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

Clinical trial: Carboplatin and Eribulin Mesylate in Triple Negative Breast Cancer Patients

Summary: This phase II trial studies how well giving eribulin mesylate and carboplatin together before surgery works in treating patients with stage I-III triple-negative breast cancer. Drugs used in chemotherapy, such as eribulin mesylate and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

Detailed description: PRIMARY OBJECTIVES:
  I. To determine the pathologic complete response rate (pCR) at the time of definitive surgery.
  SECONDARY OBJECTIVES:
  I. Determination of the clinical response rate, as measured by clinical exam and imaging studies prior to initiation of therapy and prior to surgery.
  II. Measurement of alpha B-crystalline in tissue obtained before initiation of therapy and at the time of definitive surgery.
  III. Stem cell markers (cluster of differentiation [CD]44+, CD24-, CD133, aldehyde dehydrogenase 1 [ALDH1] and evaluation of the NOTCH pathway) in tissue obtained before initiation of therapy and at the time of definitive surgery.
  IV. Measurement of proliferation markers (Ki67) before and after treatment in tissue obtained before imitation of therapy and at the time of definitive surgery.
  V. Measurement of beta III tubulin in tissue obtained before initiation of therapy and at the time of definitive surgery.
  VI. Measurement of Tau in tissue obtained before initiation of therapy and at the time of definitive surgery.
  VII. Safety evaluation, including following of patients for alopecia and neuropathy.
  VIII. Epidermal growth factor receptor (EGFR) staining before and after treatment in tissue obtained before initiation of therapy and at the time of definitive surgery.
  OUTLINE:
  Patients receive eribulin mesylate intravenously (IV) over 2-5 minutes and carboplatin IV over 30 minutes on day 1. Treatment repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.
  After completion of study treatment, patients are followed up every 6 months.

Eligibility: Inclusion Criteria:
  -  Patients must have histologically confirmed breast cancer; diagnosis must be reviewed and confirmed by the pathology department at Northwestern Memorial Hospital prior to registration on study, and all biopsy materials need to be reviewed and available for correlative studies
  -  Patients must have stage I-III breast cancer
  -  Patients must have estrogen receptor-negative (ER-), progesterone receptor-negative (PR-), human epidermal growth factor receptor 2-negative (Her2-) (0, 1+) or fluorescent in situ hybridization (FISH) < ratio of 1.8
  -  Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) by mammogram, ultrasound or physical exam
  -  Prior diagnosis of cancer is allowed as long as patient is free of disease and has been off treatment for the prior malignancy for a minimal interval of one year
  -  Patients must have a life expectancy of > 12 weeks
  -  Patients must exhibit an Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 80%)
  -  Leukocytes >= 3,000/ul
  -  Absolute neutrophil count >= 1,500/ul
  -  Platelets >= 100,000/ul
  -  Total bilirubin within normal institutional limits
  -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/ alanine transaminase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 X institutional upper limit of normal
  -  Creatinine: within normal institutional limits
  -  OR creatinine clearance >= 60 mL/min/1.73^2 for patients with creatinine levels above institutional normal
  -  Women of childbearing potential must commit to the use of effective contraception while on study
  -  Eligibility of patients receiving medications of substances known to affect, or with the potential to affect, the activity or pharmacokinetics of eribulin will be determined following review of their use by the Principal Investigator
  -  All patients must have given signed, informed consent prior to registration on study
  Exclusion Criteria:
  -  Prior chemotherapy, immunotherapy or hormonal therapy for breast cancer is NOT allowed
  -  Concomitant radiotherapy is NOT allowed
  -  Patients may NOT be receiving any other investigational agents or concurrent anticancer therapies; in addition, use of any herbal (alternative) medicines is NOT permitted
  -  Patients with uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations what would limit compliance with study requirements are NOT eligible to participate
  -  Women who are pregnant or lactating are NOT eligible to participate

Relevance to patient case: not relevant