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Study Of Lapatinib In Patients With Relapsed Or Refractory Inflammatory Breast Cancer

Primary Purpose

Neoplasms, Breast

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
lapatinib
Sponsored by
GlaxoSmithKline
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neoplasms, Breast focused on measuring ErbB2 overexpressing, ErbB1 expressing, relapsed breast cancer, refractory inflammatory breast cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria: Must have a life expectancy of at least 12 weeks. Has a left ventricular ejection fraction (LVEF) ≥ 50%, or ≥ lower limit of normal for the institution, based on ECHO or MUGA. Aspartate and alanine transaminase (AST or ALT) ≤ 3 times the upper limit of the reference range (patients with liver metastases may have AST and ALT ≤ 5 times the upper limit of the reference range and may be enrolled). Total bilirubin ≤ 3.0 mg/dL. Serum creatinine ≤ 2.0 mg/dL or calculated creatinine clearance (CrCl) ≥ 30 mL/min Adequate bone marrow function. Hemoglobin ≥ 9 gm/dL. Absolute granulocyte count ≥ 1,500/mm³ (1.5 x 10^9/L). Platelets ≥ 75,000/mm³ (100 x 10^9/L). Recovered or stabilized sufficiently from side effects associated with previous chemotherapy, surgery or radiotherapy. Provided written informed consent. ECOG (Eastern Cooperative Oncology Group) performance status 0 to 2. Able to swallow and retain oral medication. Male or female, if female: A female is eligible to enter and participate in the study if she is of: Non-childbearing potential (i.e., women with functioning ovaries who have a current documented tubal ligation or hysterectomy, or women who are postmenopausal); or Childbearing potential (i.e., women with functioning ovaries and no documented impairment of oviductal or uterine function that would cause sterility. This category includes women with oligomenorrhoea (severe), women who are perimenopausal, and young women who have begun to menstruate), has a negative serum pregnancy test at screening, and agrees to one of the following where considered acceptable to the local IRB/IEC: Double-barrier contraception (condom with spermicidal jelly, foam suppository, or film; diaphragm with spermicide; or male condom and diaphragm). Abstinence from sexual intercourse from 2 weeks prior to administration of the investigational product, throughout the active study treatment period, and through the post-treatment follow-up visit (to occur 28 days after last dose of investigational product). Male partner who is sterile prior to the female subject's entry into the study and is the sole sexual partner for that female subject. Implants of levonorgestrel. Injectable progestogen. Any intrauterine device (IUD) with a documented failure rate of less than 1% per year. Oral contraceptives (either combined or progestogen only). Barrier methods including diaphragm or condom with a spermicide. At least 18 years of age. Has either measurable disease by Response Evaluation Criteria in Solid Tumors (RESIST) or clinically evaluable skin disease. Measurable lesions may be in the field of prior adjuvant irradiation; however, there must be at least an 8 week period between the last radiation treatment and the baseline scan documenting disease status for the lesion to be measurable. Tumor that is accessible for biopsy. Tumor that overexpresses ErbB2 defined as 3+ by IHC or FISH +. The ErbB 2 overexpression must be documented prior to dosing. Documented disease progression or relapse following treatment, which must have contained a taxane and anthracycline-containing regimen in the adjuvant or metastatic setting (30 patients) plus trastuzumab (90 patients) Histological diagnosis of breast carcinoma with a clinical diagnosis of IBC based on the presence of inflammatory changes in the involved breast, including diffuse erythema and edema (peau d'orange), with or without an underlying palpable mass involving the majority of the skin of the breast. Pathologic evidence of dermal lymphatic invasion should be noted but is not required for diagnosis. Exclusion criteria: Is clinically assessed to have inadequate venous access for protocol-related blood draws. Has a clinically significant electrocardiogram (ECG) abnormality. Has Class II to IV heart failure as defined by the New York Heart Association (NYHA) functional classification system. Has physiological, familial, sociological, or geographical conditions that do not permit compliance with the protocol. Is currently receiving oral steroid treatment (inhaled steroids are permitted), or any other medication on the prohibited medications list Is currently receiving amiodarone or has received amiodarone in the 6 months prior to screening. Has received chemotherapy, immunotherapy, biologic therapy or hormonal therapy within the past 14 days, with the exception of mitomycin C within the past 6 weeks. Has received treatment with any investigational drug in the previous 4 weeks. Has a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the investigational product. These include other anilinoquinazolines, such as gefitinib [Iressa], erlotinib [Tarceva], or other chemically related compounds. Is considered medically unfit for the study by the investigator as a result of the medical interview, physical exam, or screening investigations. Has evidence of symptomatic or uncontrolled brain metastases or leptomeningeal disease. Patients with brain metastases treated by surgery and/or radiotherapy are eligible if neurologically stable and do not require steroids or anticonvulsants. Has malabsorption syndrome, a disease affecting gastrointestinal function, or resection of the stomach or small bowel. Is a pregnant or lactating female.

