Safety and QoL of Trastuzumab With Lapatinib or Chemiotherapy in MBC and HER2+ Patients Refractory to Anti HER2 Therapies

NCT ID: NCT02238509

Last Updated: 2016-06-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

154 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-11-30

Study Completion Date

2017-10-31

Brief Summary

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Recent clinical studies have shown that the combination of lapatinib and trastuzumab has superior antitumor activity compared to either single drug in both neoadjuvant and metastatic setting and is well tolerated. According to this evidence, the combination of lapatinib and trastuzumab today offers a valid chemotherapy-free option, primarily for patients with pre-treated HER2-positive MBC

Detailed Description

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The present study is designed to determine the efficacy and safety profile of the combination of lapatinib and trastuzumab (plus endocrinetherapy in ER-positive breast cancer) versus trastuzumab and chemotherapy in heavily pretreated patient population with HER2-positive MBC and to investigate the predictive role of cfDNA for detection of HER2 gene amplification on patients' outcome. The presence of circulating free DNA (cfDNA) for detection of HER2 gene amplification was associated with worse prognosis and seems to allow early response evaluation. However, many aspects of the role of cfDNA detection in patients undergoing molecular target agents such as trastuzumab or lapatinib are not well described. With the availability of improved and standardized techniques for cfDNA detection, it should now be possible to examine several of these important questions within a prospective multicenter study and a striking potential of cfDNA for detection of HER2 gene amplification might enable a more individual and optimized antimetastatic therapy inpatients with cancer.

Conditions

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Metastatic Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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lapatinib and trastuzumab

ARM A: Lapatinib and trastuzumab (experimental arm). Patients with hormone receptor (HR) positive breast cancer will also receive endocrine therapy at the physician's discretion (preferred choice with fulvestrant).

Group Type EXPERIMENTAL

Lapatinib

Intervention Type DRUG

ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).

Trastuzumab

Intervention Type DRUG

ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).

trastuzumab plus chemotherapy

ARM B: Trastuzumab plus chemotherapy (control arm). Any type of chemotherapy in combination with trastuzumab will be allowed at the physician's discretion.

Group Type EXPERIMENTAL

Trastuzumab

Intervention Type DRUG

ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).

Interventions

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Lapatinib

ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).

Intervention Type DRUG

Trastuzumab

ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).

Intervention Type DRUG

Other Intervention Names

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Tyverb Herceptin

Eligibility Criteria

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Inclusion Criteria

* Histological or cytological confirmed and documented adenocarcinoma of the breast with metastatic disease
* The original tumour specimen must be HER2 IHC 3+ positive or, in case of IHC 2+
* Age ≥18
* Life expectancy of \>12 weeks
* ECOG PS 0-1
* Measurable disease as defined by RECIST1.1 criteria
* All patients must have received prior anthracycline-and taxane-based regimens as well as trastuzumab based regimens in either the adjuvant or the metastatic setting. Patients must have been already treated with at least one line of the anti HER2 inhibitor therapy lapatinib for their metastatic breast cancer. A maximum of three previous lines of anti-HER-2 therapies in the metastatic setting are allowed.
* Adequate haematological function as defined by: ANC 1.5 x 109/L, platelet count 100 x 109/L, haemoglobin 10 g/dL.
* Adequate renal function, as defined by: creatinine 1.5 x UNL
* Adequate hepatobiliary function, as defined by the following baseline liver function tests: total serum bilirubin 1.5 upper normal limit (UNL); alanine amino transferase (ALT), aspartate amino transferase (AST) 2.5xUNL; alkaline phosphatase (AP) 2.5xUNL; if total alkaline phosphatase (AP) \> 2.5xUNL, alkaline phosphatase liver fraction must be 2.5xUNL
* Adequate contraception for all fertile patients
* Negative pregnancy test.
* Postmenopausal women fulfilling any of the NCCN criteria may be included.
* Left ventricular ejection fraction (LVEF) ≥50% during a baseline period of 28 days, as determined by either echocardiography (ECHO) or multi gated acquisition (MUGA) scan.
* Signed, written informed consent

Exclusion Criteria

* History of persistent Grade ≥ 2 hematologic toxicity resulting from previous systemic therapy
* Current peripheral neuropathy of NCI-CTCAE, Version 3.0, Grade ≥ 3 at randomization
* History of other malignancy within the last 5 years, except for carcinoma in situ of the cervix or basal cell carcinoma
* Bone-only disease, unless a measurable lesion is evident as determined by RECIST v1.1
* Bone scan, PET scan or plain films are not considered adequate imaging techniques to measure bone lesions. ve
* Blastic bone lesions are non-measurable.
* Uncontrolled hypertension (systolic \>150 mm Hg and/or diastolic \>100 mm Hg) or clinically significant (i.e. active) cardiovascular disease.
* Current dyspnoea at rest due to complications of advanced malignancy, or other diseases that require continuous oxygen therapy.
* Inadequate organ function, evidenced by the following laboratory results within 28 days prior to randomization.
* Current severe, uncontrolled systemic disease
* Major surgical procedure or significant traumatic injury within 28 days prior to study treatment start or anticipation of the need for major surgery during the course of study treatment
* History of receiving any investigational treatment within 28 days of randomization
* Current known infection with HIV, HBV, or HCV
* Receipt of IV antibiotics for infection within 14 days of randomization
* Known hypersensitivity to any of the study drugs
* Assessed by the investigator to be unable or unwilling to comply with the requirements of the protocol
* Lack of physical integrity of the upper gastrointestinal tract, clinically significant malabsorption syndrome, or inability to take oral medications
* Concurrent interventional or non-interventional studies
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Clinical Research Technology S.r.l.

