A Phase 0 of Neoadjuvant Lapatinib in Infiltrative Bladder Carcinoma Before Cystectomy (LAPAINBLAD)

This study has been terminated.
(The rythm of enrollment was not compatible with the objective of recruitement in the research.)
Sponsor:
Information provided by (Responsible Party):
University Hospital, Bordeaux
ClinicalTrials.gov Identifier:
NCT01245660
First received: November 18, 2010
Last updated: January 10, 2013
Last verified: January 2013
  Purpose

Modification of the EGF signalling pathway and / or HER 2, by Lapatinib in bladder cancer.


Condition Intervention Phase
Bladder Carcinoma
Infiltrative Bladder Carcinoma
Cystectomy
Drug: LAPATINIB
Phase 0

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Official Title: Pilot Study of Lapatinib (Tyverb®) in Neoadjuvant Treatment for Patients With Locally Bladder Carcinoma Before Cystectomy

Resource links provided by NLM:


Further study details as provided by University Hospital, Bordeaux:

Primary Outcome Measures:
  • Effect on egf pathway at a molecular level of 3 weeks treatment by lapatinib. [ Time Frame: At surgery (day 21-27) ] [ Designated as safety issue: Yes ]
    The primary objective of the study is to evaluate the effect at a molecular level, of 3 weeks of neoadjuvant lapatinib, in locally advanced muscle-invasive transitional cell carcinoma of the bladder. A comparison of tissue from the original biopsy and cystectomy after lapatinib will allow this to occur. This effect will be evaluated by studying proliferation and apoptotic markers as well as the phosphorylation of proteins which are components of the egf signalling pathway.


Secondary Outcome Measures:
  • Lapatinib biological response on key molecules of the egf pathway (EGFR, ERBB2, AKT ERK as well as their phosphorylation status.) [ Time Frame: At screening (day -10 before inclusion) , surgery (day 21-27) and Follow up visit surgery (day 42-62) ] [ Designated as safety issue: Yes ]
    Because the availability of large scale data, the correlation between lapatinib biological response and the molecular alteration of other molecules beside those involved in the egf pathway will be explored. i.e. key molecules of the pathway will also be studied at the protein level (EGFR, ERBB2, AKT ERK) as well as their phosphorylation status.

  • Histological response [ Time Frame: At surgery (day 21-27) ] [ Designated as safety issue: Yes ]
    To evaluate the histological response to lapatinib at the time of surgery


Enrollment: 3
Study Start Date: January 2011
Study Completion Date: October 2011
Primary Completion Date: October 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Patient Drug: LAPATINIB
Lapatinib, 1250 mg per day, per os, during 3 weeks +/- 5 days.

Detailed Description:

Patients with invasive bladder tumor , candidates for radical cystectomy. Patients will receive Lapatinib during 3 weeks +/- 5 days, before cystectomy. A comparison of tissue from the original biopsy and cystectomy after Lapatinib will allow this to occur.

TREATMENT AND STRATEGY Lapatinib in bladder carcinoma -Overall there are arguments for considering that egf pathway is involved in bladder carcinoma and so far that drugs inhibiting EGF pathway could have an impact for therapeutical endpoints.

Nevertheless it is unclear that from previous studies that adding egf inhibiting drug to chemotherapy is clinically relevant, essentially by difficulties to measure a beneficial endpoint while downstream EGF pathways have been modified by these drugs, as shown with lapatinib (see 2.1.5).

Furthermore, there is no argument for initial selection of patients based on the initial egfr and/or her 2 tumor profile, asking for more intense knowledge.

LAPATINIB TREATMENT Patients will receive lapatinib therapy at a daily standard dose of 1500 mg.

LAPATINIB TREATMENT DURATION Patients will then receive 3 weeks of lapatinib therapy + possible 5 days. As the study is a non direct benefit study, the exposition to the drug is proposed during the standard window of 3 to 4 weeks to organize a radical cystectomy in patients with muscle invasive bladder carcinoma. In this study patients, the standard procedure is not delayed for the purpose of the study.

The duration of exposition to lapatinib as to be long enough to have a continuous impact of biological events to induce indeed inhibition of EGF pathway but also to impact on more complex or more distal events as apoptosis and so to be able to measure it. This justifies a 3 weeks of treatment + possible up to 5 days more due to surgical organization procedures.

Surgery will take place on the last day of treatment, which is recommended due to the half-life of lapatinib. Nevertheless for surgical purpose, the drug could be not given on the day of surgery.

