A Pilot Study of VEGF Inhibition in Patients With Lymphedema Following Breast Cancer Treatment

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the effectiveness of bevacizumab in women with lymphedema as a result of previous treatment for breast cancer.

Detailed Description
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The primary objective of this study is: • To assess the degree of improvement in arm edema as measured by changes in arm volume in patients with ipsilateral lymphedema The secondary objectives of this study are: To assess the degree of improvement in arm edema as measured by changes in arm interstitial fluid pressure (IFP) To assess the degree of improvement in arm edema as measured by changes in extracellular fluid (ECF) volume based on bioelectrical impedance analysis (BIA) by lymphometer To assess the safety and tolerability of VEGF inhibition in this patient population To assess the clinical benefit in patients with ipsilateral lymphedema treated with vascular endothelial growth factor (VEGF) inhibition by evaluating patient responses to a quality of life questionnaire (FACT-B+4 lymphedema questions) To determine the impact of VEGF inhibition on circulating VEGF levels in patients with lymphedema

Official Title
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A Pilot Study of VEGF Inhibition in Patients With Lymphedema Following Breast Cancer Treatment

Conditions
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Breast Cancer, Lymphedema

Intervention / Treatment
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* Drug: bevacizumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Have unilateral lymphedema of the ipsilateral arm attributed to prior surgical treatment or radiation therapy for breast cancer that is severe enough to warrant therapy in the opinion of the subject and treating physician. All subjects must have greater than a 3 cm total difference in arm circumference between the affected and unaffected arm measured at five defined points: each hand just distal to the thumb each wrist at its narrowest point each arm 30 cm proximal to the tip of the middle finger each arm 40 cm proximal to the tip of the middle finger each arm 50 cm proximal to the tip of the middle finger (if possible before the axilla is reached.) Be at least 18 years of age Have adequate organ function as specified below: AST and ALT less than or equal to 2.0 times ULN Total bilirubin less than or equal to 1.5 mg/dL Serum creatinine less than or equal to 1.5 mg/dL Urine protein:creatinine ratio < 1.0* LVEF > institutional limits of normal by MUGA or ECHO PT INR < 1.5; PTT < 1.5 x normal Absolute neutrophil count greater than or equal to 1000/mm3 Platelets greater than or equal to 100,000/mm3 Agree to use effective contraceptive methods during the course of the study if the subject has child-producing potential Have an ECOG performance status of 0 or 1 Exclusion Criteria: Subjects must not be pregnant, lactating, or refuse to use appropriate birth control Subjects must not have an active infection requiring parenteral or oral antibiotics Subjects must not have clinically significant cardiovascular or cerebrovascular disease, including: Any history of: Cerebrovascular disease including TIA, stroke or subarachnoid hemorrhage Ischemic bowel Hypertensive crisis or hypertensive encephalopathy Within the last 12 months Myocardial infarction Unstable angina New York Heart Association (NYHA) grade II or greater congestive heart failure Grade II or greater peripheral vascular disease DVT or PE Active at study entry Uncontrolled hypertension defined as SBP > 150 or DBP > 100 Uncontrolled or clinically significant arrhythmia. Subjects may not have locally recurrent or metastatic disease Subjects may not require concurrent therapeutic anticoagulation. (NOTE: Prophylactic doses of coumadin to maintain patency of a vascular access device is allowed). In addition, subjects with a bleeding diathesis are excluded. Subjects may not have had major surgery within 4 weeks of starting protocol therapy (NOTE: Placement of a vascular access device is not considered major surgery) Subjects may not have received radiation therapy, chemotherapy or trastuzumab within the past 6 weeks (NOTE: Concurrent adjuvant hormonal therapy is allowed.) Subjects may not have altered the physical therapy regimen for lymphedema within the past month Subjects may not have an indwelling venous device in the ipsilateral arm Subjects may not have bilateral lymphedema Subjects may not have a non-healing wound, ulcer or bone fracture. Subjects may not have a known hypersensitivity to any component of Bevacizumab

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: bevacizumab|Bevacizumab 15 mg/kg IV every 21 days|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Arm Volume |  | baseline, Day 1, Day 22, q 6wks, termination | 
| The affected and unaffected arm measured at five defined points: |  | baseline, Day 1, Day 22, q 6wks, termination | 
| each hand just distal to the thumb |  | baseline, Day 1, Day 22, q 6wks, termination | 
| each wrist at its narrowest point |  | baseline, Day 1, Day 22, q 6wks, termination | 
| each arm 30 cm proximal to the tip of the middle finger |  | baseline, Day 1, Day 22, q 6wks, termination | 
| each arm 40 cm proximal to the tip of the middle finger |  | baseline, Day 1, Day 22, q 6wks, termination | 
| each arm 50 cm proximal to the tip of the middle finger (if possible before the axilla is reached.) |  | baseline, Day 1, Day 22, q 6wks, termination | 
| The volume of each arm will be calculated from these measurements using the Casley Smith method29. Treatment will be considered efficacious if there is a greater than or equal to 25% decrease in excess arm volume (affected arm volume minus unaffected arm |  | baseline, Day 1, Day 22, q 6wks, termination | 
| Patients will initially be treated for 42 days (6 weeks). |  | Day 1-42 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer, lymphedema