Patient case: 56-year-old female with breast cancer; genetic feature: ERBB2

Clinical trial: A Study to Examine the Effects of Esomeprazole on the Pharmacokinetics of Orally Administered Lapatinib in Subjects With Metastatic ErbB2 Positive Breast Cancer

Summary: This study will characterize the effect of elevated gastric pH mediated by the proton-pump inhibitor, esomeprazole, on the relative bioavailability of lapatinib in subjects with metastatic ErbB2 positive breast cancer.


Eligibility: Inclusion Criteria:
  -  Metastatic, histologically confirmed breast cancer that overexpresses ErbB2 (3+ by IHC, FISH, or CISH positive).
  -  18 years to 65 years of age.
  -  Is male or female (of non childbearing potential or willing to use contraception as specified in the protocol).
  -  Is able to swallow and retain oral medication.
  -  ECOG performance status 0 to 2.
  -  Provided written informed consent.
  -  Adequate bone marrow function (as specified in the protocol).
  -  Calculated creatinine clearance (CrCl) greater than or equal to 50 ml/min based on Cockcroft and Gault.
  -  Total bilirubin less than or equal to 1.5 X upper limit of normal of institutional values.
  -  Alanine transaminase (ALT) less than or equal to 3 times the upper limit of the institutional values or less than or equal to 5 times ULN with documented liver metastases
  -  Has a left ventricular ejection fraction (LVEF) within the normal institutional range based on ECHO or MUGA.
  -  Life expectancy of greater than or equal to 12 weeks
  -  Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form.
  Exclusion Criteria:
  -  Pregnant or lactating woman.
  -  Has malabsorption syndrome, a disease affecting gastrointestinal function, or resection of the stomach or small bowel.
  -  Has current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment)
  -  Has evidence of symptomatic or uncontrolled brain metastases or leptomeningeal disease. Subjects with brain metastases treated by surgery and/or radiotherapy are eligible if neurologically stable and do not require steroids or anticonvulsants.
  -  Is considered medically unfit for the study by the investigator.
  -  Has a known immediate or delayed benzimidazole hypersensitivity reaction or idiosyncrasy to drugs chemically related to the investigational product such as gefitinib [Iressa] and erlotinib [Tarceva].
  -  Has received treatment with any investigational drug in the previous four weeks. (with the exception of lapatinib).
  -  Has received chemotherapy, immunotherapy, biologic therapy or hormonal therapy for the treatment of cancer within the past 14 days, with the exception of mitomycin C which is restricted for the past six weeks, and lapatinib. Subjects receiving lapatinib prior to study entry are eligible to participate in the study.
  -  Is receiving any prohibited medication within the timeframe indicated on the prohibited medication list in the protocol.
  -  Has physiological, familial, sociological, or geographical conditions that do not permit compliance with the protocol.
  -  Has inadequate venous access for protocol-related blood draws.
  -  Clinically significant electrocardiogram abnormality.
  -  History of sensitivity to heparin or heparin-induced thrombocytopenia.
  -  Consumption of red wine, seville oranges, grapefruit or grapefruit juice and/or kumquats, pummelos, exotic citrus fruit (i.e. star fruit, bitter melon), grapefruit hybrids or fruit juices from seven days prior to the first dose of study medication.

Relevance to patient case: definitely relevant