Patient case: 70-year-old female with breast cancer; genetic feature: AURKA amplification

Clinical trial: Dose Escalation Study of I-131-CLR1404 in Subjects With Cancer That Does Not Respond to Treatment or Has Returned

Summary: The purpose of this study is to determine the recommended dose of I-131-CLR1404, a radiolabeled therapy compound, for treating subjects with cancer that does not respond to treatment or has returned. The identified recommended dose in this study will be used as the optimal dose of I-131-CLR1404 in subsequent clinical trials conducted for later phase clinical development.
  Subjects who meet study entry criteria will receive I-131-CLR1404. For each subject, the study will be conducted in two phases, dosimetric and therapy. In the dosimetric phase, subjects will receive one 5 mCi dose of the study drug and undergo whole body imaging on on the day of infusion and on post-infusion days 1, 2, 3, and 6 for assessment of biodistribution of I-131-CLR1404. If normal and expected biodistribution are demonstrated, the subject will begin the therapy phase. In the therapy phase, the first cohort of subjects will receive a dose of 12.5 mCi/m2. Dose escalation in subsequent cohorts will initially be in increments of 12.5 mCi/m2. Subjects will be followed and observed for unacceptable toxicity through 56 days after the therapy dose infusion with follow-up for up to one year.
  All subjects will be prescribed thyroid protection medication to be taken 24 hours prior to injection of the dosimetric dose, and continuing for 14 days after the administration of the therapy dose.


Eligibility: Inclusion Criteria:
  -  Relapsed or refractory advanced solid malignancy or choice not to pursue standard treatment. Tumor types allowed: non-small cell lung, triple negative breast, soft tissue sarcoma, colorectal, gastric, esophageal, prostate, ovarian cancer
  -  ≥ 1 lesion that qualifies as a "target lesion" based on RECIST 1.1
  -  Ambulatory w/ECOG performance status 0 to 2 and estimated life expectancy ≥ 4 mo.
  -  18 years or older
  -  Judged by Investigator to have initiative and means to be compliant with protocol and w/n geographical proximity to make required study visits
  -  Ability to read, understand and provide written informed consent for initiation of any study related procedures (subject or legal representative)
  -  Brain metastasis acceptable if clinical condition stable ≥ 1 mo. Subjects with brain metastasis requiring steroids must have been on a stable or tapering dose of corticosteroids ≥ 1 mo. prior to enrollment
  -  Negative serum pregnancy test w/n 24 hours of enrollment (Female subjects of childbearing potential)
  -  Agreement to use effective contraception method (oral contraceptives, double-barrier methods, intrauterine device, Norplant, Depo-Provera) during study and 90 days following last dose
  Exclusion Criteria:
  -  Subject or physician plans concomitant chemotherapy, therapeutic radiation and/or biological treatment for cancer including immunotherapy while on study. Localized palliative radiation therapy for bone pain allowed if clinically indicated. Ongoing hormonal therapy may be continued
  -  Received > 3 previous cytotoxic chemotherapy regimens
  -  Received > 25% of total bone marrow irradiated, total body or hemi-body irradiation or prior radioisotope therapy (except for benign thyroid disease)
  -  Diffuse lung disease or interstitial spread of carcinoma
  -  Prior radiation therapy or chemotherapy w/n 4 weeks of study start
  -  Extradural tumor in contact with spinal cord or tumor located where swelling in response to therapy may impinge upon spinal cord
  -  Other active medical condition or organ disease that may compromise safety or interfere with safety and/or outcome evaluation of study drug
  -  Laboratory abnormalities, including but not limited to: WBC < 3000/uL, Absolute neutrophil count < 1500/uL, Platelets < 150,000/uL, Hemoglobin ≤ 9.0 gm/dL, Total bilirubin > 1.5 x upper limit of normal for age, SGOT or SGPT > 3 x upper limit of normal for age if no liver metastases or > 5 x upper limit of normal for age in the presence of liver metastases, Serum creatinine > 1.5 x upper limit of normal for age, INR ≥ 2.0, 2+ proteinuria or casts indicative of intrinsic renal disease
  -  Treatment with investigational drug, investigational biologic, or investigational therapeutic device w/n 28 days of initiating study treatment
  -  Received severely marrow toxic drugs (eg nitrosoureas, mitomycin)
  -  Received blood transfusions or hematopoietic growth factor therapy w/n 30 days of study start
  -  Received prior stem cell transplantation
  -  Clinically significant cardiac co-morbidities including congestive heart failure (New York Heart Association class III-IV heart disease), left ventricular ejection fraction < 40%, unstable angina pectoris, serious cardiac arrhythmia requiring medication or pacemaker, myocardial infarction within past 6 months
  -  Concurrent or recent (w/n 1 month) use of thrombolytic agents or full-dose anticoagulants (except to maintain patency of preexisting, permanent indwelling IV catheters). Therapy with low-molecular weight heparin is acceptable as long as INR < 2.0
  -  Uncontrolled hypertension as defined by systolic blood pressure > 150 mm/Hg, diastolic blood pressure > 100 mm/Hg or uncontrolled diabetes that would compromise subject safety or interfere with safety and/or outcome evaluation of study drug
  -  Grade II-IV peripheral vascular disease or peripheral vascular surgery w/n past year
  -  Major surgery w/n 4 wks. of enrollment
  -  Poor venous access and unable to receive study drug into a peripheral venous catheter
  -  Significant traumatic injury w/n past 4 wks.
  -  Ongoing or active infection requiring antibiotics or with fever >38.1º C (>101º F) w/n 3 days of first scheduled day of dosing
  -  Receiving concurrent hemodialysis or peritoneal dialysis
  -  Known positive for HIV, Hepatitis C (active, previously treated or both) or is Hepatitis B core antigen positive
  -  Pregnant or lactating
  -  Hospitalized

Relevance to patient case: not relevant