Lapatinib and Tamoxifen in Treating Patients With Locally Advanced or Metastatic Breast Cancer That Did Not Respond to Previous Tamoxifen
Condition: Estrogen Receptor Positive; Male Breast Carcinoma; Progesterone Receptor Positive; Recurrent Breast Carcinoma; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer
MeSH terms: Carcinoma; Breast Neoplasms; Breast Neoplasms, Male
Intervention: Laboratory Biomarker Analysis; Lapatinib Ditosylate; Tamoxifen Citrate
Intervention description: Correlative studies; Given PO; Given PO
Intervention MeSH terms: Tamoxifen; Lapatinib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 19.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies how well giving lapatinib ditosylate together with tamoxifen
      citrate works in treating patients with breast cancer that has spread from where it started
      to nearby tissue or lymph nodes or to other areas of the body and did not respond to previous
      treatment with tamoxifen citrate. Lapatinib ditosylate may stop the growth of tumor cells by
      blocking some of the enzymes needed for cell growth. Estrogen can cause the growth of breast
      cancer cells. Hormone therapy using tamoxifen citrate may fight breast cancer by blocking the
      use of estrogen by the tumor cells. Sometimes when tamoxifen citrate is given, it does not
      stop the growth of tumor cells. The tumor is said to be resistant to tamoxifen citrate.
      Giving lapatinib ditosylate together with tamoxifen citrate may reduce drug resistance and
      allow the tumor cells to be killed.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Primary adenocarcinoma of the breast confirmed by histology or cytology

          -  Locally advanced or metastatic disease not amenable to surgery or radiation therapy
             with curative intent

          -  Estrogen and/or progesterone receptor positive cancer

          -  Patients have failed hormonal manipulation with tamoxifen, either showing no response
             (primary resistance) to initial therapy or relapse/progression after showing initial
             response (secondary failure)

          -  At least 1 measurable (target) lesion (i.e. any malignant tumor mass that can be
             accurately measured in at least 1 dimension, >= 20 mm with conventional radiographic
             techniques or >= 10 mm with magnetic resonance imaging [MRI] or spiral computerized
             tomography [CT] scans), in a previously un-irradiated area

          -  No more than 450 mg/m^2 of prior doxorubicin

          -  Life expectancy >= 3 months

          -  Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

          -  Absolute neutrophil count (ANC) >= 1500/mm^3

          -  Platelets >= 100,000/mm^3

          -  Hemoglobin >= 9.0 g/dL

          -  Creatinine (Cr) =< upper limit of normal (ULN) or Cr clearance > 60 mL/min/m^2

          -  Total bilirubin =< 1.5 x ULN

          -  Alanine aminotransferase (ALT) =< 1.5 x ULN or =< 3 x ULN with liver metastases

          -  Aspartate aminotransferase (AST) =< 5 x ULN or =< 3 x ULN with liver metastases

          -  Cardiac ejection fraction within the institutional range of normal as measured by
             echocardiogram or multi gated acquisition scan (MUGA) scan; (note that baseline and
             on-treatment scans should be performed using the same modality and preferably at the
             same institution)

          -  Patients on oral anticoagulants (Coumadin, warfarin) should either be switched to low
             molecular weight heparin or have a very close monitoring of international normalized
             ratio (INR), if continued on Coumadin

          -  Negative serum pregnancy test within 7 days of enrollment for pre-menopausal women and
             women within 6 months of menopause; should a woman become pregnant or suspect she is
             pregnant while participating in this study, she should inform her treating physician
             immediately; both men and women should be counseled in contraceptive use due to
             unknown effects of the drug on the fetus and breast feeding should be avoided

          -  Ability to understand and the willingness to sign a written informed consent document

          -  Ability to swallow and retain oral medication

        Exclusion Criteria:

          -  Patients who have had prior treatment with EGFR and or Her-2 targeting therapies
             (prior trastuzumab combined with chemotherapy in the adjuvant setting only is allowed,
             but the combination of trastuzumab with hormonal therapy is not allowed)

          -  Current treatment with any other anti-neoplastic agent, including trastuzumab;
             patients may continue to receive zoledronic acid for bone metastases or hypercalcemia

          -  Radiation therapy within 2 weeks of enrollment or surgery within 4 weeks

          -  Rapidly progressive disease in major organs (i.e. lymphangitic spread, bulky liver
             metastasis) or known brain/leptomeningeal metastatic disease requiring active therapy;
             (patients with asymptomatic, stable previously treated metastases to the central
             nervous system and surrounding tissues are eligible; however patients must not have a
             requirement for corticosteroids due to central nervous system metastases at the time
             of study entry)

          -  Any of the following conditions within 6 months of enrollment: myocardial infarction,
             severe/unstable angina, symptomatic congestive heart failure, cerebrovascular accident
             or transient ischemic attack, coronary/peripheral artery bypass grafting; patients who
             have experienced a pulmonary embolus, deep venous thrombosis or other clinically
             significant thromboembolic event within 6 months of enrollment are eligible if they
             are clinically stable on anticoagulation therapy

          -  Pregnancy or breast feeding; breastfeeding should be discontinued if the mother is
             treated with GW572016; female patients must agree to use effective contraception
             during the study period, be surgically sterile, or be post-menopausal; in addition,
             male patients will be required to use effective contraception during the study period
             or be surgically sterile; the definition of effective contraception will be based on
             the judgment of the investigator

          -  Human immunodeficiency virus (HIV)-positive patients receiving combination
             anti-retroviral therapy are excluded from the study

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to GW572016

          -  Patients with gastrointestinal (GI) tract disease resulting in an inability to take
             oral medication, malabsorption syndrome, a requirement for intravenous (IV)
             alimentation, prior surgical procedures affecting absorption, or uncontrolled
             inflammatory GI disease (e.g., Crohn's, ulcerative colitis)

          -  Treatment with any agents that interact with cytochrome P450 3A should be avoided and
             used with caution, if necessary; when possible, patients should be switched to
             alternative medications; patients requiring anticoagulation should either be switched
             to a low molecular weight heparin injection or have a very close monitoring of INR, if
             continued on Coumadin

          -  Previous (within 5 years of enrollment) or current malignancies at other sites, except
             adequately treated basal cell or squamous cell skin cancers and carcinoma in situ of
             the cervix

          -  Other severe acute or chronic medical or psychiatric conditions or laboratory
             abnormality that may increase the risk associated with study participation or study
             drug administration or may interfere with interpretation of study results and, in the
             judgment of the investigator, would make the patient inappropriate for study entry