Breast Cancer
Conditions
Keywords
recurrent breast cancer, stage IV breast cancer, male breast cancer
Brief summary
RATIONALE: Drugs used in chemotherapy, such as capecitabine and vinorelbine, work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor killing substances to them without harming normal cells. Giving capecitabine and vinorelbine together with trastuzumab may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving capecitabine and vinorelbine together with trastuzumab works in treating patients who have metastatic breast cancer.
Detailed description
OBJECTIVES: Primary * Determine the overall response rate in patients with HER2/neu-overexpressing metastatic breast cancer treated with first- or second-line therapy comprising capecitabine, vinorelbine, and trastuzumab (Herceptin\^®). Secondary * Determine the time to disease progression, duration of response, and overall survival of patients treated with this regimen. * Determine the safety profile of this regimen in these patients. OUTLINE: This is a multicenter study. Patients receive oral capecitabine twice daily on days 1-14, vinorelbine IV over 6-10 minutes on days 1 and 8, and trastuzumab (Herceptin\^®) IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients are followed every 3 months until disease progression and then every 6 months for up to 5 years.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed invasive breast cancer * Metastatic disease * HER2/neu-positive by immunohistochemistry (3+ by HercepTest\^™ or equivalent) OR positive for amplification by fluorescent in situ hybridization * Testing may be performed in the primary tumor or the metastatic site * Received prior anthracycline or taxane as adjuvant therapy or for metastatic disease * Measurable disease * At least one measurable lesion ≥ 2.0 cm by CT scan or MRI OR ≥ 1.0 cm by spiral CT scan * The following are considered non-measurable disease: * Bone lesions * Leptomeningeal disease * Ascites * Pleural/pericardial effusion * Inflammatory breast disease * Lymphangitis cutis/pulmonis * Abdominal masses that are not confirmed and followed by imaging techniques * Cystic lesions * No bone metastases as the only evidence of metastasis * Previously treated CNS metastases allowed provided disease has been stable for ≥ the past 3 months * Hormone receptor status: * Not specified PATIENT CHARACTERISTICS: Age * 18 and over Sex * Female or male Performance status * ECOG 0-2 Life expectancy * At least 12 weeks Hematopoietic * Absolute neutrophil count ≥ 1,500/mm\^3 * Hemoglobin ≥ 8.0 g/dL * Platelet count ≥ 100,000/mm\^3 * No known uncontrolled coagulopathy Hepatic * Bilirubin ≤ 3.0 times the upper limit of normal (ULN) * One of the following must be true: * AST or ALT ≤ 5 times ULN AND alkaline phosphatase normal * Alkaline phosphatase ≤ 5 times ULN AND AST or ALT normal * Alkaline phosphatase ≤ 2.5 times ULN AND AST or ALT ≤ 1.5 times ULN * INR ≤ 1.5 times ULN Renal * Calcium ≤ 11.5 mg/dL * Creatinine ≤ 1.5 times ULN * Creatinine clearance ≥ 30 mL/min Cardiovascular * LVEF ≥ 50% by MUGA or echocardiogram * No clinically significant (i.e., active) cardiac disease * No congestive heart failure * No symptomatic coronary artery disease * No myocardial infarction within the past 12 months * No cardiac arrhythmia not controlled with medication Gastrointestinal * Able to take oral medication * No lack of physical integrity of the upper gastrointestinal tract * No clinically significant malabsorption syndrome Other * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for 30 days after study participation * No history of allergy or hypersensitivity to study drugs, drug product excipients, including polysorbate 80, or chemically similar agents * No prior unanticipated severe reaction to fluoropyrimidine therapy * No know hypersensitivity to fluorouracil * No known dihydropyrimidine dehydrogenase deficiency * No history of uncontrolled seizures or CNS disorders * No clinically significant psychiatric disability that would preclude giving informed consent or study compliance * No other serious uncontrolled infection or disease * No other malignancy within the past 5 years except cured basal cell skin cancer, carcinoma in situ of the cervix, or contralateral breast cancer PRIOR CONCURRENT THERAPY: Biologic therapy * Prior adjuvant trastuzumab (Herceptin\^®) allowed as adjuvant or first-line therapy for metastatic disease * No concurrent immunotherapy Chemotherapy * See Disease Characteristics * No more than 1 prior chemotherapy regimen in the advanced or metastatic (non-adjuvant) setting * No prior continuous (≥ 24 hours) fluorouracil infusion * No prior capecitabine * No prior oral fluoropyrimidines (e.g., eniluracil and fluorouracil, uracil and tegafur, S1, or emitefur) Endocrine therapy * At least 1 day since prior hormonal therapy * No concurrent hormonal therapy Radiotherapy * More than 4 weeks since prior radiotherapy to the axial skeleton (i.e., skull, spinal column, sternum, or ribs) * No concurrent radiotherapy Surgery * More than 4 weeks since prior major surgery * No prior organ allografts requiring immunosuppressive therapy Other * More than 4 weeks since prior investigational drugs * No concurrent sorivudine or its chemically related analogues (e.g., brivudine) * No concurrent allopurinol, metronidazole, or cimetidine * No other concurrent cytotoxic agents * No other concurrent investigational drugs * No other concurrent anticancer therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Confirmed Response Rate | Up to 5 years | A confirmed tumor response is defined to be either a Complete Response (CR) or Partial Response (PR) noted as the objective status on 2 consecutive evaluations at least 6 weeks apart. All patients meeting the eligibility criteria who have signed a consent form and initiated study medication will be evaluable for response. The proportion of confirmed tumor responses will be estimated by the number of tumor regressions that meet the RECIST criteria for a confirmed CR or PR divided by the total number of evaluable patients. A 95% confidence interval for the true confirmed response rate will be calculated using the properties of the binomial distribution. