Lapatinib In Combination With Chemotherapy In Subjects With Relapsed Breast Cancer

Study Overview
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Brief Summary
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This study will evaluate the safety and efficacy of lapatinib in combination with chemotherapy (capecitabine, docetaxel, nab-paclitaxel) in subjects with ErbB2-overexpressing breast cancer whose disease has progressed during or within 12 months after completion of trastuzumab-containing therapy in the neoadjuvant or adjuvant setting.

Official Title
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An Open-label, Multi-centre Study of Lapatinib in Combinationwith Chemotherapy in Patients With ErbB2 Overexpressing Breastcancer After Trastuzumab Failure in the Neoadjuvant or Adjuvantsetting.

Conditions
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Relapsed Breast Cancer, Neoplasms, Breast

Intervention / Treatment
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* Drug: Lapatinib
* Drug: Capecitabine
* Drug: Docetaxel
* Drug: nab-Paclitaxel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed informed consent. Histologically/cytologically confirmed breast cancer; If the disease is restricted to a solitary lesion, the neoplastic nature of the lesion must be confirmed by cytology or histology. Measurable lesion(s) according to RECIST (Response Evaluation Criteria in Solid Tumors) [Therasse, 2000]. Documented amplification of the ErbB2 gene by fluorescence in situ hybridization (FISH) or documented overexpression of the ErbB2 protein by 3+ IHC in primary or metastatic tumor tissue. Subjects must have relapsed breast cancer where the disease progressed during or ≤ 12 months after completion of trastuzumab-containing therapy in the neoadjuvant or adjuvant setting. Note: Progression is defined using RECIST criteria, that is, either the appearance of new lesions or a >=20% increase in the sum of longest diameter (LD). Subjects must not have received prior anti-cancer therapy for metastatic breast cancer (MBC). Subjects who received prior antihormonal agents combined with trastuzumab for the treatment of disease which first presented as ER positive MBC and recurred while receiving trastuzumab or ≤ 3 months after completing this therapy are eligible. Subjects with stable central nervous system (CNS) metastases as confirmed by computerized tomography (CT)/magnetic resonance imaging (MRI) are allowed. Treatment with prophylactic anticonvulsants is permitted, unless listed within the Prohibited Medications. Subjects must have a baseline cardiac ejection fraction (LVEF) ³50% measured by echocardiogram (ECHO) (or multigated acquisition (MUGA) scan if an ECHO cannot be performed). The same modality used at baseline must be used for repeat assessment throughout study. Only subjects with controlled or asymptomatic angina or arrhythmias are eligible. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 - 2. Subjects must have archived tumor tissue from the initial diagnosis available for analysis. If tissue from the initial diagnosis is not available, then tissue must be obtained from a recurrent or metastatic site prior to initiating study treatment. Female ≥18 years. Subject must have adequate organ function as defined in Table 1. Table 1: Baseline Laboratory Values for Adequate Organ Function. SYSTEM Hematologic: Absolute neutrophil count: ≥1.5 X 10^9/L Hemoglobin: ≥9 g/dL Platelets: ≥ 75 X 10^9/L Hepatic: AST, ALT and Alkaline phosphatase: ≤ 2.5 X ULN Unless concomitant docetaxel, then ≤ 1.5 x ULN for AST and ALT, with AP ≤ 2.5 x ULN Unless documented liver metastasis, then ≤ 5 x ULN Serum bilirubin: ≤ 2.0 X ULN Albumin: ≥ 2.5 g/dL Renal: Serum Creatinine: ≤ 1.5 mg/dL OR - Calculate Creatinine Clearance: ≥ 40 mL/min Calculated by the Cockcroft and Gault Method [Cockcroft , 1976]. Exclusion Criteria: Pregnant or lactating females. Women of childbearing potential who do not practice approved contraceptive methods (for example, intrauterine device [IUD], birth control pills, or barrier device) beginning 2 weeks before the first dose of investigational product and for 28 days after the final dose of investigational product. 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 therapy given to treat cancer (chemotherapy, radiation therapy, immunotherapy, biologic therapy, anti-hormonal therapy) while taking study medication. Unresolved or unstable, serious toxicity from prior administration of another investigational drug and/or of prior cancer treatment. Malabsorption syndrome or resection of the stomach or small bowel significantly affecting gastrointestinal function. Have current active haptic or biliary disease (with excpetion of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment). Concurrent disease or condition that, in the opinion of the physician, would make the subject inappropriate for study participation or any serious medical disorder that would interfere with the subject's safety (for example, uncontrolled infection, or any psychiatric condition prohibiting understanding or rendering of informed consent). Concurrent treatment with an investigational agent or participation in another clinical trial involving investigational agents for anti-cancer therapy. Bisphosphonates may not be initiated after the first dose of study medication. Considered by the Investigator to have a life expectancy less than 3 months. Not able to swallow or retain oral medication. The subject with a known unmanageable hypersensitivity reaction or idiosyncrasy to drugs chemically related to lapatinib or excipients and those related to capecitabine, docetaxel, nab paclitaxel or their excipients.

