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Docetaxel, Carboplatin, and Trastuzumab and/or Lapatinib in Treating Women With Stage I, Stage II, or Stage III Breast Cancer That Can Be Removed by Surgery
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), December 2008
First Received: October 8, 2008   Last Updated: March 17, 2009   History of Changes
Sponsors and Collaborators: Jonsson Comprehensive Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00769470
  Purpose

RATIONALE: Drugs used in chemotherapy, such as docetaxel and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as trastuzumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Lapatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether docetaxel and carboplatin are more effective when given together with trastuzumab and/or lapatinib in treating women with stage I, stage II, or stage III breast cancer.

PURPOSE: This randomized phase II trial is studying how well docetaxel and carboplatin work when given together with trastuzumab and/or lapatinib in treating women with stage I, stage II, or stage III breast cancer that can be removed by surgery.


Condition Intervention Phase
Breast Cancer
Biological: trastuzumab
Drug: carboplatin
Drug: docetaxel
Drug: lapatinib ditosylate
Phase II

Genetics Home Reference related topics: breast cancer
MedlinePlus related topics: Breast Cancer Cancer Surgery
Drug Information available for: Carboplatin Docetaxel Trastuzumab Lapatinib Lapatinib Ditosylate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Open Label
Official Title: A Multicenter, Open Label, Randomized Phase II Trial of Presurgical Treatment With Single-Agent Trastuzumab (H) or Lapatinib (Ty) or the Combination of Trastuzumab and Lapatinib (H+Ty), Followed by Six Cycles of Docetaxel (T) and Carboplatin (C) With Trastuzumab (TCH) or Lapatinib (TCTy) or the Combination of Trastuzumab and Lapatinib (TCHTy) in Patients With HER2/Neu-Amplified Operable Breast Cancer

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

Primary Outcome Measures:
  • Pathologic complete response (pCR) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Comparison of pCR rates [ Designated as safety issue: No ]

Estimated Enrollment: 140
Study Start Date: October 2008
Estimated Primary Completion Date: September 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm I: Active Comparator
Patients receive trastuzumab IV over 90 minutes on day in course 1. Patients receive docetaxel IV, carboplatin IV, and trastuzumab IV over 30 minutes on day 1 in course 2-7. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Biological: trastuzumab
Given IV
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Arm II: Experimental
Patients receive oral lapatinib ditosylate once daily on days 1-21 in course 1. Patients receive docetaxel IV and carboplatin IV on day 1 and oral lapatinib ditosylate once daily on days 1-21 in courses 2-7.Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Drug: lapatinib ditosylate
Given orally
Arm III: Experimental
Patients receive trastuzumab IV over 90 minutes on day 1 and oral lapatinib ditosylate daily on days 1-21. Starting on day 22, patients receive docetaxel IV, carboplatin IV, and trastuzumab IV three times a week and oral lapatinib ditosylate once daily on days 1-21 in courses 2-7. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Biological: trastuzumab
Given IV
Drug: carboplatin
Given IV
Drug: docetaxel
Given IV
Drug: lapatinib ditosylate
Given orally

Detailed Description:

OBJECTIVES:

Primary

  • To investigate the clinical efficacy of neoadjuvant docetaxel and carboplatin in combination with trastuzumab (Herceptin®) and/or lapatinib ditosylate by estimating the pathologic complete response (pCR) rate in the breast and axilla of women with HER2/neu-positive resectable stage I-III adenocarcinoma of the breast.

Secondary

  • To estimate the molecular effects of lapatinib ditosylate and trastuzumab alone or in combination on tumor tissues of these patients by assessing changes in gene expression using serial gene microarray analysis.
  • To assess for gene expression and/or biomarker changes that may be correlated with or predict pCR and clinical response to lapatinib ditosylate and/or trastuzumab in these patients.
  • To evaluate the safety and tolerability of these regimens in these patients.
  • To evaluate the clinical efficacy of these regimens by estimating the clinical objective response rate (complete response and partial response) in these patients.
  • To estimate the rate of congestive heart failure or drop in LVEF (> 10% points from baseline and below lower limits of normal) in each of the three treatment arms.

OUTLINE: This is a multicenter study. Patients are stratified according to baseline tumor size (≤ 3 cm vs > 3 cm) and hormone receptor status (estrogen receptor [ER]- and/or progesterone receptor [PR]-positive vs ER- and PR- negative). Patients are randomized to 1 of 3 treatment arms.

