Gefitinib, Trastuzumab, and Docetaxel in Treating Patients With Metastatic Breast Cancer - Full Text View

Purpose

RATIONALE: Gefitinib may stop the growth of tumor cells by blocking the enzymes necessary for their growth. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining gefitinib and trastuzumab with docetaxel may kill more tumor cells.

PURPOSE: This phase I/II trial is studying the best dose of docetaxel when given together with gefitinib and trastuzumab in treating patients with metastatic breast cancer.

Condition	Intervention	Phase
Breast Cancer	Biological: trastuzumab Drug: docetaxel Drug: gefitinib	Phase 1 Phase 2


Study Type:	Interventional
Study Design:	Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Phase I/II Trial of ZD1839 (Iressa®), Trastuzumab (Herceptin®), and Docetaxel (Taxotere®) in Patients With erbB-2 (HER-2) Overexpressing, Stage IV Breast Carcinoma

Resource links provided by NLM:

Genetics Home Reference related topics: breast cancer

MedlinePlus related topics: Breast Cancer

Drug Information available for: Docetaxel Trastuzumab Gefitinib

Genetic and Rare Diseases Information Center resources: Breast Cancer, Male

U.S. FDA Resources

Further study details as provided by City of Hope Medical Center:

Primary Outcome Measures:

Number of Participants With at Least One Dose Limiting Toxicity in Phase I [ Time Frame: 4 weeks from start of treatment, up to 2 years ]
Dose Limiting Toxicity (DLT) defined as any treatment-related grade 3 or greater except for hematological toxicities which must be grade 4. Interstitial Lung Disease (ILD) related to treatment should be considered as a DLT regardless of the grade.
Recommended Phase II Dose [ Time Frame: 4 weeks from start of treatment, up to 2 years ]
The maximum tolerated dose (MTD): subjects received gefitinib 250 mg orally daily, trastuzumab 6 mg/kg intravenously every 3 weeks (after an initial dose of 8 mg/kg with cycle 1), and docetaxel 75 mg/m^2 intravenously every 3 weeks. This was to serve as the phase II dose if no dose-limiting toxicities (DLTs) occurred in the first three subjects. If one DLT occurred in the first three subjects, another three subjects where to be enrolled at this dose, whereas if two DLTs occurred in the first three subjects, the docetaxel dose was to be decreased to 60 mg/m^2. The study would then be continued only if no more than one patient had a DLT at this dose. Once the dose of docetaxel was established, all further subjects were to be treated at the phase II MTD dose.

Secondary Outcome Measures:

Progression-free Survival [ Time Frame: Until disease progression, up to 5 years. ]
Estimated using the product-limit method of Kaplan and Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST), as a 20% increase in the sum of the longest diameter of target lesions, or the appearance of new lesions.
Objective Response Rate [ Time Frame: After 3 cycles of treatment, up to 2 years. ]
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Objective Response Rate defined as percentage of patients achieving a Best Response of either CR or PR.
Overall Survival [ Time Frame: Until death from any cause, up to 5 years. ]
Estimated using the product-limit method of Kaplan and Meier.


Enrollment:	31
Study Start Date:	January 2004
Study Completion Date:	August 2015
Primary Completion Date:	August 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: ZD1839, Trastuzumab and Docetaxel	Biological: trastuzumab Cycle 1 loading dose of 8 mg/kg, followed by 6 mg/kg every 3 weeks for subsequent cycles. Drug: docetaxel 75 mg/m2 every three weeks, or 60 mg/m2 every three weeks depending on study findings Drug: gefitinib 250 mg daily or 250 mg daily on days 2 through 14 depending on study findings

Detailed Description:

OBJECTIVES:

Primary

Determine the safety and efficacy of gefitinib, trastuzumab (Herceptin®), and docetaxel, in terms of time to disease progression, in patients with HER2/neu-overexpressing metastatic adenocarcinoma of the breast.

Secondary

Determine the objective tumor response rate in patients treated with this regimen.
Correlate expression and/or degree of phosphorylation of epidermal growth factor receptor, HER2/neu, c-fos, Akt, ERK½, P13K, p53, p21, and p27 with outcome in patients treated with this regimen.

OUTLINE: This is a phase I, multicenter, dose-escalation study of docetaxel followed by a phase II study. Patients are stratified according to trastuzumab (Herceptin®)-naive vs trastuzumab-failure.

Phase I: Patients receive oral gefitinib once daily on days 2-14. Patients also receive trastuzumab* IV over 30-90 minutes and docetaxel IV over 1 hour on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

NOTE: *Trastuzumab is given at a higher dose (loading dose) in course 1 and then at a lower dose in subsequent courses.

Cohorts of 3-6 patients receive docetaxel at dose level 1. If no dose-limiting toxicity (DLT) is observed in the first cohort of 3 patients, the dose of docetaxel remains the same. If 1 DLT is observed in the first cohort of 3 patients, 3 additional patients are added (for a total of 6 patients) to dose level 1. If no further DLTs are observed at dose level 1, the dose of docetaxel remains the same. If 2 of 3 or 2 of 6 patients experience DLT at dose level 1, the dose of docetaxel is considered above the maximum tolerated dose (MTD) and is subsequently reduced. If 2 of 3 or 2 of 6 patients experience DLT at the reduced dose of docetaxel, the study is stopped.

