Use of PRO Onc Assay to Assess HER2 in Patients With Metastatic Breast Cancer

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Prometheus Laboratories
Genentech
Information provided by (Responsible Party):
SCRI Development Innovations, LLC
ClinicalTrials.gov Identifier:
NCT01048099
First received: January 12, 2010
Last updated: July 29, 2014
Last verified: July 2014
  Purpose

This trial will evaluate the clinical significance of the PRO Onc assay and will assess the efficacy of HER2-targeted therapy in patients with HER2-negative breast cancer who have been identified as having HER2 overexpression/activation by the PRO Onc Assay.


Condition Intervention
Breast Cancer
Procedure: PRO Onc Assay and Treatment
Drug: Trastuzumab
Drug: Pertuzumab

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Use of the PRO Onc Assay to Assess HER2 Overexpression and Activation in Patients With Metastatic Breast Cancer Whose Tumors Are HER2-Negative by Standard FISH Testing

Resource links provided by NLM:


Further study details as provided by SCRI Development Innovations, LLC:

Primary Outcome Measures:
  • Part 1: Assess the incidence of HER2 overexpression/activation, as measured by the PRO Onc Assay, in a group of patients with HER2-negative metastatic breast cancer (as determined by FISH testing) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Part II: Assess the objective response rate of HER2-negative metastatic breast cancer (by FISH testing) who have HER2 overexpression/activation by PRO Onc Assay [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Part I: Determine the incidence of isolation of circulating tumor cells from blood specimens of women with HER2-negative metastatic breast cancer as determined by FISH testing [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Part II: Assess the objective response rate of trastuzumab therapy in patients with HER2 overexpression identified by the PRO Onc Assay [ Time Frame: 18 months ] [ Designated as safety issue: No ]
  • Part II: Assess the objective response rate of pertuzumab therapy in patients with HER2 activation, without overexpression, identified by the PRO Onc Assay [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 450
Study Start Date: January 2011
Estimated Study Completion Date: December 2016
Estimated Primary Completion Date: August 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: PRO Onc Assay and Treatment
Blood specimens tested for circulating tumor cells followed by systemic treatment based on assay results with either trastuzumab or pertuzumab
Procedure: PRO Onc Assay and Treatment
Patients with HER2-negative metastatic breast cancer will be identified, and blood specimens will be obtained from each participant. The PRO Onc Assay will be performed on CTCs isolated from these specimens. When clinically indicated, fine needle aspiration biopsy will also be obtained and submitted for the PRO Onc Assay.
Other Names:
  • blood draw
  • fine needle aspiration
  • circulating tumor cells
Drug: Trastuzumab
8 mg/kg IV loading dose, followed by 6 mg /kg IV every 3 weeks until progressive disease or unacceptable toxicity with evaluations performed every 8 weeks
Other Names:
  • Trastuzumab
  • Herceptin
Drug: Pertuzumab
840 mg IV loading dose, followed by 420 IV every 3 weeks until progressive disease or unacceptable toxicity with evaluations performed every 8 weeks
Other Names:
  • Pertuzumab
  • Perjeta

Detailed Description:

This two-part trial is designed to evaluate the clinical significance of the PRO Onc assay when used in patients with metastatic HER2-negative breast cancer. The first part of this study will determine the incidence of HER overexpression/activation, as determined by the PRO Onc assay, in patients previously judged to have HER2-negative breast cancer by FISH analysis. Blood specimens will be obtained from patients with HER2-negative breast cancer; CTCs will then be isolated and tested for HER2 overexpression/activation using the PRO Onc Assay. When clinically indicated, fine needle aspiration biopsy will also be obtained and submitted for the PRO Onc Assay. If the incidence of HER2 overexpression/activation, as determined by the PRO Onc Assay, is >10%, the study will proceed to Part 2. Part 2 of this study will assess the efficacy of HER2-targeted therapy in a group of patients with HER2-negative breast cancer who are identified as having HER2 overexpression/activation by the PRO Onc Assay. Patients will be treated with either trastuzumab or pertuzumab. Patients who progress during the first 8 weeks will have HER2-targeted treatment discontinued and will be removed from study. After 8 weeks, patients who have stable disease will be allowed to add chemotherapy to HER2-targeted therapy. Patients who have an objective response to single-agent, HER2-targeted therapy after 8 weeks will continue single-agent therapy.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Part I

