Pilot Study to Evaluate Safety & Biological Effects of Orally Administered Reparixin in Early Breast Cancer
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Intervention: Reparixin
Intervention description: 1000 mg Oral Reparixin t.i.d. for 21 consecutive days prior to surgery
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 20.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Cancer Stem Cells; Novel targeted therapy; CXCR1/2 Inhibitors

Summary:

      This is a pilot "window of opportunity" clinical study in patients with operable breast
      cancer investigating use of reparixin as single agent in the time period between clinical
      diagnosis and surgery.

      The primary objectives of this study were:

      1- to evaluate the effects of orally administered reparixin on CSCs in the primary tumor and
      the tumoral microenvironment in an early breast cancer population:

      A. CSC were measured in tissue samples by techniques that could include: ALDEFLUOR assay and
      assessment of CD44/CD24 by flow cytometry, or examination of RNA transcripts by RT-PCR,
      aldehyde dehydrogenase-1, CD44/CD24 and epithelial mesenchymal transition markers (Snail,
      Twist, Notch) by immunohistochemistry (IHC). CSC were defined as ALDEFLUOR positive (ALDH-1+)
      and/or CD44 high/CD24 low by flow cytometry or RT-PCR and IHC and by the detection of ALDH-1+
      cells with or without epithelial mesenchymal transition (EMT) transcription factor in IHC
      assays.

      B. Serine-threonine protein kinase (AKT), focal adhesion kinase (FAK), phosphatase and tensin
      homolog (PTEN) and chemokine receptor-1 (CXCR1) levels were measured in tissue samples by
      IHC.

      C. Measurement of markers of inflammation (interleukin-1beta [IL-1β], interleukin-6 [IL-6],
      interleukin-8 [IL-8], tumor necrosis factor-alpha [TNF-α], granulocyte macrophage colony
      stimulating factor [GM-CSF], vascular endothelial growth factor [VEGF], basic fibroblast
      growth factor [b-FGF] and high-sensitivity C-reactive protein [hsCRP]) in plasma, leukocyte
      subsets (enumerate T subsets, B, and natural killer/natural killer T [NK/NKT] cells) and
      study polymorphonuclear leukocyte [PMN] biology in peripheral blood samples. D. Measurement
      of markers of angiogenesis (CD31 staining), tumor-infiltrating leukocytes (CD4, CD8, NK and
      macrophages), autophagy (P62 and LC3 by IHC), EpCAM and EMT markers (CD326, CD45, Twist1,
      SNAIL1, SLUG, ZEB1, FOXC2, TG2, Akt2, P13k and CK19 by RT-PCR) and tissue cellularity
      (residual disease characterization in tumor bed) in tumor tissue samples.

      2. To evaluate the safety of oral reparixin administered three times daily (t.i.d.) for 21
      consecutive days.

      The secondary objective was to define the pharmacokinetic (PK) profile of orally administered
      reparixin.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Female aged > 18 years.

          -  Patients with operable breast cancer, with measurable tumors of more than 1 cm in
             diameter, that are not candidates for neoadjuvant therapy.

          -  Zubrod (Eastern Co-operative Oncology Group [ECOG]) Performance Status (PS) of 0-1.

          -  No prior treatment by surgery, radiotherapy, hormone therapy e.g. TAMOXIFEN® or
             RALOXIFEN® for prevention or chemotherapy.

          -  Scheduled to undergo definitive local surgery for breast cancer.

          -  Patients must be willing to undergo two mandatory tumor biopsies (pre and post
             therapy) that are not required for standard care. A sample of tumor tissue removed
             during surgery will also be collected for analysis.

          -  Patients must be able to swallow and retain oral medication (intact tablet).

          -  Able to undergo all screening assessments outlined in the protocol after giving
             informed consent.

          -  Adequate organ function (defined by the following parameters):

               1. Serum creatinine < 140 μmol/L or creatinine clearance > 60 mL/min.

               2. Serum hemoglobin > 9 g/dL; absolute neutrophil count > 1.5 x 109/L; platelets >
                  100 x 109/L.

               3. Serum bilirubin < upper normal limit (UNL).

               4. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) ≤ UNL;
                  alkaline phosphatase (ALP) ≤ UNL; albumin within normal limits.

          -  Documented hormone receptor (ER and progesterone receptor) and HER-2- status.

          -  No known hepatitis B virus (unless due to immunization), hepatitis C virus, human
             immune deficiency virus-I and II positive status.

        Exclusion Criteria:

          -  Male.

          -  Pregnancy or lactation or unwillingness to use two adequate methods of birth control
             throughout the study and for 30 days after study discontinuation.

          -  Any other breast cancer types including inflammatory form.

          -  Prior surgery to the breast area or primary axillary dissection.

          -  Prior treatment for breast cancer.

          -  Use of an investigational drug within 30 days preceding the first dose of study
             medication.

          -  Any prior or current cancer, except in situ uterine carcinoma or basocellular
             cutaneous cancer considered as definitively cured.

          -  Any associated medical condition considered incompatible with the study, e.g. cardiac,
             renal, medullar, respiratory or hepatic insufficiency.

          -  Neurological or psychiatric disorders which may influence understanding of study and
             informed consent procedures.

          -  Active or uncontrolled infection.

          -  Malabsorption syndrome, disease significantly affecting gastrointestinal function.

          -  Hypersensitivity to:

               1. ibuprofen or to more than one non-steroidal anti-inflammatory drug;

               2. medications belonging to the class of sulfonamides, such as sulfamethazine,
                  sulfamethoxazole, sulfasalazine, nimesulide or celecoxib.