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

Clinical trial: VEGF Trap in Treating Patients With Metastatic Breast Cancer

Summary: This phase II trial is studying how well VEGF Trap works in treating patients with metastatic breast cancer. VEGF Trap may stop the growth of tumor cells by blocking blood flow to the tumor

Detailed description: PRIMARY OBJECTIVES:
  I. Assess the antitumor activity of VEGF Trap, in terms of tumor response rate, in patients with metastatic breast cancer who have received =< 2 prior chemotherapy regimens for metastatic disease, including a taxane and/or anthracycline.
  II. Assess the 6-month progression-free survival rate in patients treated with VEGF Trap.
  SECONDARY OBJECTIVES:
  I. Describe the adverse event profile (grade using the NCI CTCAE version 3.0) of VEGF Trap in these patients.
  II. Describe the progression-free survival times in patients treated with VEGF Trap.
  III. Describe the overall survival of patients treated with VEGF Trap. IV. Describe the duration of response in patients treated with VEGF Trap.
  OUTLINE: This is a multicenter study.
  Patients receive VEGF Trap IV over 1 hour on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.
  After completion of study treatment, patients are followed every 3-6 months for up to 5 years.

Eligibility: Inclusion Criteria:
  -  Histologically or cytologically confirmed adenocarcinoma of the breast
  -  Clinical evidence of metastatic disease
  -  No more than 2 prior chemotherapy regimens for metastatic disease
  -  Prior neoadjuvant or adjuvant chemotherapy allowed*
  -  At least 1 prior regimen (in any setting) must have included a taxane and/or an anthracycline
  -  Measurable disease, defined as ≥ 1 lesion whose longest diameter can be accurately measured per RECIST criteria
  -  No nonmeasurable disease, defined as all other lesions, including small lesions(longest diameter < 20 mm) and truly nonmeasurable lesions, including the following:
  -  Bone lesions
  -  Leptomeningeal disease
  -  Ascites
  -  Pleural/pericardial effusion
  -  Inflammatory breast disease
  -  Lymphangitis cutis/pulmonis
  -  Abdominal masses that are not confirmed and followed by imaging techniques
  -  Cystic lesions
  -  Patients with HER2-positive tumors (3+ by immunohistochemistry or amplified by fluorescent in situ hybridization [FISH]) must have received ≥ 1 prior trastuzumab (Herceptin®)-containing regimen in either the adjuvant or metastatic setting, unless there was a contraindication
  -  No known CNS metastases
  -  No evidence of leptomeningeal involvement
  -  Hormone receptor status not specified
  -  Male or female
  -  Menopausal status not specified
  -  ECOG performance status 0-1
  -  Life expectancy > 3 months
  -  WBC ≥ 3,000/mm³
  -  Absolute neutrophil count ≥ 1,500/mm³
  -  Platelet count ≥ 75,000/mm³
  -  Hemoglobin > 8.0 g/dL
  -  Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  -  Alkaline phosphatase ≤ 3 times ULN
  -  AST and ALT ≤ 2.5 times ULN
  -  Creatinine ≤ 1.5 times ULN
  -  Urine protein:creatinine ratio < 1 OR urine protein < 500 mg by 24-hour urine collection
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception during and for 6 months after completion of study treatment
  -  No significant traumatic injury within the past 4 weeks
  -  No history of allergy or hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies, drug product excipients, or agents chemically or biologically similar to VEGF Trap
  -  No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days
  -  No nonhealing wound, fracture, or ulcer
  -  No stage III or IV invasive, nonbreast malignancy within the past 5 years
  -  No history of lung carcinoma of squamous cell type
  -  No clinically significant cardiovascular disease, including any of the following:
  -  Cerebrovascular accident or stroke within the past 6 months
  -  Uncontrolled hypertension, defined as blood pressure (BP) > 150/100 mm Hg OR systolic BP > 180 mm Hg if diastolic blood pressure < 90 mm Hg on ≥ 2 separate occasions within the past 3 months
  -  Myocardial infarction, coronary artery bypass graft, or unstable angina within the past 6 months
  -  New York Heart Association class III or IV cardiovascular disease
  -  Serious cardiac arrhythmia requiring medication
  -  Peripheral vascular disease ≥ grade 2 within the past 6 months
  -  Pulmonary embolism, deep vein thrombosis, or other thromboembolic event within the past 6 months
  -  No evidence of bleeding diathesis or uncontrolled coagulopathy
  -  No active, unresolved infection
  -  No serious concurrent medical condition that would preclude study participation
  -  No other condition or circumstance that would preclude compliance with study requirements
  -  See Disease Characteristics
  -  Prior hormonal therapy in the neoadjuvant, adjuvant, or metastatic setting allowed
  -  No prior bevacizumab
  -  More than 4 weeks since prior chemotherapy, endocrine therapy, experimental drug therapy, or immunotherapy and recovered
  -  More than 4 weeks since prior major surgery or open biopsy
  -  More than 7 days since prior core biopsy
  -  More than 2 weeks since prior radiotherapy, except if to a nontarget lesion only
  -  Prior radiotherapy to a target lesion allowed only if there has been clear progression of the lesion since radiotherapy was completed
  -  Prior single-dose palliative radiotherapy within the past 2 weeks allowed
  -  No concurrent major surgery
  -  No concurrent trastuzumab
  -  Concurrent full-dose anticoagulants (e.g., warfarin) with PT INR > 1.5 allowed provided the following criteria are met:
  -  INR in-range (usually between 2 and 3) on a stable dose of oral anticoagulant or on a stable dose of low molecular weight heparin
  -  No active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices)
  -  No concurrent combination antiretroviral therapy for HIV-positive patients
  -  No concurrent participation in another investigational clinical trial
  -  No other concurrent chemotherapeutic agents, endocrine therapy, biologic agents, radiotherapy, or other nonprotocol antitumor therapy

Relevance to patient case: not relevant