Metastatic Breast CancerPhase 2NCT02238509
Safety and QoL of Trastuzumab With Lapatinib or Chemiotherapy in MBC and HER2+ Patients Refractory to Anti HER2 Therapies
A Phase 2 study testing Lapatinib and Trastuzumab in people with Metastatic Breast Cancer, run by Consorzio Oncotech at 36 sites in Italy.
Trial summary
Recent clinical studies have shown that the combination of lapatinib and trastuzumab has superior antitumor activity compared to either single drug in both neoadjuvant and metastatic setting and is well tolerated. Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Metastatic Breast Cancer
- What is being tested?
- Lapatinib and Trastuzumab
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 154 participants
- Where
- 36 sitesItaly
- Study dates
- Nov 2014to Oct 2017
- Phase
- Phase 2
- Are there results?
- None posted in the registry
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
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Histological or cytological confirmed and documented adenocarcinoma of the breast with metastatic disease
- The original tumour specimen must be HER2 IHC 3+ positive or, in case of IHC 2+
- Age ≥18
- Life expectancy of >12 weeks
- ECOG PS 0-1
- Measurable disease as defined by RECIST1.1 criteria
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- All patients must have received prior anthracycline-and taxane-based regimens as well as trastuzumab based regimens in either the adjuvant or the metastatic setting. Patients must have been already treated with at least one line of the anti HER2 inhibitor therapy lapatinib for their metastatic breast cancer. A maximum of three previous lines of anti-HER-2 therapies in the metastatic setting are allowed.
- Adequate haematological function as defined by: ANC 1.5 x 109/L, platelet count 100 x 109/L, haemoglobin 10 g/dL.
- Adequate renal function, as defined by: creatinine 1.5 x UNL
- Adequate hepatobiliary function, as defined by the following baseline liver function tests: total serum bilirubin 1.5 upper normal limit (UNL); alanine amino transferase (ALT), aspartate amino transferase (AST) 2.5xUNL; alkaline phosphatase (AP) 2.5xUNL; if total alkaline phosphatase (AP) > 2.5xUNL, alkaline phosphatase liver fraction must be 2.5xUNL
- Adequate contraception for all fertile patients
- Negative pregnancy test.
- Postmenopausal women fulfilling any of the NCCN criteria may be included.
- Left ventricular ejection fraction (LVEF) ≥50% during a baseline period of 28 days, as determined by either echocardiography (ECHO) or multi gated acquisition (MUGA) scan.
- Signed, written informed consent
Who cannot join
- History of persistent Grade ≥ 2 hematologic toxicity resulting from previous systemic therapy
- Current peripheral neuropathy of NCI-CTCAE, Version 3.0, Grade ≥ 3 at randomization
- History of other malignancy within the last 5 years, except for carcinoma in situ of the cervix or basal cell carcinoma
- Bone-only disease, unless a measurable lesion is evident as determined by RECIST v1.1
- Bone scan, PET scan or plain films are not considered adequate imaging techniques to measure bone lesions. ve
- Blastic bone lesions are non-measurable.
Show all 18Show fewer
- Uncontrolled hypertension (systolic >150 mm Hg and/or diastolic >100 mm Hg) or clinically significant (i.e. active) cardiovascular disease.
- Current dyspnoea at rest due to complications of advanced malignancy, or other diseases that require continuous oxygen therapy.
- Inadequate organ function, evidenced by the following laboratory results within 28 days prior to randomization.
- Current severe, uncontrolled systemic disease
- Major surgical procedure or significant traumatic injury within 28 days prior to study treatment start or anticipation of the need for major surgery during the course of study treatment
- History of receiving any investigational treatment within 28 days of randomization
- Current known infection with HIV, HBV, or HCV
- Receipt of IV antibiotics for infection within 14 days of randomization
- Known hypersensitivity to any of the study drugs
- Assessed by the investigator to be unable or unwilling to comply with the requirements of the protocol
- Lack of physical integrity of the upper gastrointestinal tract, clinically significant malabsorption syndrome, or inability to take oral medications
- Concurrent interventional or non-interventional studies
Trial locations and contacts
36 sites in 1 country.
