Patient case: 64-year-old male with gastric cancer; genetic feature: ERBB2 amplification

Clinical trial: Fulvestrant and Bevacizumab in Treating Patients With Metastatic Breast Cancer

Summary: RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using fulvestrant may fight breast cancer by blocking the use of estrogen by the tumor cells. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Fulvestrant and bevacizumab may also stop the growth of breast cancer by blocking blood flow to the tumor. Giving fulvestrant together with bevacizumab may be an effective treatment for metastatic breast cancer.
  PURPOSE: This phase II trial is studying how well giving fulvestrant together with bevacizumab works in treating patients with metastatic breast cancer.

Detailed description: OBJECTIVES:
  Primary
  -  Assess the efficacy of fulvestrant and bevacizumab, in terms of 6-month progression-free survival (PFS), in patients with metastatic breast cancer previously treated with an aromatase inhibitor.
  Secondary
  -  Assess the quality of life of patients treated with this regimen.
  -  Determine the adverse-event profile in these patients.
  -  Determine the PFS and overall survival of these patients.
  -  Determine the confirmed response rate, duration of response, time to treatment failure, and time to first cytotoxic agent in patients treated with this regimen.
  OUTLINE: This is a multicenter study.
  Patients receive fulvestrant intramuscularly on day 1 and bevacizumab IV over 30-90 minutes on days 1 and 15. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
  Quality of life is assessed at baseline, prior to every other course, and at the completion of study treatment.
  After completion of study treatment, patients are followed every 3-6 months for 5 years.
  PROJECTED ACCRUAL: A total of 51 patients will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically or cytologically confirmed breast cancer
  -  Metastatic disease
  -  Must have received an aromatase inhibitor (e.g., letrozole, anastrozole, or exemestane) in an adjuvant or metastatic setting
  -  If tumor is HER2 positive (3+ by immunohistochemistry or amplified by fluorescent in situ hybridization) the patient must have received ≥ 1 prior trastuzumab (Herceptin®)-containing regimen unless there is a contraindication to trastuzumab
  -  Measurable or nonmeasurable disease, including any of the following :
  -  Bone metastasis
  -  Pleural/pericardial effusion
  -  Ascites
  -  Inflammatory skin changes
  -  No microscopic residual disease only
  -  Enrolled on or refused enrollment on clinical trial NCCTG-N0392
  -  No evidence of active brain metastasis including leptomeningeal involvement
  -  CNS metastasis controlled (i.e., at least 2 months of no symptoms or evidence of progression) by prior surgery and/or raditherapy are allowed
  -  Hormone receptor status:
  -  Estrogen and/or progesterone receptor-positive tumor
  PATIENT CHARACTERISTICS:
  -  Male or female
  -  Female patients must be post-menopausal based on any 1 of the following criteria:
  -  Age ≥ 60 years
  -  Age ≥ 45 years with last menstrual period ≥ 12 months prior to study entry
  -  Estradiol and follicle-stimulating hormone levels in postmenopausal range
  -  History of bilateral oophorectomy
  -  ECOG performance status 0-2
  -  Life expectancy > 3 months
  -  Fertile patients must use effective contraception during and for 30 days after completion of study treatment
  -  WBC ≥ 3,000 mg/dL
  -  Hemoglobin > 8 g/dL
  -  Absolute neutrophil count > 1,000/mm³
  -  Platelet count ≥ 100,000/mm³
  -  Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  -  Alkaline phosphatase ≤ 2.5 times ULN
  -  AST and ALT ≤ 2.5 times ULN
  -  Creatinine ≤ 1.5 times ULN
  -  Urine protein < 1+ OR < 1 g of protein by 24-hour urine collection
  -  No nephrotic syndrome
  -  No uncontrolled hypertension (i.e., blood pressure [BP] > 160/90 mm Hg on ≥ 2 occasions at least 5 minutes apart)
  -  Patients who have recently started or adjusted antihypertensive medications are eligible provided BP is < 140/90 mm Hg on any new regimen for ≥ 3 different observations in ≥ 14 days
  -  No clinically significant cardiac disease, including any of the following:
  -  Congestive heart failure
  -  Symptomatic coronary artery disease
  -  Unstable angina
  -  Cardiac arrhythmias not well controlled with medication
  -  Myocardial infarction within the past 12 months
  -  No arterial or venous thrombosis within the past 12 months
  -  No hemoptysis or gastrointestinal hemorrhage within the past 6 months
  -  No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 4 weeks
  -  No significant traumatic injury within the past 4 weeks
  -  No active, unresolved infection
  -  No history of hypertensive crisis or hypertensive encephalopathy
  -  No history of bleeding diathesis or uncontrolled coagulopathy
  -  No history of cerebrovascular accident, hemorrhage, or stroke
  -  No allergy or hypersensitivity to drug product excipients, murine antibodies, or agents chemically similar to study drugs
  -  No other malignancy within the past 3 years except for basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
  -  No other serious medical condition that would preclude study therapy or compliance
  PRIOR CONCURRENT THERAPY:
  -  See Disease Characteristics
  -  Prior radiotherapy to a target lesion allowed provided there has been clear progression since radiotherapy was completed
  -  At least 4 weeks since prior radiotherapy
  -  Single-dose radiation for palliation or to a nontarget lesion only allowed within the past 4 weeks
  -  No more than 1 prior chemotherapy regimen for metastatic disease
  -  No more than 2 prior endocrine (hormonal) therapy regimens in the neoadjuvant, adjuvant, or metastatic setting
  -  At least 4 weeks since prior major surgery or open biopsy
  -  At least 4 weeks since prior chemotherapy or immunologic therapy
  -  At least 2 weeks since prior and no concurrent use of any of the following agents:
  -  Aspirin (daily low-dose [81 mg] aspirin allowed])
  -  Thrombolytic agents
  -  Anticoagulants (low-dose anticoagulation therapy to maintain patency of a vascular access device is allowed)
  -  No concurrent treatment in another clinical study with investigational procedures or investigational therapies
  -  No other concurrent anticancer therapy, including chemotherapy, biologic agents, or radiotherapy
  -  No routine use of granulocyte colony-stimulating factors during course 1
  -  No concurrent oprelvekin

Relevance to patient case: not relevant