Breast Cancer
Conditions
Keywords
recurrent breast cancer, stage IV breast cancer
Brief summary
RATIONALE: Monoclonal antibodies, such as cetuximab, 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. Cetuximab may also stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether giving cetuximab together with carboplatin is more effective than giving cetuximab alone in treating metastatic breast cancer. PURPOSE: This randomized phase II trial is studying cetuximab and carboplatin to see how well they work compared with cetuximab alone in treating women with estrogen receptor-negative (ER-), progesterone receptor-negative (PR-) metastatic breast cancer.
Detailed description
OBJECTIVES: Primary * Compare the overall response rate in women with estrogen receptor-negative, progesterone receptor-negative, human epidermal growth factor receptor 2 (HER2)-nonoverexpressing metastatic breast cancer treated with cetuximab with vs without carboplatin. Secondary * Compare the time to disease progression in patients treated with these regimens. * Correlate downstream effects of epidermal growth factor receptor (EGFR) inhibitor on Mitogen-activated protein kinases (MAPK), Protein kinase B (AKT), monoclonal antibody Ki-67 (Ki67), and EGFR-dependent signaling, proliferation, and apoptosis with toxicity and response in patients with accessible tumors treated with these regimens. * Determine the changes in biomarkers and gene expression in circulating tumor cells during treatment. * Compare the overall survival rate in patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive cetuximab IV over 60-120 minutes once a week. * Arm II: Patients receive cetuximab as in arm I and carboplatin IV on days 1, 8, and 15. In both arms, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients not responding to treatment in arm I may cross over to arm II. Blood samples are collected periodically throughout study for correlative biomarker analysis by Immunohistochemistry (IHC) and gene expression analysis. After completion of study treatment, patients are followed every 4 months.
Interventions
BIOLOGICALcetuximab
Given IV
DRUGcarboplatin
Given IV
Sponsors
National Cancer Institute (NCI)
Bristol-Myers Squibb
Avon Foundation
National Center for Research Resources (NCRR)
UNC Lineberger Comprehensive Cancer Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed breast cancer * Metastatic (stage IV) disease * Measurable disease by RECIST criteria * Irradiated lesions are not considered measurable disease * Central nervous system (CNS) metastases allowed if disease is stable (no evidence of progression) ≥ 3 months after local therapy * No lesions identifiable only by positron emission tomography (PET) scan * HER2 nonoverexpressing disease by IHC (0 or 1) or non-gene amplified by Fluorescence In Situ Hybridization (FISH) * HER2 2+ by IHC allowed * Hormone receptor status: * Estrogen receptor-negative and progesterone receptor-negative tumor Inclusion Criteria * At least 18 years of age * Metastatic breast cancer (Stage IV) with measurable disease by RECIST criteria * No more than three prior chemotherapy regimens either in the adjuvant or metastatic setting. * Histologically documented (either primary or metastatic site) breast cancer that is estrogen receptor- (ER-) negative, PR-negative, and HER-2 nonoverexpressing by immunohistochemistry (0,1) or non-gene amplified by FISH performed upon the primary tumor or metastatic lesion. HER-2 2+ by immunohistochemistry is usually negative by FISH, and this confirmatory test should be performed when possible, however may participate if fulfill other criteria. * Completion of prior chemotherapy at least 3 weeks prior to study entry. * Patients may have received therapy (ies) in the adjuvant or metastatic setting, however must have discontinued prior to entry. Patients may receive concurrent bisphosphonates, however if taking bisphosphonates, bone lesions may not be used for progression or response. * Radiation therapy must be completed at least 2 weeks prior to study entry, and radiated lesions may not serve as measurable disease. * Patients may have CNS metastases if stable (no evidence of progression) \> 3 months after local therapy. * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 and life expectancy of at least 6 months. * Adequate organ function defined as:absolute neutrophil count (ANC) \> 1500/mm3, plts \> 100,000/mm3, creatinine clearance \>50 mL/min, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤2.5 x upper limit of normal (ULN) (or ≤5 x ULN in case of liver metastases); total bilirubin ≤1.5 mg/dL. * Tissue block available for EGFR studies is recommended, although will not exclude patients from participating. * Pregnant or lactating women will be excluded. Women of child bearing potential must have documented negative pregnancy test within two weeks of study entry and agree to acceptable birth control during the duration of the study therapy. * Signed written informed consent.
