Carboplatin and Bevacizumab for Progressive Breast Cancer Brain Metastases
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ClinicalTrials.gov Identifier: NCT01004172 |
Recruitment Status :
Completed
First Posted : October 29, 2009
Results First Posted : May 22, 2017
Last Update Posted : December 14, 2018
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Metastatic Breast Cancer Breast Cancer Progressive Breast Cancer | Drug: carboplatin Drug: bevacizumab Drug: herceptin | Phase 2 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 38 participants |
Allocation: | N/A |
Intervention Model: | Single Group Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Phase II Trial of Carboplatin and Bevacizumab for Progressive Breast Cancer Brain Metastases |
Actual Study Start Date : | November 2009 |
Actual Primary Completion Date : | December 2013 |
Actual Study Completion Date : | February 2017 |

Arm | Intervention/treatment |
---|---|
Experimental: carboplatin, bevacizumab, trastuzumab (if HER2+)
Participants received treatment until disease progression in either CNS or non-CNS site. Cycle duration is 28 days. carboplatin: AUC=5 dose given intravenously on day 8 of cycle one and Day 1 of each subsequent cycle bevacizumab: 15 mg/kg dose given intravenously on day 1 of each cycle trastuzumab*: 6 mg/kg dose given intravenously on day 8 of each cycle for patients with HER2-positive breast cancer only *8mg/kg loading dose in cycle 1 for some participants HER-2: human epidermal growth factor receptor 2 |
Drug: carboplatin Drug: bevacizumab Other Name: Avastin Drug: herceptin Other Name: trastuzumab |
- Central Nervous System (CNS) Objective Response Rate [ Time Frame: Response was evaluated radiologically at baseline and every 2 cycles on treatment. Treatment duration for this study cohort was a median (range) of 8 cycles (1-20) which approximates months given the 4 week cycle length. ]
CNS objective response rate is the percentage of participants that achieve CNS complete or partial response as follows:
CNS complete response (CR) is achieved if all of the following are satisfied:
- Complete resolution of all measurable (>= 1 cm in longest dimension [LD]) and non-measurable brain metastases
- No new CNS lesions (defined as any new lesion >= 6 mm in LD)
- Stable or decreasing steroid dose
- No new/progressive tumor-related neurologic signs or symptoms
- No progression of extra-CNS disease as assessed by RECIST
CNS partial response (PR) is achieved if all of the following are satisfied:
->/= 50% reduction in the volumetric sum of all measurable (>/= 1 cm in LD) brain metastases compared to baseline
- No progression on non-measurable lesions
- No new CNS lesions (defined as any new lesion >/= 6 mm in LD)
- Stable or decreasing steroid dose
- No new/progressive tumor-related neurologic signs or symptoms
- No progression of extra-CNS disease as assessed by RECIST
- Progression-Free Survival [ Time Frame: Disease was evaluated radiologically at baseline, cycle 2, cycle 4 and thereafter on treatment every 2 cycles (CNS disease) and every 4 cycles (non-disease). Maximum PFS follow-up for this study cohort was 18.6 months. ]
Progression-Free Survival (PFS) is defined as the duration of time from start of treatment to time of disease progression (PD), second cancer, or death, whichever occurs first. PD if any of the following occur:
CNS Disease
- >/=40% increase in the volumetric sum of all measurable lesions as compared to the smallest volume on treatment
- Progression of non-measurable lesions
- New lesions (>/=6 mm)
Non-CNS Disease
• RECIST 1.0 criteria: at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded on treatment or the appearance of >/=1 new lesions. For non-target lesions, PD is the appearance of one or more new lesions and/or unequivocal progression of non-target lesions.
Symptomatic
- Increasing steroid requirement
- Global deterioration of health status requiring discontinuation of treatment
- New/progression tumor-related neurologic signs and symptoms except for transient worsening lasting </=14 days
- CNS Best Response [ Time Frame: Response was evaluated radiologically at baseline and every 2 cycles on treatment. Treatment duration for this study cohort was a median (range) of 8 cycles (1-20) which approximates months given the 4 week cycle length. ]
CNS best response was defined based on standard criteria. Adding to CR and PR (defined in the primary outcome measure):
CNS stable disease (SD) is achieving all the following:
- < 50% reduction in the volumetric sum of all measurable (>/= 1 cm in LD) brain metastases compared to baseline
- No progression on non-measurable lesions
- No new CNS lesions (defined as any new lesion >/= 6 mm in LD)
- Stable or decreasing steroid dose
- No new/progressive tumor-related neurologic signs or symptoms
- No progression of extra-CNS disease as assessed by RECIST
CNS Progressive Disease (PD) was experiencing any of the following:
->/- 40% increase in the volumetric sum of all measurable (>/= 1 cm in LD) brain metastases compared to baseline
- Progression on non-measurable lesions
- New CNS lesions (defined as any new lesion >/= 6 mm in LD)
- Increasing steroid dose
- New/progressive tumor-related neurologic signs or symptoms
- Progression of extra-CNS disease as assessed by RECIST
- Site of First Progression [ Time Frame: Disease was evaluated radiologically at baseline, cycle 2, cycle 4 and thereafter on treatment every 2 cycles (CNS disease) and every 4 cycles (non-disease). Maximum progression follow-up for this study cohort was 18.6 months. ]
Site of first progression is classified as follows:
CNS Disease
- >/=40% increase in the volumetric sum of all measurable lesions as compared to the smallest volume on treatment
- Progression of non-measurable lesions
- New lesions (>/=6 mm) Non-CNS Disease
- Per RECIST 1.0 criteria: PD is at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. For non-target lesions, PD is the appearance of one or more new lesions and/or unequivocal progression of non-target lesions.
Symptomatic
- Increasing steroid requirement
- Global deterioration of health status requiring discontinuation of treatment
- New/progression tumor-related neurologic signs and symptoms (NSS) except for transient worsening lasting </=14 days
- Overall Survival [ Time Frame: Maximum survival follow-up for the study cohort was 66 months. ]Participants were assessed every 6 months post-treatment. Overall survival is defined as the time from study entry to death or date last known alive and estimated using Kaplan-Meier (KM) methods.

