Lapatinib Combined With Paclitaxel For Patients With First-Line ErbB2-Amplified Metastatic Breast Cancer
Condition: Neoplasms, Breast
MeSH terms: Breast Neoplasms
Intervention: Lapatinib oral tablets; Paclitaxel infusion
Intervention description: Lapatinib will be given as tablets contain 410 mg of lapatinib ditosylate monohydrate, equivalent to 250 mg lapatinib free base per tablet. Subjects will be given a 4 week supply of lapatinib tables and instructed to take 6 tablets daily (1500 mg daily dose) orally at the same time each day. Subjects will receive a daily dose of lapatinib until disease progression or withdrawal from study treatment due to unacceptable toxicity or withdrawal of consent.; Subjects will receive weekly paclitaxel (80 mg/m2 IV for 3 weeks in a 4 week cycle). Subjects will be treated with paclitaxel for at least 6 months, and may continue on paclitaxel at the discretion of the Investigator, or discontinued sooner if the subject has disease progression, an unacceptable toxicity or withdraws consent.
Intervention MeSH terms: Paclitaxel; Lapatinib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 57.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Lapatinib; Metastatic breast cancer; Paclitaxel; ErbB2-amplification; GW572016

Summary:

      This study investigates the safety and efficacy of oral lapatinib in combination with an
      approved medication, paclitaxel, for patients with ErbB2 metastatic breast cancer.
    

Eligibility criteria:

        Inclusion Criteria:

        A subject will be eligible for inclusion in this study only if all of the following
        criteria apply:

          -  Signed informed consent.

          -  Only females ≥18 years of age will be recruited:

               -  Non-child-bearing potential (i.e., women with functioning ovaries who have a
                  current documented tubal ligation or hysterectomy, or women who are
                  postmenopausal); or

               -  Child-bearing potential (i.e., women with functioning ovaries and no documented
                  impairment of oviductal or uterine function that would cause sterility). This
                  category includes women with oligomenorrhoea (severe), women who are
                  perimenopausal and young women who have begun to menstruate. These subjects must
                  provide a negative serum pregnancy test at Screening and agree to one of the
                  following:

               -  Complete abstinence from intercourse from 2 weeks prior to administration of the
                  first dose of study medication until 28 days after the final dose of study
                  medication; or

               -  Consistent and correct use of one of the following acceptable methods of birth
                  control:

               -  Male partner who is sterile prior to the female subject's entry into the study
                  and is the sole sexual partner for that female subject.

               -  Implants of levonorgestrel.

               -  Injectable progestogen.

               -  Any intrauterine device (IUD) with a documented failure rate of less than 1% per
                  year.

               -  Oral contraceptives (either combined or progestogen only).

               -  Barrier methods, including diaphragm or condom with a spermicide.

          -  Subjects must have histologically confirmed invasive breast cancer with stage
             IVdisease;

             • Where the disease is restricted to a solitary lesion, the neoplastic nature of the
             lesion should be confirmed by cytology or histology.

          -  Subjects whose disease is ER+ and/or PR+ or unknown status will only be included in
             the study if they meet the following criteria:

               -  They have symptomatic visceral disease that requires chemotherapy (e.g., patients
                  with liver or lung metastases).

               -  The disease is considered by the Investigator to be progressing rapidly or
                  lifethreatening.

               -  Subjects who have received endocrine therapy and who are no longer benefiting
                  from this therapy.

          -  Documented amplification of ErbB2 defined by FISH in primary or metastatic tumor
             tissue. Results of FISH testing at local laboratories are acceptable, however, tissue
             sample must still be sent to Central laboratory where results will be repeated but not
             used for eligibility criterion.

          -  If a taxane had been administered in the neoadjuvant or adjuvant setting, progression
             must have occurred ≥12 months after completion of this treatment.

          -  Measurable lesion(s) according to RECIST (Response Evaluation Criteria in Solid
             Tumors) criteria [Stephens, 2004; Therasse, 2000].