Clinical Research Technology contact
36 sites in 1 country
Italy36 sites, 36 recruiting
- Not yet recruiting
A.O.U. Ospedali Riuniti Umberto I
Ancona, 60020
Stefano Cascinu, MD
Stefano Cascinu, MD
- Recruiting
Centro di Riferimento Oncologico
Aviano, 33081
Simon Spazzapan, MD
Simon Spazzapan, Md
- Not yet recruiting
Policlinico S. Orsola Malpighi
Bologna, MD
Claudio Zamagni, MD
Claudio Zamagni, MD
- Not yet recruiting
Ospedale Centrale di Bolzano
Bolzano, 39100
Elisabetta Cretella, MD
Elisabetta Cretella, MD
- Recruiting
Presidio Ospedaliero 'Antonio Perrino
Brindisi, 72100
Saverio Cinieri, MD
Saverio Cinieri, MD
- Recruiting
A.O.R.N.A.S. Garibaldi Nesima di Catania
Catania, 95122
Roberto Bordonaro, MD
Roberto Bordonaro, MD
- Not yet recruiting
Humanitas Centro Catanese di Oncologia
Catania, 95126
Michele Caruso, MD
Michele Caruso, MD
- Not yet recruiting
Azienda Ospedaliera S. Anna
Como, 22100
Monica Giordano, MD
Monica Giordano, MD
- Not yet recruiting
Ospedale 'F. Spaziani'
Frosinone, 03100
Teresa Gamucci, MD
Teresa Gamucci, MD
- Not yet recruiting
I.R.C.C.S. A.O.U. San Martino
Genova, 16132
Lucia Del Mastro, MD
Lucia Del Mastro, MD
- Not yet recruiting
Ospedale Civile di Guastalla
Guastalla, 42016
Laura Scaltriti, Md
Laura Scaltriti, Md
- Recruiting
Ospedale Vito Fazzi
Lecce, 73100
Mariangela Ciccarese, MD
Mariangela Ciccarese, MD
- Not yet recruiting
Ospedale di Lugo - AUSL della Romagna
Lugo, 48022
Michele Gianni Turolla, MD
Michele Gianni Turolla, Md
- Not yet recruiting
Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori
Meldola, 47014
Dino Amadori, MD
Dino Amadori, MD
- Not yet recruiting
Ospedale Niguarda Ca' Granda
Milan, 20162
Salvatore Siena, Md
Salvatore Siena, Md
- Recruiting
A.O. San Gerardo
Monza, 20900
Marina Elena Cazzaniga, MD, 039-233.3683, ricercaindipendente.monza@gmail.com
Marina Elena Cazzaniga, MD
- Recruiting
Istituto Nazionale Tumori - IRCCS "Fondazione G.Pascale"
Naples, 8011
Michele De Laurentiis, MD
Michele De Laurentiis, MD
- Recruiting
AORN "A. Cardarelli"
Naples, 80131
Nando Riccardi, MD, 08174721740, nando.riccardi@alice.it
- Not yet recruiting
Policlinico SUN
Naples, 80131
Michele Orditura, MD
Michele Orditura, MD
- Recruiting
Università degli Studi di Napoli "Federico II"
Naples, 80131
Grazia Arpino, MD
Grazia Arpino, MD
- Recruiting
A.R.N.A.S. Ospedale Civico e Benfratelli
Palermo, 90127
Vita Leonardi, MD
Vita Leonardi, MD
- Recruiting
Ospedale S. Maria della Misericordia
Perugia, 06156
Anna Maria Mosconi, MD
Anna Maria Mosconi, MD
- Not yet recruiting
Azienda Ospedaliera Santa Maria degli Angeli
Pordenone, 33170
Silvana Saracchini, MD
Silvana Saracchini, MD
- Not yet recruiting
Ospedale di Ravenna
Ravenna, 48100
Claudio Dazzi, MD
Dazzi Claudio, MD
- Not yet recruiting
Arcispedale S. Maria Nuova Azienda Ospedaliera di Reggio Emilia
Reggio Emilia, 42123
Corrado Boni, MD
Corrado Boni, MD
- Not yet recruiting
Ospedale Infermi di Rimini
Rimini, 47923
Lorenzo Gianni, MD
Lorenzo Gianni, MD
- Recruiting
Policlinico Universitario Campus Biomedico
Roma, 00128
Giuseppe Tonini, Md
Giuseppe Tonini, MD
- Recruiting
Istituto Regina Elena per lo studio e la cura dei tumori
Roma, 00144
Francesco Cognetti, Md
Cognetti Francesco, MD
- Not yet recruiting
Ospedale G. Da Procida
Salerno, 84126
Maria Luisa Barzelloni, MD
Maria Luisa Barzelloni, MD
- Recruiting
Ospedale Civile di Sassari SS Annunaziata
Sassari, 07100
Nina Olmeo, MD
Nina Olmeo, MD
- Recruiting
Ospedale 'SS. Trinità'
Sora, 03039
Teresa Gamucci, MD
Teresa Gamucci, MD
- Recruiting
Azienda Ospedaliera S.Maria di Terni
Terni, 05100
Fauso Roila, Md
Fausto Roila, MD
- Not yet recruiting
A.O.U. San Giovanni Battista di Torino
Torino, 10126
Mario Airoldi, MD
Mario Airoldi, MD
- Recruiting
A.O.U. Santa Maria della Misericordia di Udine
Udine, 33100
fabio Puglisi, MD
Fabio Puglisi, MD
- Not yet recruiting
A.O. Ospedale di Circolo e Fondazione Macchi
Varese, 21100
Giovanni Giardina, MD
Giovanni Giardina, MD
- Not yet recruiting
Ospedale Sacro Cuore Don Calabria
Verona, 37024
Stefania Gori, MD
Stefania Gori, MD
About this study