Sites / Locations

  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site
  • GSK Investigational Site

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lapatinib

Arm Description

Single arm study of lapatinib with no comparator arm.

Outcomes

Primary Outcome Measures

Objective Response rate (complete response plus partial response)

Secondary Outcome Measures

Clinical benefit (progression free survival, time to progression, response duration)
Assessment of clinical benefit, defined as CR or PR for at least 4 weeks, or SD for at least 6 months
Calculation of progression-free survival, defined as the time between the first dose of investigational product and the first documented sign of disease progression or death.
Calculation of time-to-response, defined as the time between the first dose of investigational product and the first documented CR or PR.
Calculation of duration of response, defined as the time from initial documented CR or PR to the first documented sign of disease progression.
Evaluation of changes in QoL and pain scale measurements collected on Day 1 and every 4 weeks while receiving study treatment.
Evaluation of adverse events (AEs), changes in laboratory values and echocardiogram (ECHO) or multiple gated acquisition scan (MUGA) results from pre-dose, during dosing and post-dose assessments
Comparison of the effects of lapatinib on biomarkers that are involved in regulating tumor cell proliferation and survival (e.g., phosphorylated forms of Erk1/2 and Akt, STAT3, S6 Kinase, Bad, truncated ErbB2 and potentially other downstream mediators of
tumor cell growth and survival) by quantitative IHC and by direct and genome-wide methods (e.g., direct sequencing and DNA microarray) in tumor tissue collected prior to and following 28 days of lapatinib monotherapy.
Examination of the effects of lapatinib therapy on the levels of circulating ErbB1 and ErbB2 ECD and the proteomic profile of peripheral blood. Investigation of the use of FDG-PET to predict early response to treatment with lapatinib.

Full Information

First Posted
March 18, 2005
Last Updated
September 24, 2015
Sponsor
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT00105950
Brief Title
Study Of Lapatinib In Patients With Relapsed Or Refractory Inflammatory Breast Cancer
Official Title
A Phase II Study to Evaluate the Efficacy, Safety and Pharmacodynamics of Lapatinib in Patients With Relapsed or Refractory Inflammatory Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
May 2015
Overall Recruitment Status
Completed
Study Start Date
March 2005 (undefined)
Primary Completion Date
September 2007 (Actual)
Study Completion Date
May 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GlaxoSmithKline