Phase II: Patients receive docetaxel at the MTD and gefitinib and trastuzumab as in phase I.

Patients are followed for survival.

PROJECTED ACCRUAL: A total of 3-76 patients will be accrued for this study within 26 months.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

Histologically confirmed adenocarcinoma of the breast
- Metastatic disease
HER-2/neu overexpression (3+ by immunohistochemistry OR 2+ by fluorescence in situ hybridization)
Measurable or evaluable disease
Hormone receptor status:
- Not specified

PATIENT CHARACTERISTICS:

Age

18 and over

Sex

Male or female

Menopausal status

Not specified

Performance status

ECOG 0-2

Life expectancy

Not specified

Hematopoietic

Absolute granulocyte count ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3

Hepatic

AST and ALT < 2.5 times upper limit of normal (ULN) (5.0 times ULN in the presence of liver metastases)
Bilirubin < 1.5 times ULN
No unstable or uncompensated hepatic disease

Renal

Creatinine < 1.6 mg/dL
No unstable or uncompensated renal disease

Cardiovascular

LVEF > 45% by echocardiogram or MUGA
No prior New York Heart Association class I-IV heart disease
No prolonged PR interval or atrioventricular block on ECG
No unstable or uncompensated cardiac disease

Pulmonary

No unstable or uncompensated respiratory disease
No clinically active interstitial lung disease
- Patients who are asymptomatic and have chronic stable radiographic changes are allowed

Immunologic

No autoimmune disorders
No conditions of immunosuppression
No severe hypersensitivity to taxane or gefitinib or any of its excipients

Other

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No other prior or concurrent malignancy within the past 5 years except basal cell carcinoma or carcinoma in situ of the cervix
No other severe or uncontrolled systemic disease
No other acute or chronic medical condition that would preclude study participation
No other significant clinical disorder or laboratory finding that would preclude study participation
No psychiatric illness that would preclude study compliance

PRIOR CONCURRENT THERAPY:

Biologic therapy

Prior adjuvant trastuzumab (Herceptin®) allowed if > 6 months elapsed before disease recurrence
No prior trastuzumab for metastatic breast cancer
No prior monoclonal antibodies directed at the epidermal growth factor receptor (EGFR)

Chemotherapy

Prior adjuvant chemotherapy (or as first-line therapy for metastatic breast cancer) allowed
Prior adjuvant taxane allowed if completed > 6 months before diagnosis of metastatic breast cancer
No prior docetaxel for metastatic breast cancer

Endocrine therapy

Prior adjuvant hormonal therapy (or as first-line therapy for metastatic breast cancer) allowed
No concurrent hormonal therapy
- Concurrent steroids allowed provided dose is stable

Radiotherapy

Not specified

Surgery

Fully recovered from prior oncologic or other major surgery
No concurrent surgery within 7 days of gefitinib administration

Other

Recovered from prior anticancer therapy (alopecia allowed)
More than 30 days since prior non-approved drug or investigational agent
No other prior EGFR-directed therapy (i.e., tyrosine kinase inhibitors)
No concurrent use of any of the following medications:
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampin
- Hypericum perforatum (St. John's wort)
No other concurrent anticancer therapy
No concurrent cardioprotective drugs
No concurrent oral retinoids
Concurrent participation in the City of Hope indium-labeled trastuzumab imaging study allowed

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: NCT00086957

Locations


United States, California
Tower Cancer Research Foundation
Beverly Hills, California, United States, 90211-1850
City of Hope Comprehensive Cancer Center
Duarte, California, United States, 91010-3000
Hematology Oncology Consultants-Hemet
Hemet, California, United States, 92543
Breastlink Medical Group, Incorporated at Long Beach Memorial Medical Center
Long Beach, California, United States, 90806
USC/Norris Comprehensive Cancer Center and Hospital
Los Angeles, California, United States, 90089-9181
City of Hope Medical Group
Pasadena, California, United States, 91105

Sponsors and Collaborators

City of Hope Medical Center

National Cancer Institute (NCI)

Investigators


Principal Investigator:	George Somlo, MD	City of Hope Medical Center

More Information

Publications:

Somlo G, Koczywas M, Luu T, et al.: A phase I-II study of trastuzumab, gefitinib, and docetaxel as first line chemotherapy in patients with HER-2 overexpressing stage IV breast carcinoma. [Abstract] Breast Cancer Research and Treatment 94 (Suppl 1): A-2035, 2005.


Responsible Party:	City of Hope Medical Center
ClinicalTrials.gov Identifier:	NCT00086957 History of Changes
Other Study ID Numbers:	03049 P30CA033572 ( US NIH Grant/Contract Award Number ) CHNMC-03049 ZENECA-1839US/0274 ZENECA-IRUSIRES0012 CDR0000371908 ( Registry Identifier: NCI PDQ )
Study First Received:	July 8, 2004
Results First Received:	November 4, 2016
Last Updated:	January 6, 2017

Keywords provided by City of Hope Medical Center:


stage IV breast cancer male breast cancer recurrent breast cancer

Additional relevant MeSH terms:


Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Docetaxel Gefitinib Trastuzumab	Antineoplastic Agents Tubulin Modulators Antimitotic Agents Mitosis Modulators Molecular Mechanisms of Pharmacological Action Protein Kinase Inhibitors Enzyme Inhibitors

ClinicalTrials.gov processed this record on June 23, 2017