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Phase III Randomized Study of Fulvestrant With or Without Lapatinib Tosylate and/or Aromatase Inhibitor Therapy in Postmenopausal Women With Metastatic Breast Cancer That Progressed After Prior Aromatase Inhibitor Therapy
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Trial Contact Information Registry Information
Alternate Title
Fulvestrant With or Without Lapatinib and/or Aromatase Inhibitor therapy in Treating Postmenopausal Women With Metastatic Breast Cancer That Progressed After Previous Aromatase Inhibitor Therapy
Basic Trial Information
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Status
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Age
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Sponsor
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Protocol IDs
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Phase III
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Treatment
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Active
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18 and over
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Other, Pharmaceutical / Industry
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GIM-GIM8-OVER GIM8-OVER, EUDRACT-2007-006031-30, EU-20853, GSK-GIM-GIM8-OVER, ZENECA-GIM-GIM8-OVER, OVER, NCT00688194
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Objectives Primary - To compare the progression-free survival of postmenopausal women with progressive metastatic breast cancer treated with fulvestrant with or without lapatinib tosylate and/or aromatase inhibitor therapy.
Secondary - To compare time to progression in these patients.
- To compare overall survival of these patients.
- To compare response rates in these patients.
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To compare clinical benefit rates in these patients.
Entry Criteria Disease Characteristics:
- Histologically or cytologically confirmed breast cancer
- Confirmed disease progression after treatment with an aromatase inhibitor (AI) administered in the adjuvant or metastatic setting
- Must have demonstrated a prior response to AI therapy (i.e., responded after > 2 years of treatment in the adjuvant setting OR complete or partial response or stable disease after ≥ 24 weeks of treatment in the metastatic setting) AND have subsequent disease progression after completion of AI therapy
- Meets 1 of the following criteria:
- Measurable disease, defined as ≥ 1 lesion that can be accurately measured in ≥ 1 dimension (longest diameter to be recorded) as ≥ 20 mm
with conventional techniques or ≥ 10 mm with spiral CT scan
- Evaluable disease, defined as bone lesions, lytic or mixed (lytic and sclerotic), evaluable by plain x-ray, CT scan, or MRI
- Lesions identified only by radionucleotide bone scan are not allowed
- No HER2/neu-overexpressing tumor (IHC 3+ or FISH+)
- Hormone receptor status:
- Estrogen receptor- and/or progesterone receptor-positive primary or metastatic tumor
Prior/Concurrent Therapy:
- See Disease Characteristics
- Prior radiotherapy for the primary or metastatic tumor allowed
- More than 4 months since prior LHRH analogues
- More than 30 days (or 5 half-lives, whichever is
longer) since prior investigational agents
- More than 14 days since prior and no concurrent CYP3A4 inducers*, including any of the following:
- Rifampin, rifapentine, rifabutin, or other rifamycin class agents
- Phenytoin, carbamazepine, or barbiturates (e.g., phenobarbital)
- Efavirenz or nevirapine
- Oral glucocorticoids (e.g., cortisone [> 50 mg], hydrocortisone [> 40 mg], prednisone [> 10 mg], methylprednisolone [> 8 mg], or dexamethasone [> 1.5 mg])
- Modafinil
- More than 14 days since prior and no concurrent herbal or dietary supplements*, including any of the following:
- St. John's wort
- Ginkgo biloba
- Kava
- Grape seed
- Valerian
- Ginseng
- Echinacea
- Evening primrose oil
- More than 7 days since prior and no concurrent CYP3A4 inhibitors*, including any of the following:
- Clarithromycin, erythromycin, or troleandomycin
- Itraconazole, ketoconazole, fluconazole (> 150
mg daily), or voriconazole
- Delaviridine, nelfinavir, amprenavir, ritonavir,
indinavir, saquinavir, or lopinavir
- Verapamil or diltiazem
- Nefazodone or fluvoxamine
- Cimetidine or aprepitant
- Grapefruit or grapefruit juice
- More than 6 months since prior and no concurrent amiodarone*
- No prior fulvestrant and/or lapatinib tosylate
- No prior resection of the stomach or small bowel