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study was designed to determine how effective and safe a new investigational drug, lapatinib, is in treating patients with treatment refractory or relapsed inflammatory breast cancer. Tumor tissue collected pre-treatment and at Day 28 will be examined for biologic activity by IHC (immunohistochemistry). Treatment will consist of daily oral therapy with lapatinib. A patient may continue treatment as long as they are receiving benefit. Blood samples for hematology and chemistry panels, MUGA/ECHO (multigated acquisition/echocardiogram) exams and physical exams will be performed throughout the study to monitor safety.
Detailed Description
This Phase II open label, multicenter study is designed to evaluate the efficacy, safety, and pharmacodynamic effects of oral lapatinib administered as a single agent therapy to patients with relapsed or refractory inflammatory breast cancer. Eligible patients must have a diagnosis of inflammatory breast cancer based on clinicopathologic criteria, tumor that is readily accessible for biopsy, and must have previously received treatment with an anthracycline and taxane-containing regimen (30 patients) plus trastuzumab (90 patients). Patients enrolled must have tumors that overexpress ErbB2, with or without co-expression of ErbB1. The primary objective for this study is to evaluate the objective response rate (defined as complete response plus partial response). Secondary objectives are to evaluate clinical benefit including quality of life parameters, progression-free survival, overall survival, time-to-response, response duration, safety and tolerability, pharmacodynamic effects on intracellular mediators that regulate tumor cell growth and survival, as well as effects on proteomic profile, and circulating levels of extracellular domains of ErbB1 and ErbB2 in peripheral blood.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neoplasms, Breast
Keywords
ErbB2 overexpressing, ErbB1 expressing, relapsed breast cancer, refractory inflammatory breast cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
126 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Lapatinib
Arm Type
Experimental
Arm Description
Single arm study of lapatinib with no comparator arm.
Intervention Type
Drug
Intervention Name(s)
lapatinib
Intervention Description
Tyrosine kinase inhibitor administered daily at 1500 mg/kg
Primary Outcome Measure Information:
Title
Objective Response rate (complete response plus partial response)
Time Frame
Week 84
Secondary Outcome Measure Information:
Title
Clinical benefit (progression free survival, time to progression, response duration)
Time Frame
week 84
Title
Assessment of clinical benefit, defined as CR or PR for at least 4 weeks, or SD for at least 6 months
Time Frame
week 84
Title
Calculation of progression-free survival, defined as the time between the first dose of investigational product and the first documented sign of disease progression or death.
Time Frame
week 84
Title
Calculation of time-to-response, defined as the time between the first dose of investigational product and the first documented CR or PR.
Time Frame
week 84
Title
Calculation of duration of response, defined as the time from initial documented CR or PR to the first documented sign of disease progression.
Time Frame
week 84
Title
Evaluation of changes in QoL and pain scale measurements collected on Day 1 and every 4 weeks while receiving study treatment.
Time Frame
week 84
Title
Evaluation of adverse events (AEs), changes in laboratory values and echocardiogram (ECHO) or multiple gated acquisition scan (MUGA) results from pre-dose, during dosing and post-dose assessments
Time Frame
week 84
Title
Comparison of the effects of lapatinib on biomarkers that are involved in regulating tumor cell proliferation and survival (e.g., phosphorylated forms of Erk1/2 and Akt, STAT3, S6 Kinase, Bad, truncated ErbB2 and potentially other downstream mediators of
Time Frame
Day 28
Title
tumor cell growth and survival) by quantitative IHC and by direct and genome-wide methods (e.g., direct sequencing and DNA microarray) in tumor tissue collected prior to and following 28 days of lapatinib monotherapy.
Time Frame
Day 28
Title
Examination of the effects of lapatinib therapy on the levels of circulating ErbB1 and ErbB2 ECD and the proteomic profile of peripheral blood. Investigation of the use of FDG-PET to predict early response to treatment with lapatinib.
