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Study of Preoperative Weekly Paclitaxel and Carboplatin With Lapatinib (Tykerb®) in Patients With ErbB2-Positive Stage I-III Breast Cancer

Primary Purpose

ErbB2-Positive Stage I-III Breast Cancer

Status
Unknown status
Phase
Phase 2
Locations
Singapore
Study Type
Interventional
Intervention
paclitaxel/carboplatin/lapatinib
Sponsored by
National University Hospital, Singapore
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for ErbB2-Positive Stage I-III Breast Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • • Female, Age ≥ 18 years

    • Histologic or cytologic diagnosis of breast carcinoma
    • T1-4 breast cancer with measurable primary breast tumor, defined as palpable tumor with the largest diameter measuring 2.0cm or greater by calipers
    • Tumor is HER2 positive either by IHC (3+) or FISH amplification (amplification ratio >2.2)
    • Patients must not have received prior chemotherapy or hormonal therapy for the treatment of breast cancer
    • Karnofsky performance status of 70 or higher
    • Estimated life expectancy of at least 12 weeks
    • Adequate organ function including the following:

Bone marrow:

  • Absolute neutrophil (segmented and bands) count (ANC) >= 1.5 x 109/L
  • Platelets >= 100 x 109/L

Hepatic:

  • Bilirubin <= 1.5 x upper limit of normal (ULN),
  • ALT or AST <= 2.5x ULN

Renal:

o Calculated creatinine clearance >30ml/minute

  • Left ventricular ejection fraction >=50% measured by 2D echo or MUGA
  • Signed informed consent from patient or legal representative
  • Patient with reproductive potential must use an approved contraceptive method if appropriate (e.g. intrauterine device, birth control pills, or barrier device) during and for three months after the study. Females with childbearing potential must have a negative serum pregnancy test within 7 days prior to study enrollment

Exclusion Criteria:

  • • Prior treatment for locally advanced or metastatic breast cancer

    • Treatment within the last 30 days with any investigational drug
    • Concurrent administration of any other tumor therapy, including cytotoxic chemotherapy, hormonal therapy, and immunotherapy
    • Major surgery within 28 days of study drug administration
    • Active infection that in the opinion of the investigator would compromise the patient's ability to tolerate therapy
    • Breast feeding
    • Serious cardiac illness or medical conditions including but not confined to:

      • History of documented congestive cardiac failure or systolic dysfunction (LVEF <50%)
      • High-risk uncontrolled arrhythmias (ventricular tachycardia, high-grade AV block, supraventricular arrhythmias which are not adequately rate-controlled)
      • History of significant ischaemic heart disease
      • Clinically significant valvular heart disease
      • Poorly controlled hypertension (e.g. systolic BP > 180mmHg or diastolic >100mmHg)
    • Poorly controlled diabetes mellitus.
    • Second primary malignancy that is clinically detectable at the time of consideration for study enrollment.
    • History of significant neurological or mental disorder, including seizures or dementia.
    • Subjects who have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones or stable chronic liver disease per investigator assessment)
    • Concomitant use of CYP3A4 inhibitors

Sites / Locations

  • National University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Pre-operative Therapy

Arm Description

Neoadjuvant paclitaxel/carboplatin/lapatinib x 12 weeks

Outcomes

Primary Outcome Measures

Rate of pathologic complete response

Secondary Outcome Measures

Treatment related toxicities
Breast conservation rates
Clinical response rates
Relapse free survival (RFS)
Identification of tumor biomarkers that predict pathologic complete response

Full Information

First Posted
March 3, 2011
Last Updated
October 13, 2014
Sponsor
National University Hospital, Singapore
Collaborators
National Cancer Centre, Singapore
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1. Study Identification

Unique Protocol Identification Number
NCT01309607
Brief Title
Study of Preoperative Weekly Paclitaxel and Carboplatin With Lapatinib (Tykerb®) in Patients With ErbB2-Positive Stage I-III Breast Cancer
Official Title
Phase II Open-Label Study of Preoperative Weekly Paclitaxel and Carboplatin With Lapatinib (Tykerb®) in Patients With ErbB2-Positive Stage I-III Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
October 2014
Overall Recruitment Status
Unknown status
Study Start Date
April 2011 (undefined)
Primary Completion Date
December 2014 (Anticipated)
Study Completion Date
December 2015 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National University Hospital, Singapore
Collaborators
National Cancer Centre, Singapore

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the efficacy and safety of weekly paclitaxel and carboplatin, in combination with lapatinib, in the neoadjuvant treatment of non-metastatic erbB2-positive breast cancer. Secondary objectives include: To determine the safety and tolerability of weekly paclitaxel and carboplatin, combined with lapatinib, in an Asian population To determine breast conservation rates following neoadjuvant paclitaxel/ carboplatin/ lapatinib To determine clinical response rates and relapse-free survival of patients treated with neoadjuvant paclitaxel/ carboplatin/ lapatinib To identify predictive tumour biomarkers for pathologic complete response The investigators hypothesize that pathologic complete response rates will be improved from 15% to 35% with the neoadjuvant regimen of carboplatin/ paclitaxel/ lapatinib compared to standard chemotherapy alone in HER2 positive early stage breast cancers.
Detailed Description
Pathologic complete response following neoadjuvant chemotherapy has been shown to be an independent, strong predictor of disease-free and overall survival in operable breast cancer The addition of neoadjuvant trastuzumab to chemotherapy results in a 2-3 fold increase in pCR rates in operable ErbB2-positive breast cancer Lapatinib is being explored as an alternative to trastuzumab in large clinical trials in operable ErbB2-positive breast cancer In a randomised phase III adjuvant trial, BCIRG 006, non-anthracycline chemotherapy (docetaxel and carboplatin) has been shown to be as effective as conventional sequential anthracycline-containing chemotherapy and docetaxel, in combination with trastuzumab, but with improved cardiac safety Weekly paclitaxel has been shown in a randomized phase III study to be the optimal adjuvant taxane regimen Weekly paclitaxel and carboplatin, in combination with lapatinib, has demonstrated safety and efficacy in Phase I/II clinical studies of metastatic breast and ovarian cancer The investigators aim to assess the efficacy of a non-anthracycline containing regimen, weekly paclitaxel and carboplatin, in combination with lapatinib in inducing pCR in the neoadjuvant treatment of ErbB2-positive non-metastatic breast cancer. The investigators hypothesize that this combination will achieve pCR rates of at least 35%

