Pilot Study to Evaluate Reparixin With Weekly Paclitaxel in Patients With HER 2 Negative Metastatic Breast Cancer (MBC)
Condition: Metastatic Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Interventional
Phase: Phase 1

Summary: 
      This is a phase I study to evaluate the safety and define the pharmacokinetic (PK) profile of
      orally administered reparixin in combination with paclitaxel in HER 2 (Human epidermal growth
      factor receptor-2) negative metastatic breast cancer patients.

      The primary objective of this study was to evaluate the safety and define the pharmacokinetic
      (PK) profile of orally administered reparixin in combination with paclitaxel in HER-2
      negative MBC patients.

      The secondary objectives were to:

        1. Evaluate the effects of orally administered reparixin on cancer stem cell (CSC) markers,
           the tumoral microenvironment and markers of cytokine inflammation;

        2. Evaluate peripheral blood samples for enumeration of circulating tumor cells (CTCs),
           molecular characterization as CSCs and perform epithelial-mesenchymal transition (EMT)
           biomarker profiling;

        3. Assess disease response for indication of efficacy.
    

Detailed description: 
      The CSC (Cancer stem cell) concept has important implications for understanding
      carcinogenesis as well as for the development of cancer therapeutics. According to this
      concept, tumors are initiated and maintained by a cellular subcomponent that displays stem
      cell properties. These properties include self-renewal, which drives tumorigenesis, and
      differentiation (albeit aberrant), which contributes to tumor cellular heterogeneity. The
      existence of CSCs has been described in a variety of hematologic and solid tumors including
      those of the breast, brain, colon, pancreas, lung, liver, and head and neck. In addition to
      driving tumorigenesis, CSCs may contribute to tumor metastasis as well as to tumor recurrence
      after treatment.

      One of the therapeutic strategies being pursued to target CSCs involves inhibition of self
      renewal or survival pathways in these cells. These pathways include NOTCH (Notch signaling
      pathway), Hedgehog, and WNT (Wnt signaling pathway). Such strategies may be limited by the
      role of these pathways in normal stem cell function, which could result in systemic
      toxicities from pathway inhibition. In addition to intrinsic pathways regulating stem cell
      functions, normal and malignant stem cells are regulated by extrinsic signals generated in
      the microenvironment or CSC niche. In the breast, this niche is composed of immune cells,
      mesenchymal elements that include fibroblasts, endothelial cells, adipocytes, and
      extracellular matrix components. These components play an important role in normal breast
      development and carcinogenesis. If the cellular microenvironment plays an important role in
      the regulation of CSC growth and survival, then strategies aimed at interfering with these
      interactions represent a rational approach to target breast CSCs.

      There are limited data on the impact of treatment tailoring based on CSCs detection. Gene
      profiling of CSCs could lead to identification of therapeutic targets on CSCs (e.g. hormone
      receptors, HER-2 [Human epidermal growth factor receptor-2] expression, EGFR [Epidermal
      growth factor receptor] expression), and could represent tumor biopsy in "real time". Several
      groups showed frequent discordance of HER-2 status between primary tumor and CSCs, and case
      reports showed clinical utility to use of trastuzumab-based therapy based on HER-2 CSCs
      status. Similarly, the hormonal status of CSCs could be different from that of the primary
      tumor, which could lead to increase the number of patients suitable for endocrine therapy,
      but also could explain why endocrine therapy fails in a subset of hormone receptor-positive
      patients. The study provided the in vivo demonstration that CXCR-1 (Chemokine receptor 1)
      targeting with specific blocking antibodies or reparixin is associated with reduced systemic
      metastases. The experimental data provides another therapeutic target in metastatic disease
      and warrants a pilot study investigation in humans to further explore effects of reparixin on
      breast CSCs and the tumoral microenvironment.

      Reparixin seems to be a good candidate for use in breast cancer patients because of its very
      acceptable toxicity profile shown in the Phase I and II clinical trials conducted so far,
      along with its observed activity in vitro against breast cancer cell lines and in vivo in
      tumor xenografts in mice. It potentially addresses another therapeutic target in metastatic
      disease. The current pilot study thus aims at exploring the safety and PK profile of orally
      administered reparixin in HER-2 negative metastatic breast cancer patients and its effects on
      breast CSC markers.
    

Intervention name(s): Paclitaxel+Reparixin
Intervention type(s): Drug
Intervention description(s): Association of Paclitaxel at fixed dosage with three increasing dosage of Reparixin
Other intervention name(s): PAC + REP
Intervention MeSH terms: Paclitaxel
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: HER 2 negative; metastatic breast cancer; Cancer Stem Cells