  Eligibility

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

Inclusion Criteria:

  • Patients must sign and date IRB/EC-approved informed consent,
  • Age ≥ 18
  • Patients must have a life expectancy of at least 6 months,
  • Patients must have a Karnofsky performance status ≥ 80%,
  • Clinical stage T2NxM0 to T4aNxM0 bladder cancer
  • Muscle-invasive transitional cell carcinoma by histology (focal squamous and/or adenocarcinoma differentiation defined as ≤ 10% of tumor volume allowed, sarcomatoid and small-cell components not allowed)
  • Considered to have a macroscopic residue in the bladder to allow comparison of tissue samples at cystectomy to initial biopsies
  • Candidates for radical cystectomy
  • Patient with normal cardiac function, LVEF ≥ 50% measured by echocardiography or MUGA scan
  • Able to swallow and retain oral medication
  • A female is eligible to enter and participate in this study if she is of : Non-child-bearing potential (i.e., a woman with functioning ovaries who have a current documented tubal ligation or hysterectomy or a woman who is menopausal), or Child-bearing potential (i.e. a woman with functioning ovaries and no documented impairment of oviductal or uterine function that would cause sterility. This category includes women with oligomenorrhoea (even severe), women who are perimenopausal and young women who have begun to menstruate), who have a negative serum pregnancy test at screening, and agree to one of the following consistent and correct use of one acceptable methods of birth control : Any intrauterine device (IUD) with a documented failure rate of less than 1% per year, or combined oral contraception
  • care must be taken to avoid pregnancy in partners of male patients.
  • Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.
  • Affiliated or profit patient of a social security system

Exclusion Criteria:

  • Prior pelvic radiation or neoadjuvant chemotherapy.
  • Pregnancy or breastfeeding.
  • Other severe acute or chronic medical or psychiatric condition that would impart, in the judgment of the investigator, excess risk associated with study participation or study drug administration, or which, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
  • Patients with significantly reduced LVEF or LVEF < 50%.
  • Patient with any of the following liver abnormal laboratory test :
  • Serum bilirubin > 1,5 x upper limit of normal (ULN) (in case of Gilbert syndrome, a higher serum total bilirubin (< 2 ULN) is allowed
  • Alanine amino transferase (ALAT) or aspartate amino transferase (ASAT) > 2,5 ULN
  • Platelets <100 x 109/L, hemoglobin < 9 g/dl, absolute neutrophil count (ANC) <1.5 x 109/L
  • Have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment)
  • Serum creatinine > 1.5 x ULN.
  • Previous therapy targeting EGFR or HER-2.
  • Predominantly non transitional cell histology.
  • Diagnosis of any second malignancy within the last 3 years, except basal cell carcinoma, squamous cell skin cancer, or in situ carcinoma of the cervix uteri that has been adequately treated with no evidence of recurrent disease for 12 months.
  • Malabsorption syndrome, disease significantly affecting gastrointestinal function, or major resection of the stomach or bowel, that could affect absorption of lapatinib.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to lapatinib
  • Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, that would limit compliance with study requirements.
  • 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
  • Use of an investigational agent within 30 days or 5 half-lives, whichever is the longer, preceding the first dose of investigational product.
  • Concurrent treatment with an investigational agent
  • Concurrent treatment with cytotoxic chemotherapy, immunotherapy, biologic therapy, hormonal therapy or curative radiotherapy for locally advanced or metastatic TCC of the urothelial tract.
  • Concomitant requirement for medication classified as CYP3A4 inducers or inhibitors.
  • Patient under safeguard of justice
  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: NCT01245660

Locations
France
CHU Bordeaux - Hôpital Saint André - Department of Medical Oncology
Bordeaux, France, 33075
Sponsors and Collaborators
University Hospital, Bordeaux
Investigators
Study Chair: Geneviève CHENE, Pr USMR Bordeaux
  More Information

Publications:
Responsible Party: University Hospital, Bordeaux
ClinicalTrials.gov Identifier: NCT01245660     History of Changes
Other Study ID Numbers: CHUBX 2009/04
Study First Received: November 18, 2010
Last Updated: January 10, 2013
Health Authority: France: Ministry of Health

Keywords provided by University Hospital, Bordeaux:
Phase 0
Bladder carcinoma
egf pathway
infiltrative bladder carcinoma
cystectomy
LAPATINIB

Additional relevant MeSH terms:
Urinary Bladder Neoplasms
Carcinoma
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Urinary Bladder Diseases
Urologic Diseases
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Lapatinib
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on July 29, 2014