T-DM1 With Abraxane and Lapatinib for Metastatic HER2 Positive Breast Cancer

Study Overview
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Brief Summary
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This open-label, single-center Phase Ib study will assess the safety and tolerability of combining trastuzumab emtansine (T-DM1) with Lapatinib and Abraxane in patients with metastatic HER2-positive breast cancer.

Detailed Description
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This open-label, single-center Phase Ib study will assess the safety and tolerability of combining trastuzumab emtansine (T-DM1) with Lapatinib and Abraxane in patients with metastatic HER2-positive breast cancer. Patients will receive Abraxane on Day 1 of each 1-week cycle and T-DM1 on Day 1 of each 3-week cycle. Patients with take Lapatinib orally daily. Patients will receive the study treatment for 12 weeks.

Official Title
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Phase Ib Trial of Trastuzumab Emtansine In Combination With Lapatinib Plus Abraxane In Metastatic Her 2 Neu Over-Expressed Breast Cancer Patients

Conditions
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Metastatic Breast Cancer

Intervention / Treatment
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* Drug: T-DM1
* Drug: Lapatinib
* Drug: Abraxane


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Documented metastatic Her2 over-expressed breast cancer. Age ≥ 18 years Patients must have received at least two prior therapies for their malignant disease. Patients must have < Grade 2 pre-existing peripheral neuropathy (per CTCAE) Adequate organ function (cardiac ejection fraction of ≥ 45%), CBC not less than .75 of institutional lower limit. Patients must have adequate liver function: AST and ALT < 2.5 X upper limit of normal, alkaline phosphatase < 2.5 X upper limit of normal, unless bone metastasis is present in the absence of liver metastasis Bilirubin < 1.5 mg/dL Patients must have adequate renal function: creatinine <1.5 mg/dL is recommended; however, institutional norms are acceptable. Negative serum or urine β-hCG pregnancy test at screening for patients of childbearing potential Fertile patients must use effective contraception (barrier method - condoms, diaphragm - also in conjunction with spermicidal jelly, or total abstinence. Oral, injectable, or implant hormonal contraceptives are not allowed). Contraception method must be used during treatment and for three months after completing treatment Signed informed consent form (ICF) Exclusion Criteria: Any medical or psychiatric condition that would prevent informed consent or limit survival to less than 4 weeks. Absolute QT interval of >460 msec in the presence of potassium >4.0mEq/L and Magnesium >1.8mg/dl. Patient with HIV and post- transplant associated lymphoproliferative disorders. Patient with concurrent use of complementary or alternative medicines that would confound the interpretation of toxicities and antitumor activity of Trastuzumab Emtansine, Lapatinib or Abraxane. Pregnant or lactating women. Concurrent treatment with an investigational agent or participation in another therapeutic clinical trial Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to trastuzumab Emtansine, lapatinib, abraxane, or their components. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel. Subjects with ulcerative colitis are also excluded.

Ages Eligible for Study
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Minimum Age: 18 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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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: T-DM1 + Lapatinib + Abraxane<br>T-DM1 with Laptinib followed by Abraxane | Drug: T-DM1<br>* antibody-drug conjugate of trastuzumab and emtansine<br>* Other names: Kadcyla;Drug: Lapatinib<br>* Dual tyrosine kinase inhibitor (HER2 and EGFR)<br>* Other names: Tykerb;Drug: Abraxane<br>* albumin-bound paclitaxel. Chemotherapy - microtubule inhibitor<br>* Other names: nab-paclitaxel;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Tolerable Dose | Maximum tolerated dose (MTD) of Trastuzumab Emtansine in combination with Lapatinib plus Abraxane in metastatic Her2 over-expressed breast cancer. | approximately 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dose Limiting Toxicities | Describe the dose-limiting toxicity (DLT) associated with Trastuzumab Emtansine in combination with Lapatinib plus Abraxane as assessed by CTCAE v4.0. | From date of randomization through study follow up (approximately 16 weeks) | 
| Measure toxicities associated with treatment combination | Describe and measure other toxicities associated with Trastuzumab Emtansine in combination with Lapatinib plus Abraxane as assessed by CTCAE v4.0. | From date of randomization through study follow up (approximately 16 weeks) | 
| Anti-tumor activity through imaging | Document anti-tumor activity of Trastuzumab Emtansine in combination with Lapatinib plus Abraxane in metastatic Her2 over-expressed breast cancer as assessed by RECIST 1:1 criteria | approximately 16 weeks from randomization | 
| Plasma pharmacokinetics and pharmacodynamic effect of treatment combination | Determine the plasma pharmacokinetics of Trastuzumab Emtansine in combination with Lapatinib plus Abraxane. | Day 1 and 1,2,4,and 24hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer, HER2 positive Breast Cancer