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Breast CancerEarly Phase 1NCT00331630

Abraxane and Lapatinib in Treating Patients With Stage I, Stage II, or Stage III Breast Cancer

A Early Phase 1 study testing lapatinib ditosylate and paclitaxel albumin-stabilized nanoparticle formulation in people with Breast Cancer, run by Northwestern University at 5 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

RATIONALE: Drugs used in chemotherapy, such as Abraxane, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Lapatinib may stop the growth of tumor cells by blocking some of the enzymes needed for their growth. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Breast Cancer
What is being tested?
lapatinib ditosylate and paclitaxel albumin-stabilized nanoparticle formulation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
5 sitesUnited States
Study dates
4 May 2006to 5 Aug 2010
Phase
Early Phase 1
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

DISEASE CHARACTERISTICS:

  • Histologically confirmed breast cancer
  • Clinical stage I-III disease
  • Measurable disease defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm with spiral CT scan
  • HER2/neu 3+ by immunohistochemistry or positive by fluorescent in situ hybridization
  • No known brain metastases
  • Hormone receptor status unspecified

PATIENT CHARACTERISTICS:

  • Menopausal status not specified
  • Male or female
  • Life expectancy > 12 weeks
  • ECOG performance status (PS) 0-1 OR Karnofsky PS 80-100%
  • WBC ≥ 3,000/mm^3
  • Absolute neutrophil count ≥ 1,500 mm^3
  • Platelet count ≥ 100,000/mm^3
  • Total bilirubin normal
  • AST and ALT ≤ 2.5 times upper limit of normal
  • Creatinine normal OR creatinine clearance ≥ 60 mL/min
  • LVEF ≥ 50% as measured by echocardiogram or MUGA scan
  • No other malignancy within the past year
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Able to swallow and retain oral medication
  • No history of allergic reactions attributed to compounds of similar chemical or biologic composition to lapatinib
  • No ongoing or active infection
  • No symptomatic congestive heart failure
  • No unstable angina pectoris
  • No cardiac arrhythmia
  • No psychiatric illness or social situation that would preclude study compliance
  • No other uncontrolled illness
  • No gastrointestinal (GI) tract disease that would preclude ability to take oral medication
  • No malabsorption syndrome
  • No requirement for IV alimentation
  • No uncontrolled inflammatory GI disease (e.g., Crohn's disease or ulcerative colitis)

PRIOR CONCURRENT THERAPY:

  • No prior chemotherapy, immunotherapy, radiotherapy, or hormonal therapy for breast cancer
  • No prior treatment with epidermal growth factor receptor targeting therapies
  • No prior surgical procedures affecting absorption
  • No prior surgery for breast cancer
  • At least 14 days since prior and no concurrent CYP3A4 inducers, including any of the following:
  • Dexamethasone or dexamethasone equivalent dose ≥ 1.5 mg/day, including any of the following:
  • Cortisone (≥ 50 mg/day)
  • Hydrocortisone (≥ 40 mg/day)
  • Prednisone (≥ 10 mg/day)
  • Methylprednisolone (≥ 8 mg/day)
  • Phenytoin
  • Carbamazepine
  • Phenobarbital
  • Efavirenz
  • Nevirapine
  • Rifampin
  • Rifabutin
  • Rifapentine
  • Hypericum perforatum (St. John's wort)
  • Modafinil
  • At least 7 days since prior and no concurrent CYP3A4 inhibitors, including any of the following:
  • Clarithromycin
  • Erythromycin
  • Troleandomycin
  • Delavirdine
  • Ritonavir
  • Indinavir
  • Saquinavir
  • Nelfinavir
  • Amprenavir
  • Lopinavir
  • Itraconazole
  • Ketoconazole
  • Voriconazole
  • Fluconazole (doses up to 150 mg/day are permitted)
  • Nefazodone
  • Fluvoxamine
  • Verapamil
  • Diltiazem
  • Cimetidine
  • Aprepitant
  • Grapefruit or its juice
  • At least 6 months since prior and no concurrent amiodarone
  • At least 2 days since prior and no concurrent gastric pH modifiers*, including any of the following:
  • Cimetidine
  • Ranitidine
  • Nizatidine
  • Famotidine
  • Omeprazole
  • Esomeprazole
  • Rabeprazole
  • Pantoprazole
  • Lansoprazole
  • NOTE: *Antacids are allowed within 1 hour before and after administration of study drug
  • No other concurrent investigational agents
  • No other concurrent anticancer therapy, including chemotherapy, radiotherapy, immunotherapy, or antitumor hormonal therapy
  • No concurrent herbal (alternative) medicines
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • Concurrent bisphosphonates allowed

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United States5 sites
  • Northwestern University, Northwestern Medical Faculty Foundation