Official title: A Randomised, Multicentre, Open-label Phase II Trial Investigating Activity of Chemotherapy and Lapatinib and Trastuzumab in Patients With HER2-positive Metastatic Breast Cancer (MBC) Refractory to Anti HER2 Therapies
Recent clinical studies have shown that the combination of lapatinib and trastuzumab has superior antitumor activity compared to either single drug in both neoadjuvant and metastatic setting and is well tolerated. According to this evidence, the combination of lapatinib and trastuzumab today offers a valid chemotherapy-free option, primarily for patients with pre-treated HER2-positive MBC
Read the detailed description
The present study is designed to determine the efficacy and safety profile of the combination of lapatinib and trastuzumab (plus endocrinetherapy in ER-positive breast cancer) versus trastuzumab and chemotherapy in heavily pretreated patient population with HER2-positive MBC and to investigate the predictive role of cfDNA for detection of HER2 gene amplification on patients' outcome. The presence of circulating free DNA (cfDNA) for detection of HER2 gene amplification was associated with worse prognosis and seems to allow early response evaluation. However, many aspects of the role of cfDNA detection in patients undergoing molecular target agents such as trastuzumab or lapatinib are not well described. With the availability of improved and standardized techniques for cfDNA detection, it should now be possible to examine several of these important questions within a prospective multicenter study and a striking potential of cfDNA for detection of HER2 gene amplification might enable a more individual and optimized antimetastatic therapy inpatients with cancer.
- Conditions
- Metastatic Breast Cancer
- Being tested
- Lapatinib, Trastuzumab
- Keywords
- Breast cancer, HER2 Positive, HER2+, MBC, Metastatic, Metastatic breast cancer, Chemotherapy, Lapatinib, Trastuzumab, anti HER2 therapies
- Medical subject headings
- Breast Neoplasms, Neoplasm Metastasis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
LapatinibDrug
Also called Tyverb
ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).
TrastuzumabDrug
Also called Herceptin
ARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose).
| Study group | Role | What they receive |
|---|---|---|
| lapatinib and trastuzumab | Experimental | ARM A: Lapatinib and trastuzumab (experimental arm). Patients with hormone receptor (HR) positive breast cancer will also receive endocrine therapy at the physician's discretion (preferred choice with fulvestrant). Receives: Drug: Lapatinib; Drug: Trastuzumab |
| trastuzumab plus chemotherapy | Experimental | ARM B: Trastuzumab plus chemotherapy (control arm). Any type of chemotherapy in combination with trastuzumab will be allowed at the physician's discretion. Receives: Drug: Trastuzumab |
What is being measured
The primary outcome is the main question the study is designed to answer.
Clinical Benefit Rate
To evaluate clinical benefit rate (CBR) for patients treated with lapatinib and trastuzumab and for patients treated with trastuzumab and chemotherapy. CBR is defined as: confirmed complete response (CR) plus partial response (PR) at any time, plus stable disease (SD) for 24 weeks
Measured: Clinical Benefit Rate is defined as confirmed complete response plus partial response at any time, plus stable disease up to 24 weeks
Secondary outcomes (4)
Progression free survival
Second-line progression-free survival, defined as the time from first dosing to the first documented disease progression or death from any cause, whichever occurs first.
Measured: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Overall Survival
OS is defined as the time from first dosing in second line to death from any cause.
Measured: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Safety and tolerability
Safety of second line treatment will be evaluated by the frequency of AEs and SAEs, cardiac events, clinically significant abnormal laboratory tests, vital signs, and ECOG PS. All patients who received at least one dose of study treatment will be included in the safety analysis.
