The primary objective of this study is to determine if estrogen receptor-targeted therapy
with fulvestrant used in combination with RAD001 (Everolimus) is an effective and safe
therapy for women with hormone receptor positive metastatic breast cancer after failure of
aromatase inhibitor therapy.
All subjects must be female. Postmenopausal status, defined as any one of the following
criteria: (a) Documented history of bilateral oophorectomy.
(b) Age 60 years or more. (c) Age 45 to 59 and satisfying one or more of the following
1. Amenorrhea for at least 12 months and intact uterus.
2. Amenorrhea for less than 12 months and a follicle stimulating hormone (FSH)
concentration within postmenopausal range including:
1. Patients who have had a hysterectomy.
2. Patients who have received hormone replacement. Patients must have
histologically confirmed invasive breast cancer. Metastatic or locally advanced
disease. Patients must have estrogen receptor and/or progesterone receptor
Measurable or evaluable disease. Failure of aromatase inhibitor therapy within the
previous 6 months. Patients who received prior tamoxifen are eligible to enroll.
Prior aromatase inhibitor therapy or other endocrine therapy must be discontinued at least
1 week prior to enrollment and any toxicity from such therapy must have reverted to grade
I or less at the time of enrollment.
Patients must not have received chemotherapy, radiation therapy, or had surgery within 4
weeks prior to enrollment and any toxicity from such therapy must have recovered to grade
1 or less prior to enrollment.
Patients must not have received either of the study medications previously. WHO
performance status of 0, 1, or 2.
Adequate organ function defined as follows:
1. Adequate renal function, defined by a serum creatinine within the upper limits of
2. Adequate liver function, defined by a bilirubin of < 1.5 the upper limit of normal
(ULN) and AST, ALT of ≤ 2.5 times the ULN.
3. Adequate bone marrow function, defined as an ANC ≥ 1.5 x 109/L, PLT >100,000/ul, Hb
4. INR <1.3.
Known severe hypersensitivity to RAD001 (or similar drugs) or any of the excipients of
Premenopausal status. Other coexisting malignancies with the exception of basal cell
carcinoma or cervical cancer in situ.
Patients with brain metastasis or leptomeningeal involvement. Patients with malignant
pleural effusion or ascites only disease. Rapidly progressive visceral disease. WHO
performance status of 3 or 4.
As judged by the investigator, uncontrolled intercurrent illness including, but not
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris or significant cardiac arrhythmia
- Psychiatric illness/social situations that would limit compliance with study
- Severely impaired lung function such as severe COPD or interstitial lung disease, a
known FEV1 of < 1.5 liters, or dyspnea of grade III or greater.
- Uncontrolled diabetes as defined by a FBS of > 1.5 ULM.
- Known liver disease such as cirrhosis or chronic hepatitis.
- Known HIV positivity.
- Known condition causing malabsorption. Chronic treatment with systemic steroids or
other immunosuppressive agents. Patients should not receive immunization with
attenuated live vaccines within one week of study entry or during study period.
Evidence of any other significant clinical disorder or laboratory finding that makes it
undesirable for the subject to participate in the clinical trial.
Prior treatment with an mTOR inhibitor. Treatment with a non-approved or investigational
drug within 30 days or 5 half-lives of the drug, whichever is greater, before Day 1 of
In the opinion of the investigator, bleeding diathesis or anticoagulation therapy that
would preclude intramuscular injections.
History of hypersensitivity to castor oil.