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

Clinical trial: Study Evaluating The Combination Of Neratinib And Capecitabine In Solid Tumors And Breast Cancer

Summary: This is a world wide phase 1/2, open-label, study of neratinib in combination with capecitabine, conducted in 2 parts.
  In Part 1, 3 to 9 subjects with solid tumors will be enrolled in each dose group of the combination of neratinib and capecitabine. Each subject will participate in only 1 dose group.
  Additional subjects may be included at any dose level to further assess the safety and tolerability at that dose level.
  In Part 2, up to 60 subjects with erbB-2 positive metastatic breast cancer will receive treatment with the combination of neratinib and capecitabine at the maximum tolerated dose level, as determined in Part 1. In addition 20 subjects with prior lapatinib exposure will be enrolled in Part 2.
  Depending on the safety and activity profile observed during the dose escalation phase, the dose selected for Part 2 may be adjusted, if appropriate. In case one test article of the combination is discontinued due to intolerance the other test article can be administered alone.
  The primary objectives of Part 1 are to assess the safety and tolerability, and to define the Maximum tolerated dose (MTD) of neratinib in combination with capecitabine in subjects with advanced solid tumors.
  The primary objective of Part 2 of this study is to confirm the MTD determined in Part 1.
  The secondary objective of Part 1 is to collect information on preliminary anti-tumor activity of the combination of neratinib and capecitabine.
  Secondary objectives for Part 2 are to collect pharmacokinetic information and to obtain additional efficacy data, such as Objective Response Rate, for subjects with erbB-2 positive breast cancer treated at the MTD of neratinib + capecitabine.


Eligibility: Inclusion Criteria:
  -  Part 1: confirmed pathologic diagnosis of a solid tumor not curable with available therapies for which neratinib plus capecitabine is a reasonable treatment option.
  -  Part 2: confirmed histologically and/or cytologically confirmed diagnosis of breast cancer, metastatic or locally advanced.
  -  Part 2: erbB-2 gene amplified tumor (FISH or CISH) or erbB-2 overexpression (IHC 3+, or IHC2+ with FISH or CISH confirmation), based on local testing, or based on centralized FISH testing prior to day 1.
  -  Part 2: disease progression on or following at least 1 prior trastuzumab containing treatment regimen (at least 6 weeks) for metastatic or locally advanced disease. (Prior adjuvant trastuzumab is allowed but not required). A 2 week period is required between the last dose of trastuzumab treatment and first dose of the test article.
  -  Prior treatment with a taxane in the neoadjuvant, adjuvant, locally advanced, and/or metastatic disease treatment setting.
  -  Parts 1+2: At least 1 measurable lesion as defined by RECIST criteria.
  -  Parts 1+2: LVEF within institutional range of normal as measured by multi-gated acquisition (MUGA) or echocardiogram (ECHO).
  Exclusion Criteria:
  -  Part 2: prior treatment with capecitabine, lapatinib (20 subjects with prior lapatinib exposure will be enrolled) or any erbB-2 targeted agents except trastuzumab. Treatment with erbB-2 targeted therapy must exceed 2 weeks (14 days) in order to be exclusionary.
  -  Part 2: prior treatment with anthracyclines with a cumulative dose of doxorubicin of greater than 400 mg/m2, epirubicin dose of greater than 800 mg/m2, or the equivalent dose for other anthracyclines.
  -  Parts 1+2: Subjects with bone as the only site of disease.
  -  Parts 1+2: Active uncontrolled or symptomatic central nervous system (CNS) metastases, as indicated by clinical symptoms, cerebral edema, and/or progressive growth. Subjects with a history of CNS metastases or cord compression are allowable if they have been considered definitively treated and are off anticonvulsants and steroids for at least 4 weeks before the first dose of test article.
  -  Parts 1+2: Any other cancer within 5 years prior to screening with the exception of adequately treated cervical carcinoma in situ, or adequately treated basal or squamous cell carcinoma of the skin.

Relevance to patient case: definitely relevant