Lapatinib and WBRT for Patients With Brain Metastases From Lung or Breast Tumors

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2013 by Hellenic Cooperative Oncology Group
Sponsor:
Information provided by (Responsible Party):
Hellenic Cooperative Oncology Group
ClinicalTrials.gov Identifier:
NCT01218529
First received: October 8, 2010
Last updated: July 3, 2013
Last verified: July 2013
  Purpose

This phase II open-label study will be performed to evaluate the response rate of brain metastases from lung and breast tumors under treatment with WBRT and lapatinib.


Condition Intervention Phase
Brain Metastases
Lung Tumors
Breast Tumors
Drug: Lapatinib
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Lapatinib and Whole Brain Radiotherapy for Patients With Brain Metastases From Lung and Breast Tumors. A Phase II Study of the Hellenic Cooperative Oncology Group (HeCOG).

Resource links provided by NLM:


Further study details as provided by Hellenic Cooperative Oncology Group:

Primary Outcome Measures:
  • Response rate in brain as assessed by volumetric analysis of brain Mangnetic Resonance Imaging (MRI). [ Time Frame: At the 6 weeks timepoint, radiological assessment with brain MRI will take place to evaluate the response of the patients ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Response rate for systemic disease [ Time Frame: At 6 weeks ] [ Designated as safety issue: No ]
    Chest, abdomen, and pelvic Computerized Tomography (CT) scans will be performed at the 6 weeks timepoint to evaluate the response for systemic disease

  • Time To Progression in brain and/or non-Central Nervous System (CNS) [ Time Frame: At the 6 weeks timepoint, radiological assessment with brain MRI will take place to evaluate the response of the patients.The patients will be followed-up every 12 weeks for disease progression and survival. ] [ Designated as safety issue: No ]
  • Safety and tolerability of proposed schema. Adverse Events (AEs) of all participants will be recorded and assessed upon signature of the informed consent form, until 30 days after the last administration of study treatment. [ Time Frame: 10 weeks (6 weeks therapy + 4 weeks follow-up period for AEs) ] [ Designated as safety issue: Yes ]
    Adverse Events will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v3.0 criteria and will be reported in a frequency table according to the highest severity grade observed per patient.

  • To explore the 20% volumetric reduction of brain metastatic lesions as a meaningful threshold of CNS response. [ Time Frame: At the 6 weeks timepoint, radiological assessment with brain MRI will take place to evaluate the response of the patients. ] [ Designated as safety issue: No ]

Estimated Enrollment: 81
Study Start Date: October 2010
Estimated Study Completion Date: April 2014
Estimated Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Whole Brain Radiation Therapy (WBRT) + lapatinib
Whole Brain Radiation Therapy (30Gy in 10 fractions) and lapatinib 1250mg once daily for 2 weeks followed by lapatinib treatment 1500mg once daily for 4 weeks.
Drug: Lapatinib
Co-administration of lapatinib 1250mg once daily during the WBRT period (2 weeks)and then monotherapy with lapatinib 1500mg once daily for 4 weeks.

Detailed Description:

Patients with breast or lung cancer who have developed brain metastases will be treated with WBRT (30Gy in 10 fractions) and lapatinib 1250mg once daily, followed by lapatinib treatment 1500mg once daily for a total duration of 6 weeks. At the 6 weeks timepoint, radiological assessment with brain MRI will take place to evaluate the response of the patients. Subsequent to the 6 weeks treatment period with lapatinib, the patients may discontinue lapatinib as monotherapy and the physicians can proceed with any therapy, according to their discretion. The patients will be followed-up every 12 weeks for disease progression and survival.

  Eligibility

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

Inclusion Criteria:

  1. Signed written informed consent;
  2. Age >=18 years old;
  3. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2;
  4. Life expectancy of at least 12 weeks;
  5. Subjects must have histologically or cytologically confirmed invasive lung or breast cancer, with Stage IV disease;
  6. Epidermal growth factor receptor (ErbB1/EGFR) overexpressing primary tumour, defined as 2+/3+ staining by immunohistochemistry (IHC) is mandatory to assess the patient population, but it is not a requirement for study entry.
  7. At least one measurable lesion in the brain, defined as any lesion >= 10mm in longest dimension on T1-weighted, gadolinium-enhanced MRI;
  8. Cardiac ejection fraction within institutional range of normal as measured by echocardiogram. Multigated acquisition scan (MUGA) scans will be accepted in cases where an echocardiogram cannot be performed or is inconclusive;
  9. At least 3 weeks since last chemotherapy, immunotherapy, biologic therapy, or hormonal therapy for cancer, and sufficiently recovered or stabilized from side effects associated with prior therapy. Concurrent treatment with bisphosphonates is permitted;
  10. At least 3 weeks since major surgical procedures;
  11. Able to swallow and retain oral medications;
  12. Female subjects with child bearing potential or male subjects able to father a child must be completely abstinent from intercourse or use acceptable methods for birth control during the course of the study;
  13. Subjects must complete all screening assessments as outlined in the protocol;
  14. Subjects must have normal organ and marrow function as defined below:

SYSTEM LABORATORY VALUES Hematologic Absolute neutrophil count (ANC) 1.0 x 109/L Hemoglobin >= 9 g/dL (after transfusion if needed) Platelets >= 50 x 109/L Hepatic Albumin >= 2.5 g/dL Serum bilirubin <= 1.5x ULN unless due to Gilbert's syndrome Aspartate aminotransferase (AST) and Alaninine Aminotransferase (ALT) <= 5x upper limit of normal (ULN) if documented liver metastases <= 3x ULN without liver metastases Renal Serum Creatinine <= 2.0 mg/dL or Calculated Creatinine Clearance* >= 25 mL/min*Calculated by the Cockcroft and Gault Method

Exclusion Criteria:

  1. Subjects are suitable for brain surgery or stereotactic radiosurgery (SRS);
  2. Subjects who have had prior cranial radiotherapy. Prior radiotherapy for lesions outside CNS is allowed.
  3. Subjects who have had chemotherapy or radiotherapy within 2 weeks prior to entering the study or who have unresolved or unstable, serious toxicity from prior administration of another investigational drug and/or of prior cancer treatment;
  4. Concurrent treatment with an investigational agent or participation in another treatment clinical trial;
  5. Subjects receiving concurrent chemotherapy, radiation therapy, immunotherapy, biologic therapy (including an ErbB1 and/or ErbB2 inhibitor), or hormonal therapy for treatment of their non-CNS cancer. Concurrent treatment with bisphosphonates is allowed;
  6. Subjects with leptomeningeal carcinomatosis as the only site of CNS involvement;
  7. History of allergic reactions attributed to compounds of similar chemical composition (quinazolines) to lapatinib;
  8. Concurrent treatment with medications that are either inducers or inhibitors of CYP3A4 is prohibited. (For important exceptions, refer to Section Prohibited Medications);
  9. Malabsorption Syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel. Subjects with active, uncontrolled ulcerative colitis are also excluded;
  10. Any underlying liver or biliary disease (except for patients with Gilbert syndrome, asymptomatic cholelithiasis, liver metastases or stable chronic liver disease according to the physician)
  11. Other known contraindication to MRI, such as a cardiac pacemaker, implanted cardiac defibrillator, brain aneurysm clips, cochlear implant, ocular foreign body, or shrapnel;
  12. Concurrent disease or condition that would make the subject inappropriate for study participation or any serious medical or psychiatric disorder that would interfere with the subject's safety;
  13. Dementia, altered mental status, or any psychiatric condition that would prohibit the understanding or rendering of informed consent;
  14. Pre-existing severe cerebral vascular disease, such as stroke involving a major vessel, CNS vasculitis, or malignant hypertension;
  15. Active cardiac disease, defined as one or more of the following:

    • History of uncontrolled or symptomatic angina
    • History of arrhythmias requiring medications, or clinically significant, with the exception of asymptomatic atrial fibrillation requiring anticoagulation
    • Myocardial infarction < 6 months from study entry
    • Uncontrolled or symptomatic congestive heart failure
    • Ejection fraction below the institutional normal limit
    • Any other cardiac condition, which in the opinion of the treating physician, would make this protocol unreasonably hazardous for the patient
  16. Uncontrolled infection;
  17. History of other malignancy, except for curatively treated basal cell carcinoma or squamous cell carcinoma of the skin, or carcinoma in situ of the cervix. Subjects with other malignancies who have been disease-free for at least 5 years are eligible;
  18. Pregnant or lactating females.
  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: NCT01218529