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Histologically or cytologically confirmed invasive breast cancer, with metastatic disease. patients without pathologic or cytologic confirmation of metastatic disease should have unequivocal evidence of metastasis by physical exam or radiologic study
- Measurable disease. Patients must have measurable CNS disease, defined as at least one parenchymal brain lesion that can be accurately measured in at least one dimension with longest dimension >/= 10mm by local radiology review
- New or progressive CNS lesions, as assessed by the patient's treating physician
- No increase in corticosteroid dose in the week prior to the baseline brain MRI
- 18 years of age or older
- Life expectancy of greater than 12 weeks
- Eastern Cooperative Oncology Group Performance Score (ECOG PS) performance status 0-2
- Normal organ and marrow function as outlined in the protocol
- Left ventricular ejection fraction >/= 50%, as determined by radionuclide ventriculography (RVG) or echocardiogram within 60 days prior to initiation of protocol therapy
- Prior carboplatin is allowed if it was not given in conjunction with bevacizumab
- Prior trastuzumab is allowed
- No prior bevacizumab since diagnosis of CNS metastases or within 6 months prior to diagnosis of CNS metastases
- Women of child-bearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation
Exclusion Criteria:
- Patients who have had chemotherapy within 14 days prior to entering the study, or those who have not recovered adequately from adverse events due to agents administered earlier
- Patients may not receive any concurrent investigational agents while on study
- Patients may not receive any cancer-directed concurrent therapy , such as concurrent chemotherapy, radiotherapy, or hormonal therapy while on study. Concurrent treatment with bisphosphonates is allowed
- History of Grade 3 or 4 allergic reactions attributed to compounds of similar or identical biologic composition to bevacizumab, carboplatin, or trastuzumab
- Known contraindication to MRI with gadolinium contrast, such as cardiac pacemaker, shrapnel, or ocular foreign body
- Leptomeningeal carcinomatosis as the only site of CNS involvement
- More than 2 seizures over last 4 weeks prior to study entry
- Grade 1 or higher CNS hemorrhage on baseline brain MRI
- History of grade 2 or higher CNS hemorrhage within 12 months of study entry
- Inadequately controlled hypertension
- Prior history of hypertensive crisis or hypertensive encephalopathy
- New York Heart Association (NYHA) Grade II or greater congestive heart failure
- History of myocardial infraction or unstable angina within 6 months prior to day 1
- Significant vascular disease within 6 months prior to day 1
- History of hemoptysis within 1 month prior to day 1
- Evidence of bleeding diathesis or significant coagulopathy
- Current, ongoing treatment with full-dose warfarin or its equivalent
- Use of aspirin (>325 mg/day) within 10 days prior to day 1
- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to day 1 or anticipation of need for major surgical procedure during the course of the study.
- Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to day 1
- History of abdominal fistula or gastrointestinal perforation within 6 months prior to day 1
- Serious, non-healing wound, active ulcer, or untreated bone fracture
- Proteinuria as demonstrated by a urine protein-creatinine ratio >/= 1.0 at screening
- Known hypersensitivity to any component of bevacizumab
- Pregnancy or lactation

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01004172
United States, Massachusetts | |
Massachusetts General Hospital | |
Boston, Massachusetts, United States, 02114 | |
Beth Israel Deaconess Medical Center | |
Boston, Massachusetts, United States, 02115 | |
Dana-Farber Cancer Institute | |
Boston, Massachusetts, United States, 02215 |
Principal Investigator: | Nancy Lin, MD | Dana-Farber Cancer Institute |
Responsible Party: | Nancy Lin, MD, Assistant Professor of Medicine, Dana-Farber Cancer Institute |
ClinicalTrials.gov Identifier: | NCT01004172 |
Other Study ID Numbers: |
09-224 |
First Posted: | October 29, 2009 Key Record Dates |
Results First Posted: | May 22, 2017 |
Last Update Posted: | December 14, 2018 |
Last Verified: | December 2018 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
carboplatin bevacizumab |
Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Bevacizumab Trastuzumab Carboplatin |
Antineoplastic Agents, Immunological Antineoplastic Agents Angiogenesis Inhibitors Angiogenesis Modulating Agents Growth Substances Physiological Effects of Drugs Growth Inhibitors |