High Throughput Technologies to Drive Breast Cancer Patients to Specific Phase I/II Trials of Targeted Agents

Study Overview
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Brief Summary
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High sensitivity to targeted agents has been observed in patients whose tumor cells present a genetic/genomic deregulation of the target (Kit mutation, ERBB2 amplification, EGFR mutations) together with addiction to the given target. More recently, activation of alternative pathways (Kras mutation, PI3K mutations) have been reported as a common resistance mechanism to single agent tyrosine kinase inhibitors (trastuzumab, cetuximab). From these data has emerged the hypothesis that identification of the deregulated pathway through new molecular tools could allow to propose a more tailored targeted regimen. Based on these concepts, numbers of phase I/II trials enrich their populations in patients presenting specific molecular alterations. High throughput technologies (array CGH, sequencing, gene expression array) identify deregulated genes. In addition, these technologies determine whether such genomic alterations are single (expected efficacy of single agent) or multiple (rationale for combination). In a pilot study that included 135 patients, we recently performed a combination of array CGH and hot spot mutation array in order to drive patients into phase I/II clinical trials. This study led to the conclusions that high throughput technologies i. are feasible (80%) and robust, ii. identify targetable genomic alterations in around 40% of samples. In the present study, the investigators will perform high throughput technologies to drive 400 metastatic breast cancer patients into specific phase I/II trials.

Official Title
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High Throughput Technologies to Drive Breast Cancer Patients to Specific Phase I/II Trials of Targeted Agents

Conditions
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Metastatic Breast Cancer

Intervention / Treatment
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* Other: Biopsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and Women with histologically diagnosed breast cancer Metastatic relapse or stage IV breast cancer at diagnosis Metastases amenable to biopsy Age <70 years old PS 0/1 No restriction regarding the number of previous chemotherapy or endocrine therapies Exclusion Criteria: Age <18 Life expectancy <3 months Symptomatic or progressing brain metastases Progressive patients at the time of biopsy LVEF <50% (MUGA or ultrasonography) Inadequate bone marrow reserve or organ function as demonstrated by any of the following laboratory values: Absolute neutrophil count < 1.5 x 109/L Platelet count < 100 x 109/L Haemoglobin < 90 g/L ASAT/ALAT > 2.5 times the upper limit of normal (ULN) if no demonstrable liver metastases or > 5 times ULN in the presence of liver metastases Total bilirubin > 1.5 times ULN Creatinine >1.5 times ULN Corrected calcium > ULN Phosphate > ULN Abnormal blood coagulation that contra-indicates biopsy Patients deprived of liberty or placed under the authority of a tutor

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Biopsy|Breast metastases biopsy|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of patients included in early phase trials evaluating targeted drugs | To use whole genome / integrated biology approach to drive patients in early clinical trials. The goal is to include at least 30% of the patients in a clinical trial evaluating targeted agent, according to the molecular alteration detected on high throughput technologies | one year after obtaining the molecular profile | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| overall survival | To evaluate the efficacy of such patient selection in terms of survival | 3 years after inclusion in SAFIR | 
| Progression free survival | To evaluate the efficacy of such patient selection in terms of progression free survival | 3 years after inclusion in SAFIR | 
| To evaluate the efficacy of such patient selection in terms of survival response rate | To evaluate the efficacy of such patient selection in terms of best response rate | 3 years after inclusion in SAFIR |