Trastuzumab and External Beam Radiation Therapy in Treating Women With Stage III or Stage IV Breast Cancer

• Pathologic response rate [ Time Frame: 5 weeks ] [ Designated as safety issue: No ]
  Pathological response will be measured for those subjects who are deemed surgical candidates. Pathologic response will be defined as invasive tumor present pathologically, or complete invasive tumor clearance (pCR), which includes those tumors with no tumor present as well as those tumors with only in situ carcinoma present after all therapy
• Locoregional recurrence rate [ Time Frame: up to 5 years ] [ Designated as safety issue: No ]
  Radiographic response and recurrence rate will captured using RECIST criteria. Subjects will be followed up for 5 years to document recurrence.
• Time to locoregional recurrence [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
  Radiographic response and recurrence rate will captured using RECIST criteria. Subjects will be followed up to 5 years to document recurrence
• Time to local progression (in patients who are deemed to be non-surgical candidates) [ Time Frame: Up to 5 years ] [ Designated as safety issue: No ]
  Radiographic response and recurrence rate will captured using RECIST criteria. Disease progression is defined as an increase in the product of two perpendicular diameters of any measured lesion by > 25% over the size at study entry or the appearance of new areas of malignant disease

• Pathologic response rate [ Designated as safety issue: No ]
• Locoregional recurrence rate [ Designated as safety issue: No ]
• Time to locoregional recurrence [ Designated as safety issue: No ]
• Time to local progression (in patients who are deemed to be non-surgical candidates) [ Designated as safety issue: No ]

RATIONALE: Monoclonal antibodies, such as trastuzumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Radiation therapy uses high-energy x-rays to kill tumor cells. Trastuzumab may make tumor cells more sensitive to radiation therapy. Giving trastuzumab together with radiation therapy may kill more tumor cells.

PURPOSE: This phase II trial is studying the side effects and how well giving trastuzumab together with external beam radiation therapy works in treating women with stage III or stage IV breast cancer.

OBJECTIVES:

Primary

• Determine the tolerability of trastuzumab (Herceptin®) and concurrent external beam radiotherapy in women with HER2-overexpressing stage III or IV breast cancer.

Secondary

• Determine the pathologic response rate in patients treated with this regimen.
• Determine the locoregional recurrence rate (as site of first recurrence or any recurrence) and time to locoregional recurrence in patients treated with this regimen.
• Determine the time to local progression in patients (who are deemed to be non-surgical candidates) treated with this regimen .

OUTLINE: This is a multicenter study.

Patients receive trastuzumab IV over 30-90 minutes once a week for 5 weeks. Patients also undergo external beam radiotherapy once daily 5 days a week for 5 weeks.

Three weeks after the completion of trastuzumab and radiotherapy, patients undergo surgical evaluation. Patients deemed to be surgical candidates undergo surgery. Patients deemed to be non-surgical candidates continue to receive trastuzumab and external beam radiotherapy for 2 additional weeks.

After completion of study therapy, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

• Radiation: external beam radiation therapy
  Radiation therapy will consist of 50Gy in 2Gy fractions to the breast/chest wall and regional lymphatics for 5 consecutive days up to 5 weeks for surgical candidates and 7 weeks for non-surgical candidates
• Drug: Herceptin
  Patients who are already receiving weekly Herceptin® will continue weekly Herceptin®, 2mg/kg IV on day 1 of each week of radiotherapy. Patients who have not been receiving weekly Herceptin® as a component of systemic therapy will begin Herceptin® one week prior to beginning radiotherapy with a loading dose of 4mg/kg followed by weekly Herceptin® at 2mg/kg on day 1 of each week of radiotherapy

• Active Comparator: Surgical Candidate
  After 5 consecutive weeks of treatment with Radiation and Herceptin, these subjects will receive mastectomy excision
  Interventions:

  • Radiation: external beam radiation therapy
  • Drug: Herceptin
• Active Comparator: Non-Surgical Candidate
  After 5 weeks of consecutive treatment with radiation and herceptin, these subjects will not be eligible for surgery. They will continue with radiation and herceptin for an additional 2 weeks.
  Interventions:

  • Radiation: external beam radiation therapy
  • Drug: Herceptin

DISEASE CHARACTERISTICS:

• Histologically confirmed* invasive primary carcinoma of the breast by fine-needle aspiration, core needle biopsy, or incisional biopsy
• Excisional biopsy is not allowed

• Stage III or IV disease (clinical and radiographic staging), including any of the following:

  • Any T with N2 disease (metastasis to ipsilateral axillary lymph nodes fixed to one another or other structures) or N3 disease (metastasis to ipsilateral internal mammary lymph nodes)
  • T4, any N disease
  • Inflammatory disease
  • Supraclavicular and/or infraclavicular adenopathy
  • Distant metastasis with measurable disease in the breast or lymph nodes
• HER2-overexpressing tumor
• Measurable or evaluable disease
• Residual locoregional disease after completion of neoadjuvant chemotherapy OR locoregional recurrent disease
• Synchronous bilateral primary cancers allowed provided the more serious of the two cancers meets staging criteria
• Hormone receptor status not specified

PATIENT CHARACTERISTICS:

• Menopausal status not specified
• WBC > 2,000/mm^3
• Platelet count > 50,000/mm^3
• Hemoglobin > 11 g/dL
• Negative pregnancy test
• Fertile patients must use effective contraception
• Radionucleotide ventriculography/LVEF normal OR ≤ 10% asymptomatic decline from baseline after completion of neoadjuvant chemotherapy

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior radiotherapy to the breast or regional lymph nodes
• Concurrent participation in neoadjuvant chemotherapy clinical trials allowed