START : Study on Androgen Receptor and Triple Negative Breast Cancer

Prior treatment

• PREVIOUS TREATMENT IN THE METASTATIC SETTING: Previous treatment with: capecitabine (MET SETTING), first generation (bicalutamide) or second–generation AR inhibitors (enzalutamide, ARN–509, darolutamide) or other investigational AR inhibitors CYP17 enzyme inhibitor such as abiraterone (capecitabine in the adjuvant setting is allowed provided the last administration was at least ≥12 months prior to study entry)
• Prior anticancer therapy within the last 3 weeks including radiotherapy, endocrine therapy, immunotherapy; chemotherapy (6 weeks for nitrosoureas and mitomycin C), or other investigational agents; concurrent palliative radiotherapy is allowed;
• Concurrent enrolment in another clinical trial in which investigational therapies are administered;
• Non-malignant systemic disease, including active infection or concurrent serious illness that would make the patient a high medical risk;
• Persistent toxicities grade ≥ 2 from any cause, except chemotherapy-induced alopecia and Grade 2 peripheral neuropathy;

Other illness

• An active viral hepatitis, known human immunodeficiency virus infection with detectable viral load, or chronic liver disease requiring treatment;
• Patients with known deficit of dihydropyrimidine dehydrogenase (DPD) activity; or in case of hypersensitivity to capecitabine or to any of its excipients or to fluorouracil;
• Patients with any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule. Those conditions should be discussed with the patient before registration in the trial;
• Patients with history of non-compliance to medical regimens or unwilling or unable to comply with the protocol;
• Active brain metastases or leptomeningeal disease; history of brain metastases allowed provided lesions are stable for at least 3 months as documented by head CT scan or MRI of the brain.
• Significant cardiovascular disease, including any of the following: a) NYHA class III-IV congestive heart failure b) Stroke, unstable angina pectoris, or myocardial infarction within the past 6 months c) Severe valvular heart disease d) Ventricular arrhythmia requiring treatment;
• Any gastrointestinal disorder interfering with absorption of the study drug;

Lab values

• Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not be included;

Age

• Other concurrent malignancies, except adequately treated cone-biopsied in situ carcinoma of the cervix or basal cell or squamous cell carcinoma of the skin; patients who have undergone potentially curative therapy for a prior malignancy are eligible provided there is no evidence of disease for ≥ 5 years and patient is deemed to be at low risk for recurrence;

Other

• HER2-positive status (positivity defined as IHC3+ and/or FISH amplification >2);
• Pregnant women, women who are likely to become pregnant or are breast-feeding;
• Individual deprived of liberty or placed under the authority of a tutor.
• Difficulties with swallowing tablets;

• Woman ≥ 18 years old;
• Normal hepatic function: total bilirubin ≤ 1.5 upper normal limit (UNL) unless this increase is due to a known Gilbert's disease; ASAT and ALAT ≤ 2.5 UNL (or ≤ 5 UNL in case of hepatic metastasis);
• Creatinine clearance (MDRD formula) ≥ 50 mL/min;
• Uracilemia< 16 ng/ml
• Systolic blood pressure (BP) < 160 mm Hg and diastolic BP < 95 mm Hg, as documented on day of registration/consent (Hypertension allowed provided it is currently controlled);
• Cardiac ejection fraction ≥50% measured by MUGA or ECHO done within 4 weeks before inclusion;
• For premenopausal patients, patient agreeing to use effective contraception during and for ≥ 6 months after completion of study treatment;
• Patient able to comply with the protocol;
• Patient must have signed a written informed consent form prior to any study specific procedures;
• Patient must be affiliated to a Social Health Insurance.
• Histologically confirmed locally recurrent (unresectable) or metastatic breast cancer;
• Triple-negative breast cancer
• Androgen receptor (AR)-positive, as defined centrally by a ≥ 10% tumor stained cells by IHC
• Patients with a relapse should be chemotherapy naïve or have received a maximum of one line of chemotherapy for advanced disease (providing they are not presenting with life-threatening metastasis); patients could have received adjuvant or neo-adjuvant therapy;
• In the exceptional situation of pre-menopausal patient, the addition of a LHRH analog is recommended (androgens might act as an estrogen antagonist in premenopausal patients);
• Presence of measurable or evaluable disease according to RECIST v1.1;
• ECOG ≤ 1;
• Normal hematological function: ANC ≥ 1.500/mm3; platelets count ≥ 100.000/mm3; hemoglobin > 10 g/dL;