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) 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; Overall Response (OR) = CR + PR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Progression (TTP) | Up to 5 years | Time to progression is defined as the time from registration to disease progression. Patients who died without documentation of progression will be considered to have progressed on the date of their death. If a patient starts treatment and fails to return for any evaluations, that patient will be censored for progression of disease at day one post-registration. Otherwise, for patients that do not progress, censoring will occur at the last follow up date. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as at least a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions or unequivocal progression of existing non-target lesions. |
| Duration of Response as Measured by RECIST Criteria | Up to 5 years | Duration of response is defined for all eligible patients who have achieved an objective response as the date at which the patient's objective status is first noted to be either a Complete Response (CR) or Partial Response (PR) to the date progression is documented. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) 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. |
| Overall Survival as Assessed by Time | Up to 5 years | Overall survival: The overall survival or survival time is defined as the time from registration to death due to any cause. The distribution of overall survival will be estimated using the method of Kaplan-Meier method. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Capecitabine + Vinorelbine + Trastuzumab Treatment followed a 21-day cycle. Capecitabine was administered orally twice daily at a dose of 825 mg/m\^2 on days 1 to 14, vinorelbine was administered intravenously (IV) at a dose of 25 mg/m\^2 on days 1 and 8 every 3 weeks, and trastuzumab was administered IV at a dose of 6 mg/kg on day 1 of every 3-week cycle (except cycle 1, when patients were given a loading dose of 8 mg/kg). | 46 |
| Total | 46 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Cancel participation before receiving tx | 1 |
| Overall Study | Protocol Violation | 1 |
Baseline characteristics
| Characteristic | Capecitabine + Vinorelbine + Trastuzumab |
|---|---|
| Age, Continuous | 60 years |
| Region of Enrollment United States | 46 participants |
| Sex: Female, Male Female | 46 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 46 / 46 |
| serious Total, serious adverse events | 9 / 46 |
Outcome results
Confirmed Response Rate
A confirmed tumor response is defined to be either a Complete Response (CR) or Partial Response (PR) noted as the objective status on 2 consecutive evaluations at least 6 weeks apart. All patients meeting the eligibility criteria who have signed a consent form and initiated study medication will be evaluable for response. The proportion of confirmed tumor responses will be estimated by the number of tumor regressions that meet the RECIST criteria for a confirmed CR or PR divided by the total number of evaluable patients. A 95% confidence interval for the true confirmed response rate will be calculated using the properties of the binomial distribution. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) 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; Overall Response (OR) = CR + PR.
Time frame: Up to 5 years
Population: Patients who completed the study were included in all analyses unless otherwise specified.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Capecitabine + Vinorelbine + Trastuzumab | Confirmed Response Rate | 0.67 proportion of patients |
Duration of Response as Measured by RECIST Criteria
Duration of response is defined for all eligible patients who have achieved an objective response as the date at which the patient's objective status is first noted to be either a Complete Response (CR) or Partial Response (PR) to the date progression is documented. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) 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.
Time frame: Up to 5 years
Population: Patients who completed the study or deemed a protocol violation were included in all analyses unless otherwise specified.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Capecitabine + Vinorelbine + Trastuzumab | Duration of Response as Measured by RECIST Criteria | 13.2 months |
Overall Survival as Assessed by Time
Overall survival: The overall survival or survival time is defined as the time from registration to death due to any cause. The distribution of overall survival will be estimated using the method of Kaplan-Meier method.
Time frame: Up to 5 years
Population: Patients who completed the study or deemed a protocol violation were included in all analyses unless otherwise specified.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Capecitabine + Vinorelbine + Trastuzumab | Overall Survival as Assessed by Time | 28.5 months |
Time to Progression (TTP)
Time to progression is defined as the time from registration to disease progression. Patients who died without documentation of progression will be considered to have progressed on the date of their death. If a patient starts treatment and fails to return for any evaluations, that patient will be censored for progression of disease at day one post-registration. Otherwise, for patients that do not progress, censoring will occur at the last follow up date. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as at least a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions or unequivocal progression of existing non-target lesions.
Time frame: Up to 5 years
Population: Patients who completed the study or deemed a protocol violation were included in all analyses unless otherwise specified.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Capecitabine + Vinorelbine + Trastuzumab | Time to Progression (TTP) | 11.3 months |