolizumab and Bevacizumab Cohort; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with no specified gene signatures will be enrolled in this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Atezolizumab - 28 Day Cycle; Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.; Other Names: Tecentriq; L01XC32; Drug: Bevacizumab; Bevacizumab will be given to participants intravenously at a dosage of 10mg per participant kilogram every 2 weeks of the 28-day cycle.; Other Names: Avastin; L01XC07
Experimental: Atezolizumab and Ipatasertib Cohort; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with PIK3CA/AKT1/PTEN-altered tumors will be enrolled in this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Atezolizumab - 28 Day Cycle; Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.; Other Names: Tecentriq; L01XC32; Drug: Ipatasertib; Ipatasertib will be given as an orally at a dosage of 400 mg once daily for 21 days of each 28-day cycle.; Other Names: RG7440; GDC-0068
Experimental: Atezolizumab and Talazoparib Cohort; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that have a ≥16%genomic loss of heterozygosity (LOH) will be assigned to this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Atezolizumab - 28 Day Cycle; Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.; Other Names: Tecentriq; L01XC32; Drug: Talazoparib; Talazoparib will be given in an orally at a dosage of 1 mg once daily for each day of the 28-day cycle.; Other Names: Talzenna; L01XX60
Experimental: Atezolizumab and Trastuzumab emtansine (TDM-1) Cohort; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that with an amplification of ERBB2/HER2 will be assigned to this cohort. Twenty participants will be enrolled. Once twenty participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Trastuzumab emtansine; Trastuzumab emtansine be given to participants intravenously at a dosage of 3.6 mg per participant kilogram, on day 1 of each 21-day cycle.; Other Names: T-DM1; Kadcyla; Drug: Atezolizumab - 21 Day Cycle; Atezolizumab will be given to participants intravenously at a dosage of 1200 mg on day 1 of each 21-day cycle.; Other Names: Tecentriq; L01XC32
Experimental: Atezolizumab and Tiragolumab Cohort; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumor type MSI-H and/or tTMB >=10 mut/mb will be assigned to this cohort. Twenty participants will be enrolled initially. Once twenty participants are enrolled, the cohort may be expanded if a positive signal is shown. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Atezolizumab - 28 Day Cycle; Atezolizumab will be given to participants intravenously at a dosage of 1680 mg on day 1 of each 28-day cycle.; Other Names: Tecentriq; L01XC32; Drug: Tiragolumab; Tiragolumab will be given to participants intravenously at a dosage of 840 mg on day 1 of each 28-day cycle.
Experimental: Inavolisib and Letrozole Cohort; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that with PIK3CA activating mutations in the absence of PTEN loss-of-function alterations or AKT1 activating mutations will be assigned to this cohort. Twenty-four participants will be enrolled. Once twenty-four participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Inavolisib; Inavolisib will be given in an orally at a dosage of 9 mg once daily for each day of the 28-day cycle.; Other Name: GDC-0077; Drug: Letrozole; Letrozole will be given orally at a dosage of 2.5 mg once daily for each day of the 28-day cycle.; Other Name: Femara
Experimental: Giredestrant and Abemaciclib; Following the submission of tumor tissue for the FoundationOne® companion diagnostic (F1CDx) test, participants with tumors that are RB1 intact with a local grade 1-2 estrogne receptor positive (ER+) are assigned to this cohort. Twenty-four participants will be enrolled. Once twenty-four participants are enrolled, the cohort will be closed to further enrollment. Participants in this study cohort will commence treatment as specified on Day 1 of each cycle.	Drug: Giredestrant; Giredestrant will be given orally at a dosage of 30 mg once daily for each day of the 28-day cycle.; Other Name: GDC-9545; Drug: Abemaciclib; Giredestrant will be given orally at a dosage of 150 mg twice daily for each day of the 28-day cycle.; Other Name: Verzenio

Outcome Measures

Primary Outcome Measures :

