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GDC-0449 and RO4929097 in Treating Women With Advanced Breast Cancer
This study has been suspended.
( Potential risk of severe or life-threatening arrhythmia )

First Received on February 18, 2010.   Last Updated on November 1, 2011   History of Changes
Sponsor: Barbara Ann Karmanos Cancer Institute
Collaborator: National Cancer Institute (NCI)
Information provided by: Barbara Ann Karmanos Cancer Institute
ClinicalTrials.gov Identifier: NCT01071564
  Purpose

RATIONALE: GDC-0449 and RO4929097 may slow the growth of tumor cells and may be an effective treatment for advanced breast cancer.

PURPOSE: This phase I trial is studying the side effects and best dose of giving GDC-0449 together with RO4929097 in treating women with advanced breast cancer.


Condition Intervention Phase
Breast Cancer
Drug: Hedgehog antagonist GDC-0449
Drug: gamma-secretase inhibitor RO4929097
Other: laboratory biomarker analysis
Other: pharmacogenomic studies
Other: pharmacological study
Phase 1

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I Dose-Escalation Study of the Hedgehog Smoothened Antagonist GDC-0449 (NSC # 747691) Plus Pan-Notch Inhibitor RO4929097 (NSC # 749225) Administered in Patients With Advanced Breast Cancer

Resource links provided by NLM:


Further study details as provided by Barbara Ann Karmanos Cancer Institute:

Primary Outcome Measures:
  • Occurrence of adverse events and the associated NCI CTCAE grade [ Designated as safety issue: Yes ]
  • Occurrence of dose-limiting toxicities and the associated NCI CTCAE grade [ Designated as safety issue: Yes ]
  • Identification of the maximum tolerated dose and/or recommended phase II dose [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Pharmacokinetic and pharmacogenetic parameters [ Designated as safety issue: No ]
  • Levels of select breast cancer stem cell (BCSC) biomarkers in the Hedgehog and Notch signaling pathways as measured at baseline and at 2 and 3 weeks [ Designated as safety issue: No ]
  • Percentage of BCSC in breast tumor biopsies as measured at baseline and at 2 and 3 weeks [ Designated as safety issue: No ]
  • Tumor response as measured by RECIST criteria before and after treatment [ Designated as safety issue: No ]

Estimated Enrollment: 36
Study Start Date: February 2010
Estimated Primary Completion Date: September 2012 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Hedgehog antagonist GDC-0449
    Schedule A & Schedule B: 150mg administered orally daily starting Day 8
    Drug: gamma-secretase inhibitor RO4929097
    Schedule A: RO4929097 administered single dose orally - Cycle 1,Day 1 and Days 1-3, 8-10 every 21 days starting Day 22 (Cycle 2, Day 1) Schedule B: RO4929097 administered single dose orally - Cycle 1, Day -2, -1,and 1 and PO Days 1-3, 8-10 every 21 days starting Day 22 (Cycle 2, Day 1)
    Other: laboratory biomarker analysis
    The first biopsy will occur within one week prior to the first dose of RO4929097 (baseline). The second biopsy will occur either within 4-6 hours after the scheduled daily dose of GDC-0449 on Cycle 1 Day 17 (SCHEDULE A) or within 4-6 hours after the scheduled daily dose of RO4929097 on Cycle 1 Day 1 (SCHEDULE B). The third biopsy will occur on Cycle 2 Day 9 and will be obtained within 4-6 hours after the scheduled daily dose of GDC-0449 and RO4929097 on Cycle 2 Day 9. PD markers will be evaluated in surrogate tissue (hair follicles) at all biopsy timepoints.
    Other: pharmacogenomic studies
    Samples collected one week prior to treatment.
    Other: pharmacological study
    SCHEDULE A: Cycle 1, Days 1-3 SCHEDULE B: Cycle 1, Days -2, -1, and 1 Cycle 1 Day 17 & 21 Cycle 2 Day 7,9 & 10
Detailed Description:

OBJECTIVES:

Primary

  • To determine the safety and tolerability of Hedgehog antagonist GDC-0449 in combination with gamma-secretase inhibitor RO4929097 in women with advanced breast cancer.
  • To determine the dose-limiting toxicity and maximum tolerated dose and/or recommended phase II dose of this regimen in these patients.

Secondary

  • To determine the pharmacokinetics and pharmacogenetics of Hedgehog antagonist GDC-0449 and gamma-secretase inhibitor RO4929097 when administered alone and in combination.
  • To attempt to evaluate select pharmacodynamic stem cell differentiation biomarkers in the Hedgehog and Notch signaling pathways (e.g., Gli1/2/3, Ptch1/2, Hes1, Hip1, Hey1, Notch4, Jagged1, Numb, Bmi-1, CD44/CD24, ALDH) and the percentage of breast cancer stem cells in serial breast tumor biopsies before and after Hedgehog antagonist GDC-0449 or gamma-secretase inhibitor RO4929097 when administered alone and after 1 course of treatment when administered in combination.
  • To determine tumor response in patients with measurable disease as assessed by RECIST criteria.

OUTLINE: This is a multicenter study.

Patients receive oral gamma-secretase inhibitor RO4929097 on day 1 OR on days -2, -1, and 1 and oral Hedgehog antagonist GDC-0449 on days 8-21 of course 1. Beginning in course 2, patients receive oral gamma-secretase inhibitor RO4929097 on days 1-3 and 8-10 and oral Hedgehog antagonist GDC-0449 on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Blood, tumor tissue, and hair samples are collected periodically for pharmacokinetic, pharmacodynamic, pharmacogenomic, and other correlative biomarker studies.

