Patient case: 35-year-old female with Breast cancer. Genetic variant: NRAS Amplification. Other conditions: None.

Clinical trial: PTK787 + Trastuzumab for HER2 Overexpressing Metastatic Breast Cancer

Summary: HER2 gene amplification increases VEGF production in breast cancers; combined inhibition of HER2 and VEGF enhances response in xenograft models. The upregulation of VEGF in HER2-overexpressing breast cancers may contribute to the aggressive phenotype observed in HER2-positive breast cancer. New therapeutics targeting VEGF and/or its receptors may enhance the efficacy of trastuzumab monotherapy.
  This trial will investigate the safety and efficacy of combined HER2 and VEGF inhibition.

Detailed description: OUTLINE: This is a multi-center study.
  PTK787 daily plus trastuzumab 4 mg/kg IV week 1, followed by 2 mg/kg weekly with disease evaluation every other cycle.
  Patients may continue treatment until disease progression or toxicity intervenes.
  Performance Status: ECOG 0 or 1
  Life Expectancy: Not specified
  Hematopoietic:
  -  ANC > 1500 mm3
  -  Platelets > 100,000 mm3
  -  Hemoglobin > 9 g/dL
  -  PTT and INR < 1.5 x ULN
  Hepatic:
  -  ALT and AST < 3 x ULN (< 5 x ULN in patients with known liver metastases)
  -  Alkaline phosphatase < 2.5 x ULN
  -  Serum bilirubin < 1.5 x ULN
  Renal:
  -  Serum creatinine < 1.5 x ULN
  -  Proteinuria < 1+ by dipstick OR total urinary protein < 500 mg/24 hours with measured creatinine clearance (CrCl) ≥ 50 mL/min
  Cardiovascular:
  -  No clinically significant cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease and cardiac arrhythmias not well controlled with medication) or myocardial infarction within the last 6 months.
  -  LVEF > LLN by MUGA or ECHO (obtained within 28 days prior to being registered for protocol therapy)
  Pulmonary:
  -  Not specified

Eligibility: Inclusion Criteria:
  -  Histologic or cytologic diagnosis of breast cancer with evidence of measurable (1) unresectable, locally recurrent, or (2) metastatic disease. Locally recurrent disease must not be amenable to resection OR radiation with curative intent.
  -  Patient's disease may not involve more than 3 metastatic sites. In addition, patient may not be symptomatic from pulmonary metastasis or have liver metastasis involving > 50% of parenchyma.
  -  HER2 gene amplification by FISH. HER protein overexpression by immunohistochemistry will not be sufficient for entry.
  -  Negative pregnancy test
  Exclusion Criteria:
  -  No prior cytotoxic chemotherapy or trastuzumab for locally recurrent or metastatic disease.
  -  No prior treatment with any VEGF inhibiting agents
  -  No history or presence of central nervous system (CNS) disease.
  -  No other forms of cancer therapy including radiation, chemotherapy and hormonal therapy within 21 days prior to being registered for protocol therapy.
  -  No major surgery within 28 days prior to being registered for protocol therapy.
  -  No uncontrolled hypertension (SBP > 170, DBP > 90), history of labile hypertension or history of poor compliance with antihypertensive therapy.
  -  No requirement for therapeutic anticoagulation, regular aspirin (> 325 mg/day) or NSAID use.
  -  No current breast feeding.
  -  No impairment of gastrointestinal (GI) function that may significantly alter the absorption of PTK787.
  -  No evidence of other serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator).

Relevance to patient case: not relevant