Fulvestrant and Bevacizumab in Treating Patients With Metastatic Breast Cancer
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Intervention: bevacizumab; fulvestrant
Intervention MeSH terms: Bevacizumab; Fulvestrant
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 36.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: stage IV breast cancer; male breast cancer; recurrent breast cancer

Summary:

      RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using
      fulvestrant may fight breast cancer by blocking the use of estrogen by the tumor cells.
      Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some
      block the ability of tumor cells to grow and spread. Others find tumor cells and help kill
      them or carry tumor-killing substances to them. Fulvestrant and bevacizumab may also stop the
      growth of breast cancer by blocking blood flow to the tumor. Giving fulvestrant together with
      bevacizumab may be an effective treatment for metastatic breast cancer.

      PURPOSE: This phase II trial is studying how well giving fulvestrant together with
      bevacizumab works in treating patients with metastatic breast cancer.
    

Eligibility criteria:

        DISEASE CHARACTERISTICS:

          -  Histologically or cytologically confirmed breast cancer

               -  Metastatic disease

          -  Must have received an aromatase inhibitor (e.g., letrozole, anastrozole, or
             exemestane) in an adjuvant or metastatic setting

          -  If tumor is HER2 positive (3+ by immunohistochemistry or amplified by fluorescent in
             situ hybridization) the patient must have received ≥ 1 prior trastuzumab
             (Herceptin®)-containing regimen unless there is a contraindication to trastuzumab

          -  Measurable or nonmeasurable disease, including any of the following :

               -  Bone metastasis

               -  Pleural/pericardial effusion

               -  Ascites

               -  Inflammatory skin changes

          -  No microscopic residual disease only

          -  Enrolled on or refused enrollment on clinical trial NCCTG-N0392

          -  No evidence of active brain metastasis including leptomeningeal involvement

               -  CNS metastasis controlled (i.e., at least 2 months of no symptoms or evidence of
                  progression) by prior surgery and/or raditherapy are allowed

          -  Hormone receptor status:

               -  Estrogen and/or progesterone receptor-positive tumor

        PATIENT CHARACTERISTICS:

          -  Male or female

          -  Female patients must be post-menopausal based on any 1 of the following criteria:

               -  Age ≥ 60 years

               -  Age ≥ 45 years with last menstrual period ≥ 12 months prior to study entry

               -  Estradiol and follicle-stimulating hormone levels in postmenopausal range

               -  History of bilateral oophorectomy

          -  ECOG performance status 0-2

          -  Life expectancy > 3 months

          -  Fertile patients must use effective contraception during and for 30 days after
             completion of study treatment

          -  WBC ≥ 3,000 mg/dL

          -  Hemoglobin > 8 g/dL

          -  Absolute neutrophil count > 1,000/mm³

          -  Platelet count ≥ 100,000/mm³

          -  Bilirubin ≤ 1.5 times upper limit of normal (ULN)

          -  Alkaline phosphatase ≤ 2.5 times ULN

          -  AST and ALT ≤ 2.5 times ULN

          -  Creatinine ≤ 1.5 times ULN

          -  Urine protein < 1+ OR < 1 g of protein by 24-hour urine collection

               -  No nephrotic syndrome

          -  No uncontrolled hypertension (i.e., blood pressure [BP] > 160/90 mm Hg on ≥ 2
             occasions at least 5 minutes apart)

               -  Patients who have recently started or adjusted antihypertensive medications are
                  eligible provided BP is < 140/90 mm Hg on any new regimen for ≥ 3 different
                  observations in ≥ 14 days

          -  No clinically significant cardiac disease, including any of the following:

               -  Congestive heart failure

               -  Symptomatic coronary artery disease

               -  Unstable angina

               -  Cardiac arrhythmias not well controlled with medication

               -  Myocardial infarction within the past 12 months

          -  No arterial or venous thrombosis within the past 12 months

          -  No hemoptysis or gastrointestinal hemorrhage within the past 6 months

          -  No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
             the past 4 weeks

          -  No significant traumatic injury within the past 4 weeks

          -  No active, unresolved infection

          -  No history of hypertensive crisis or hypertensive encephalopathy

          -  No history of bleeding diathesis or uncontrolled coagulopathy

          -  No history of cerebrovascular accident, hemorrhage, or stroke

          -  No allergy or hypersensitivity to drug product excipients, murine antibodies, or
             agents chemically similar to study drugs

          -  No other malignancy within the past 3 years except for basal cell or squamous cell
             skin cancer or carcinoma in situ of the cervix

          -  No other serious medical condition that would preclude study therapy or compliance

        PRIOR CONCURRENT THERAPY:

          -  See Disease Characteristics

          -  Prior radiotherapy to a target lesion allowed provided there has been clear
             progression since radiotherapy was completed

          -  At least 4 weeks since prior radiotherapy

               -  Single-dose radiation for palliation or to a nontarget lesion only allowed within
                  the past 4 weeks

          -  No more than 1 prior chemotherapy regimen for metastatic disease

          -  No more than 2 prior endocrine (hormonal) therapy regimens in the neoadjuvant,
             adjuvant, or metastatic setting

          -  At least 4 weeks since prior major surgery or open biopsy

          -  At least 4 weeks since prior chemotherapy or immunologic therapy

          -  At least 2 weeks since prior and no concurrent use of any of the following agents:

               -  Aspirin (daily low-dose [81 mg] aspirin allowed])

               -  Thrombolytic agents

               -  Anticoagulants (low-dose anticoagulation therapy to maintain patency of a
                  vascular access device is allowed)

          -  No concurrent treatment in another clinical study with investigational procedures or
             investigational therapies

          -  No other concurrent anticancer therapy, including chemotherapy, biologic agents, or
             radiotherapy

          -  No routine use of granulocyte colony-stimulating factors during course 1

          -  No concurrent oprelvekin