Time Frame
Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Must have a life expectancy of at least 12 weeks. Has a left ventricular ejection fraction (LVEF) ≥ 50%, or ≥ lower limit of normal for the institution, based on ECHO or MUGA. Aspartate and alanine transaminase (AST or ALT) ≤ 3 times the upper limit of the reference range (patients with liver metastases may have AST and ALT ≤ 5 times the upper limit of the reference range and may be enrolled). Total bilirubin ≤ 3.0 mg/dL. Serum creatinine ≤ 2.0 mg/dL or calculated creatinine clearance (CrCl) ≥ 30 mL/min Adequate bone marrow function. Hemoglobin ≥ 9 gm/dL. Absolute granulocyte count ≥ 1,500/mm³ (1.5 x 10^9/L). Platelets ≥ 75,000/mm³ (100 x 10^9/L). Recovered or stabilized sufficiently from side effects associated with previous chemotherapy, surgery or radiotherapy. Provided written informed consent. ECOG (Eastern Cooperative Oncology Group) performance status 0 to 2. Able to swallow and retain oral medication. Male or female, if female: A female is eligible to enter and participate in the study if she is of: Non-childbearing potential (i.e., women with functioning ovaries who have a current documented tubal ligation or hysterectomy, or women who are postmenopausal); or Childbearing potential (i.e., women with functioning ovaries and no documented impairment of oviductal or uterine function that would cause sterility. This category includes women with oligomenorrhoea (severe), women who are perimenopausal, and young women who have begun to menstruate), has a negative serum pregnancy test at screening, and agrees to one of the following where considered acceptable to the local IRB/IEC: Double-barrier contraception (condom with spermicidal jelly, foam suppository, or film; diaphragm with spermicide; or male condom and diaphragm). Abstinence from sexual intercourse from 2 weeks prior to administration of the investigational product, throughout the active study treatment period, and through the post-treatment follow-up visit (to occur 28 days after last dose of investigational product). Male partner who is sterile prior to the female subject's entry into the study and is the sole sexual partner for that female subject. Implants of levonorgestrel. Injectable progestogen. Any intrauterine device (IUD) with a documented failure rate of less than 1% per year. Oral contraceptives (either combined or progestogen only). Barrier methods including diaphragm or condom with a spermicide. At least 18 years of age. Has either measurable disease by Response Evaluation Criteria in Solid Tumors (RESIST) or clinically evaluable skin disease. Measurable lesions may be in the field of prior adjuvant irradiation; however, there must be at least an 8 week period between the last radiation treatment and the baseline scan documenting disease status for the lesion to be measurable. Tumor that is accessible for biopsy. Tumor that overexpresses ErbB2 defined as 3+ by IHC or FISH +. The ErbB 2 overexpression must be documented prior to dosing. Documented disease progression or relapse following treatment, which must have contained a taxane and anthracycline-containing regimen in the adjuvant or metastatic setting (30 patients) plus trastuzumab (90 patients) Histological diagnosis of breast carcinoma with a clinical diagnosis of IBC based on the presence of inflammatory changes in the involved breast, including diffuse erythema and edema (peau d'orange), with or without an underlying palpable mass involving the majority of the skin of the breast. Pathologic evidence of dermal lymphatic invasion should be noted but is not required for diagnosis. Exclusion criteria: Is clinically assessed to have inadequate venous access for protocol-related blood draws. Has a clinically significant electrocardiogram (ECG) abnormality. Has Class II to IV heart failure as defined by the New York Heart Association (NYHA) functional classification system. Has physiological, familial, sociological, or geographical conditions that do not permit compliance with the protocol. Is currently receiving oral steroid treatment (inhaled steroids are permitted), or any other medication on the prohibited medications list Is currently receiving amiodarone or has received amiodarone in the 6 months prior to screening. Has received chemotherapy, immunotherapy, biologic therapy or hormonal therapy within the past 14 days, with the exception of mitomycin C within the past 6 weeks. Has received treatment with any