    Chicago, Illinois, 60611-3013

  • Hematology-Oncology Associates of Illinois

    Chicago, Illinois, 60611

  • Midwest Center for Hematology/Oncology

    Joliet, Illinois, 60432

  • Joe Arrington Cancer Research and Treatment Center

    Lubbock, Texas, 79410-1894

  • Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia Fields

    Olympia Fields, Illinois, 60461

Other trials in United States

About this study

Official title: Pilot Neoadjuvant Trial in Breast Cancer With Combination of ABI-007 (Abraxane) and GW572016 (Lapatinib)

RATIONALE: Drugs used in chemotherapy, such as Abraxane, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Lapatinib may stop the growth of tumor cells by blocking some of the enzymes needed for their growth. Giving Abraxane together with lapatinib may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving Abraxane together with lapatinib works in treating patients with stage I, stage II, or stage III breast cancer.

Read the detailed description

OBJECTIVES:

Primary

  • Determine the clinical response rate, as measured by clinical exam and imaging studies, in patients with stage I-III breast cancer treated with neoadjuvant Abraxane in combination with lapatinib.

Secondary

  • Determine the pathologic complete response rate in patients treated with this regimen.
  • Correlate proliferation (Ki67), apoptosis (cleaved caspase-3), and angiogenesis (vW, CD34) markers, measured before and after treatment, with tumor response in these patients.
  • Conduct other correlative studies, including epidermal growth factor receptor (EGFR), HER2/neu, matrix metalloproteinases (MMPs), and transforming growth factor (TGF-β), before and after treatment with this regimen to assess tumor response in these patients.
  • Determine the toxicity of this regimen in these patients.

OUTLINE: This is a pilot study. Patients are assigned to 1 of 2 treatment groups.

  • Group 1: The first 10 patients receive Abraxane IV over 30 minutes on day 1 and oral lapatinib once daily on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
  • Group 2: The next 20 patients receive Abraxane and lapatinib (at a higher dose) as in group 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo blood collection and tumor biopsies periodically for correlative biomarker studies.

PROJECTED ACCRUAL: A total of 30 patients will be accrued to this study.

Conditions
Breast Cancer
Being tested
lapatinib ditosylate, paclitaxel albumin-stabilized nanoparticle formulation
Keywords
stage I breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • lapatinib ditosylateDrug

    Also called Tykerb, Tyverb

    Oral lapatinib is taken once daily on days 1-21 of each treatment cycle. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.

  • paclitaxel albumin-stabilized nanoparticle formulationDrug

    Also called Abraxane, ABI-007

    30 patients receive Abraxane IV over 30 minutes on day 1 each of each treatment cycle. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.

Study groups in NCT00331630
Study groupRoleWhat they receive
Treatment armExperimental30 patients receive Abraxane IV over 30 minutes on day 1 and oral lapatinib once daily on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Receives: Drug: lapatinib ditosylate; Drug: paclitaxel albumin-stabilized nanoparticle formulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical Response Rate (cRR)

    cRR measured by RECIST for target lesions assessed by clinical exam+ mammogram+ ultrasound (US). cRR is defined as number of patients who's best response in any of the assessments (clinical exam/mammogram/US) is CR+PR. Response will be defined as one of the following in either clinical exam, mammogram or US: Complete Response (CR)-Disappearance of all target lesions. Partial Response (PR)>=30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum.

    Stable Disease-neither sufficient shrinkage to qualify for Partial disease nor sufficient increase to qualify for progressive disease, taking as reference the smallest sum LD while on study.

    Progressive Disease <=20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.

    Measured: At Baseline, then before each treatment cycle begins and after 4 cycles of study treatment (1 cycle = 21 days)

Secondary outcomes (6)
  1. Pathologic Complete Response (pCR)

    Pathologic Complete Response (pCR) will be assessed by breast biopsy at baseline and after 4 cycles of study treatment (1 cycle = 21 days) and at surgery. This will be defined as the number of patients that show a pCR after surgery. pCR is defined as the absence of histologic evidence of invasive tumor cells in the surgical breast specimen and axillary lymph nodes.

    Measured: At baseline, then after 4 cycles of study treatment (1 cycle = 21 days ) and at surgery

  2. Proliferation (Ki67) Measured at Baseline and After Completion of Study Treatment

    Correlation of proliferation (Ki67) will be assessed by breast biopsy at baseline and after 4 cycles of study treatment (1 cycle = 21 days). Ki67 scoring was performed based on degree of staining (0= no staining, 1=weak nuclear staining, 2=moderate nuclear staining, 3=strong nuclear staining). Ki67 scores were counted on a maximum of 10 randomly selected x40 high-power fields with an eyepiece grid of 10x10 squares containing representative sections of tumor and calculated as percentage of positively stained cells to total tumor cells (Percent Score method) Ki67 labeling Index (LI) as assessed by counting a maximum of 1,000 malignant cells at x400 magnification.

