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Phase 3 Trial of Elacestrant vs. Standard of Care for the Treatment of Patients With ER+/HER2- Advanced Breast Cancer (EMERALD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03778931
Recruitment Status : Active, not recruiting
First Posted : December 19, 2018
Results First Posted : December 5, 2023
Last Update Posted : March 29, 2024
Sponsor:
Information provided by (Responsible Party):
Stemline Therapeutics, Inc.

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: None (Open Label);   Primary Purpose: Treatment
Condition Breast Cancer
Interventions Drug: Elacestrant
Drug: Standard of Care
Enrollment 478
Recruitment Details  
Pre-assignment Details  
Arm/Group Title Elacestrant Standard of Care (SoC)
Hide Arm/Group Description

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
Period Title: Overall Study
Started 239 239
Intent-to-Treat Population 239 239
Safety Population 237 230
Completed 95 [1] 114 [1]
Not Completed 144 125
[1]
Overall study includes survival follow-up; subjects designated as "Not Completed" were still in survival follow-up.
Arm/Group Title Elacestrant Standard of Care (SoC) Total
Hide Arm/Group Description

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
Total of all reporting groups
Overall Number of Baseline Participants 239 239 478
Hide Baseline Analysis Population Description
[Not Specified]
Age, Categorical  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 239 participants 239 participants 478 participants
<=18 years
0
   0.0%
0
   0.0%
0
   0.0%
Between 18 and 65 years
135
  56.5%
128
  53.6%
263
  55.0%
>=65 years
104
  43.5%
111
  46.4%
215
  45.0%
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 239 participants 239 participants 478 participants
Female
233
  97.5%
238
  99.6%
471
  98.5%
Male
6
   2.5%
1
   0.4%
7
   1.5%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 239 participants 239 participants 478 participants
Hispanic or Latino
19
   7.9%
18
   7.5%
37
   7.7%
Not Hispanic or Latino
194
  81.2%
191
  79.9%
385
  80.5%
Unknown or Not Reported
26
  10.9%
30
  12.6%
56
  11.7%
Height   [1] 
Mean (Standard Deviation)
Unit of measure:  Cm
Number Analyzed 236 participants 237 participants 473 participants
162.27  (7.860) 160.97  (7.149) 161.62  (7.532)
[1]
Measure Analysis Population Description: subjects were missing from these measures
Weight  
Mean (Standard Deviation)
Unit of measure:  Kg
Number Analyzed 239 participants 239 participants 478 participants
72.70  (16.093) 72.39  (16.390) 72.55  (16.226)
Body Mass Index   [1] 
Mean (Standard Deviation)
Unit of measure:  Kg/m^2
Number Analyzed 236 participants 237 participants 473 participants
27.58  (5.494) 27.92  (5.853) 27.75  (5.673)
[1]
Measure Analysis Population Description: 5 subjects missing
Eastern Cooperative Oncology Group Performance Status   [1] 
Measure Type: Count of Participants
Unit of measure:  Participants
0: Fully active, able to carry on all pre-disease performance without restriction Number Analyzed 239 participants 239 participants 478 participants
143
  59.8%
135
  56.5%
278
  58.2%
1: Restricted in physically strenuous activity but ambulatory & can carry out light, sedentary work Number Analyzed 239 participants 239 participants 478 participants
96
  40.2%
103
  43.1%
199
  41.6%
2: Ambulatory and capable of all selfcare but unable to carry out any work activities Number Analyzed 239 participants 239 participants 478 participants
0
   0.0%
1
   0.4%
1
   0.2%
[1]
Measure Description:

Participated were graded on a scale from 0 to 5, where 5 was worst:

0: Normal activity. Fully active, able to carry on all pre-disease performance w/o restriction

  1. Symptoms, but ambulatory. Restricted in strenuous activity, ambulatory and able to carry out light work
  2. In bed <50% of time. Ambulatory, capable of all self-care, unable to carry out any work activities
  3. In bed >50% of time. Capable of limited self-care
  4. 100% bedridden. Completely disabled. Cannot carry out any self-care. Confined to bed or chair
  5. Dead
1.Primary Outcome
Title Progression-free Survival in ESR1-mut Subjects
Hide Description Progression-free Survival based on blinded IRC assessment in ESR1-mut subjects defined as the length of time from randomization until the date of objective disease progression per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) as assessed by the blinded IRC or death from any cause. Progression is defined per RECIST v1.1 as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.
Time Frame From Date of Randomization until Disease Progression or Death Due to Any Cause (up to 12 Months)
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Elacestrant Standard of Care (SoC)
Hide Arm/Group Description:

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
Overall Number of Participants Analyzed 115 113
Median (95% Confidence Interval)
Unit of Measure: months
3.78
(2.17 to 7.26)
1.87
(1.87 to 2.14)
2.Primary Outcome
Title Progression-free Survival in All Subjects
Hide Description Progression-free Survival based on blinded Imaging Review Committee (IRC) assessment in all (ESR1-mut and ESR1-WT) subjects
Time Frame From Date of Randomization until Disease Progression or Death Due to Any Cause (up to 12 Months)
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Elacestrant Standard of Care (SoC)
Hide Arm/Group Description:

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
Overall Number of Participants Analyzed 239 239
Median (95% Confidence Interval)
Unit of Measure: months
2.79
(1.94 to 3.78)
1.91
(1.87 to 2.10)
3.Secondary Outcome
Title Overall Survival in ESR1-mut Subjects
Hide Description Overall Survival in ESR1-mut subjects, where Overall Survival is defined as the length of time from randomization until the date of death from any cause
Time Frame From Date of Randomization until Death Due to Any Cause (Estimated up to 24 Months)
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Elacestrant Standard of Care (SoC)
Hide Arm/Group Description:

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
Overall Number of Participants Analyzed 115 113
Median (95% Confidence Interval)
Unit of Measure: months
NA [1] 
(18.60 to NA)
16.95 [1] 
(14.00 to NA)
[1]
NA=not calculable (insufficient number of participants with events)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Elacestrant, Standard of Care (SoC)
Comments The analysis was performed using a stratified Cox Proportional Hazards model with ties=Efron and the stratification factors: prior treatment with fulvestrant (yes vs no) and presence of visceral metastases (yes vs no); the CI calculated using a profile likelihood approach.
Type of Statistical Test Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.6141
Comments The p-value was generated by using a two-sided stratified log-rank test.
Method Log Rank
Comments [Not Specified]
Method of Estimation Estimation Parameter Hazard Ratio (HR)
Estimated Value 0.894
Confidence Interval (2-Sided) 95%
0.577 to 1.386
Estimation Comments [Not Specified]
4.Secondary Outcome
Title Overall Survival in All Subjects
Hide Description Overall Survival in All (ESR1-mut and ESR1-WT) Subjects
Time Frame From Date of Randomization until Death Due to Any Cause (Estimated up to 24 Months)
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Elacestrant Standard of Care (SoC)
Hide Arm/Group Description:

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
Overall Number of Participants Analyzed 239 239
Median (95% Confidence Interval)
Unit of Measure: months
NA [1] 
(19.29 to NA)
NA [1] 
(15.80 to NA)
[1]
NA=not calculable (insufficient number of participants with events)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Elacestrant, Standard of Care (SoC)
Comments [Not Specified]
Type of Statistical Test Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.0697
Comments [Not Specified]
Method Log Rank
Comments The p-value was generated by using a two-sided stratified log-rank test.
Method of Estimation Estimation Parameter Hazard Ratio (HR)
Estimated Value 0.742
Confidence Interval (2-Sided) 95%
0.536 to 1.025
Estimation Comments Applied a stratified Cox Proportional Hazards model with ties=Efron and the stratification factors: ESR1-mutational status (ESR1-mut vs ESR1-mut-nd), prior treatment with fulvestrant (yes vs no) and presence of visceral metastases (yes vs no).
Time Frame 24 months
Adverse Event Reporting Description All-Cause Mortality was assessed in the Intention-to-Treat Population (239, 239 participants), which consists of all randomized subjects. This is the primary population for Progression-Free Survival and Overall Survival analyses in the Outcome Measures. Adverse Events reporting reflects the Safety Population (237, 230 participants), which consists of all subjects who received at least 1 dose of study medication. Serious and Other Adverse Events were assessed in the Safety Population.
 
Arm/Group Title Elacestrant Standard of Care (SoC)
Hide Arm/Group Description

Subjects in Arm 1 will receive elacestrant

Elacestrant: 400 mg/day once daily oral dosing

Subjects in Arm 2 will receive Investigator's choice of one of the Standard of Care drugs (fulvestrant, anastrozole, letrozole, or exemestane)

Standard of Care: • Fulvestrant: 500 mg administered intramuscularly (IM) into the buttocks as two 5 mL injections on C1D1, C1D15 and C2D1 and Day 1 of every subsequent 28-day cycle