          -  Radiotherapy prior to initiation of study medication is allowed to a limited area
             (e.g., palliative treatment for painful bone metastases), if it is not the sole site
             of disease. Subject must have completed radiation treatment and recovered from all
             acute radiation treatment-related toxicities, in particular bone marrow suppression.

          -  Bisphosphonate therapy for bone metastases is allowed however; treatment must be
             initiated prior to the first dose of study medication. Prophylactic use of
             bisphosphonates in subjects without bone disease, except for the treatment of
             osteoporosis, is not permitted.

          -  Subjects with stable central nervous system (CNS) metastases (stable for at least 3
             months) as confirmed by computerized tomography (CT)/magnetic resonance imaging (MRI))
             or leptomeningeal involvement are eligible only if they are not taking oral steroids
             or enzyme-inducing anticonvulsants.

          -  Subjects must have a cardiac ejection fraction within institutional range of normal as
             measured by echocardiogram (or multigated acquisition (MUGA) scan if an echocardiogram
             cannot be performed or is inconclusive). Subjects with known history of uncontrolled
             or symptomatic angina, arrhythmias, or congestive heart failure are not eligible.

          -  Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 - 1.

          -  Considered by the Investigator to have a life expectancy of at least 3 months.

          -  Able to swallow and retain oral medication.

          -  Subjects must have new or archived tumor tissue available for analysis.

          -  Subjects must complete all screening assessments as outlined in the protocol.

          -  Subject must have adequate organ function as defined in Table 1.

        Table 1 Baseline Laboratory Values for Adequate Organ Function SYSTEM LABORATORY VALUES

        Haematologic

        Absolute neutrophil count ≥1.5 × 10^9/L Haemoglobin ≥9 g/dL Platelets ≥100 × 10^9/L

        Hepatic

        Albumin ≥2.5 g/dL Serum bilirubin

          -  1.25 x ULN AST and ALT ≤3 × ULN without liver metastases

          -  5 × ULN with documented liver metastases

        Renal

        Serum Creatinine1 ≤2.0 mg/dL

          -  OR - Calculate Creatinine Clearance1 ≥40 mL/min

               1. Calculated by the Cockcroft and Gault Method. ALT = alanine aminotransferase; AST
                  = aspartate aminotransferase

                  Exclusion Criteria:

                  A subject will not be eligible for inclusion in this study if any of the
                  following criteria apply:

          -  Pregnant or lactating females.

          -  Received prior chemotherapy, hormonal therapy, immunotherapy, biologic therapy for
             metastatic disease.

          -  Prior therapy with ErbB1 and/or ErbB2 inhibitors.

          -  Concurrent anti-cancer therapy (chemotherapy, radiation therapy, immunotherapy,
             biologic therapy, hormonal therapy) while taking study medication.

          -  Unresolved or unstable, serious toxicity from prior administration of another
             investigational drug and/or of prior cancer treatment.

          -  Peripheral neuropathy of grade 2 or greater.

          -  Malabsorption syndrome, disease significantly affecting gastrointestinal function, or
             resection of the stomach or small bowel. Subjects with ulcerative colitis are also
             excluded.

          -  History of other malignancy. However, subjects who have been disease-free for 5 years,
             or subjects with a history of completely resected non-melanoma skin cancer or
             successfully treated in situ carcinoma are eligible.

          -  Concurrent disease or condition that would make the subject inappropriate for study
             participation, or any serious medical disorder that would interfere with the subject's
             safety.

          -  Active or uncontrolled infection.

          -  Dementia, altered mental status, or any psychiatric condition that would prohibit the
             understanding or rendering of informed consent.

          -  Known history of uncontrolled or symptomatic angina, arrhythmias, or congestive heart
             failure.

          -  Concurrent treatment with an investigational agent or participation in another
             clinical trial involving investigational agents.

          -  Used an investigational drug within 30 days or five half-lives, whichever is longer,
             preceding the first dose of investigational treatment.

          -  The subject has a known immediate or delayed hypersensitivity reaction or idiosyncrasy
             to drugs chemically related to lapatinib or excipients and those related to paclitaxel
             or excipients.