Measured: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Quality of life
QoL and symptom control will be assessed using the FACT-B questionnaire.
Measured: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Sep 2014 (estimated)
- Study startNov 2014
- Primary completionOct 2017 (estimated)
- Study completionOct 2017 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (15)Papers the sponsor has linked to this study.
- Other trials for Metastatic Breast CancerStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 154 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Consorzio Oncotech
- Sponsor type
- University, hospital or other
- Collaborators
- Clinical Research Technology S.r.l.
- Responsible party
- Sponsor
- Investigators
- Grazia Arpino, MD, Principal investigator, Dipartimento di Medicina Clinica e Chirurgia Oncologia Università degli Studi di Napoli "Federico II"
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02238509
- Sponsor's protocol ID
- GIM12-TYPHER
- Other IDs
- 2013-005044-29
- Status last verified
- Jun 2016
- First submitted
- 9 Sep 2014
- Last updated
- 15 Jun 2016
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Nahta R, Esteva FJ. Herceptin: mechanisms of action and resistance. Cancer Lett. 2006 Feb 8;232(2):123-38. doi: 10.1016/j.canlet.2005.01.041.
PubMed 16458110Nahta R, Yu D, Hung MC, Hortobagyi GN, Esteva FJ. Mechanisms of disease: understanding resistance to HER2-targeted therapy in human breast cancer. Nat Clin Pract Oncol. 2006 May;3(5):269-80. doi: 10.1038/ncponc0509.
PubMed 16683005Jagiello-Gruszfeld A, Tjulandin S, Dobrovolskaya N, Manikhas A, Pienkowski T, DeSilvio M, Ridderheim M, Abbey R. A single-arm phase II trial of first-line paclitaxel in combination with lapatinib in HER2-overexpressing metastatic breast cancer. Oncology. 2010;79(1-2):129-35. doi: 10.1159/000318043. Epub 2010 Nov 22.
PubMed 21088439Geyer CE, Forster J, Lindquist D, Chan S, Romieu CG, Pienkowski T, Jagiello-Gruszfeld A, Crown J, Chan A, Kaufman B, Skarlos D, Campone M, Davidson N, Berger M, Oliva C, Rubin SD, Stein S, Cameron D. Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med. 2006 Dec 28;355(26):2733-43. doi: 10.1056/NEJMoa064320.
PubMed 17192538Clemens M, Eidtmann H, Nitz U, Niederle N, du Bois A, Grischke EM, Hinke A, von Minckwitz G. Trastuzumab single-drug therapy after failure of cytotoxic treatment for metastatic breast cancer. Onkologie. 2010;33(8-9):425-30. doi: 10.1159/000318144. Epub 2010 Jul 27.
PubMed 20838057von Minckwitz G, Schwedler K, Schmidt M, Barinoff J, Mundhenke C, Cufer T, Maartense E, de Jongh FE, Baumann KH, Bischoff J, Harbeck N, Luck HJ, Maass N, Zielinski C, Andersson M, Stein RC, Nekljudova V, Loibl S; GBG 26/BIG 03-05 study group and participating investigators. Trastuzumab beyond progression: overall survival analysis of the GBG 26/BIG 3-05 phase III study in HER2-positive breast cancer. Eur J Cancer. 2011 Oct;47(15):2273-81. doi: 10.1016/j.ejca.2011.06.021. Epub 2011 Jul 7.
PubMed 21741829Blackwell KL, Burstein HJ, Storniolo AM, Rugo H, Sledge G, Koehler M, Ellis C, Casey M, Vukelja S, Bischoff J, Baselga J, O'Shaughnessy J. Randomized study of Lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer. J Clin Oncol. 2010 Mar 1;28(7):1124-30. doi: 10.1200/JCO.2008.21.4437. Epub 2010 Feb 1.
PubMed 20124187Wu Y, Amonkar MM, Sherrill BH, O'Shaughnessy J, Ellis C, Baselga J, Blackwell KL, Burstein HJ. Impact of lapatinib plus trastuzumab versus single-agent lapatinib on quality of life of patients with trastuzumab-refractory HER2+ metastatic breast cancer. Ann Oncol. 2011 Dec;22(12):2582-2590. doi: 10.1093/annonc/mdr014. Epub 2011 Mar 15.