1. Investigator-assessed overall response rate (ORR) of each biomarker cohort [ Time Frame: 48 Months ]
   AFT-50A Protocol: Overall response rate for each biomarker cohort is defined as the proportion of participants achieving a complete (CR) or partial (PR) response on two consecutive occasions at least 4 weeks apart, as determined by the investigator from AFT50A Protocol: Tumor assessments per RECIST v1.1.
2. The proportion of participants in each biomarker cohort who remain alive and progression-free for at least 6 months [ Time Frame: 6 Months ]
   AFT-50B Protocol: Progression free survival rate at 6 months is defined as the proportion of participants who have not experienced disease progression or death from any cause at 6 months, as determined by the investigator according to RECIST v1.1

Secondary Outcome Measures :

1. Relative proportion of participants in each biomarker cohort who remain progression-free for at least 6 months compared to that from historical control studies [ Time Frame: 6 Months per cohort ]
   AFT-50A Protocol: PFS rate at 6 months is defined as the proportion of participants who have not experienced disease progression or death from any cause at 6 months, as determined by the investigator according to RECIST v1.1
2. Investigator assessed disease-control rate of each biomarker cohort [ Time Frame: 48 Months ]
   AFT-50A Protocol: Disease-control rate is defined as the proportion of participants achieving either stable disease, complete response, or partial response.
3. Duration of response for participants in each biomarker cohort who achieve a complete or partial response. [ Time Frame: 48 Months ]
   AFT-50A Protocol: Duration of response is defined as the time from the first occurrence of a documented objective response to disease progression or death from any cause (whichever occurs first), as determined by the investigator according to RECIST v1.1.
4. Overall survival (OS) rates of participants in each biomarker cohort after 24 months [ Time Frame: 24 Months per cohort ]
   AFT-50A Protocol: 24-month overall survival rate is defined as the proportion of participants who have not experienced death from any cause at 24 months.
5. Investigator assessed disease-control rate of each biomarker cohort [ Time Frame: 48 Months ]
   AFT-50B Protocol: Disease control rate is defined as the proportion of participants achieving either stable disease, complete response, or partial response at any time.
6. Duration of response for participants in each biomarker cohort who achieve a confirmed response (complete or partial) [ Time Frame: 48 Months ]
   AFT-50B Protocol: Duration of response is defined as the time from the first occurrence of a documented objective response (complete or partial) to disease progression or death from any cause (whichever occurs first), as determined by the investigator according to RECIST v1.1
7. Overall survival rates of participants in each biomarker cohort [ Time Frame: 24 Months ]
   AFT-50B Protocol: 24-month overall survival rate is defined as the proportion of participants who have not experienced death from any cause at 24 months.

Other Outcome Measures:

1. Safety of each biomarker cohort: adverse events [ Time Frame: 48 Months ]
   AFT-50A Protocol: The incidence and severity of adverse events, with severity determined according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0), as well as summaries of changes in clinically relevant laboratory test results, changes in vital signs, and study treatment exposures for each biomarker cohort
2. The safety of each biomarker cohort: Adverse Events [ Time Frame: 48 Months ]
   AFT-50B Protocol: The incidence and severity of adverse events, with severity determined according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events, Version 5.0 (NCI CTCAE v5.0). Summaries of changes in clinically relevant laboratory test results, changes in vital signs, and study treatment exposures for each biomarker cohort
3. Assess exploratory biomarkers in tumor tissue and peripheral blood, and their association with other molecular characteristics, disease status and/or participant response to study treatment [ Time Frame: 48 Months ]
   AFT-50A and AFT-50B Protocols: Association of exploratory biomarkers with clinical outcomes, including but not limited to molecular analysis of tumor tissue and peripheral blood, as well as cytokine/chemokine and cellular analysis of peripheral blood.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Criteria

Key Inclusion Criteria:

• Recurrent or persistent endometrial carcinoma which has progressed or recurred after at least 1, but no more than 2, prior lines of therapy. Prior hormonal therapies (e.g., tamoxifen, aromatase inhibitors) will not count toward the prior regimen limit. Chemotherapy given in conjunction with radiotherapy as a radiosensitizer will be counted as a systemic therapeutic regimen.
• Measurable disease per RECIST 1.1
• Availability of a representative tumor specimen that is suitable for determination of biomarker status via central testing (F1CDx) OR If a patient has a prior F1CDx report from 1 September 2019 or later, those NGS results can be used to determine biomarker status as long as the tumor tissue used in the report was obtained within 5 years prior to prescreening and appropriate signed consent is obtained from the patient.
• Life expectancy > 12 weeks
• Recovery from effects of recent radiotherapy, surgery, or chemotherapy

Key Exclusion Criteria:

• Endometrial tumors with the following histologies: squamous carcinomas, sarcomas
• Other invasive malignancies within the last 5 years, except for non-melanoma skin cancer with no evidence of disease within the past 5 years AND localized breast cancer with previous adjuvant chemotherapy treatment for breast cancer completed > 5 years ago
• Synchronous primary invasive ovarian or cervical cancer
• Have an active or history of autoimmune disease or immune deficiency
• Have a history of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis based on a screening chest computed tomography (CT) scan
• Active tuberculosis
• Severe infections within 4 weeks
• Have received therapeutic oral or IV antibiotic medication within 2 weeks, except prophylactic antibiotic medication
• Have significant cardiovascular disease
• Are administered treatment with a live attenuated vaccine within 4 weeks, or anticipation of need for such a vaccine during the course of the study
• Have prior allogeneic bone marrow transplantation or solid organ transplant
• Prior treatment with T-cell costimulating or immune checkpoint blockade therapies including, but not limited to, CD137 agonists, anti-PD-1, anti-PD-L1, and anti-CTLA-4 therapeutic antibodies
• History of treatment with systemic immunostimulatory agents (including but not limited to interferons, interleukin-2) within 4 weeks or 5 half-lives of the drug, whichever is longer, prior to initiation of study treatment
• History of treatment with systemic immunosuppressive medications within 2 weeks except acute, low-dose, systemic immunosuppressant medications, corticosteroids for chronic obstructive pulmonary disease and asthma, or mineralocorticoids and low-dose corticosteroids for participants with orthostatic hypotension or adrenocortical insufficiency
• Have a history or clinical evidence of any untreated CNS disease, seizures not controlled with standard medical therapy, or history of cerebrovascular accident (stroke), transient ischemic attack or subarachnoid hemorrhage within 6 months

Note: Additional study cohort specific inclusion and exclusion criteria may apply based on cohort assignment.

Contacts and Locations

Contacts

Contact: Quality Management and Compliance; 617-732-8727; ClinicalTrials.Queries@alliancefoundationtrials.org