Exclusion criteria
* Lesions identifiable only by PET. * More than three prior chemotherapy regimens (including adjuvant). Sequential regimens such as doxorubicin and cyclophosphamide followed by paclitaxel (AC-paclitaxel) are considered one regimen. * Prior therapy which specifically and directly targets the EGFR pathway with therapeutic intent. * Prior platinum agent for metastatic disease. If platinum agent was used adjuvantly, the patient must have had at least 12 months disease-free interval prior to relapse. * Prior severe infusion reaction to a monoclonal antibody. * Major medical conditions that might affect study participation (uncontrolled pulmonary, renal, or hepatic dysfunction, uncontrolled infection). * Significant history of uncontrolled cardiac disease; i.e., uncontrolled hypertension, unstable angina, recent myocardial infarction (within prior 6 months), uncontrolled congestive heart failure, and cardiomyopathy that is either symptomatic or asymptomatic but with decreased ejection fraction \<45% * Other significant comorbid condition which the investigator feels might compromise effective and safe participation in the study. * Inability to comply with the requirements of the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Disease Response Rate | 5 years | Overall response rate of single agent cetuximab and cetuximab + carboplatin will be measured by radiographic response using Response Evaluation Criteria In Solid Tumors (RECIST) criteria every 8 weeks until subject experiences disease progression. Overall response will be measured as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD).Per RECIST v1.0 for target lesions and assessed by CT (spiral): Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progression, as 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; Stable Disease (SD), neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for disease progression |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Every four months until death of any cause or end of data collection up to 40 months | Subjects will be contacted every 4 months after discontinuation of active treatment to assess survival. |
| Progression-Free Survival | Every four months until progression, death of any cause, or end of data collection up to 40 months | Time to disease progression of cetuximab or cetuximab + carboplatin as indicated by radiographic assessment |
Countries
United States
Participant flow
Recruitment details
Subjects were recruited between December 2005 and October 2007 from thirteen cancer centers throughout the US.
Pre-assignment details
Four patients declined participation for personal reasons, three were screen failures, three had death or progression during the screening period.
Participants by arm
| Arm | Count |
|---|---|
| Cetuximab Patients receive cetuximab IV over 60-120 minutes once a week. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients not responding to treatment may cross over to arm II.
cetuximab: Given IV | 31 |
| Cetuximab and Carboplatin Patients receive cetuximab as in arm I and carboplatin IV on days 1, 8, and 15. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
cetuximab: Given IV
carboplatin: Given IV | 71 |
| Total | 102 |
Baseline characteristics
| Characteristic | Cetuximab and Carboplatin | Cetuximab | Total |
|---|---|---|---|
| Age, Continuous | 52 years | 49 years | 50.5 years |
| Dominant metastatic site Bone | 4 Participants | 1 Participants | 5 Participants |
| Dominant metastatic site Liver | 17 Participants | 8 Participants | 25 Participants |
| Dominant metastatic site Locoregional | 10 Participants | 5 Participants | 15 Participants |
| Dominant metastatic site Lung | 20 Participants | 9 Participants | 29 Participants |
| Dominant metastatic site Lymph nodes | 14 Participants | 4 Participants | 18 Participants |
| Dominant metastatic site Other | 1 Participants | 1 Participants | 2 Participants |
| Dominant metastatic site Skin/soft tissue | 5 Participants | 3 Participants | 8 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 0 | 37 Participants | 17 Participants | 54 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 1 | 28 Participants | 14 Participants | 42 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 2 | 4 Participants | 0 Participants | 4 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status missing | 2 Participants | 0 Participants | 2 Participants |
| Menopausal Status Postmenopausal | 56 Participants | 21 Participants | 77 Participants |
