Irinotecan and Docetaxel in Treating Patients With Refractory Metastatic Breast Cancer

RATIONALE: Drugs used in chemotherapy, such as irinotecan and docetaxel, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving irinotecan together with docetaxel works in treating patients with refractory metastatic breast cancer.

OBJECTIVES:

Primary

* Determine the antitumor activity of irinotecan and docetaxel, in terms of response rate, in patients with refractory metastatic breast cancer.

Secondary

* Determine the toxicity profile of this regimen in these patients.
* Determine the progression-free and overall survival of patients treated with this regimen.

OUTLINE: This is a multicenter study.

Patients receive docetaxel IV over 1 hour followed by irinotecan IV over 1 hour on days 1 and 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients who achieve a complete response (CR) receive 2 additional courses beyond CR.

Patients are followed every 2 months until disease progression and then every 6 months thereafter.

Eligibility Criteria:
DISEASE CHARACTERISTICS:

* Histologically confirmed adenocarcinoma of the breast

  * Metastatic disease
* Previously treated with chemotherapy in the adjuvant setting and/or for metastatic disease
* At least one unidimensionally measurable lesion

  * At least 20 mm by CT scan or MRI OR at least 10 mm by spiral CT scan
  * Superficial clinical lesions (e.g., skin nodules or palpable lymph nodes) are allowed
  * Lesions on chest x-ray are allowed provided they are clearly defined and surrounded by aerated lung
  * The following are not considered measurable:

    * Bone lesions
    * Ascites
    * Leptomeningeal disease
    * Pleural/pericardial effusion
    * Inflammatory breast disease
    * Lymphangitis cutis/pulmonis
    * Cystic lesions
* No known CNS metastases unless controlled by prior surgery and/or radiotherapy
* Hormone receptor status:

  * Estrogen receptor (ER) and/or progesterone receptor (PR) status known

PATIENT CHARACTERISTICS:

Age

* 18 and over

Sex

* Male or female

Menopausal status

* Not specified

Performance status

* ECOG 0-2

Life expectancy

* At least 3 months

Hematopoietic

* Granulocyte count ≥ 1,500/mm\^3
* Hemoglobin ≥ 8.0 g/dL
* Platelet count ≥ 100,000/mm\^3

Hepatic

* Bilirubin ≤ upper limit of normal (ULN)
* Meets 1 of the following criteria:

  * AST or ALT ≤ ULN AND alkaline phosphatase ≤ 5 times ULN
  * Alkaline phosphatase ≤ ULN AND AST or ALT ≤ 5 times ULN
  * AST or ALT ≤ 1.5 times ULN AND alkaline phosphatase ≤ 2.5 times ULN

Renal

* Creatinine ≤ 1.5 times ULN

Cardiovascular

* No myocardial infarction within the past 180 days
* No congestive heart failure
* No unstable angina
* No clinically significant pericardial effusion or arrhythmias

Other

* No active, unresolved infection
* No prior severe hypersensitivity reaction to docetaxel, irinotecan, or any drug formulated with polysorbate 80
* No other malignancy within the past 5 years except curatively treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
* No grade 1 or greater sensory or motor neuropathy
* No other concurrent severe condition that would preclude study participation
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

* Prior trastuzumab (Herceptin®) required for HER-2-positive patients (unless contraindicated)

Chemotherapy

* See Disease Characteristics
* More than 14 days since prior chemotherapy
* No more than 2 prior chemotherapy regimens for metastatic disease
* No prior irinotecan or docetaxel for metastatic disease

  * Docetaxel as adjuvant therapy allowed
* No other concurrent chemotherapy

Endocrine therapy

* Prior hormonal therapy required for patients with ER- and/or PR-positive tumors (unless contraindicated)

Radiotherapy

* See Disease Characteristics
* At least 30 days since prior radiotherapy
* No concurrent radiotherapy

Surgery

* See Disease Characteristics
* At least 3 weeks since prior major surgery and recovered

Other

* More than 7 days since prior parenteral antibiotic therapy
* No other concurrent experimental drugs