  • Anastrozole 1 mg/day on a continuous dosing schedule
  • Letrozole: 2.5 mg/day on a continuous dosing schedule
  • Exemestane: 25 mg/day on a continuous dosing schedule
All-Cause Mortality
Elacestrant Standard of Care (SoC)
Affected / at Risk (%) Affected / at Risk (%)
Total   70/239 (29.29%)   80/239 (33.47%) 
Hide Serious Adverse Events
Elacestrant Standard of Care (SoC)
Affected / at Risk (%) Affected / at Risk (%)
Total   29/237 (12.24%)   25/230 (10.87%) 
Blood and lymphatic system disorders     
Antiphospholipid syndrome  1  1/237 (0.42%)  0/230 (0.00%) 
Cardiac disorders     
Cardiac arrest  1  1/237 (0.42%)  0/230 (0.00%) 
Angina pectoris  1  0/237 (0.00%)  1/230 (0.43%) 
Arrhythmia  1  0/237 (0.00%)  1/230 (0.43%) 
Myocardial infarction  1  0/237 (0.00%)  1/230 (0.43%) 
Gastrointestinal disorders     
Nausea  1  3/237 (1.27%)  0/230 (0.00%) 
Vomiting  1  2/237 (0.84%)  0/230 (0.00%) 
Small intestinal obstruction  1  2/237 (0.84%)  0/230 (0.00%) 
Abdominal pain  1  0/237 (0.00%)  2/230 (0.87%) 
Colitis  1  0/237 (0.00%)  1/230 (0.43%) 
Diarrhoea  1  0/237 (0.00%)  1/230 (0.43%) 
Enteritis  1  0/237 (0.00%)  1/230 (0.43%) 
Ileus  1  0/237 (0.00%)  1/230 (0.43%) 
Intestinal ischaemia  1  1/237 (0.42%)  0/230 (0.00%) 
General disorders     
General physical health deterioration  1  1/237 (0.42%)  1/230 (0.43%) 
Pyrexia  1  1/237 (0.42%)  0/230 (0.00%) 
Asthenia  1  1/237 (0.42%)  0/230 (0.00%) 
Mucosal inflammation  1  1/237 (0.42%)  0/230 (0.00%) 
Gait disturbance  1  0/237 (0.00%)  1/230 (0.43%) 
Hepatobiliary disorders     
Cholecystitis acute  1  1/237 (0.42%)  0/230 (0.00%) 
Infections and infestations     
Diverticulitis  1  1/237 (0.42%)  1/230 (0.43%) 
Pneumonia  1  1/237 (0.42%)  3/230 (1.30%) 
Septic shock  1  1/237 (0.42%)  0/230 (0.00%) 
COVID-19  1  0/237 (0.00%)  1/230 (0.43%) 
Device related sepsis  1  0/237 (0.00%)  1/230 (0.43%) 
Sepsis  1  0/237 (0.00%)  1/230 (0.43%) 
Urinary tract infection  1  0/237 (0.00%)  2/230 (0.87%) 
Injury, poisoning and procedural complications     
Femoral neck fracture  1  1/237 (0.42%)  0/230 (0.00%) 
Road traffic accident  1  1/237 (0.42%)  0/230 (0.00%) 
Investigations     
Blood bilirubin increased  1  1/237 (0.42%)  0/230 (0.00%) 
Neutrophil count decreased  1  0/237 (0.00%)  1/230 (0.43%) 
Platelet count decreased  1  0/237 (0.00%)  1/230 (0.43%) 
Metabolism and nutrition disorders     
Decreased appetite  1  1/237 (0.42%)  0/230 (0.00%) 
Dehydration  1  1/237 (0.42%)  0/230 (0.00%) 
Electrolyte imbalance  1  1/237 (0.42%)  0/230 (0.00%) 
Hypercalcaemia  1  1/237 (0.42%)  1/230 (0.43%) 
Hypokalaemia  1  0/237 (0.00%)  1/230 (0.43%) 
Musculoskeletal and connective tissue disorders     
Back pain  1  2/237 (0.84%)  0/230 (0.00%) 
Bone pain  1  1/237 (0.42%)  0/230 (0.00%) 
Pain in extremity  1  1/237 (0.42%)  0/230 (0.00%) 
Pathological fracture  1  1/237 (0.42%)  1/230 (0.43%) 
Arthritis  1  0/237 (0.00%)  1/230 (0.43%) 
Neoplasms benign, malignant and unspecified (incl cysts and polyps)     
Malignant neoplasm of pleura  1  0/237 (0.00%)  1/230 (0.43%) 
Tumour pain  1  0/237 (0.00%)  1/230 (0.43%) 
Nervous system disorders     
Spinal cord compression  1  2/237 (0.84%)  0/230 (0.00%) 
Headache  1  1/237 (0.42%)  0/230 (0.00%) 
Nervous system disorder  1  1/237 (0.42%)  0/230 (0.00%) 
Cerebrovascular accident  1  0/237 (0.00%)  1/230 (0.43%) 
Cranial nerve paralysis  1  0/237 (0.00%)  1/230 (0.43%) 
Dysarthria  1  0/237 (0.00%)  1/230 (0.43%) 