    Measured: At baseline, then after 4 cycles of study treatment (1 cycle = 21 days )

  3. Apoptosis (Cleaved Caspase-3) Measured at Baseline and After Completion of Study Treatment

    Apoptosis/cleaved caspase-3 (CC3) will be assessed by breast biopsy at baseline and after 4 cycles of study treatment (1 cycle = 21 days). Scoring was based on the degree of staining (0=more than 90% of tumor cells with no staining, 1= more than 90% of tumor cells have weak staining, 2= more than 90% of tumor cells have moderate staining, 3= more than 90% of tumor cells have strong staining). CC3 scores were counted on a maximum of 10 randomly selected x40 high-power fields with an eyepiece grid of 10x10 squares containing representative sections of tumor and calculated as percentage of positively stained cells to total tumor cells (Percent Score method) CC3 labeling Index (LI) as assessed by counting a maximum of 1,000 malignant cells at x400 magnification.

    Measured: At baseline, then after 4 cycles of study treatment (1 cycle = 21 days )

  4. Angiogenesis (vW, CD34) Markers as Measured at Baseline and After Completion of Study Treatment

    Angiogenesis (vW, CD34) markers will be assessed by breast biopsy at baseline and after 4 cycles of study treatment (1 cycle = 21 days). Expressions were analyzed by light microscopy in invasive breast cancer regions.

    Tumor cells were assigned a score:

    0 = no staining

    1. weak staining less than 1% of tumor cells
    2. = medium staining in 1-10% of tumor cells/weak staining in less than 1% of tumor cells
    3. = medium or strong staining in more than 10% of the tumor cells. Capillary density was assessed in breast sections stained for CD34 at a x200 magnification by counting the number of capillaries per field with five fields per slide and results expressed as the average number of capillaries per field.

    Measured: At baseline, then after 4 cycles of study treatment (1 cycle = 21 days )

  5. Epidermal Growth Factor Receptor (EGFR), and Matrix Metalloproteinases (MMPs), Measured at Baseline and After Completion of Study Treatment

    Epidermal growth factor receptor (EGFR), HER2/neu, matrix metalloproteinases (MMPs), and transforming growth factor (TGF-β) will be assessed by breast biopsy at baseline and after 4 cycles of study treatment (1 cycle = 21 days) with expressions analyzed by light microscopy in invasive breast cancer regions.

    MMP2 cytoplasmic staining intensity was assigned a score:

    0=no reactivity,

    1. =1-10% of tumor cells reactive,
    2. =11-25% of tumor cells reactive,
    3. = 26-50% of cells reactive,
    4. = more than 50% of cells reactive

    Greater than or equal to 2+ score was considered positive for expression.

    EGFR membrane staining was assigned a score:

    0 = no staining or faint staining in less than 10% of cells

    1. = faint incomplete membrane staining in more than 10% of cells
    2. = weak to moderate complete membrane staining of more than 10% of cells
    3. = strong complete membrane staining in more than 10% of tumor cells

    Measured: At baseline, then after 4 cycles of study treatment (1 cycle = 21 days )

  6. Side Effects From the Combination of Abraxane and Lapatinib

    Side effects from the combination of Abraxane and Lapatinib will be assessed using CTCAE 3.0. Side effects that were related to study treatment and grade 3 or higher were collected where:

    Grade 1= Mild Grade 2 = Moderate Grade 3 = Severe Grade 4 = Life-threatening Grade 5 = Death

    Measured: At baseline, then before the start of each study treatment cycle (1 cycle = 21 days) begins

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 May 2006 (estimated)
  2. Study start4 May 2006
  3. Primary completion10 Nov 2006
  4. Study completion5 Aug 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Early Phase 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00331630
Sponsor's protocol ID
NU 05B2
Other IDs
NU 05B2, STU00007257
Status last verified
Jan 2020
First submitted
30 May 2006
Last updated
6 Mar 2020
Data monitoring committee
Yes

Publications

  • Kaklamani VG, Siziopikou K, Scholtens D, Lacouture M, Gordon J, Uthe R, Meservey C, Hansen N, Khan SA, Jeruss JS, Bethke K, Cianfrocca M, Rosen S, Von Roenn J, Wayne J, Parimi V, Jovanovic B, Gradishar W. Pilot neoadjuvant trial in HER2 positive breast cancer with combination of nab-paclitaxel and lapatinib. Breast Cancer Res Treat. 2012 Apr;132(3):833-42. doi: 10.1007/s10549-011-1411-8. Epub 2011 Feb 27.

    PubMed 21359953

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing lapatinib ditosylate and paclitaxel albumin-stabilized nanoparticle formulation in people with Breast Cancer, run by Northwestern University at 5 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 6 Mar 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical Response Rate (cRR) (time frame: At Baseline, then before each treatment cycle begins and after 4 cycles of study treatment (1 cycle = 21 days)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00331630, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Mar 2020.

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