  • Arm I: Patients receive a trastuzumab IV over 90 minutes on day 1 in course 1. Patients receive docetaxel IV, carboplatin IV, and trastuzumab IV over 30 minutes on day 1 in courses 2-7. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Arm II: Patients receive oral lapatinib ditosylate once daily on days 1-21 in course 1. Patients receive docetaxel IV, carboplatin IV as in arm I and oral lapatinib ditosylate once daily on days 1-21 in courses 2-7. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Arm III: Patients receive trastuzumab IV as in arm I on day 1 and oral lapatinib ditosylate as in arm II on days 1-21 in course 1. Patients receive docetaxel IV, carboplatin IV, and trastuzumab IV as in arm I on day 1 and oral lapatinib ditosylate as in arm II on days 1-21 in courses 2-7. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Within 4-6 weeks after completion of chemotherapy, all patients under go definitive surgery and/or radiotherapy at the discretion of the treating physician. Tumor biopsy and blood samples are collected for biomarker analysis and molecular analysis at baseline, after course 1, and at the time of definitive breast surgery or completion of chemotherapy. Gene expression changes are analyzed by mRNA microarray analysis and molecular changes in protein expression profiles by IHC. Samples may also be analyzed by RT-PCR.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed adenocarcinoma of the breast

    • Stage I or II disease (early stage) with tumor measuring ≥ 1 cm and meeting any the following criteria:

      • Grade > 1
      • Estrogen receptor- and progesterone receptor-negative
      • Age ≤ 35 years
    • Stage II-III (locally advanced) disease
    • Resectable disease
  • Meets none of the following criteria:

    • Inflammatory breast cancer, defined as the presence of erythema or induration involving > 1/3 of the breast
    • Bilateral invasive breast cancer
    • Metastatic disease
  • HER2/neu-positivity by fluorescence in situ hybridization (FISH)
  • Hormone receptor status known

PATIENT CHARACTERISTICS:

  • Menopausal status not specified
  • ECOG performance status 0-1
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Hemoglobin ≥ 9.0 g/dL
  • Creatinine < 1.5 mg/dL
  • Total bilirubin ≤ 1.0 times upper limit of normal (ULN) (< 3 times ULN in patients with Gilbert's syndrome confirmed by genotyping or Invader UGTIA1 molecular assay)
  • Alkaline phosphatase (AP), ALT, and AST must meet 1 of the following criteria:

    • AP normal AND AST/ALT ≤ 2.5 times upper limit of normal (ULN)
    • AP ≤ 2.5 times ULN AND ALT/AST ≤ 1.5 times ULN
    • AP ≤ 5 times ULN AND AST/ALT normal
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for ≥ 3 months after completion of study treatment
  • Cardiac function normal (ejection fraction ≥ lower limit of normal) as determined by MUGA or echocardiogram
  • No history of any other malignancy within the past 5 years, with the exception of nonmelanoma skin cancer or carcinoma in situ of the cervix
  • No pre-existing motor or sensory neurotoxicity ≥ grade 2 by NCI NTCAE version 3.0
  • No cardiac disease including any of the following:

    • Myocardial infarction within the past 6 months
    • Unstable angina
    • New York Heart Association class II-IV congestive heart failure
  • No inflammatory bowel disease or other bowel condition causing chronic diarrhea and requiring active therapy
  • No active, uncontrolled infection requiring parenteral antimicrobials
  • No known hypersensitivity to Chinese hamster ovary products or other recombinant human or humanized antibodies and/or known hypersensitivity to any of the study drugs or their ingredients (e.g., polysorbate 80 in docetaxel)
  • Accessible and willing to comply with treatment, tissue acquisition, and follow up
  • No other medical or psychiatric disorder that, in the opinion of the treating physician, would contraindicate the use of study drugs or place the subject at undue risk for treatment complications

PRIOR CONCURRENT THERAPY:

  • At least 14 days since prior and no concurrent hormonal agent (e.g., raloxifene, tamoxifen citrate, or other selective estrogen receptor modulators) for osteoporosis or prevention of breast cancer
  • At least 14 days since prior herbal or dietary supplements
  • No prior ipsilateral radiotherapy for invasive or noninvasive breast cancer or to the ipsilateral chest wall for any malignancy
  • No prior chemotherapy, radiotherapy, or endocrine therapy for currently diagnosed invasive or noninvasive breast cancer
  • No concurrent ovarian hormonal replacement therapy
  • No concurrent therapy with any other non-protocol anticancer therapy
  • No concurrent inducers and inhibitors or CYP3A4
  • No concurrent grapefruit juice or grapefruit
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00769470