Locations

United States, California

City of Hope Comprehensive Cancer Center; Recruiting

Duarte, California, United States, 91010

Contact: Daphne Stewart

Principal Investigator: Daphne Stewart, MD, MS

UCSF Helen Diller Family Comprehensive Cancer Center; Recruiting

San Francisco, California, United States, 94143

Contact: Edwin Alvarez, MD

Principal Investigator: Edwin Alvarez, MD

United States, District of Columbia

Medstar Georgetown Cancer Institute; Recruiting

Washington, District of Columbia, United States, 20007

Contact: Ebony Hoskins, MD

Principal Investigator: Ebony Hoskins, MD

United States, Florida

Mount Sinai Comprehensive Cancer Center; Recruiting

Miami Beach, Florida, United States, 33140

Contact: Brian Slomovitz, MD

Principal Investigator: Brian Slomovitz, MD

United States, Illinois

University of Chicago; Recruiting

Chicago, Illinois, United States, 60637

Contact: John Moroney, MD

Principal Investigator: John Moroney, MD

United States, Kansas

University of Kansas Cancer Center; Recruiting

Westwood, Kansas, United States, 66205

Contact: Andrea Jewell, MD

Principal Investigator: Andrea Jewell, MD

United States, Massachusetts

Dana Farber Cancer Institute; Recruiting

Boston, Massachusetts, United States, 02125

Contact: Joyce Liu, MD, MPH

Principal Investigator: Joyce Liu, MD, MPH

United States, Minnesota

University of Minnesota; Recruiting

Minneapolis, Minnesota, United States, 55455

Contact: Britt Erickson, MD

Principal Investigator: Britt Erickson, MD

United States, Missouri

Washington University School of Medicine Siteman Cancer Center; Recruiting

Saint Louis, Missouri, United States, 63110

Contact: Premal Thaker, MD, MS

Principal Investigator: Premal Thaker, MD, MS

United States, Nebraska

Nebraska Methodist Hospital; Recruiting

Omaha, Nebraska, United States, 68114

Contact: Brent Tierney, MD

Principal Investigator: Brent Tierney, MD

United States, New Jersey

Englewood Health; Active, not recruiting

Englewood, New Jersey, United States, 07631

Atlantic Health Systems/Morristown Medical Center; Recruiting

Morristown, New Jersey, United States, 07960

Contact: Nana Tchabo, MD

Principal Investigator: Nana Tchabo, MD

United States, New York

Roswell Park; Recruiting

Buffalo, New York, United States, 14263

Contact: Peter Frederick, MD

Principal Investigator: Peter Frederick, MD

Weill Cornell Medicine; Recruiting

New York, New York, United States, 10065

Contact: Evelyn Cantillo, MD, MPH

Principal Investigator: Evelyn Cantillo, MD, MPH

United States, North Carolina

Duke University Cancer Center; Recruiting

Durham, North Carolina, United States, 27710

Contact: Angeles Alvarez Secord, MD

Principal Investigator: Angeles Alvarez Secord, MD

United States, Oklahoma

University of Oklahoma Health Stephenson Cancer Center; Recruiting

Oklahoma City, Oklahoma, United States, 73104

Contact: Debra Richardson, MD

Principal Investigator: Debra Richardson, MD

United States, Oregon

Providence Portland Cancer Institute; Recruiting

Portland, Oregon, United States, 97213

Contact: Christopher Darus, MD

Principal Investigator: Christopher Darus, MD

United States, Pennsylvania

University of Pittsburgh Medical Center; Recruiting

Pittsburgh, Pennsylvania, United States, 15261

Contact: Alexander B. Olawaiye, MD

Principal Investigator: Alexander B Olawaiye, MD

United States, Rhode Island

Lifespan - Rhode Island Hospital; Recruiting

Providence, Rhode Island, United States, 02903

Contact: Don Dizon, MD

Principal Investigator: Don Dizon, MD

United States, Tennessee

Baptist Memorial Hospital; Recruiting

Memphis, Tennessee, United States, 38120

Contact: David Engle, MD

Principal Investigator: David Engle, MD

Sponsors and Collaborators

Alliance Foundation Trials, LLC.

Genentech, Inc.

Foundation Medicine

Pfizer

Eli Lilly and Company

More Information

Additional Information:

CTCAE Version 5.0 

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• Responsible Party: Alliance Foundation Trials, LLC.
• ClinicalTrials.gov Identifier: NCT04486352
• Other Study ID Numbers: AFT-50
• First Posted: July 24, 2020
• Last Update Posted: December 26, 2023
• Last Verified: December 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Endometrial Neoplasms; Uterine Neoplasms; Genital Neoplasms, Female; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Uterine Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Bevacizumab; Trastuzumab; Atezolizumab; Ado-Trastuzumab Emtansine; Letrozole; Maytansine; Talazoparib; Ipatasertib; Antibodies, Monoclonal; Inavolisib; Antineoplastic Agents, Immunological; Antineoplastic Agents; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Physiological Effects of Drugs; Growth Inhibitors; Immune Checkpoint Inhibitors