Patient case: 67-year-old female with Breast cancer. Genetic variant: FGFR1 Amplification, PTEN (Q171). Other conditions: Depression, Hypertension, Heart Disease.

Clinical trial: Cixutumumab and Temsirolimus in Treating Patients With Locally Recurrent or Metastatic Breast Cancer

Summary: This phase I/II trial is studying the side effects and best dose of IMC-A12 when given together with temsirolimus and to see how well they work in treating patients with locally recurrent or metastatic breast cancer. Monoclonal antibodies, such as cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving IMC-A12 together with temsirolimus may kill more tumor cells.

Detailed description: PRIMARY OBJECTIVES:
  I. To establish the recommended dose level of cixutumumab and temsirolimus for the phase II study in patients with metastatic breast cancer. (Phase I) II. To examine the safety profile of this combination in patients with metastatic breast cancer. (Phase I) III. To assess the anti-tumor activity (in terms of overall response rate) and toxicity profile of cixutumumab in combination with temsirolimus in patients with metastatic breast cancer. (Phase II)
  SECONDARY OBJECTIVES:
  I. To estimate the progression-free survival (PFS) and overall survival distributions (as well as the 6-month PFS rate).
  II. To evaluate the in vivo mechanisms of action of temsirolimus in combination with cixutumumab and to examine potential biomarker predictors of treatment response.
  OUTLINE: This is a dose-escalation study of cixutumumab. Patients receive temsirolimus IV over 30 minutes and cixutumumab IV over 60 minutes on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  Peripheral blood samples are collected periodically for circulating markers and mononuclear cells. Samples are analyzed for pharmacodynamic assessments via western blot and proteomic studies. If pre-existing tumor tissue is available, tissue is examined by immunohistochemical staining for markers (e.g., pIRS-1, pIGF-IR, pMAPK, pAKT [S473], pS6, PTEN, Stathmin). Fluorescence in situ hybridization is used to assess IGF-IR amplification. Gene resequencing is performed to identify mutations of PIK3CA (exons 9 and 20), AKT1, and other genes. Genes IGF-1, IGF-II, IGFBP-1, IGFBP-3, and others are analyzed by reverse transcriptase-polymerase chain reaction.
  After completion of study treatment, patients are followed up periodically for up to 2 (phase I) or 5 (phase II) years.

Eligibility: Inclusion Criteria:
  -  Histologically confirmed diagnosis of breast cancer
  -  Metastatic or locally recurrent disease (locally recurrent disease should be stage IV [e.g, chest wall involvement])
  -  Measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 20 mm by conventional techniques or as ≥ 10 mm by spiral CT scan (phase II only)
  -  Must have received at least 1, but no more than 2, prior chemotherapy regimens in the setting of metastatic or locally recurrent (stage IV chest wall involvement) disease (phase II only)
  -  No uncontrolled brain metastases
  -  Brain metastases are not permitted on study unless the metastases have been treated by surgery or radiotherapy, and the patient has been neurologically stable and off of steroids for ≥ 12 weeks
  -  ECOG performance status (PS) 0-1 OR Karnofsky PS 80-100%
  -  Life expectancy > 12 weeks
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception during and for 3 months after completion of study treatment
  -  Absolute neutrophil count ≥ 1,500/μL
  -  Hemoglobin ≥ 8.5 g/dL
  -  Platelets ≥ 100,000/μL
  -  Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
  -  AST and ALT ≤ 3 times ULN (5 times ULN if LFT elevations due to liver metastases)
  -  Creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 60 mL/min
  -  Fasting serum cholesterol ≤ 350 mg/dL (9.0 mmol/L)
  -  Fasting triglycerides ≤ 400 mg/dL (4.56 mmol/L)
  -  Albumin ≥ 3.4 mg/dL
  -  Fasting serum glucose < 120 mg/dL
  -  No baseline diabetes requiring oral hypoglycemics or insulin (phase I only)
  -  No poorly controlled diabetes mellitus (phase II only)
  -  Patients with a history of diabetes mellitus on oral hypoglycemics or insulin are allowed to participate, provided that their fasting blood glucose is < 120 mg/dL and that they are on a stable dietary or therapeutic regimen for this condition
  -  No prior invasive non-breast malignancy, except for adequately treated basal cell or squamous cell carcinoma of the skin or other cancer from which the patient has been disease free for ≥ 5 years
  -  No known hypersensitivity reactions to macrolide antibiotics (such as erythromycin, clarithromycin, and azithromycin)
  -  No allergic reactions attributed to compounds of similar chemical or biologic composition to anti-IGF-1R recombinant monoclonal antibody IMC-A12 or temsirolimus
  -  Known HIV-positive patients who have CD4 counts below the normal range are not eligible
  -  No uncontrolled intercurrent illness including, but not limited to:
  -  Ongoing or active infection
  -  Symptomatic congestive heart failure
  -  Unstable angina pectoris
  -  Uncontrolled symptomatic cardiac arrhythmia
  -  Psychiatric illness/social situations that would limit compliance with study requirements
  -  No systemic anticancer therapy within the past 3 weeks
  -  No radiotherapy within the past 2 weeks
  -  No prior treatment with agents targeting the IGF-IR/IGFs or PI3K/Akt/mT OR pathway
  -  Any number of prior therapy regimens allowed (phase I only)
  -  No concurrent hormonal agents used for the treatment of breast cancer with the exception that premenopausal women who have been on a gonadotrophin-releasing hormone (GnRH)agonist and subsequently progressed may, at the discretion of the treating physician, continue on the GnRH agonist
  -  No other concurrent investigational agents or herbal preparations
  -  No concurrent oral corticosteroids except for replacement for adrenal insufficiency
  -  No concurrent combination antiretroviral therapy for HIV-positive patients
  -  No concurrent enzyme-inducing antiepileptic drugs (EIAEDs) (e.g., phenytoin, carbamazepine, phenobarbital) or any other CYP3A4 inducer such as rifampin or Hypericum perforatum (St. John's wort)
  -  No other concurrent chemotherapy or radiotherapy

Relevance to patient case: not relevant