After completion of study treatment, patients are followed up for 30 days.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed advanced breast cancer for which standard curative or palliative measures do not exist or are no longer effective

    • Metastatic or unresectable disease
  • HER-2 non-expressing tumor, defined as IHC 0-2+ AND FISH ratio < 2.0
  • Measurable disease per RECIST guidelines OR evaluable (non-measurable) disease
  • Tumor must be accessible and suitable for serial biopsy with 3 passes of a 16-gauge needle
  • Failed ≥ 1 prior systemic therapy for metastatic breast cancer
  • No known active brain metastases

    • Brain metastases that have been previously treated and stable for ≥ 1 month are allowed provided they were not accompanied by seizures and that a baseline brain MRI scan before study entry demonstrates no current evidence of progressive brain metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
  • Life expectancy > 12 weeks
  • ANC ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 9 g/dL
  • AST and ALT ≤ 2.5 times upper limit of normal (ULN) (≤ 5 times ULN in the presence of liver metastases)
  • Alkaline phosphatase ≤ 2.0 times ULN (≤ 5 times ULN in the presence of bone or liver metastases)
  • Bilirubin ≤ 1.5 times ULN
  • Creatinine ≤ 1.5 times ULN OR calculated or measured creatinine clearance ≥ 60 mL/min
  • QTc interval of ≤ 470 ms as measured by ECG using Bazett's formula
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use 2 forms of effective contraception (i.e., 1 barrier method and 1 other method of contraception) for ≥ 4 weeks before, during, and for ≥ 12 months after completion of study treatment
  • Able and willing to provide archival tissue block or paraffin sample from archival tissue block (approximately 10 sections) for use in pharmacodynamic and pharmacogenomic correlative studies
  • Agrees to undergo a total of 3 serial biopsies for research purposes
  • Able to swallow tablets
  • No malabsorption syndrome or other condition that would interfere with intestinal absorption
  • No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, or hypokalemia, defined as less than the lower limit of normal despite adequate electrolyte supplementation
  • No co-morbid condition(s) that, in the opinion of the investigator, would preclude safe treatment
  • No concurrent uncontrolled illness including, but not limited to, any of the following:

    • Ongoing or active infection
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Psychiatric illness or social situation that would limit compliance with study requirements
  • No active infection or fever > 38.5°C
  • No HIV or hepatitis B or C positivity
  • No clinically active liver disease, including active viral or other hepatitis or cirrhosis
  • No history of seizures

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior therapy with either a γ-secretase or Hedgehog inhibitor

    • Patients who received prior Hedgehog antagonist GDC-0449 or gamma-secretase inhibitor RO4929097 as part of a single or limited dosing study (i.e., phase 0 study) may be eligible
  • No prior allogeneic stem cell transplantation
  • No prior radiotherapy to ≥ 50% of total marrow volume
  • More than 3 weeks since prior radiotherapy to ≤ 5% of total marrow volume (4 weeks for radiotherapy to > 5% of total marrow volume) and recovered to < grade 2 toxicities
  • More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered

    • Patients with residual taxane neuropathy of ≤ grade 1 are eligible
  • More than 30 days or 5 half-lives since prior investigational therapy or immunotherapy and recovered
  • No concurrent growth factor support (e.g., Neulasta®, Neupogen®) for chronic maintenance of WBC counts or granulocyte counts
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No concurrent medications or food that may interfere with the metabolism of Hedgehog antagonist GDC-0449 and gamma-secretase inhibitor RO4929097, including ketoconazole, grapefruit juice, and/or grapefruit
  • No other concurrent anticancer therapy (e.g., cytotoxic therapy, biologic therapy, radiotherapy, or hormonal therapy other than for replacement)

    • Medications that are prescribed for supportive care but may potentially have an anticancer effect (e.g., megestrol acetate or bisphosphonates) are allowed provided they were started 1 month before study enrollment
  • No other concurrent investigational therapy
  • Concurrent warfarin anticoagulation allowed provided all of the following criteria are met:

    • Patients are therapeutic on a stable warfarin dose
    • INR target range is ≤ 3
    • INR is monitored weekly
    • No active bleeding or pathological condition that carries a high risk of bleeding
  • Other concurrent anticoagulants, including enoxaparin (Lovenox) or fondaparinux (Arixtra) allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01071564

Locations
United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231-2410
United States, Michigan
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, United States, 48109-5942
Barbara Ann Karmanos Cancer Institute
Detroit, Michigan, United States, 48201-1379
United States, Mississippi
University of Mississippi Cancer Clinic
Jackson, Mississippi, United States, 39216
United States, Texas
Dan L. Duncan Cancer Center at Baylor College of Medicine
Houston, Texas, United States, 77030
Sponsors and Collaborators
Barbara Ann Karmanos Cancer Institute
Investigators
Principal Investigator: Patricia M. LoRusso, DO Barbara Ann Karmanos Cancer Institute
  More Information

Additional Information:
No publications provided

Responsible Party: Patricia M. LoRusso, Barbara Ann Karmanos Cancer Institute
ClinicalTrials.gov Identifier: NCT01071564     History of Changes
Other Study ID Numbers: CDR0000662081, U01CA062487, WSU-2009-099
Study First Received: February 18, 2010
Last Updated: November 1, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Barbara Ann Karmanos Cancer Institute:
stage IIIA breast cancer
stage IIIB breast cancer
stage IIIC breast cancer
stage IV breast cancer
recurrent breast cancer
HER2-negative breast cancer

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases

ClinicalTrials.gov processed this record on May 23, 2012