PubMed 21406472Johnston S, Pippen J Jr, Pivot X, Lichinitser M, Sadeghi S, Dieras V, Gomez HL, Romieu G, Manikhas A, Kennedy MJ, Press MF, Maltzman J, Florance A, O'Rourke L, Oliva C, Stein S, Pegram M. Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer. J Clin Oncol. 2009 Nov 20;27(33):5538-46. doi: 10.1200/JCO.2009.23.3734. Epub 2009 Sep 28.
PubMed 19786658Page K, Hava N, Ward B, Brown J, Guttery DS, Ruangpratheep C, Blighe K, Sharma A, Walker RA, Coombes RC, Shaw JA. Detection of HER2 amplification in circulating free DNA in patients with breast cancer. Br J Cancer. 2011 Apr 12;104(8):1342-8. doi: 10.1038/bjc.2011.89. Epub 2011 Mar 22.
PubMed 21427727Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, Tan-Chiu E, Martino S, Paik S, Kaufman PA, Swain SM, Pisansky TM, Fehrenbacher L, Kutteh LA, Vogel VG, Visscher DW, Yothers G, Jenkins RB, Brown AM, Dakhil SR, Mamounas EP, Lingle WL, Klein PM, Ingle JN, Wolmark N. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1673-84. doi: 10.1056/NEJMoa052122.
PubMed 16236738Wang YC, Morrison G, Gillihan R, Guo J, Ward RM, Fu X, Botero MF, Healy NA, Hilsenbeck SG, Phillips GL, Chamness GC, Rimawi MF, Osborne CK, Schiff R. Different mechanisms for resistance to trastuzumab versus lapatinib in HER2-positive breast cancers--role of estrogen receptor and HER2 reactivation. Breast Cancer Res. 2011;13(6):R121. doi: 10.1186/bcr3067. Epub 2011 Nov 28.
PubMed 22123186Tan-Chiu E, Yothers G, Romond E, Geyer CE Jr, Ewer M, Keefe D, Shannon RP, Swain SM, Brown A, Fehrenbacher L, Vogel VG, Seay TE, Rastogi P, Mamounas EP, Wolmark N, Bryant J. Assessment of cardiac dysfunction in a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel, with or without trastuzumab as adjuvant therapy in node-positive, human epidermal growth factor receptor 2-overexpressing breast cancer: NSABP B-31. J Clin Oncol. 2005 Nov 1;23(31):7811-9. doi: 10.1200/JCO.2005.02.4091.
PubMed 16258083Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med. 2001 Mar 15;344(11):783-92. doi: 10.1056/NEJM200103153441101.
PubMed 11248153Rusnak DW, Lackey K, Affleck K, Wood ER, Alligood KJ, Rhodes N, Keith BR, Murray DM, Knight WB, Mullin RJ, Gilmer TM. The effects of the novel, reversible epidermal growth factor receptor/ErbB-2 tyrosine kinase inhibitor, GW2016, on the growth of human normal and tumor-derived cell lines in vitro and in vivo. Mol Cancer Ther. 2001 Dec;1(2):85-94.
PubMed 12467226
Study at a glance
From the registry record, last updated by the sponsor on 15 Jun 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomised, Multicentre, Open-label Phase II Trial Investigating Activity of Chemotherapy and Lapatinib and Trastuzumab in Patients With HER2-positive Metastatic Breast Cancer (MBC) Refractory to Anti HER2 Therapies
- ClinicalTrials.gov ID
- NCT02238509
- Acronym / sponsor ID
- GIM12-TYPHER
- Conditions
- Metastatic Breast Cancer
- Keywords
- Breast cancer, HER2 Positive, HER2+, MBC, Metastatic, Metastatic breast cancer, Chemotherapy, Lapatinib
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 154 participants (estimated)
- Lead sponsor
- Consorzio OncotechUniversity, hospital or other
- Collaborators
- Clinical Research Technology S.r.l.
