Clinical Trials /

Nab-Paclitaxel and Bevacizumab Followed By Bevacizumab and Erlotinib in Metastatic Breast Cancer

NCT00733408

Description:

This phase II trial studies how well giving paclitaxel albumin-stabilized nanoparticle (Nab-paclitaxel) formulation together with bevacizumab followed by bevacizumab and erlotinib hydrochloride work in treating patients with metastatic breast cancer. Drugs used in chemotherapy, such as paclitaxel albumin-stabilized nanoparticle formulation, 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 bevacizumab, can prevent cancer growth by blocking the ability of cancer cells to grow and spread. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. This trial evaluates a maintenance treatment with erlotinib and bevacizumab after Nab-paclitaxel and bevacizumab which may control cancer growth with biologic therapies.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Completed

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Paclitaxel Albumin-Stabilized Nanoparticle Formulation and Bevacizumab Followed By Bevacizumab and Erlotinib Hydrochloride in Treating Patients With Metastatic Breast Cancer
  • Official Title: Combined Targeted Therapies for Triple Negative Advanced Breast Cancer - A Phase II Trial of Weekly Nab-Paclitaxel and Bevacizumab Followed by Maintenance Targeted Therapy With Bevacizumab and Erlotinib

Clinical Trial IDs

  • ORG STUDY ID: 6628
  • SECONDARY ID: NCI-2010-00041
  • SECONDARY ID: 6628
  • SECONDARY ID: P30CA015704
  • NCT ID: NCT00733408

Conditions

  • Estrogen Receptor-negative Breast Cancer
  • HER2-negative Breast Cancer
  • Progesterone Receptor-negative Breast Cancer
  • Recurrent Breast Cancer
  • Stage IV Breast Cancer
  • Triple-negative Breast Cancer

Interventions

DrugSynonymsArms
paclitaxel albumin-stabilized nanoparticle formulationABI-007, nab paclitaxel, nab-paclitaxel, nanoparticle albumin-bound paclitaxelTreatment (chemo, monoclonal antibody, and enzyme inhibitor)
bevacizumabanti-VEGF humanized monoclonal antibody, anti-VEGF monoclonal antibody, Avastin, rhuMAb VEGFTreatment (chemo, monoclonal antibody, and enzyme inhibitor)
erlotinib hydrochlorideCP-358,774, erlotinib, OSI-774Treatment (chemo, monoclonal antibody, and enzyme inhibitor)

Purpose

This phase II trial studies how well giving paclitaxel albumin-stabilized nanoparticle (Nab-paclitaxel) formulation together with bevacizumab followed by bevacizumab and erlotinib hydrochloride work in treating patients with metastatic breast cancer. Drugs used in chemotherapy, such as paclitaxel albumin-stabilized nanoparticle formulation, 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 bevacizumab, can prevent cancer growth by blocking the ability of cancer cells to grow and spread. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. This trial evaluates a maintenance treatment with erlotinib and bevacizumab after Nab-paclitaxel and bevacizumab which may control cancer growth with biologic therapies.

Detailed Description

      PRIMARY OBJECTIVES:

      I. Progression free survival.

      SECONDARY OBJECTIVES:

      I. Response rate.

      II. Overall survival.

      III. Safety and toxicity.

      IV. Exploratory biomarkers will be assessed as potential predictors of response to treatment
      including: expression of epidermal growth factor receptor (EGFR) and secreted protein acidic
      and rich in cysteine (SPARC) in the primary tumor and changes in levels of circulating tumor
      cells (CTCs) and circulating endothelial cells (CECs).

      OUTLINE:

      INDUCTION THERAPY: Patients receive paclitaxel albumin-stabilized nanoparticle formulation
      intravenously (IV) on days 1, 8, and 15 and bevacizumab IV over 30-90 minutes on days 1 and
      15. Treatment repeats every 28 days for 6 courses in the absence of disease progression or
      unacceptable toxicity.

      MAINTENANCE THERAPY: Patients achieving complete response, partial response, or stable
      disease after completion of induction therapy will receive bevacizumab IV over 30-90 minutes
      once every 14 or 21 days and erlotinib hydrochloride orally (PO) once daily (QD) in the
      absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up per physician discretion.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (chemo, monoclonal antibody, and enzyme inhibitor)ExperimentalINDUCTION THERAPY: Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV on days 1, 8, and 15 and bevacizumab IV over 30-90 minutes on days 1 and 15. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients achieving complete response, partial response, or stable disease after completion of induction therapy will receive bevacizumab IV over 30-90 minutes once every 14 or 21 days and erlotinib hydrochloride PO QD in the absence of disease progression or unacceptable toxicity.
  • paclitaxel albumin-stabilized nanoparticle formulation
  • erlotinib hydrochloride

Eligibility Criteria

        Inclusion Criteria:

          -  Have histologically confirmed invasive breast cancer that is estrogen receptor (ER)
             negative (=< 10%), progesterone receptor (PR) negative (=< 10%) and human epidermal
             growth factor receptor 2 (HER2) normal (=< 10% of cells) by immunohistochemistry (IHC)
             or fluorescence in situ hybridization (FISH)

          -  Be receiving first-line therapy for metastatic disease

          -  Measurable disease by Response Evaluation Criteria In Solid Tumors (RECIST) criteria;
             X-rays, scans or physical examinations used for tumor measurement must have been
             completed within 28 days prior to registration; X-rays, scans or other tests for
             assessment of non-measurable disease must have been performed within 42 days prior to
             registration