Locations
United States, California
Cancer Care Associates Medical Group, Incorporated - Redondo Beach Recruiting
Torrance, California, United States, 90505
Contact: David Chan, MD     310-530-9389        
Central Coast Medical Oncology Corporation Recruiting
Santa Maria, California, United States, 93454
Contact: Robert A. Dichmann, MD     805-349-9393        
Central Hematology Oncology Medical Group, Incorporated - Alhambra Recruiting
Alhambra, California, United States, 91801
Contact: Eddie H.L. Hu, MD     626-588-2825        
Santa Barbara Hematology Oncology - Solvang Recruiting
Solvang, California, United States, 93463
Contact: Frederic C. Kass, MD     805-686-5370        
North Valley Hematology-Oncology Medical Group Recruiting
Northridge, California, United States, 91328
Contact: Sheldon J. Davidson, MD, FACP     818-773-6363     sheljdavid@aol.com    
Sansum Medical Clinic Recruiting
Santa Barbara, California, United States, 93105
Contact: Clinical Trials Office - Sansum Medical Clinic     805-682-7300        
Comprehensive Blood and Cancer Center Recruiting
Bakersfield, California, United States, 93309-0633
Contact: Clinical Trials Office - Comprehensive Blood and Cancer Center     661-862-7178        
St. Jude Heritage Medical Group at Virginia K. Crosson Cancer Center Recruiting
Fullerton, California, United States, 92835
Contact: Giribala Patel, MD     714-446-5900        
Wilshire Oncology Medical Group, Incorporated - Pomona Recruiting
Pomona, California, United States, 91767-3021
Contact: Linda D. Bosserman, MD, FACP     909-865-9960     linda.bosserman@womgi.com    
United States, Florida
Cancer Institute of Florida, PA - Orlando Recruiting
Orlando, Florida, United States, 32804
Contact: Rebecca L. Moroose, MD     407-898-2343     rebecca.moroosemd@flhosp.org    
Florida Hospital Cancer Institute Recruiting
Orlando, Florida, United States, 32804
Contact: Clinical Trials Office - Florida Hospital Cancer Institute     407-303-5623        
Hematology and Oncology Consultants, PA - Orlando Recruiting
Orlando, Florida, United States, 32804
Contact: Philip H. Dunn, MD     407-898-5452     phdunnmd@att.net    
United States, Indiana
Providence Medical Group Recruiting
Haute Terre, Indiana, United States, 47802
Contact: Sang Huh, MD     812-232-1418     thehuh@aol.com    
United States, Nevada
Comprehensive Cancer Centers of Nevada - Henderson Recruiting
Henderson, Nevada, United States, 89052
Contact: M. A. Allison, MD     702-952-3444     maryann.allison@usoncology.com    
United States, New Mexico
New Mexico Cancer Center Recruiting
Albuquerque, New Mexico, United States, 87109
Contact: Richard O. Giudice, MD     505-842-8171        
Sponsors and Collaborators
Jonsson Comprehensive Cancer Center
Investigators
Principal Investigator: Sara Hurvitz, MD Jonsson Comprehensive Cancer Center
  More Information

Additional Information:
No publications provided

Study ID Numbers: CDR0000616008, TRIO-TORI-B-07, SANOFI-AVENTIS-TRIO-TORI-B-07, WIRB-20080822
Study First Received: October 8, 2008
Last Updated: March 17, 2009
ClinicalTrials.gov Identifier: NCT00769470     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage I breast cancer
stage II breast cancer
stage IIIA breast cancer
stage IIIB breast cancer
stage IIIC breast cancer
HER2-positive breast cancer

Study placed in the following topic categories:
Docetaxel
Skin Diseases
Trastuzumab
Breast Neoplasms
Lapatinib
Carboplatin
Protein Kinase Inhibitors
Breast Diseases

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Skin Diseases
Antineoplastic Agents
Breast Neoplasms
Enzyme Inhibitors
Lapatinib
Carboplatin
Protein Kinase Inhibitors
Pharmacologic Actions
Docetaxel
Neoplasms
Neoplasms by Site
Therapeutic Uses
Trastuzumab
Breast Diseases

ClinicalTrials.gov processed this record on May 07, 2009