Patient case: 45-year-old female with cervical cancer; genetic feature: ERBB2 (S310Y)

Clinical trial: Gefitinib in Treating Patients With Cervical Cancer

Summary: RATIONALE: Biological therapies such as gefitinib may interfere with the growth of the tumor cells and slow the growth of cervical cancer. Comparing results of diagnostic procedures performed before, during, and after treatment with gefitinib may help doctors predict a patient's response to treatment and help plan the most effective treatment.
  PURPOSE: This phase II trial is studying how well gefitinib works in treating patients with cervical cancer.

Detailed description: OBJECTIVES:
  -  Determine the reduction in phosphorylation of epidermal growth factor receptor (EGFR), AKT, and ERK by proteomics in tumor and normal skin of patients with ovarian epithelial cancer or cervical cancer receiving gefitinib. (Open to accrual for cervical cancer patients only as of 4/5/2005)
  -  Determine the clinical activity of this drug in these patients.
  -  Determine the toxicity of this drug in these patients.
  -  Correlate the biologic modulation of EGFR, ERK, and AKT by this drug with outcome and toxic effects in these patients.
  -  Correlate EGFR modulation in skin with outcome and toxic effects in patients treated with this drug.
  -  Correlate expression of EGFR and phosphorylated-EGFR in tissue biopsies from these patients with biochemical modulation and outcome.
  -  Determine the application of surface-enhanced laser desorption and ionization with time-of-flight detection (SELDI-TOF) and artificial intelligence bioinformatics to serially obtained serum samples for predicting response and toxic effects in these patients.
  OUTLINE: Patients are stratified according to disease (cervical cancer vs ovarian epithelial, fallopian tube, and primary peritoneal cancer). (Open to accrual for cervical cancer patients only as of 4/5/2005)
  Patients receive oral gefitinib daily. Treatment continues every 28 days in the absence of disease progression or unacceptable toxicity.
  Biopsies of a sentinel lesion (with CT guidance or laparoscopy) are obtained at baseline and at 4 weeks. Skin biopsies of unaffected areas are also obtained at these time points. Tissue is examined using immunohistochemical methods. Proteomic profiling using surface-enhanced laser desorption/ionization with time-of-flight (SELDI-TOF) mass spectrometry is conducted on serum at baseline and then every 4 weeks.
  Patients are followed monthly.
  PROJECTED ACCRUAL: A total of 30-40 patients (15-20 per stratum) will be accrued for this study within 10-12 months. (Open to accrual for cervical cancer patients only as of 4/5/2005)

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed ovarian epithelial cancer or cervical cancer (open to accrual for cervical cancer patients only as of 4/5/2005)
  -  Relapsed or refractory
  -  The following are also eligible: (open to accrual for cervical cancer patients only as of 4/5/2005)
  -  Cancer of the fallopian tube
  -  Primary peritoneal cancer
  -  Cancer with low malignant potential and an invasive recurrence
  -  Block or recuts of primary tumor or recent resection specimen of a metastatic site required
  -  Measurable disease with a sentinel lesion adequate for core biopsy by percutaneous biopsy or laparoscopy
  -  No CNS involvement
  PATIENT CHARACTERISTICS:
  Age
  -  18 and over
  Performance status
  -  ECOG 0-2
  Life expectancy
  -  Not specified
  Hematopoietic
  -  WBC greater than 3,000/mm^3
  -  Platelet count greater than 100,000/mm^3
  Hepatic
  -  Bilirubin less than 1.5 mg/dL
  -  AST and ALT no greater than 2.5 times upper limit of normal
  Renal
  -  Creatinine less than 1.5 mg/dL
  Cardiovascular
  -  No myocardial infarction within the past 6 months
  -  No unstable dysrhythmia within the past 6 months
  Other
  -  No other invasive malignancy within the past 5 years except noninvasive nonmelanoma skin cancer
  -  No active ocular inflammation or infection
  -  No active infection
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception during and for 2 months after study
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  No prior cetuximab or monoclonal antibody ABX-EGF
  Chemotherapy
  -  At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered
  Endocrine therapy
  -  At least 4 weeks since prior hormonal therapy and recovered
  -  No concurrent tamoxifen
  Radiotherapy
  -  At least 4 weeks since prior radiotherapy and recovered
  Surgery
  -  Recovered from prior oncologic or other major surgery
  Other
  -  No prior epidermal growth factor receptor inhibitory agents (e.g., OSI-774)
  -  No concurrent antiretroviral therapy
  -  No concurrent itraconozole, ketoconazole, erythromycin, verapamil, chlorpromazine, amiodarone, or chloroquine
  -  No concurrent drugs known to induce CYP3A4 enzymes (e.g., phenytoin, carbamazepine, rifampicin, barbiturates, oxacarbazepine, rifapentine, or Hypericum perforatum)

Relevance to patient case: possibly relevant