          -  OR non-measurable disease only, with rising serum cancer antigen (CA)15-3 or CA 27.29
             or carcinoembryonic antigen (CEA) documented by two consecutive measurements taken at
             least 14 days apart with the most recent measurement being within 42 days prior to
             registration; the second CA 15-3 or CA 27.29 or CEA value must have at least a 20%
             increase over the first and for CA 15-3 or CA 27.29 be greater than or equal to 40
             units/mL or for CEA be greater than or equal to 4 ng/mL

          -  Subjects with brain metastases as their first site of disease recurrence may be
             eligible if treated by definitive radiation (stereotactic radiosurgery or whole brain)
             with clinically controlled neurologic symptoms for a period of 21 days prior to study
             treatment

          -  Bilirubin =< 1.5 mg/dL

          -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 X upper
             limit of normal, unless bone metastasis is present in the absence of liver metastasis

          -  Alkaline phosphatase =< 2.5 X upper limit of normal, unless bone metastasis is present
             in the absence of liver metastasis

          -  Platelets > 100,000 cells/mm^3

          -  Hemoglobin > 9.0 g/dL

          -  Absolute neutrophil count (ANC) >= 1,500 cells/mm^3

          -  Creatinine =< 1.5 mg/dL is recommended; however, institutional norms are acceptable

          -  If of childbearing potential must have a negative pregnancy test and use an effective
             method to avoid pregnancy for the duration of the trial and for at least 6 months
             after completion of study therapy

          -  Pre-existing peripheral neuropathy, if present, must be < grade 2 (per Common
             Terminology Criteria for Adverse Events [CTCAE] version 3.0)

          -  Patients must be informed of the investigational nature of this study and must sign
             and give informed consent in accordance with institutional standards and federal
             guidelines

        Exclusion Criteria:

          -  Recurrent disease within 12 months after completion of adjuvant chemotherapy
             containing a weekly taxane

          -  Central nervous system (CNS) metastases that are symptomatic and/or requiring steroids

          -  Pre-existing nephritic syndrome

          -  Serious intercurrent medical or psychiatric illness including serious active infection

          -  Inadequately controlled hypertension (defined as systolic blood pressure > 150 and/or
             diastolic blood pressure > 100 mmHg on antihypertensive medications)

          -  Any prior history of hypertensive crisis or hypertensive encephalopathy

          -  New York Heart Association (NYHA) grade II or greater congestive heart failure

          -  History of myocardial infarction or unstable angina within 6 months prior to study
             enrollment

          -  History of stroke or transient ischemic attack within 6 months prior to study
             enrollment

          -  Significant vascular disease (e.g., aortic aneurysm, aortic dissection)

          -  Symptomatic peripheral vascular disease

          -  Evidence of bleeding diathesis or coagulopathy

          -  Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
             prior to study enrollment 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 study enrollment

          -  History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess
             within 6 months prior to study enrollment

          -  Serious, non-healing wound, ulcer, or bone fracture

          -  Proteinuria at screening as demonstrated by either:

               -  Urine protein:creatinine (UPC) ratio >= 1.0 at screening OR

               -  Urine dipstick for proteinuria > 2+ (patients discovered to have > 2+ proteinuria
                  on dipstick urinalysis at baseline must have a UPC ratio done that is < 1.0 to be
                  eligible; if the UPC ratio is >= 1.0 then the patient should undergo a 24-hour
                  urine collection which must demonstrate =< 1 g of protein in 24 hours for the
                  patient to be eligible)

          -  Known hypersensitivity to any component of bevacizumab or to nab-paclitaxel
             (paclitaxel albumin-stabilized nanoparticle formulation)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:N/A
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression-free survival (PFS)
Time Frame:Time from date of registration to date of first documentation of progression or symptomatic deterioration or death due to any cause, assessed up to 8 years
Safety Issue:
Description:Kaplan-Meier survival curves will be used. A 95% confidence interval for the median PFS will be calculated. A lower bound greater than 8 months would be strong evidence that Nab-Paclitaxel- bevacizumab induction therapy followed by bevacizumab-erlotinib hydrochloride maintenance therapy is superior to paclitaxel and bevacizumab. However, a median PFS of 13 months or greater (regardless of whether the 95% confidence interval for the median extends below 8 months) could also indicate promising results.

Secondary Outcome Measures

Measure:Overall survival
Time Frame:Time from date of registration to date of death due to any cause, assessed up to 8 years
Safety Issue:
Description:Kaplan-Meier survival curves will be used.
Measure:Response rate
Time Frame:Up to 8 years
Safety Issue:
Description:Will be summarized and an exact 90% binomial confidence interval determined for evaluable subjects.
Measure:Incidence of adverse events as assessed by National Cancer Institute CTCAE version 3.0
Time Frame:Up to 30 days after treatment discontinuation
Safety Issue:
Description:Adverse events that meet severity grade 2 or greater will be collected and reported. The number and percent of subjects reporting adverse events (all, severe or worse, serious and related) will be summarized for all patients, and stratified by center and other subgroups of interest.
Measure:EGFR and SPARC expression in the primary tumor
Time Frame:Up to 8 years
Safety Issue:
Description:
Measure:Changes in levels of circulating tumor cells
Time Frame:Baseline to up to 8 years
Safety Issue:
Description:
Measure:Changes in levels of circulating endothelial cells
Time Frame:Baseline to up to 8 years
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:University of Washington

Last Updated

November 20, 2017