Clinical Trials /

Neratinib in Treating Older Patients With Stage IV HER2-Positive Breast Cancer

NCT02673398

Description:

This phase II trial studies the side effects of and how well neratinib works in treating older patients with stage IV HER2-positive breast cancer. Neratinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Neratinib in Treating Older Patients With Stage IV HER2-Positive Breast Cancer
  • Official Title: Phase II Study of Neratinib in Patients 60 and Older With HER2 Positive Metastatic Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: 15342
  • SECONDARY ID: NCI-2015-02282
  • SECONDARY ID: 15342
  • SECONDARY ID: K12CA001727
  • SECONDARY ID: P30CA033572
  • NCT ID: NCT02673398

Conditions

  • HER2 Positive Breast Carcinoma
  • Stage IV Breast Cancer AJCC v6 and v7

Interventions

DrugSynonymsArms
Neratinib(2E)-N-(4-((3-chloro-4-((pyridin-2-yl)methoxy)phenyl)amino)-3-cyano-7-ethoxyquinolin-6-yl)-4-(dimethylamino)but-2-enamide, HKI 272, HKI-272, PB 272, PB-272Treatment (neratinib)

Purpose

This phase II trial studies the side effects of and how well neratinib works in treating older patients with stage IV HER2-positive breast cancer. Neratinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To estimate the safety and tolerability of neratinib in adults age 60 or older with
      locally advanced or metastatic HER2 over-expressing breast cancer.

      SECONDARY OBJECTIVES:

      I. To describe the full toxicity profile including all grade toxicities measured by National
      Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0.

      II. To estimate the rate of all grades of gastrointestinal (GI) toxicities such as diarrhea,
      nausea, and vomiting.

      III. To estimate the rate of dose reduction, delays and discontinuation related to study
      drug.

      IV. To describe pharmacokinetic parameters of neratinib in adults 60 and older. V. To
      estimate overall response rate (ORR) and clinical benefit rate (CBR) defined by Response
      Evaluation Criteria in Solid Tumors (RECIST) 1.1.

      VI. To estimate event free survival (EFS), progression-free survival (PFS) and overall
      survival (OS).

      VII. To evaluate the role of cancer-specific geriatric assessment tool in predicting
      treatment toxicities.

      VIII. To estimate adherence rate to neratinib in older adults (percentage of doses of
      neratinib taken).

      IX. To explore the association of pharmacokinetic (PK) parameters and geriatric assessment
      findings.

      X. To explore if serum biomarkers of aging (interleukin [IL]-6, C-reactive protein [CRP], and
      D-dimer) are associated with treatment toxicities.

      OUTLINE:

      Patients receive neratinib orally (PO) once daily (QD) on days 1-28. Cycles repeat every 28
      days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up for 30 days and then
      periodically thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (neratinib)ExperimentalPatients receive neratinib PO QD on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Neratinib

Eligibility Criteria

        Inclusion Criteria:

          -  Eastern Cooperative Oncology Group (ECOG) performance 0-2

          -  Life expectancy of greater than 12 weeks

          -  Histologically or cytologically proven metastatic breast cancer (metastases can be
             proven with imaging results in certain circumstances provided that the initial tumor
             was demonstrated histologically)

          -  Stage IV HER2/Neu positive breast cancer patients who failed previous anti-HER2
             targeted therapies

          -  HER2 positivity as defined by American Society of Clinical Oncology (ASCO)/College of
             American Pathologists (CAP) guidelines

          -  If HER2 negative by immunohistochemistry (IHC) or fluorescence in situ hybridization
             (FISH), but activating somatic mutations of HER2 gene identified through genomic
             sequencing including but not limited to the following (Clinical Laboratory Improvement
             Act [CLIA] certified lab test): missense substitutions (G309A, G309E, S310F, S310Y,
             S653C, V659E, R678Q, V697L, T733I, L755S, L755P, E757A, D769H, D769Y, D769N, G776V,
             G776C, V777L, L841V, V842I, R849W, L869R, R896C); insertions/deletions
             (A775_G776insYVMA aka Y772_A755dup, G776VinsC, G776AinsVGC, G776 insertions,
             G778_S779insCPG, P780_781insGSP aka G778_P780dup, L755_T759del) and/or HER3 activating
             mutations; there is no limitation on the number of prior lines of systemic therapy or
             HER2-targeted therapies (prior neratinib not allowed)

          -  Both measurable as well as non-measurable disease will be allowed

          -  Hemoglobin >= 9 g/dL (after transfusion, if necessary) within 4 weeks of
             pre-registration

          -  Total bilirubin within normal institutional limits within 4 weeks of pre-registration

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
             [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
             =< 2.5 x institutional upper limit of normal within 4 weeks of pre-registration

          -  Creatinine clearance >= 30 mL/min as calculated by Cockcroft-Gault formula within 4
             weeks of pre-registration

          -  Baseline left ventricular ejection fraction LVEF >= 50% as evaluated by echocardiogram
             (ECHO) or multiple-gated acquisition scan (MUGA)

          -  All grade >= 2 toxicities other than alopecia from prior therapy have resolved by the
             time of study commencement

          -  Patient must have completed radiation therapy with adequate recovery of bone marrow
             and organ functions, before starting neratinib

          -  Patient with stable or treated brain metastases are eligible; asymptomatic patients
             with metastatic brain disease who have been on a stable dose of corticosteroids for
             treatment of brain metastases for at least 14 days are eligible to participate in the
             study

          -  Provide written, informed consent to participate in the study and follow the study
             procedures

        Exclusion Criteria:

          -  Prior treatment with neratinib

          -  Concurrent usage of other investigational agents, chemotherapy, or hormone therapy;
             prior chemotherapy, hormonal therapy, targeted therapy, and investigational agents are
             allowed but all toxicities grade >= 2 must have resolved by the time of study
             commencement (except alopecia)