- No other concurrent anticancer therapy, including chemotherapy, immunotherapy,
and biologic therapy
- Concurrent bisphosphonates allowed
- No other concurrent investigational therapy
- No concurrent participation in
another clinical trial
[Note: *For patients randomized to receive lapatinib] Patient Characteristics:
- Female
- Postmenopausal, as defined by any of the following criteria:
- At least 60 years of age
- 45 to 59 years of age and meets ≥ 1 of the following
criteria:
- Amenorrhea for ≥ 12 months and intact uterus
- Amenorrhea for < 12 months and follicle-stimulating hormone within the
postmenopausal range (including patients with hysterectomy, prior hormone replacement therapy, or chemotherapy-induced
amenorrhea)
- Patients who received prior luteinizing hormone-releasing hormone (LHRH)
analogues must not have restarted their menses after cessation of therapy
- Over 18 years of age and bilateral oophorectomy
- WHO performance status 0-2
- Life expectancy ≥ 8 months
- Leukocytes ≥ 3,000/μL
- Absolute neutrophil count ≥ 1,500/μL
- Platelet count ≥ 100,000/μL
- Total bilirubin normal
- AST/ALT ≤ 2.5 times upper limit of normal
- Creatinine normal
OR
creatinine clearance ≥ 60 mL/min
- LVEF normal as
measured by ECHO or MUGA
- Able to swallow and retain oral medication
- No ulcerative colitis
- No malabsorption syndrome or disease significantly affecting gastrointestinal
function
- No known history of uncontrolled or symptomatic angina, arrhythmias, or
congestive heart failure
- No known immediate or delayed hypersensitivity reaction or idiosyncrasy
to drugs chemically related to fulvestrant, aromatase inhibitors, lapatinib tosylate, or
excipients
- No unresolved or unstable serious toxicity from prior therapy
- No active or uncontrolled infection
- No dementia, altered mental status, or any psychiatric condition that would
prohibit the understanding or rendering of informed consent
- No other malignancy within the past 5 years except for adequately treated cervical carcinoma in situ,
melanoma in situ, or basal cell or squamous cell carcinoma of the skin
- No other concurrent disease or condition that would make the patient
inappropriate for study participation
- No serious medical disorder that
would interfere with patient safety
Expected Enrollment 396Outcomes Primary Outcome(s)Progression-free survival
Secondary Outcome(s)Time to progression Overall survival Response rate Clinical benefit rate
Outline This is a multicenter study. Patients are stratified according to timing of progressive disease (during adjuvant therapy vs > 12 months after completion of adjuvant therapy vs during treatment for metastatic disease). Patients are randomized to 1 of 4 treatment arms. - Arm I: Patients receive fulvestrant intramuscularly (IM) on days 0, 14, and 28 of course 1 and on day 1 of all subsequent courses. Patients also receive oral placebo once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
- Arm II: Patients receive fulvestrant and placebo as in arm I. Patients also receive aromatase inhibitor (AI) therapy (e.g., exemestane, anastrozole, or letrozole) according to standard treatment regulations.
- Arm III: Patients receive fulvestrant as in arm I and oral lapatinib tosylate once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
- Arm IV: Patients receive fulvestrant as in arm I and lapatinib as in arm III. Patients also receive AI therapy according to standard treatment regulations.
Trial Contact Information
Trial Lead Organizations Gruppo Italiano Mammella | | | Sabino De Placido, MD, Principal investigator | | | | Trial Sites
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Italy |
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Naples |
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| | | Federico II University Medical School |
| | Contact Person | |
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Registry Information | | Official Title | | Overcoming Endocrine Resistance in Metastatic Breast Cancer: A Randomized Trial with factorial Design comparing Fulvestrant ± Lapatinib ± Aromatase Inhibitor in metastatic breast cancer progressing after Aromatase Inhibitor therapy | | Trial Start Date | | 2008-05-05 | | Trial Completion Date | | 2013-05-05 (estimated) | | Registered in ClinicalTrials.gov | | NCT00688194 | | Date Submitted to PDQ | | 2008-05-16 | | Information Last Verified | | 2008-05-29 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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