Lapatinib in Combination With Weekly Paclitaxel in Patients With ErbB2 Amplified Advanced Gastric Cancer
Condition: Neoplasms, Gastrointestinal Tract
MeSH terms: Stomach Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms
Intervention: Lapatinib; Paclitaxel
Intervention description: 6 pills at 250 mg each once daily; Infusion at 80 mg/m2 weekly
Intervention MeSH terms: Paclitaxel; Lapatinib
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 273.0
Sex: All
Minimum age: 20 Years
Healthy volunteers: No
Keywords: lapatinib; paclitaxel; ErbB2; Gastric cancer; Advanced gastric cancer

Summary:

      EGF104578 is two-part study (Pilot part/Randomized part).Pilot part is designed to find the
      optimal (best) doses of lapatinib and paclitaxel when given together,Randomized part is
      designed to evaluate the overall survival in patients receiving lapatinib and paclitaxel
      compared to patients receiving only paclitaxel.
    

Eligibility criteria:

        Inclusion criteria:

        Specific Information regarding warnings, precautions, contraindications, adverse events,
        and other pertinent information on the investigational product that may impact subject
        eligibility is provided in the Investigator's Brochure (IB) Pilot Part

        Subjects eligible for enrollment in the Pilot Part of the study must meet all of the
        following criteria:

          -  Signed informed consent

          -  Male or female; ≥ 20 years (at the time of giving consent)

          -  Any histologically or cytologically confirmed gastric carcinoma independent of tumor
             ErbB2 status

          -  Subjects who have received one prior regimen for gastric carcinoma and developed
             disease progression or recurrence. The regimen must have contained 5-fluoropyrimidine
             and/or cisplatin

          -  Left ventricular ejection fraction (LVEF) within institutional range of normal as
             measured by echocardiogram (ECHO). Multigated acquisition (MUGA) scans will be
             accepted in cases where an echocardiogram cannot be performed or is inconclusive (LVEF
             of ≥50% required if normal range of LVEF is not provided by institution)

          -  Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 1

          -  Able to swallow and retain oral medication

          -  Women and men with potential to have children must be willing to practice acceptable
             methods of birth control during the study

          -  Washout period from the prior last therapy as follows; Chemotherapy (except for agents
             below) 4 weeks (I.V) Chemotherapy (except for agents below) 2 weeks (P.O) Trastuzumab,
             Bevacizumab 4 weeks Mitomycin-C, nitrosourea 6 weeks Radiotherapy, Immunotherapy,
             Biologic therapy and Surgery (except for minor surgical procedure) 2 weeks

          -  Willing to complete all screening assessments as outlined in the protocol

          -  Adequate organ function as defined in Table 2 Baseline Laboratory Values

          -  Able to be hospitalized for PK analysis during cycle 1

          -  Life expectancy of at least 12 weeks from the first dose of study treatment)

        Randomized Part

        Subjects eligible for enrollment in the Randomized Part of the study must meet all of the
        following criteria:

          -  Signed informed consent

          -  Male or female; ≥ 20 years (at the time of giving consent)

          -  Histologically or cytologically confirmed gastric carcinoma with documented
             amplification of ErbB2 by fluorescence in situ hybridization (FISH) in primary or
             metastatic tumor tissue

          -  Subjects who received one prior regimen for gastric carcinoma and defined as
             progression disease. The regimen must be containing 5-fluoropyrimidine and/or
             cisplatin

          -  Measurable lesion(s) according to RECIST (Response Evaluation Criteria in Solid
             Tumors)

          -  Left ventricular ejection fraction (LVEF) within institutional range of normal as
             measured by echocardiogram. MUGA scans will be accepted in cases where an
             echocardiogram cannot be performed or is inconclusive (LVEF of ≥50% required if normal
             range of LVEF is not provided by institution)

          -  ECOG Performance Status of 0 to 1

          -  Able to swallow and retain oral medication

          -  Archived (or Biopsy ) tumor tissue available for FISH testing [Wolff, 2007] in central
             laboratory

          -  Women and men with potential to have children must be willing to practice acceptable
             methods of birth control during the study

          -  Washout period from the prior last therapy as follows; Chemotherapy (except for agents
             below) 4 weeks (IV) Chemotherapy (except for agents below) 2 weeks (P.O) Trastuzumab,
             Bevacizumab 4 weeks Mitomycin-C, nitrosourea 6 weeks Radiotherapy, Immunotherapy,
             Biologic therapy and Surgery (except for minor surgical procedure) 2 weeks

          -  Willing to complete all screening assessments as outlined in the protocol

          -  Adequate organ function as defined in Table 2

          -  Gastrectomy status depending on the result in the Pilot Part

          -  Life expectancy of at least 12 weeks from the first dose of study treatment

        Table 2 Baseline Laboratory Values

        SYSTEM LABORATORY (VALUES)

        Hematologic:

        ANC (absolute neutrophil count)

        Hemoglobin:

        Platelets (≥ 2.0 × 10^9/L) (≥ 9 g/dL) (≥ 100 × 10^9/L) Hepatic Albumin Serum bilirubin AST
        and ALT (≥ 2.5 g/dL) (≤ 1.25 x ULN) (≤ 2.5 × ULN without liver metastases) (≤ 5 × ULN if
        documented liver metastases) Renal Serum Creatinine

        Calculate Creatinine Clearance (see Section 11.3) (≤ 2.0 mg/dL)

        - OR - (≥30 mL/min)

        Exclusion criteria:

        Subjects meeting any of the following criteria must not be enrolled in the study:

          -  Pregnant or lactating female at anytime during the study

          -  Planned concurrent anti-cancer therapy (chemotherapy, radiotherapy, immunotherapy,
             biologic therapy, hormonal therapy) while taking investigational treatment

          -  Unresolved or unstable, serious toxicity from prior cancer treatment (any toxicities
             greater than grade 2)

          -  Peripheral neuropathy of Grade 2 or greater

          -  Malabsorption syndrome, disease significantly affecting gastrointestinal function.
             Subjects with ulcerative colitis and Crohn's disease 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

          -  Life threatening 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

          -  Known history or clinical evidence of central nervous system (CNS) metastasis

          -  Concurrent treatment with prohibited medications, including herbal remedies and
             Chinese traditional medicines

          -  Concurrent treatment with an investigational agent within 28 days prior to the
             administration of paclitaxel and/or lapatinib

          -  Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs
             chemically related to paclitaxel, including polyethoxylated castor oil, alcohol, or
             lapatinib or their excipients

          -  Anamnesis or diagnosis of pulmonary disorder, such as interstitial pneumonia,
             pulmonary fibrosis or serious hypoxia

          -  Gastrectomy surgery if Pilot Part of the study determines that partial gastrectomy
             (pylorus spared) or total/partial gastrectomy (pylorus removed) has a significant
             negative impact upon lapatinib PK and safety profile

          -  Known history of use of any EGFR agent (except Trastuzumab)

          -  Prior gastric cancer treatment which included a taxane.