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
ErbB2-Positive Stage I-III Breast Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
34 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Pre-operative Therapy
Arm Type
Experimental
Arm Description
Neoadjuvant paclitaxel/carboplatin/lapatinib x 12 weeks
Intervention Type
Drug
Intervention Name(s)
paclitaxel/carboplatin/lapatinib
Intervention Description
Drug doses for the neoadjuvant regimen: Paclitaxel 80mg/m2, day 1, 8, 15 of a 21-day cycle Carboplatin AUC of 2, day 1, 8 of a 21-day cycle Lapatinib 750mg daily continuously
Primary Outcome Measure Information:
Title
Rate of pathologic complete response
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Treatment related toxicities
Time Frame
12 weeks
Title
Breast conservation rates
Time Frame
16 weeks
Title
Clinical response rates
Time Frame
1 year
Title
Relapse free survival (RFS)
Time Frame
2 years
Title
Identification of tumor biomarkers that predict pathologic complete response
Time Frame
16 weeks

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: • Female, Age ≥ 18 years Histologic or cytologic diagnosis of breast carcinoma T1-4 breast cancer with measurable primary breast tumor, defined as palpable tumor with the largest diameter measuring 2.0cm or greater by calipers Tumor is HER2 positive either by IHC (3+) or FISH amplification (amplification ratio >2.2) Patients must not have received prior chemotherapy or hormonal therapy for the treatment of breast cancer Karnofsky performance status of 70 or higher Estimated life expectancy of at least 12 weeks Adequate organ function including the following: Bone marrow: Absolute neutrophil (segmented and bands) count (ANC) >= 1.5 x 109/L Platelets >= 100 x 109/L Hepatic: Bilirubin <= 1.5 x upper limit of normal (ULN), ALT or AST <= 2.5x ULN Renal: o Calculated creatinine clearance >30ml/minute Left ventricular ejection fraction >=50% measured by 2D echo or MUGA Signed informed consent from patient or legal representative Patient with reproductive potential must use an approved contraceptive method if appropriate (e.g. intrauterine device, birth control pills, or barrier device) during and for three months after the study. Females with childbearing potential must have a negative serum pregnancy test within 7 days prior to study enrollment Exclusion Criteria: • Prior treatment for locally advanced or metastatic breast cancer Treatment within the last 30 days with any investigational drug Concurrent administration of any other tumor therapy, including cytotoxic chemotherapy, hormonal therapy, and immunotherapy Major surgery within 28 days of study drug administration Active infection that in the opinion of the investigator would compromise the patient's ability to tolerate therapy Breast feeding Serious cardiac illness or medical conditions including but not confined to: History of documented congestive cardiac failure or systolic dysfunction (LVEF <50%) High-risk uncontrolled arrhythmias (ventricular tachycardia, high-grade AV block, supraventricular arrhythmias which are not adequately rate-controlled) History of significant ischaemic heart disease Clinically significant valvular heart disease Poorly controlled hypertension (e.g. systolic BP > 180mmHg or diastolic >100mmHg) Poorly controlled diabetes mellitus. Second primary malignancy that is clinically detectable at the time of consideration for study enrollment. History of significant neurological or mental disorder, including seizures or dementia. Subjects who have current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones or stable chronic liver disease per investigator assessment) Concomitant use of CYP3A4 inhibitors
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Soo Chin Lee
Organizational Affiliation
National University Hospital, Singapore
Official's Role
Principal Investigator
Facility Information:
Facility Name
National University Hospital
City
Singapore
ZIP/Postal Code
119228
Country
Singapore

12. IPD Sharing Statement

Citations:
PubMed Identifier
9704717
Citation
Fisher B, Bryant J, Wolmark N, Mamounas E, Brown A, Fisher ER, Wickerham DL, Begovic M, DeCillis A, Robidoux A, Margolese RG, Cruz AB Jr, Hoehn JL, Lees AW, Dimitrov NV, Bear HD. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998 Aug;16(8):2672-85. doi: 10.1200/JCO.1998.16.8.2672.
Results Reference
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PubMed Identifier
17192538
Citation
Geyer CE, Forster J, Lindquist D, Chan S, Romieu CG, Pienkowski T, Jagiello-Gruszfeld A, Crown J, Chan A, Kaufman B, Skarlos D, Campone M, Davidson N, Berger M, Oliva C, Rubin SD, Stein S, Cameron D. Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med. 2006 Dec 28;355(26):2733-43. doi: 10.1056/NEJMoa064320. Erratum In: N Engl J Med. 2007 Apr 5;356(14):1487.
Results Reference
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Study of Preoperative Weekly Paclitaxel and Carboplatin With Lapatinib (Tykerb®) in Patients With ErbB2-Positive Stage I-III Breast Cancer

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