INDUSTRY

Sponsor Role collaborator

Consorzio Oncotech

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Grazia Arpino, MD

Role: PRINCIPAL_INVESTIGATOR

Dipartimento di Medicina Clinica e Chirurgia Oncologia Università degli Studi di Napoli "Federico II"

Locations

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A.O.U. Ospedali Riuniti Umberto I

Ancona, , Italy

Site Status NOT_YET_RECRUITING

Centro di Riferimento Oncologico

Aviano, , Italy

Site Status RECRUITING

Policlinico S. Orsola Malpighi

Bologna, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Centrale di Bolzano

Bolzano, , Italy

Site Status NOT_YET_RECRUITING

Presidio Ospedaliero 'Antonio Perrino

Brindisi, , Italy

Site Status RECRUITING

A.O.R.N.A.S. Garibaldi Nesima di Catania

Catania, , Italy

Site Status RECRUITING

Humanitas Centro Catanese di Oncologia

Catania, , Italy

Site Status NOT_YET_RECRUITING

Azienda Ospedaliera S. Anna

Como, , Italy

Site Status NOT_YET_RECRUITING

Ospedale 'F. Spaziani'

Frosinone, , Italy

Site Status NOT_YET_RECRUITING

I.R.C.C.S. A.O.U. San Martino

Genova, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Civile di Guastalla

Guastalla, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Vito Fazzi

Lecce, , Italy

Site Status RECRUITING

Ospedale di Lugo - AUSL della Romagna

Lugo, , Italy

Site Status NOT_YET_RECRUITING

Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori

Meldola, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Niguarda Ca' Granda

Milan, , Italy

Site Status NOT_YET_RECRUITING

A.O. San Gerardo

Monza, , Italy

Site Status RECRUITING

AORN "A. Cardarelli"

Naples, , Italy

Site Status RECRUITING

Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale"

Napoli, , Italy

Site Status RECRUITING

Policlinico SUN

Napoli, , Italy

Site Status NOT_YET_RECRUITING

Università degli Studi di Napoli "Federico II"

Napoli, , Italy

Site Status RECRUITING

A.R.N.A.S. Ospedale Civico e Benfratelli

Palermo, , Italy

Site Status RECRUITING

Ospedale S. Maria della Misericordia

Perugia, , Italy

Site Status RECRUITING

Azienda Ospedaliera Santa Maria degli Angeli

Pordenone, , Italy

Site Status NOT_YET_RECRUITING

Ospedale di Ravenna

Ravenna, , Italy

Site Status NOT_YET_RECRUITING

Arcispedale S. Maria Nuova Azienda Ospedaliera di Reggio Emilia

Reggio Emilia, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Infermi di Rimini

Rimini, , Italy

Site Status NOT_YET_RECRUITING

Policlinico Universitario Campus Biomedico

Roma, , Italy

Site Status RECRUITING

Istituto Regina Elena per lo studio e la cura dei tumori

Roma, , Italy

Site Status RECRUITING

Ospedale G. Da Procida

Salerno, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Civile di Sassari SS Annunaziata

Sassari, , Italy

Site Status RECRUITING

Ospedale 'SS. Trinità'

Sora, , Italy

Site Status RECRUITING

Azienda Ospedaliera S.Maria di Terni

Terni, , Italy

Site Status RECRUITING

A.O.U. San Giovanni Battista di Torino

Torino, , Italy

Site Status NOT_YET_RECRUITING

A.O.U. Santa Maria della Misericordia di Udine

Udine, , Italy

Site Status RECRUITING

A.O. Ospedale di Circolo e Fondazione Macchi

Varese, , Italy

Site Status NOT_YET_RECRUITING

Ospedale Sacro Cuore Don Calabria

Verona, , Italy

Site Status NOT_YET_RECRUITING

Countries

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Italy

Central Contacts

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Clinical Research Technology

Role: CONTACT

0039089301545

Facility Contacts

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Stefano Cascinu, MD

Role: primary

Simon Spazzapan, MD

Role: primary

Claudio Zamagni, MD

Role: primary

Elisabetta Cretella, MD

Role: primary

Saverio Cinieri, MD

Role: primary

Roberto Bordonaro, MD

Role: primary

Michele Caruso, MD

Role: primary

Monica Giordano, MD

Role: primary

Teresa Gamucci, MD

Role: primary

Lucia Del Mastro, MD

Role: primary

Laura Scaltriti, Md

Role: primary

Mariangela Ciccarese, MD

Role: primary

Michele Gianni Turolla, MD

Role: primary

Dino Amadori, MD

Role: primary

Salvatore Siena, Md

Role: primary

Marina Elena Cazzaniga, MD

Role: primary

039-233.3683

Nando Riccardi, MD

Role: primary

08174721740

Michele De Laurentiis, MD

Role: primary

Michele Orditura, MD

Role: primary

Grazia Arpino, MD

Role: primary

Vita Leonardi, MD

Role: primary

Anna Maria Mosconi, MD

Role: primary

Silvana Saracchini, MD

Role: primary

Claudio Dazzi, MD

Role: primary

Corrado Boni, MD

Role: primary

Lorenzo Gianni, MD

Role: primary

Giuseppe Tonini, Md

Role: primary

Francesco Cognetti, Md

Role: primary

Maria Luisa Barzelloni, MD

Role: primary

Nina Olmeo, MD

Role: primary

Teresa Gamucci, MD

Role: primary

Fauso Roila, Md

Role: primary

Mario Airoldi, MD

Role: primary

fabio Puglisi, MD

Role: primary

Giovanni Giardina, MD

Role: primary

Stefania Gori, MD

Role: primary

References

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Other Identifiers

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2013-005044-29

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

GIM12-TYPHER

Identifier Type: -

Identifier Source: org_study_id

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