Locations
Greece
General Peripheral Hospital of Athens "Alexandra" Recruiting
Athens, Greece, 11528
Contact: Christos Papadimitriou, Ass.Professor       chr_papadim@yahoo.gr   
Principal Investigator: Christos Papadimitriou, Ass.Professor         
Metropolitan Hospital, 2nd Dept of Medical Oncology Recruiting
Athens, Greece, 18547
Contact: Chistos Christodoulou, MD       c_christodoulou@yahoo.gr   
Principal Investigator: Christos Christodoulou, MD         
General Hospital of Athens 'Hippokratio', 2nd Dept of Internal Medicine Not yet recruiting
Athens, Greece, 11527
Contact: Dimitrios Pectasides, Professor       pectasid@otenet.gr   
Principal Investigator: Dimitrios Pectasides, Ass.Professor         
Agii Anargiri Cancer Hospital, 3rd Dept of Medical Oncology Recruiting
Athens, Greece, 14564
Contact: Anastasios Visvikis, MD       hecogaga@otenet.gr   
Principal Investigator: Anastasios Visvikis, MD         
Hygeia Hospital, 1st Dept of Medical Oncology Recruiting
Athens, Greece, 15123
Contact: Evangelia Razis, MD       e.razis@hygeia.gr   
Principal Investigator: Evangelia Razis, MD         
Metropolitan Hospital, 1st Dept of Medical Oncology Recruiting
Athens, Greece, 18547
Contact: Dimitrios Bafaloukos, MD       dimmp@otenet.gr   
Principal Investigator: Dimitrios Bafaloukos, MD         
Sotiria General Hospital, 3rd Dept of Medicine, Oncology Unit Recruiting
Athens, Greece, 11527
Contact: Konstantinos N. Syrigos, Ass.Professor       ksyrigos@med.uoa.gr   
Principal Investigator: Konstantinos N. Syrigos, Ass.Professor         
Hygeia Hospital, 2nd Dept of Medical Oncology Recruiting
Athens, Greece, 15123
Contact: Charalambos Bakoyiannis, MD       parkosmi@otenet.gr   
Principal Investigator: Charalambos Bakoyiannis, MD         
Chania General Hospital, Oncology Section Recruiting
Chania, Greece, 73100
Contact: Ioannis Varthalitis, MD       oncol@chaniahospital.gr   
Principal Investigator: Ioannis Varthalitis, MD         
Ioannina University Hospital, Dept of Medical Oncology Recruiting
Ioannina, Greece, 45110
Contact: Evangelos Briasoulis, Ass.Professor       oncoresearch@uhi.gr   
Principal Investigator: Evangelos Briassoulis, Ass.Professor         
University Hospital of Larissa, Dept of Internal Medicine, Oncology Section Recruiting
Larissa, Greece, 44110
Contact: Danae Daliani, MD       cpapandreou@med.uth.gr   
Principal Investigator: Danae Daliani, MD         
Rio University Hospital, Dept of Medical Oncology Recruiting
Patras, Greece, 26500
Contact: Haralambos P. Kalofonos, Ass.Professor       kalofonos@upatras.gr   
Principal Investigator: Haralambos P. Kalofonos, Ass.Professor         
Papageorgiou General Hospital, Dept of Medical Oncology Recruiting
Thessaloniki, Greece, 56429
Contact: George Fountzilas, Professor       fountzil@auth.gr   
Principal Investigator: George Fountzilas, Professor         
Sponsors and Collaborators
Hellenic Cooperative Oncology Group
Investigators
Study Chair: Christos Christodoulou, MD Metropolitan Hospital, 2nd Dept of Medical Oncology
  More Information

No publications provided

Responsible Party: Hellenic Cooperative Oncology Group
ClinicalTrials.gov Identifier: NCT01218529     History of Changes
Other Study ID Numbers: HE 42/09, 2009-013128-22
Study First Received: October 8, 2010
Last Updated: July 3, 2013
Health Authority: Greece:National Ethics Committee
Greece:National Organization for Medicines

Keywords provided by Hellenic Cooperative Oncology Group:
Brain metastases from lung and breast tumors

Additional relevant MeSH terms:
Breast Neoplasms
Lung Neoplasms
Neoplasm Metastasis
Neoplasms, Second Primary
Brain Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Respiratory Tract Neoplasms
Thoracic Neoplasms
Lung Diseases
Respiratory Tract Diseases
Neoplastic Processes
Pathologic Processes
Central Nervous System Neoplasms
Nervous System Neoplasms
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Lapatinib
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on August 26, 2014