Enzalutamide for the Treatment of Androgen Receptor-Expressing Triple-Negative Breast Cancer

Abstract

Purpose Studies suggest that a subset of patients with triple-negative breast cancer (TNBC) have tumors that express the androgen receptor (AR) and may benefit from an AR inhibitor. This phase II study evaluated the antitumor activity and safety of enzalutamide in patients with locally advanced or metastatic AR-positive TNBC. Patients and Methods Tumors were tested for AR with an immunohistochemistry assay optimized for breast cancer; nuclear AR staining > 0% was considered positive. Patients received enzalutamide 160 mg once per day until disease progression. The primary end point was clinical benefit rate (CBR) at 16 weeks. Secondary end points included CBR at 24 weeks, progression-free survival, and safety. End points were analyzed in all enrolled patients (the intent-to-treat [ITT] population) and in patients with one or more postbaseline assessment whose tumor expressed ≥ 10% nuclear AR (the evaluable subgroup). Results Of 118 patients enrolled, 78 were evaluable. CBR at 16 weeks was 25% (95% CI, 17% to 33%) in the ITT population and 33% (95% CI, 23% to 45%) in the evaluable subgroup. Median progression-free survival was 2.9 months (95% CI, 1.9 to 3.7 months) in the ITT population and 3.3 months (95% CI, 1.9 to 4.1 months) in the evaluable subgroup. Median overall survival was 12.7 months (95% CI, 8.5 months to not yet reached) in the ITT population and 17.6 months (95% CI, 11.6 months to not yet reached) in the evaluable subgroup. Fatigue was the only treatment-related grade 3 or higher adverse event with an incidence of > 2%. Conclusion Enzalutamide demonstrated clinical activity and was well tolerated in patients with advanced AR-positive TNBC. Adverse events related to enzalutamide were consistent with its known safety profile. This study supports additional development of enzalutamide in advanced TNBC.

Trial registration: ClinicalTrials.gov NCT01889238.

Fig 1.

CONSORT diagram. MD, physician; RECIST, Response Evaluation Criteria in Solid Tumors; TNBC, triple-negative breast cancer.

Fig 2.

Kaplan-Meier plots of primary analysis of progression-free survival (PFS) in the (A) intent-to-treat (ITT) population and (B) evaluable subgroup and of overall survival (OS) in the (C) ITT population and (D) evaluable subgroup.

Fig 3.

Kaplan-Meier plots of updated overall survival in the (A) intent-to-treat population and (B) evaluable subgroup.

Fig A1.

Nuclear androgen receptor (AR) staining by immunohistochemistry on breast tissue samples using AR441 (Dako, Carpinteria, CA) and SP107 (Ventana, Tucson, AZ). ITT, intent to treat.