investigational drug in the previous 4 weeks. Has a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the investigational product. These include other anilinoquinazolines, such as gefitinib [Iressa], erlotinib [Tarceva], or other chemically related compounds. Is considered medically unfit for the study by the investigator as a result of the medical interview, physical exam, or screening investigations. Has evidence of symptomatic or uncontrolled brain metastases or leptomeningeal disease. Patients with brain metastases treated by surgery and/or radiotherapy are eligible if neurologically stable and do not require steroids or anticonvulsants. Has malabsorption syndrome, a disease affecting gastrointestinal function, or resection of the stomach or small bowel. Is a pregnant or lactating female.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GSK Clinical Trials
Organizational Affiliation
GlaxoSmithKline
Official's Role
Study Director
Facility Information:
Facility Name
GSK Investigational Site
City
Miami
State/Province
Florida
ZIP/Postal Code
33136-1002
Country
United States
Facility Name
GSK Investigational Site
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
GSK Investigational Site
City
Zion
State/Province
Illinois
ZIP/Postal Code
60099
Country
United States
Facility Name
GSK Investigational Site
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892-1201
Country
United States
Facility Name
GSK Investigational Site
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
GSK Investigational Site
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
GSK Investigational Site
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
GSK Investigational Site
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
Facility Name
GSK Investigational Site
City
Bruxelles
ZIP/Postal Code
1000
Country
Belgium
Facility Name
GSK Investigational Site
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4N 3M5
Country
Canada
Facility Name
GSK Investigational Site
City
Bayonne
ZIP/Postal Code
64100
Country
France
Facility Name
GSK Investigational Site
City
Lyon Cedex 08
ZIP/Postal Code
69373
Country
France
Facility Name
GSK Investigational Site
City
Marseille Cedex 09
ZIP/Postal Code
13273
Country
France
Facility Name
GSK Investigational Site
City
Paris Cedex 20
ZIP/Postal Code
75970
Country
France
Facility Name
GSK Investigational Site
City
Paris Cedex 5
ZIP/Postal Code
75248
Country
France
Facility Name
GSK Investigational Site
City
Saint-Herblain
ZIP/Postal Code
44805
Country
France
Facility Name
GSK Investigational Site
City
Ramat Gan
ZIP/Postal Code
52621
Country
Israel
Facility Name
GSK Investigational Site
City
Zrifin
ZIP/Postal Code
70300
Country
Israel
Facility Name
GSK Investigational Site
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
GSK Investigational Site
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
GSK Investigational Site
City
Girona
ZIP/Postal Code
17007
Country
Spain
Facility Name
GSK Investigational Site
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
GSK Investigational Site
City
Sfax
ZIP/Postal Code
3000
Country
Tunisia
Facility Name
GSK Investigational Site
City
Sfax
ZIP/Postal Code
3029
Country
Tunisia
Facility Name
GSK Investigational Site
City
Tunis
ZIP/Postal Code
1004
Country
Tunisia
Facility Name
GSK Investigational Site
City
Tunis
ZIP/Postal Code
1007
Country
Tunisia
Facility Name
GSK Investigational Site
City
London
ZIP/Postal Code
SW3 6JJ
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
19394894
Citation
Kaufman B, Trudeau M, Awada A, Blackwell K, Bachelot T, Salazar V, DeSilvio M, Westlund R, Zaks T, Spector N, Johnston S. Lapatinib monotherapy in patients with HER2-overexpressing relapsed or refractory inflammatory breast cancer: final results and survival of the expanded HER2+ cohort in EGF103009, a phase II study. Lancet Oncol. 2009 Jun;10(6):581-8. doi: 10.1016/S1470-2045(09)70087-7. Epub 2009 Apr 24.
Results Reference
result
PubMed Identifier
20214527
Citation
Kaufman B, Wu Y, Amonkar MM, Sherrill B, Bachelot T, Salazar V, Viens P, Johnston S. Impact of lapatinib monotherapy on QOL and pain symptoms in patients with HER2+ relapsed or refractory inflammatory breast cancer. Curr Med Res Opin. 2010 May;26(5):1065-73. doi: 10.1185/03007991003680323.
Results Reference
result

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Study Of Lapatinib In Patients With Relapsed Or Refractory Inflammatory Breast Cancer

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