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Gefitinib, Trastuzumab, and Docetaxel in Treating Patients With Metastatic Breast Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), November 2008
Sponsors and Collaborators: Beckman Research Institute
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00086957
  Purpose

RATIONALE: Gefitinib may stop the growth of tumor cells by blocking the enzymes necessary for their growth. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining gefitinib and trastuzumab with docetaxel may kill more tumor cells.

PURPOSE: This phase I/II trial is studying the best dose of docetaxel when given together with gefitinib and trastuzumab in treating patients with metastatic breast cancer.


Condition Intervention Phase
Breast Cancer
Drug: docetaxel
Drug: gefitinib
Drug: trastuzumab
Phase I
Phase II

Genetics Home Reference related topics: breast cancer
MedlinePlus related topics: Breast Cancer Cancer
Drug Information available for: Docetaxel ZD1839 Trastuzumab
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment
Official Title: Phase I/II Trial of ZD1839 (Iressa®), Trastuzumab (Herceptin®), and Docetaxel (Taxotere®) in Patients With erbB-2 (HER-2) Overexpressing, Stage IV Breast Carcinoma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Time to progression at 6 months and 1 year [ Designated as safety issue: No ]
  • Feasibility at 6 months and 1 year [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Response rate by RECIST at 1 and 2 years [ Designated as safety issue: No ]
  • Overall survival at 1 and 2 years [ Designated as safety issue: No ]
  • Changes in molecular markers at 1 and 2 years [ Designated as safety issue: No ]

Estimated Enrollment: 76
Study Start Date: January 2004
Estimated Primary Completion Date: December 2008 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the safety and efficacy of gefitinib, trastuzumab (Herceptin®), and docetaxel, in terms of time to disease progression, in patients with HER2/neu-overexpressing metastatic adenocarcinoma of the breast.

Secondary

  • Determine the objective tumor response rate in patients treated with this regimen.
  • Correlate expression and/or degree of phosphorylation of epidermal growth factor receptor, HER2/neu, c-fos, Akt, ERK½, P13K, p53, p21, and p27 with outcome in patients treated with this regimen.

OUTLINE: This is a phase I, multicenter, dose-escalation study of docetaxel followed by a phase II study. Patients are stratified according to trastuzumab (Herceptin®)-naive vs trastuzumab-failure.

  • Phase I: Patients receive oral gefitinib once daily on days 2-14. Patients also receive trastuzumab* IV over 30-90 minutes and docetaxel IV over 1 hour on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

NOTE: *Trastuzumab is given at a higher dose (loading dose) in course 1 and then at a lower dose in subsequent courses.

Cohorts of 3-6 patients receive docetaxel at dose level 1. If no dose-limiting toxicity (DLT) is observed in the first cohort of 3 patients, the dose of docetaxel remains the same. If 1 DLT is observed in the first cohort of 3 patients, 3 additional patients are added (for a total of 6 patients) to dose level 1. If no further DLTs are observed at dose level 1, the dose of docetaxel remains the same. If 2 of 3 or 2 of 6 patients experience DLT at dose level 1, the dose of docetaxel is considered above the maximum tolerated dose (MTD) and is subsequently reduced. If 2 of 3 or 2 of 6 patients experience DLT at the reduced dose of docetaxel, the study is stopped.

  • Phase II: Patients receive docetaxel at the MTD and gefitinib and trastuzumab as in phase I.

Patients are followed for survival.

PROJECTED ACCRUAL: A total of 3-76 patients will be accrued for this study within 26 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed adenocarcinoma of the breast

    • Metastatic disease
  • HER-2/neu overexpression (3+ by immunohistochemistry OR 2+ by fluorescence in situ hybridization)
  • Measurable or evaluable disease
  • Hormone receptor status:

    • Not specified

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Sex

  • Male or female

Menopausal status

  • Not specified

Performance status

  • ECOG 0-2

Life expectancy

  • Not specified

Hematopoietic

  • Absolute granulocyte count ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3

Hepatic

  • AST and ALT < 2.5 times upper limit of normal (ULN) (5.0 times ULN in the presence of liver metastases)
  • Bilirubin < 1.5 times ULN
  • No unstable or uncompensated hepatic disease

Renal

  • Creatinine < 1.6 mg/dL
  • No unstable or uncompensated renal disease

Cardiovascular

  • LVEF > 45% by echocardiogram or MUGA
  • No prior New York Heart Association class I-IV heart disease
  • No prolonged PR interval or atrioventricular block on ECG
  • No unstable or uncompensated cardiac disease