  1. Women with HER2-negative breast cancer, as defined by FISH testing. (FISH testing may have been performed on the primary tumor, or subsequently on a biopsy of a metastatic lesion.)
  2. Patients should be currently receiving chemotherapy, or scheduled to start chemotherapy (second-line or subsequent), for HER2-negative metastatic breast cancer.
  3. To begin protocol treatment, patients must have progressed after at least 1 previous chemotherapy regimen for metastatic breast cancer.
  4. Patients who are ER/PR positive or negative are eligible. ER/PR positive patients should be refractory to hormonal therapy, or not good candidates for hormonal therapy due to clinical features.
  5. ECOG performance status of 0, 1 or 2.
  6. Adequate recovery from recent surgery; ≥ 1 week must have elapsed from the time of a minor surgery; ≥ 4 weeks must have elapsed from the time of a major surgery.
  7. Patients must have measurable disease per RECIST criteria.
  8. Laboratory values as follows: Absolute neutrophil count (ANC) ≥1500/μL Hemoglobin (Hgb) ≥10 g/dL Platelets ≥100,000/L AST or ALT and alkaline phosphatase (ALP) must be <2.5 x ULN, or <5 x ULN in patients with liver metastases. Total bilirubin <1.5 x the institutional ULN Serum creatinine <1.5 x institutional ULN or calculated creatinine clearance ≥45 mL/min Patients from Part 1 who have HER2 overexpression/activation identified by the PRO Onc Assay may enter the treatment portion of Part 2, if they meet all Part 2 eligibility criteria.
  9. Life expectancy of ≥ 12 weeks.
  10. Patient must be accessible for treatment and follow-up.
  11. Patients must be able to understand the investigational nature of this study and give written informed consent prior to study entry.

Part II

  1. Women with HER2-negative breast cancer, as defined by FISH testing. (FISH testing may have been performed on the primary tumor, or subsequently on a biopsy of a metastatic lesion.)
  2. Patients should be currently receiving chemotherapy, or scheduled to start chemotherapy, for HER2-negative metastatic breast cancer.
  3. Patients who are ER/PR positive or negative are eligible. ER/PR positive patients should be refractory to hormonal therapy, or not good candidates for hormonal therapy due to clinical features.
  4. ECOG performance status of 0, 1 or 2.
  5. Adequate recovery from recent surgery; ≥ 1 week must have elapsed from the time of a minor surgery; ≥ 4 weeks must have elapsed from the time of a major surgery.
  6. Patients must have measurable disease per RECIST criteria.
  7. Laboratory values as follows:

    • Absolute neutrophil count (ANC) ≥1500/μL
    • Hemoglobin (Hgb) ≥10 g/dL
    • Platelets ≥100,000/uL
    • AST or ALT and alkaline phosphatase (ALP) must be <2.5 x ULN, or <5 x ULN in patients with liver metastases.
    • Total bilirubin <1.5 x the institutional ULN
    • Serum creatinine <1.5 x institutional ULN or calculated creatinine clearance ≥45 mL/min
  8. Life expectancy of ≥ 12 weeks.
  9. Patient must be accessible for treatment and follow-up.
  10. Patients must be able to understand the investigational nature of this study and give written informed consent prior to study entry.
  11. Patients who are eligible for HER2-targeted treatment will begin this treatment at the first time a treatment change is necessary (i.e. at the next progression of metastatic breast cancer). This may occur immediately after PRO Onc assay results are received, or may be several months later, for patients responding well to their current chemotherapy.
  12. Patients must continue to meet all inclusion and exclusion criteria for the Part 2 screening population at the time they are ready to start HER2-targeted treatment.
  13. Ejection fraction ≥ 50%, as measured by echocardiogram (ECHO) or MUGA.

