Doxorubicin and Cyclophosphamide Followed By Trastuzumab, Paclitaxel, and Lapatinib in Treating Patients With Early-Stage HER2-Positive Breast Cancer That Has Been Removed By Surgery
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Purpose
RATIONALE: Drugs used in chemotherapy, such as doxorubicin, cyclophosphamide, and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. 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. Lapatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving combination chemotherapy together with trastuzumab and lapatinib after surgery may kill any tumor cells that remain after surgery.
PURPOSE: This randomized phase II trial is studying the side effects and how well giving doxorubicin together with cyclophosphamide followed by trastuzumab, paclitaxel, and lapatinib works in treating patients with early-stage HER2-positive breast cancer that has been removed by surgery.
| Condition | Intervention | Phase |
|---|---|---|
|
Breast Cancer Cardiac Toxicity |
Biological: trastuzumab Drug: cyclophosphamide Drug: doxorubicin hydrochloride Drug: lapatinib ditosylate Drug: paclitaxel Genetic: gene expression analysis Genetic: reverse transcriptase-polymerase chain reaction Other: fluorophotometry Other: laboratory biomarker analysis Other: mass spectrometry Procedure: adjuvant therapy Procedure: quality-of-life assessment |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Primary Purpose: Treatment |
| Official Title: | Phase II Study of Cardiac Safety and Tolerability of an Adjuvant Chemotherapy Plus Trastuzumab With Lapatinib in Patients With Resected HER2 + Breast Cancer |
- Number of Patients With Congestive Heart Failure (CHF) While on Active Treatment [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- Adverse Event Profile as Measured by NCI CTCAE v 3.0 [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]Maximum grade for each type of adverse event will be recorded for each patient.
- Cumulative Incidence (CI) of Cardiac Events [ Time Frame: 5 years ] [ Designated as safety issue: No ]
Evaluable patients included those completed the AC phase of their treatment regimen; with post AC cardiac evaluation indicates they are eligible to begin treatment with PTL; and those have begun their post-AC therapy.
Cardiac events: symptomatic congestive heart failure (CHF), cardiac death and other cardiac events (NCI Common Terminology Criteria for Adverse Events (CTCAE) Grade >=3)
- Number of Patients Who Experience >= 10 Percent Drop in Left Ventricular Ejection Fraction (LVEF) Between Two Time Points [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- Disease-free Survival (DFS) [ Time Frame: 5 years ] [ Designated as safety issue: No ]DFS was defined as the time from registration to the earliest date of documentation of any local, regional, or distant recurrence of breast cancer (BC); the development of a contralateral BC or second primary other than squamous or basal cell carcinoma of the skin, carcinoma in situ of the cervix, or lobular carcinoma in situ of the breast; or death from any cause without the documentation of one of these events. Participants were followed for a maximum of 5 years from randomization. The median OS with 95%CI was estimated using the Kaplan Meier method.
- Overall Survival (OS) [ Time Frame: 5 years ] [ Designated as safety issue: No ]OS was defined as the time from registration to death of any cause. Participants were followed for a maximum of 5 years from randomization. The median OS with 95%CI was estimated using the Kaplan Meier method.
- Comparison of Selected Quality-of-life Questionnaires [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- Quality-of-life [ Time Frame: 5 years ] [ Designated as safety issue: No ]
- Incidence of Pulmonary Events [ Time Frame: 5 years ] [ Designated as safety issue: No ]Pulmonary events to be included were grade 3 and higher pulmonary adverse events at least possibly related to study treatment, which occur at any time after post-AC treatment is begun, but prior to documentation of a breast cancer recurrence, contralateral breast cancer, secondary primary cancer, non-pulmonary death, or pulmonary death not related to study treatment.
| Enrollment: | 122 |
| Study Start Date: | March 2007 |
| Primary Completion Date: | April 2009 (Final data collection date for primary outcome measure) |
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Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
Histologically confirmed diagnosis of early-stage breast cancer
HER2 positive by immunohistochemistry (IHC) (3+) or fluorescent in situ hybridization (FISH)
- Ductal carcinoma in situ (DCIS) components should not be counted in the determination of degree of IHC staining or FISH amplification
No locally advanced tumors (i.e., T4) at diagnosis, including the following:
- Tumors fixed to chest wall
- Peau d'orange
- Skin ulcerations or nodules
- Clinical inflammatory changes (e.g., diffuse brawny cutaneous induration with an erysipeloid edge)
Has undergone mastectomy or lumpectomy with axillary node or sentinel node dissection within the past 84 days
Patients who have undergone a mastectomy must meet the following criteria:
No evidence of gross or microscopic tumor (i.e., invasive DCIS) at the surgical resection margins noted in final surgery or pathology reports
- Patients with close margins are eligible
- Radiation therapy is required for 4 or more positive lymph nodes and must be started after completion of chemotherapy
Patients who have undergone a lumpectomy with axillary node or sentinel node dissection must meet the following criteria:
- No evidence of invasive cancer or DCIS at the surgical resection margins
- No gross residual adenopathy
- Planning to undergo radiation therapy to the breast with or without regional lymphatics after completion of chemotherapy
No active hepatic or biliary disease
- Patients with liver metastases, stable chronic liver disease, Gilbert's syndrome, or asymptomatic gallstones are eligible
