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Gefitinib, Trastuzumab, and Docetaxel in Treating Patients With Metastatic Breast Cancer

Phase I/II Trial of ZD1839 (Iressa®), Trastuzumab (Herceptin®), and Docetaxel (Taxotere®) in Patients With erbB-2 (HER-2) Overexpressing, Stage IV Breast Carcinoma

Status
Completed
Phases
Phase 1Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00086957
Enrollment
31
Registered
2004-07-12
Start date
2004-01-31
Completion date
2015-08-31
Last updated
2017-02-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Breast Cancer

Keywords

stage IV breast cancer, male breast cancer, recurrent breast cancer

Brief summary

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.

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.

Interventions

BIOLOGICALtrastuzumab

Cycle 1 loading dose of 8 mg/kg, followed by 6 mg/kg every 3 weeks for subsequent cycles.

DRUGdocetaxel

75 mg/m2 every three weeks, or 60 mg/m2 every three weeks depending on study findings

DRUGgefitinib

250 mg daily or 250 mg daily on days 2 through 14 depending on study findings

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
City of Hope Medical Center
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion 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 non-approved 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

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants With at Least One Dose Limiting Toxicity in Phase I4 weeks from start of treatment, up to 2 yearsDose Limiting Toxicity (DLT) defined as any treatment-related grade 3 or greater except for hematological toxicities which must be grade 4. Interstitial Lung Disease (ILD) related to treatment should be considered as a DLT regardless of the grade.
Recommended Phase II Dose4 weeks from start of treatment, up to 2 yearsThe maximum tolerated dose (MTD): subjects received gefitinib 250 mg orally daily, trastuzumab 6 mg/kg intravenously every 3 weeks (after an initial dose of 8 mg/kg with cycle 1), and docetaxel 75 mg/m\^2 intravenously every 3 weeks. This was to serve as the phase II dose if no dose-limiting toxicities (DLTs) occurred in the first three subjects. If one DLT occurred in the first three subjects, another three subjects where to be enrolled at this dose, whereas if two DLTs occurred in the first three subjects, the docetaxel dose was to be decreased to 60 mg/m\^2. The study would then be continued only if no more than one patient had a DLT at this dose. Once the dose of docetaxel was established, all further subjects were to be treated at the phase II MTD dose.

Secondary

MeasureTime frameDescription
Progression-free SurvivalUntil disease progression, up to 5 years.Estimated using the product-limit method of Kaplan and Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST), as a 20% increase in the sum of the longest diameter of target lesions, or the appearance of new lesions.
Objective Response RateAfter 3 cycles of treatment, up to 2 years.Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Objective Response Rate defined as percentage of patients achieving a Best Response of either CR or PR.
Overall SurvivalUntil death from any cause, up to 5 years.Estimated using the product-limit method of Kaplan and Meier.

Countries

United States

Participant flow

Participants by arm

ArmCount
Dose Levels 1 & 2 - Docetaxel 60 & 75 mg/m^2
trastuzumab: Cycle 1 loading dose of 8 mg/kg, followed by 6 mg/kg every 3 weeks for subsequent cycles. docetaxel: 75 mg/m\^2 every three weeks, or 60 mg/m\^2 every three weeks depending on study findings gefitinib: 250 mg daily or 250 mg daily on days 2 through 14 depending on study findings
31
Total31

Baseline characteristics

CharacteristicDose Levels 1 & 2 - Docetaxel 60 & 75 mg/m^2
Age, Continuous52 years
Gender
Female
31 Participants
Gender
Male
0 Participants
Region of Enrollment
United States
31 participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
2 / 229 / 29
serious
Total, serious adverse events
2 / 27 / 29

Outcome results

Primary

Number of Participants With at Least One Dose Limiting Toxicity in Phase I

Dose Limiting Toxicity (DLT) defined as any treatment-related grade 3 or greater except for hematological toxicities which must be grade 4. Interstitial Lung Disease (ILD) related to treatment should be considered as a DLT regardless of the grade.

Time frame: 4 weeks from start of treatment, up to 2 years

Population: All patients receiving treatment were evaluated for DLT.

ArmMeasureValue (NUMBER)
Phase I: Dose Level 1 - Docetaxel 75 mg/m^2Number of Participants With at Least One Dose Limiting Toxicity in Phase I2 participants with DLTs
Phase I: Dose Level 2 - Docetaxel 60 mg/m^2Number of Participants With at Least One Dose Limiting Toxicity in Phase I0 participants with DLTs
Primary

Recommended Phase II Dose

The maximum tolerated dose (MTD): subjects received gefitinib 250 mg orally daily, trastuzumab 6 mg/kg intravenously every 3 weeks (after an initial dose of 8 mg/kg with cycle 1), and docetaxel 75 mg/m\^2 intravenously every 3 weeks. This was to serve as the phase II dose if no dose-limiting toxicities (DLTs) occurred in the first three subjects. If one DLT occurred in the first three subjects, another three subjects where to be enrolled at this dose, whereas if two DLTs occurred in the first three subjects, the docetaxel dose was to be decreased to 60 mg/m\^2. The study would then be continued only if no more than one patient had a DLT at this dose. Once the dose of docetaxel was established, all further subjects were to be treated at the phase II MTD dose.

Time frame: 4 weeks from start of treatment, up to 2 years

Population: All patients observed for 21 days while receiving a full course of therapy or who experienced a DLT. Patients withdrawing before completion of the first course, for reasons other than DLT, were replaced.

ArmMeasureValue (NUMBER)
Phase I: Dose Level 1 - Docetaxel 75 mg/m^2Recommended Phase II Dose60 mg/m^2
Secondary

Objective Response Rate

Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Objective Response Rate defined as percentage of patients achieving a Best Response of either CR or PR.

Time frame: After 3 cycles of treatment, up to 2 years.

Population: All patients treated at the phase II docetaxel dose (7 in the phase I portion, 22 in the phase II portion). Patients who complete 3 cycles of treatment or who terminate treatment for reasons of toxicity, or who progress prior to the completion of 3 cycles of therapy on the Phase II portion of the study.

ArmMeasureValue (NUMBER)
Phase I: Dose Level 1 - Docetaxel 75 mg/m^2Objective Response Rate64 percentage of participants
Secondary

Overall Survival

Estimated using the product-limit method of Kaplan and Meier.

Time frame: Until death from any cause, up to 5 years.

Population: All patients treated at the phase II docetaxel dose (7 in the phase I portion, 22 in the phase II portion).

ArmMeasureValue (MEDIAN)
Phase I: Dose Level 1 - Docetaxel 75 mg/m^2Overall Survival43.2 Months
Secondary

Progression-free Survival

Estimated using the product-limit method of Kaplan and Meier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST), as a 20% increase in the sum of the longest diameter of target lesions, or the appearance of new lesions.

Time frame: Until disease progression, up to 5 years.

Population: All patients treated at the phase II docetaxel dose (7 in the phase I portion, 22 in the phase II portion).

ArmMeasureValue (MEDIAN)
Phase I: Dose Level 1 - Docetaxel 75 mg/m^2Progression-free Survival12.7 Months

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026