- Study start
- Nov 2014
- Primary completion
- Oct 2017 (estimated)
- Study completion
- Oct 2017 (estimated)
- First posted
- 12 Sep 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Recent clinical studies have shown that the combination of lapatinib and trastuzumab has superior antitumor activity compared to either single drug in both neoadjuvant and metastatic setting and is well tolerated. According to this evidence, the combination of lapatinib and trastuzumab today offers a valid chemotherapy-free option, primarily for patients with pre-treated HER2-positive MBC
Detailed description
The present study is designed to determine the efficacy and safety profile of the combination of lapatinib and trastuzumab (plus endocrinetherapy in ER-positive breast cancer) versus trastuzumab and chemotherapy in heavily pretreated patient population with HER2-positive MBC and to investigate the predictive role of cfDNA for detection of HER2 gene amplification on patients' outcome. The presence of circulating free DNA (cfDNA) for detection of HER2 gene amplification was associated with worse prognosis and seems to allow early response evaluation. However, many aspects of the role of cfDNA detection in patients undergoing molecular target agents such as trastuzumab or lapatinib are not well described. With the availability of improved and standardized techniques for cfDNA detection, it should now be possible to examine several of these important questions within a prospective multicenter study and a striking potential of cfDNA for detection of HER2 gene amplification might enable a more individual and optimized antimetastatic therapy inpatients with cancer.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| lapatinib and trastuzumab | Experimental | Drug: Lapatinib, Drug: TrastuzumabARM A: Lapatinib and trastuzumab (experimental arm). Patients with hormone receptor (HR) positive breast cancer will also receive endocrine therapy at the physician's discretion (preferred choice with fulvestrant). |
| trastuzumab plus chemotherapy | Experimental | Drug: TrastuzumabARM B: Trastuzumab plus chemotherapy (control arm). Any type of chemotherapy in combination with trastuzumab will be allowed at the physician's discretion. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (15 listed)
- Histological or cytological confirmed and documented adenocarcinoma of the breast with metastatic disease
- The original tumour specimen must be HER2 IHC 3+ positive or, in case of IHC 2+
- Age ≥18
- Life expectancy of >12 weeks
- ECOG PS 0-1
Key exclusion criteria (18 listed)
- History of persistent Grade ≥ 2 hematologic toxicity resulting from previous systemic therapy
- Current peripheral neuropathy of NCI-CTCAE, Version 3.0, Grade ≥ 3 at randomization
- History of other malignancy within the last 5 years, except for carcinoma in situ of the cervix or basal cell carcinoma
- Bone-only disease, unless a measurable lesion is evident as determined by RECIST v1.1
- Bone scan, PET scan or plain films are not considered adequate imaging techniques to measure bone lesions. ve
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| LapatinibAlso: TyverbARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose). | Drug | lapatinib and trastuzumab |
| TrastuzumabAlso: HerceptinARM A: oral lapatinib 1,000 mg daily in combination with intravenous trastuzumab 6mg/kg q3wks (after the initial 8 mg/kg loading dose). | Drug | lapatinib and trastuzumab, trastuzumab plus chemotherapy |
Primary outcome
Clinical Benefit Rate
Time frame: Clinical Benefit Rate is defined as confirmed complete response plus partial response at any time, plus stable disease up to 24 weeks
To evaluate clinical benefit rate (CBR) for patients treated with lapatinib and trastuzumab and for patients treated with trastuzumab and chemotherapy. CBR is defined as: confirmed complete response (CR) plus partial response (PR) at any time, plus stable disease (SD) for 24 weeks
4 secondary outcomes
Progression free survival
Time frame: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Overall Survival
Time frame: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Safety and tolerability
Time frame: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Quality of life
Time frame: Patients enrolled will receive study medication until disease progression, unacceptable toxicity, withdrawal of consent or death, whichever comes first, assessed up to 36 months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jun 2016.
- Background: PubMed 16458110Nahta R, Esteva FJ. Herceptin: mechanisms of action and resistance. Cancer Lett. 2006 Feb 8;232(2):123-38. doi: 10.1016/j.canlet.2005.01.041.
- Background: PubMed 16683005Nahta R, Yu D, Hung MC, Hortobagyi GN, Esteva FJ. Mechanisms of disease: understanding resistance to HER2-targeted therapy in human breast cancer. Nat Clin Pract Oncol. 2006 May;3(5):269-80. doi: 10.1038/ncponc0509.
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- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Clinical Research Technology contact
Grazia Arpino, MD principal investigator
Dipartimento di Medicina Clinica e Chirurgia Oncologia Università degli Studi di Napoli "Federico II"
36 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Lapatinib and Trastuzumab in people with Metastatic Breast Cancer, run by Consorzio Oncotech at 36 sites in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 15 inclusion and 18 exclusion criteria. 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: status not confirmed, as of the sponsor's last update on 15 Jun 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 36 sites in Italy. 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?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Clinical Research Technology (0039089301545), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Clinical Benefit Rate (time frame: Clinical Benefit Rate is defined as confirmed complete response plus partial response at any time, plus stable disease up to 24 weeks). 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 NCT02238509, which also lists 15 linked publications.
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 15 Jun 2016.