Hormone receptor status:
- Estrogen receptor and progesterone receptor status known
PATIENT CHARACTERISTICS:
- Male or female
- Menopausal status not specified
- ECOG performance status 0-2
- Absolute neutrophil count ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Hemoglobin ≥ 10.0 g/dL
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- AST and ALT ≤ 2.5 times ULN
- Alkaline phosphatase ≤ 2.5 times ULN
- Creatinine normal OR creatinine clearance ≥ 60 mL/min
- LVEF ≥ 50% by MUGA scan or echocardiogram
- Able to complete questionnaire(s) by themselves or with assistance
- Able and willing to provide blood and tissue samples
- No known sensitivity to benzyl alcohol
- No sensory neuropathy ≥ grade 2
No active cardiac disease, including any of the following:
- Myocardial infarction within the past 6 months
- Prior or concurrent congestive heart failure
- Prior or concurrent arrhythmia or cardiac valvular disease requiring medications or that is clinically significant
- Uncontrolled hypertension, defined as diastolic blood pressure (BP) >100 mm Hg or systolic BP > 200 mm Hg on 2 separate occasions ≥ 14 days apart
- Clinically significant pericardial effusion
- Prior or concurrent uncontrolled or symptomatic angina
- Other cardiac condition that, in the opinion of the treating physician, would put the patient at hazardous risk
- No history of allergic reactions attributed to compounds of similar chemical or biologic composition as lapatinib ditosylate
No uncontrolled intercurrent illness including, but not limited to, the following:
- Ongoing or active infection
- Psychiatric illness or social situations that would preclude study compliance
Able to swallow and retain oral medication
No history of gastrointestinal (GI) disease resulting in an inability to take oral medication, including any of the following:
- Malabsorption syndrome
- Requirement for IV alimentation
- Prior surgical procedures affecting absorption
- Uncontrolled inflammatory GI disease (e.g., Crohn's disease or ulcerative colitis)
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 6 months after completion of study treatment
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior chemotherapy, radiation therapy, immunotherapy, or biotherapy for breast cancer
- No primary breast radiation therapy as part of breast-conserving treatment
- No prior anthracycline or taxane therapy for any malignancy
- No prior epidermal growth factor receptor-targeting therapies (e.g., gefitinib, cetuximab, erlotinib hydrochloride, rituximab, trastuzumab [Herceptin®], lapatinib ditosylate, panitumumab, or nimotuzumab)
At least 14 days since prior and no concurrent CYP3A4 inducers, including the following:
- Rifamycin-class antibiotics (e.g., rifampin, rifabutin, or rifapentine)
- Anticonvulsants (e.g., phenytoin, carbamazepine, or barbiturates [e.g., phenobarbital])
- Antiretrovirals (e.g., efavirenz or nevirapine)
Glucocorticoids (e.g., oral cortisone, hydrocortisone, prednisone, methylprednisolone, or dexamethasone)
- Daily oral dexamethasone ≤ 1.5 mg (or equivalent) allowed
- Modafinil
- Hypericum perforatum (St. John's wort)
At least 7 days since prior and no concurrent CYP3A4 inhibitors, including the following:
- Antibiotics (e.g., clarithromycin, erythromycin, or troleandomycin)
- Antifungals (e.g., itraconazole, ketoconazole, fluconazole [> 150 mg daily], or voriconazole)
- Antiretrovirals and protease inhibitors (e.g., delaviridine, nelfinavir, amprenavir, ritonavir, indinavir, saquinavir, or lopinavir)
- Calcium channel blockers (e.g., verapamil or diltiazem)
- Antidepressants (e.g., nefazodone or fluvoxamine)
- Gastrointestinal agents (e.g., cimetidine or aprepitant)
- Grapefruit and grapefruit juice
- At least 6 months since prior and no concurrent amiodarone
- No herbal or alternative medicines or supplements ≥ 14 days before, during, and for 30 days after completion of study treatment
No concurrent hormonal agents (e.g., birth control pills, ovarian hormonal replacement therapy, or raloxifene)
- Adjuvant hormonal agents (e.g., tamoxifen, aromatase inhibitors) allowed after completion of chemotherapy as part of treatment for breast cancer
- No concurrent antiretroviral therapy for HIV-positive patients
- No concurrent digitalis or beta-blockers for congestive heart failure
- No concurrent arrhythmia or angina pectoris medication
- No other concurrent investigational agents or anticancer therapies, including cytotoxic agents or immunotherapy
Contacts and Locations| United States, Minnesota | |
| Mayo Clinic Cancer Research Consortium | |
| Rochester, Minnesota, United States, 55905 | |
| Study Chair: | Edith A. Perez, MD | Mayo Clinic in Florida |
| Principal Investigator: | Donald W. Northfeld, MD | Mayo Clinic in Arizona |
| Principal Investigator: | James N. Ingle, MD | Mayo Clinic in Rochester |
More Information
Additional Information:
Publications:
| Responsible Party: | Edith A. Perez, Mayo Clinic in Florida |
| ClinicalTrials.gov Identifier: | NCT00436566 History of Changes |
| Other Study ID Numbers: | CDR0000533793, P30CA015083, RC0639, 06-004049 |
| Study First Received: | February 15, 2007 |
| Results First Received: | October 22, 2012 |
| Last Updated: | November 20, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by Mayo Clinic:
|
cardiac toxicity male breast cancer stage I breast cancer stage II breast cancer stage IIIA breast cancer |
Additional relevant MeSH terms:
|
Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Adjuvants, Immunologic Cyclophosphamide Trastuzumab Lapatinib Doxorubicin Paclitaxel Immunologic Factors Physiological Effects of Drugs Pharmacologic Actions Immunosuppressive Agents |
Antirheumatic Agents Therapeutic Uses Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Myeloablative Agonists Antibiotics, Antineoplastic Tubulin Modulators Antimitotic Agents Mitosis Modulators Antineoplastic Agents, Phytogenic Protein Kinase Inhibitors Enzyme Inhibitors |
ClinicalTrials.gov processed this record on May 23, 2013