Ischaemic stroke  1  0/237 (0.00%)  1/230 (0.43%) 
Meningeal disorder  1  0/237 (0.00%)  1/230 (0.43%) 
Seizure  1  0/237 (0.00%)  1/230 (0.43%) 
Renal and urinary disorders     
Acute kidney injury  1  1/237 (0.42%)  0/230 (0.00%) 
Respiratory, thoracic and mediastinal disorders     
Dyspnoea  1  1/237 (0.42%)  0/230 (0.00%) 
Lung disorder  1  1/237 (0.42%)  0/230 (0.00%) 
Pleural effusion  1  1/237 (0.42%)  0/230 (0.00%) 
Pulmonary embolism  1  1/237 (0.42%)  1/230 (0.43%) 
1
Term from vocabulary, MedDRA version 23.0
Indicates events were collected by systematic assessment
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 5%
Elacestrant Standard of Care (SoC)
Affected / at Risk (%) Affected / at Risk (%)
Total   218/237 (91.98%)   198/230 (86.09%) 
Blood and lymphatic system disorders     
Anaemia  1  22/237 (9.28%)  17/230 (7.39%) 
Lymphocyte count decreased  1  12/237 (5.06%)  5/230 (2.17%) 
Gastrointestinal disorders     
Nausea  1  83/237 (35.02%)  44/230 (19.13%) 
Vomiting  1  45/237 (18.99%)  20/230 (8.70%) 
Diarrhoea  1  33/237 (13.92%)  23/230 (10.00%) 
Constipation  1  29/237 (12.24%)  15/230 (6.52%) 
Dyspepsia  1  24/237 (10.13%)  6/230 (2.61%) 
Abdominal pain  1  15/237 (6.33%)  14/230 (6.09%) 
General disorders     
Fatigue  1  45/237 (18.99%)  44/230 (19.13%) 
Asthenia  1  22/237 (9.28%)  19/230 (8.26%) 
Injection site pain  1  0/237 (0.00%)  14/230 (6.09%) 
Infections and infestations     
Urinary tract infection  1  16/237 (6.75%)  12/230 (5.22%) 
Investigations     
Aspartate aminotransferase increased  1  31/237 (13.08%)  29/230 (12.61%) 
Alanine aminotransferase increased  1  22/237 (9.28%)  24/230 (10.43%) 
Blood cholesterol increased  1  16/237 (6.75%)  7/230 (3.04%) 
Blood alkaline phosphatase increased  1  15/237 (6.33%)  17/230 (7.39%) 
Blood pressure Increased  1  9/237 (3.80%)  12/230 (5.22%) 
Blood glucose increased  1  6/237 (2.53%)  12/230 (5.22%) 
Metabolism and nutrition disorders     
Decreased appetite  1  35/237 (14.77%)  22/230 (9.57%) 
Musculoskeletal and connective tissue disorders     
Arthralgia  1  34/237 (14.35%)  37/230 (16.09%) 
Back pain  1  33/237 (13.92%)  22/230 (9.57%) 
Musculoskeletal chest pain  1  14/237 (5.91%)  7/230 (3.04%) 
Musculoskeletal pain  1  11/237 (4.64%)  13/230 (5.65%) 
Myalgia  1  11/237 (4.64%)  17/230 (7.39%) 
Pain in extremity  1  18/237 (7.59%)  14/230 (6.09%) 
Bone pain  1  15/237 (6.33%)  15/230 (6.52%) 
Nervous system disorders     
Headache  1  29/237 (12.24%)  26/230 (11.30%) 
Psychiatric disorders     
Insomnia  1  18/237 (7.59%)  11/230 (4.78%) 
Respiratory, thoracic and mediastinal disorders     
Dyspnoea  1  18/237 (7.59%)  16/230 (6.96%) 
Cough  1  15/237 (6.33%)  12/230 (5.22%) 
Vascular disorders     
Hot flush  1  27/237 (11.39%)  19/230 (8.26%) 
1
Term from vocabulary, MedDRA version 23.0
Indicates events were collected by systematic assessment
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Carlos A. Garay, MD, Senior Vice President, Clinical Development & Medical Affairs - Solid Tumors
Organization: Stemline Therapeutics, Inc.
Phone: 877-332-7967
EMail: clinicaltrials@menarinistemline.com
Layout table for additonal information
Responsible Party: Stemline Therapeutics, Inc.
ClinicalTrials.gov Identifier: NCT03778931    
Other Study ID Numbers: RAD1901-308
First Submitted: December 3, 2018
First Posted: December 19, 2018
Results First Submitted: March 20, 2023
Results First Posted: December 5, 2023
Last Update Posted: March 29, 2024