          -  Any major surgery =< 28 days prior to the initiation of investigational products

          -  Received chemotherapy or biologic therapy =< 3 weeks prior to the start of neratinib

          -  Active uncontrolled cardiac disease, including cardiomyopathy, congestive heart
             failure (New York Heart Association functional classification of >= 2, including
             individuals who currently use digitalis specifically for congestive heart failure),
             unstable angina, myocardial infarction within 12 month of enrollment or ventricular
             arrhythmia

          -  Concurrent use of digoxin due to cardiac disease; corrected QT (QTc) interval >= 450
             milliseconds in men and >= 470 milliseconds in women within 2 weeks of registration or
             known history of QTc prolongation or Torsades de Pointes

          -  Inability to take oral medication

          -  Other malignancy within the past 3 years with the exception of: a) adequately treated
             basal cell carcinoma, squamous cell skin cancer, or thyroid cancer; b) cervix or vulva
             carcinoma in situ; c) cancer considered cured by surgical resection or unlikely to
             impact survival during the duration of the study, such as localized transitional cell
             carcinoma of the bladder, or benign tumors of the adrenal or pancreas

          -  Significant chronic gastrointestinal disorder with diarrhea as a major symptom (e.g.,
             Crohn?s disease, malabsorption, or grade >= 2 National Cancer Institute [NCI] Common
             Terminology Criteria for Adverse Events [CTCAE] v.4.0 diarrhea of any etiology at
             baseline)

          -  Known clinically active infection with hepatitis B or hepatitis C virus

          -  Evidence of significant medical illness, abnormal laboratory finding or psychiatric
             illness/social situations that would, in the investigator?s judgment, makes the
             patient inappropriate for this study
      
Maximum Eligible Age:N/A
Minimum Eligible Age:60 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of grade 2 or higher toxicities
Time Frame:Up to 30 days after the completion of study treatment
Safety Issue:
Description:Will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Tables will be created to summarize the toxicities and side effects by organ system, attribution and severity for all participants that receive at least one dose of neratinib. Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for grade 2 or higher toxicities attributed to neratinib.

Secondary Outcome Measures

Measure:Incidence of all toxicities
Time Frame:Up to 30 days after the completion of study treatment
Safety Issue:
Description:Will be graded according to the NCI CTCAE version 4.0. Tables will be created to summarize the toxicities and side effects by organ system, attribution and severity for all participants that receive at least one dose of neratinib.
Measure:Incidence of gastrointestinal (GI) toxicities such as diarrhea, nausea and vomiting
Time Frame:Up to 30 days after the completion of study treatment
Safety Issue:
Description:Will be graded according to the NCI CTCAE version 4.0. Tables will be created to summarize the toxicities and side effects by organ system, attribution and severity for all participants that receive at least one dose of neratinib. Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for all grade GI toxicities (diarrhea, nausea and vomiting).
Measure:Rate of dose reduction
Time Frame:Up to 48 months
Safety Issue:
Description:Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for dose reduction.
Measure:Rate of holds
Time Frame:Up to 48 months
Safety Issue:
Description:Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for holds.
Measure:Rate of hospitalizations
Time Frame:Up to 48 months
Safety Issue:
Description:Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for hospitalizations.
Measure:Clearance
Time Frame:Day 15 of course 1 and day 1 of courses 3-4
Safety Issue:
Description:Clearance will be estimated using population pharmacokinetic (PK) methods.
Measure:Volume of distribution
Time Frame:Day 15 of course 1 and day 1 of courses 3-4
Safety Issue:
Description:Volume of distribution will be estimated using population PK methods.
Measure:Overall response rate
Time Frame:Up to 48 months
Safety Issue:
Description:Will be measured by Response Evaluation Criteria in Solid Tumors (RECIST). Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for objective response (complete response [CR] + partial response [PR]).
Measure:Clinical benefit rate
Time Frame:Up to 48 months
Safety Issue:
Description:Clinical benefit rate is defined as the proportion of patients who achieved overall tumor response (CR or PR) or stable disease (SD) for at least 24 weeks, measured by RECIST. Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for clinical benefit (CR+PR+SD).
Measure:Event free survival (EFS)
Time Frame:Up to 48 months
Safety Issue:
Description:EFS will be estimated using the product limit method of Kaplan and Meier.
Measure:Progression-free survival (PFS)
Time Frame:From the date of randomization until the first date on which recurrence, progression or death due to any cause, assessed up to 16 weeks
Safety Issue:
Description:Rates and associated 95% exact Clopper and Pearson binomial confidence limits will be estimated for PFS. PFS will be estimated using the product limit method of Kaplan and Meier.
Measure:Overall survival (OS)
Time Frame:Time from randomization to death due to any cause, assessed up to 48 months
Safety Issue:
Description:OS will be estimated using the product limit method of Kaplan and Meier.
Measure:Geriatric assessment score
Time Frame:Up to 48 months
Safety Issue:
Description:Generalized linear models and graphical methods will be used to explore factors as identified by a cancer-specific geriatric assessment.
Measure:Adherence, as defined by pill count
Time Frame:Up to 48 months
Safety Issue:
Description:Descriptive statistics will be provided for drug adherence and participant demographics.
Measure:IL-6, CRP, and D-dimer analysis
Time Frame:Baseline to up to 48 months
Safety Issue:
Description:Will be measured and descriptive statistics provided. Generalized linear models and graphical methods will be used to explore factors as identified by serum biomarkers that may be predictive of toxicity dose reductions, dose holds or hospitalizations.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:City of Hope Medical Center

Last Updated

December 17, 2020