Pulmonary

  • No unstable or uncompensated respiratory disease
  • No clinically active interstitial lung disease

    • Patients who are asymptomatic and have chronic stable radiographic changes are allowed

Immunologic

  • No autoimmune disorders
  • No conditions of immunosuppression
  • No severe hypersensitivity to taxane or gefitinib or any of its excipients

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No other prior or concurrent malignancy within the past 5 years except basal cell carcinoma or carcinoma in situ of the cervix
  • No other severe or uncontrolled systemic disease
  • No other acute or chronic medical condition that would preclude study participation
  • No other significant clinical disorder or laboratory finding that would preclude study participation
  • No psychiatric illness that would preclude study compliance

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • Prior adjuvant trastuzumab (Herceptin®) allowed if > 6 months elapsed before disease recurrence
  • No prior trastuzumab for metastatic breast cancer
  • No prior monoclonal antibodies directed at the epidermal growth factor receptor (EGFR)

Chemotherapy

  • Prior adjuvant chemotherapy (or as first-line therapy for metastatic breast cancer) allowed
  • Prior adjuvant taxane allowed if completed > 6 months before diagnosis of metastatic breast cancer
  • No prior docetaxel for metastatic breast cancer

Endocrine therapy

  • Prior adjuvant hormonal therapy (or as first-line therapy for metastatic breast cancer) allowed
  • No concurrent hormonal therapy

    • Concurrent steroids allowed provided dose is stable

Radiotherapy

  • Not specified

Surgery

  • Fully recovered from prior oncologic or other major surgery
  • No concurrent surgery within 7 days of gefitinib administration

Other

  • Recovered from prior anticancer therapy (alopecia allowed)
  • More than 30 days since prior nonapproved drug or investigational agent
  • No other prior EGFR-directed therapy (i.e., tyrosine kinase inhibitors)
  • No concurrent use of any of the following medications:

    • Phenytoin
    • Carbamazepine
    • Barbiturates
    • Rifampin
    • Hypericum perforatum (St. John's wort)
  • No other concurrent anticancer therapy
  • No concurrent cardioprotective drugs
  • No concurrent oral retinoids
  • Concurrent participation in the City of Hope indium-labeled trastuzumab imaging study allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00086957

Locations
United States, California
Breastlink Medical Group, Incorporated at Long Beach Memorial Medical Center Recruiting
Long Beach, California, United States, 90806
Contact: Clinical Trials Office - Breastlink Medical Group, Incorporate     562-981-6101        
City of Hope Comprehensive Cancer Center Recruiting
Duarte, California, United States, 91010-3000
Contact: Clinical Trials Office - City of Hope Comprehensive Cancer Cen     800-826-4673     becomingapatient@coh.org    
City of Hope Medical Group Recruiting
Pasadena, California, United States, 91105
Contact: Doni Woo, RN     626-396-2621        
USC/Norris Comprehensive Cancer Center and Hospital Recruiting
Los Angeles, California, United States, 90089-9181
Contact: Clinical Trials Office - USC/Norris Comprehensive Cancer Cente     323-865-0451        
Tower Cancer Research Foundation Recruiting
Beverly Hills, California, United States, 90211-1850
Contact: Philomena F. McAndrew, MD     310-888-8680        
Hematology Oncology Consultants - Hemet Recruiting
Hemet, California, United States, 92543
Contact: Kishore Sehgal, MD     909-766-6460        
Sponsors and Collaborators
Beckman Research Institute
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Publications of Results:
Somlo G, Koczywas M, Luu T, et al.: A phase I-II study of trastuzumab, gefitinib, and docetaxel as first line chemotherapy in patients with HER-2 overexpressing stage IV breast carcinoma. [Abstract] Breast Cancer Research and Treatment 94 (Suppl 1): A-2035, 2005.

Responsible Party: City of Hope Comprehensive Cancer Center ( George Somlo )
Study ID Numbers: CDR0000371908, CHNMC-03049, ZENECA-1839US/0274, ZENECA-IRUSIRES0012
Study First Received: July 8, 2004
Last Updated: November 7, 2008
ClinicalTrials.gov Identifier: NCT00086957  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage IV breast cancer
male breast cancer
recurrent breast cancer

Study placed in the following topic categories:
Docetaxel
Skin Diseases
Breast Neoplasms, Male
Trastuzumab
Breast Neoplasms
Gefitinib
Breast Diseases
Recurrence
Carcinoma

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Site
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Therapeutic Uses
Enzyme Inhibitors
Protein Kinase Inhibitors
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 15, 2009