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lapatinib plus Chemotherapy<br>Lapatinib is administered in combination with one of the following chemotherapies based on the discretion of the investigator : capecitabine, docetaxel or nab-paclitaxel. | Drug: Lapatinib<br>* Small molecule tyrosine kinase inhibitor<br>Drug: Capecitabine<br>* Chemotherapy<br>Drug: Docetaxel<br>* Chemotherapy<br>Drug: nab-Paclitaxel<br>* Chemotherapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Tumor Response | Overall tumor response is defined as the percentage of participants with a confirmed complete or partial tumor response per Response Evaluation Criteria in Solid Tumors (RECIST). Complete response (CR) is defined as the disappearance of all target lesions. CR could only be declared if all target and non-target lesions had disappeared. Partial response (PR) is defined as a decrease of 30% or greater in the sum of the longest diameter of target lesions. | from start of treatment and every 6 weeks (wks) until Wk 12, then every 12 wks thereafter through the end of treatment ( 95 wks; dependent on when participant discontinued study therapy due to disease progression, death, adverse event, of other reason) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical Benefit (CB) | CB is defined as the percentage of participants (par.) with either a confirmed CR or PR or stable disease (SD) for at least 24 weeks. SD is defined as small changes that do not meet criteria for CR, PR, or Progressive Disease (defined as at least a 20% increase in the sum of the longest diameter of target lesions). | from start of treatment and every 6 weeks (wks) until Wk 12, then every 12 wks thereafter through the end of treatment ( 95 weeks; dependent on when participant discontinued study therapy due to disease progression, death, adverse event, or other reason) | 
| Duration of Response | For the subset of participants with a confirmed CR or PR, duration of response was measured as the time from first documented evidence of CR or PR until the first documented sign of disease progression or death. | time from first documented evidence of CR or PR until the first documented sign of disease progression or death (approximately 95 weeks) | 
| Time to Response (TTR) | TTR is defined as the time from the start of treatment until the first documented evidence of PR or CR (whichever status was recorded first). When tumor response was confirmed at a repeat assessment, the TTR was taken to be the first time that the response was observed. | start of treatment until first documented evidence of CR or PR (approximately 95 weeks) | 
| Progression-free Survival | The time from the start of treatment until the earliest date of disease progression or death due to any cause was measured. | from start of treatment and every 6 weeks (wks) until Wk 12, then every 12 wks thereafter through the end of treatment ( 95 weeks); dependent on when participant discontinued study therapy due to disease progression, death, adverse event, or other reason) | 
| Number of Participants With the Indicated Serious Adverse Events and Adverse Events | Qualitative and quantitative toxicities associated with the combination of capecitabine, docetaxel, or nab-paclitaxel and lapatinib were measured. Data are presented as serious adverse events (SAEs) and adverse events (AEs). See the SAE/AE section of the results record for data. | Baseline through End of Treatment, or discontinuation of study therapy (approximately 95 weeks); from the first dose of lapatinib until 5 days after the last dose of lapatinib | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ErbB1, ErbB2, GW572016, lapatinib, Relapsed breast cancer, dual tyrosine kinase inhibitor, MBC, EGFR, Her-2/neu, FISH amplification