Patient case: 73-year-old female with breast cancer; genetic feature: CDKN2A

Clinical trial: Phase I/IIa Trial of Gemcitabine Plus Trastuzumab and Pertuzumab in Previously Treated Metastatic HER2+ Breast Cancer

Summary: The purpose of this study is to evaluate the safety and activity of gemcitabine plus trastuzumab and pertuzumab in patients with metastatic human epidermal growth factor receptor 2 (HER2)+ breast cancer who have progressed on at least one prior line of chemotherapy plus HER2 targeted agent such as T-DM1, trastuzumab, or lapatinib.


Eligibility: Inclusion Criteria:
  -  Adult males or females (aged 18 or older) with histologically confirmed, metastatic human epidermal growth factor receptor 2 (HER2)+ (by immunohistochemistry (IHC) 3+ or fluorescence in situ hydridization (FISH) ratio ≥ 2.0) breast cancer
  -  Have progressed on at least one prior line of chemotherapy plus HER2 directed therapy such as trastuzumab and/or pertuzumab in the metastatic setting. T-DM1 would count as a line of therapy and patients previously treated with T-DM1 are eligible.
  -  Have not been treated with gemcitabine in the metastatic setting
  -  Measurable disease per Response Evaluation in Solid Tumors (RECIST) 1.1 criteria
  -  Eastern Cooperative Oncology Group (ECOG) performance status 2≤
  -  Left Ventricular Ejection Fraction (LVEF) ≥ 50% at baseline as determined by either echocardiogram (ECHO) or multiple gated acquisition scan (MUGA)
  -  Adequate bone marrow function as indicated by the following: absolute neutrophil count (ANC) >1500/µL; Platelets ≥100,000/µL; Hemoglobin >10 g/dL
  -  Adequate renal function, as indicated by creatinine ≤1.5x upper limit of normal (ULN)
  -  Adequate liver function, as indicated by bilirubin ≤1.5x ULN, aspartic transaminase (AST) or alanine transaminase (ALT) <2x ULN unless related to metastatic breast cancer to the liver (in which case AST/ALT < 5x ULN is allowed).
  -  Signed informed consent
  -  Adequate birth control in sexually active women of childbearing potential
  Exclusion Criteria:
  -  Active uncontrolled infection or major concurrent illness which in the opinion of the investigator would render the participant unsafe to proceed with the study
  -  Uncontrolled central nervous system (CNS) metastases. Treated, non-progressing CNS disease (documented by brain magnetic resonance imaging [MRI]) off corticosteroids for at least 1 month potential participants are eligible.
  -  Women who are pregnant or lactating
  -  Prior chemotherapy within the last 3 weeks (last 6 weeks for nitrosureas/mitomycin)
  -  Prior radiation therapy within the last 4 weeks; prior radiation therapy to indicator lesion (unless objective disease recurrence or progression within the radiation portal has been documented since completion of radiation)
  -  Other concomitant active malignancies
  -  History of significant cardiac disease, cardiac risk factors or uncontrolled arrhythmias
  -  Ejection fraction <50% or below the lower limit of the institutional normal range, whichever is lower
  -  Hypersensitivity to any of the study medications
  -  Untreated psychiatric conditions preventing informed consent

Relevance to patient case: not relevant