Exclusion Criteria:

Part I:

  1. Patients currently responding to hormonal therapy.
  2. Previous treatment with any HER2-targeted agent.
  3. Patients with meningeal metastases.
  4. Patients who are not considered likely candidates for subsequent therapy after next progression of metastatic breast cancer.
  5. Women who are pregnant or lactating.
  6. Patients with New York Heart Association class II or greater congestive heart failure.
  7. Any of the following ≤6 months prior to starting study treatment:

    • myocardial infarction;
    • severe unstable angina;
    • ongoing cardiac dysrhythmia
  8. Concurrent severe, intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit safety and compliance with study requirements.
  9. Mental condition that would prevent patient comprehension of the nature of, and risk associated with, the study.
  10. Use of any non-approved or investigational agent ≤ 30 days of administration of the first dose of study drug. Patients may not receive any other investigational or anti-cancer treatments while participating in this study.

Part II

  1. Patients currently responding to hormonal therapy.
  2. Previous treatment with any HER2-targeted agent.
  3. Patients with meningeal metastases.
  4. Patients with active brain metastases. Patients who have received radiation or surgery for brain metastases are eligible if there is no evidence of central nervous system (CNS) disease progression, and at least 4 weeks have elapsed since treatment. Ideally, patients should not still require use of seizure medication or steroids.
  5. Patients who are not considered likely candidates for subsequent therapy after next progression of metastatic breast cancer.
  6. Women who are pregnant or lactating.
  7. Patients with New York Heart Association class II or greater congestive heart failure.
  8. Any of the following ≤6 months prior to starting study treatment:

    • myocardial infarction;
    • severe unstable angina;
    • ongoing cardiac dysrhythmia.
  9. Concurrent severe, intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit safety and compliance with study requirements.
  10. Mental condition that would prevent patient comprehension of the nature of, and risk associated with, the study.
  11. Use of any non-approved or investigational agent ≤ 30 days of administration of the first dose of study drug. Patients may not receive any other investigational or anti-cancer treatments while participating in this study.
  12. Past or current history of neoplasm other than the entry diagnosis with the exception of treated non-melanoma skin cancer or carcinoma in situ of the cervix, or other cancers cured by local therapy alone and a DFS ≥5 years.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01048099

Locations
United States, Florida
Florida Cancer Specialists
Fort Myers, Florida, United States, 33916
Florida Cancer Specialists
St. Petersburg, Florida, United States, 33705
United States, Ohio
Oncology Hematology Care, Inc.
Cincinnati, Ohio, United States, 45242
United States, Tennessee
Chattanooga Oncology Hematology Associates
Chattanooga, Tennessee, United States, 37404
Tennessee Oncology, PLLC
Nashville, Tennessee, United States, 37023
United States, Texas
Center for Cancer and Blood Disorders
Fort Worth, Texas, United States, 76104
United States, Virginia
Virginia Cancer Institute
Richmond, Virginia, United States, 23230
Sponsors and Collaborators
SCRI Development Innovations, LLC
Prometheus Laboratories
Genentech
Investigators
Study Chair: John D. Hainsworth, M.D. SCRI Development Innovations, LLC
  More Information

No publications provided

Responsible Party: SCRI Development Innovations, LLC
ClinicalTrials.gov Identifier: NCT01048099     History of Changes
Other Study ID Numbers: SCRI BRE 166
Study First Received: January 12, 2010
Last Updated: July 29, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by SCRI Development Innovations, LLC:
Breast Cancer
Metastatic
PRO Onc Assay
FISH Testing
HER Negative
HER Overexpression
HER Activation

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Trastuzumab
Pertuzumab
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions

ClinicalTrials.gov processed this record on September 22, 2014