| Menopausal Status Pre- or perimenopausal | 15 Participants | 10 Participants | 25 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 17 Participants | 11 Participants | 28 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 51 Participants | 19 Participants | 70 Participants |
| Region of Enrollment United States | 71 participants | 31 participants | 102 participants |
| Sex: Female, Male Female | 71 Participants | 31 Participants | 102 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
| Treatment Adjuvant/neoadjuvant | 60 participants | 26 participants | 86 participants |
| Treatment Metastatic | 34 participants | 21 participants | 55 participants |
| Treatment Prior chemotherapy | 67 participants | 30 participants | 97 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 27 / 31 | 24 / 25 | 68 / 71 |
| serious Total, serious adverse events | 3 / 31 | 8 / 25 | 20 / 71 |
Outcome results
Primary
Overall Disease Response Rate
Overall response rate of single agent cetuximab and cetuximab + carboplatin will be measured by radiographic response using Response Evaluation Criteria In Solid Tumors (RECIST) criteria every 8 weeks until subject experiences disease progression. Overall response will be measured as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD).Per RECIST v1.0 for target lesions and assessed by CT (spiral): Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progression, as 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; Stable Disease (SD), neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for disease progression
Time frame: 5 years
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Cetuximab | Overall Disease Response Rate | Not evaluable | 0 Participants |
| Cetuximab | Overall Disease Response Rate | Progressive disease | 26 Participants |
| Cetuximab | Overall Disease Response Rate | Complete response | 0 Participants |
| Cetuximab | Overall Disease Response Rate | Partial response | 2 Participants |
| Cetuximab | Overall Disease Response Rate | Stable disease | 3 Participants |
| Cetuximab | Overall Disease Response Rate | Stable disease > 6 months | 1 Participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Disease Response Rate | Stable disease | 7 Participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Disease Response Rate | Complete response | 0 Participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Disease Response Rate | Partial response | 4 Participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Disease Response Rate | Progressive disease | 12 Participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Disease Response Rate | Stable disease > 6 months | 3 Participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Disease Response Rate | Not evaluable | 2 Participants |
| Cetuximab and Carboplatin | Overall Disease Response Rate | Stable disease | 15 Participants |
| Cetuximab and Carboplatin | Overall Disease Response Rate | Not evaluable | 6 Participants |
| Cetuximab and Carboplatin | Overall Disease Response Rate | Complete response | 1 Participants |
| Cetuximab and Carboplatin | Overall Disease Response Rate | Stable disease > 6 months | 10 Participants |
| Cetuximab and Carboplatin | Overall Disease Response Rate | Progressive disease | 38 Participants |
| Cetuximab and Carboplatin | Overall Disease Response Rate | Partial response | 11 Participants |
| Cetuximab and Carboplatin Subset | Overall Disease Response Rate | Not evaluable | 3 Participants |
| Cetuximab and Carboplatin Subset | Overall Disease Response Rate | Progressive disease | 32 Participants |
| Cetuximab and Carboplatin Subset | Overall Disease Response Rate | Stable disease | 8 Participants |
| Cetuximab and Carboplatin Subset | Overall Disease Response Rate | Complete response | 1 Participants |
| Cetuximab and Carboplatin Subset | Overall Disease Response Rate | Partial response | 17 Participants |
| Cetuximab and Carboplatin Subset | Overall Disease Response Rate | Stable disease > 6 months | 7 Participants |
Secondary
Overall Survival
Subjects will be contacted every 4 months after discontinuation of active treatment to assess survival.
Time frame: Every four months until death of any cause or end of data collection up to 40 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Cetuximab | Overall Survival | 32 months | 1 participants surviving |
| Cetuximab | Overall Survival | 28 months | 5 participants surviving |
| Cetuximab | Overall Survival | Baseline | 31 participants surviving |
| Cetuximab | Overall Survival | 4 months | 22 participants surviving |
| Cetuximab | Overall Survival | 8 months | 12 participants surviving |
| Cetuximab | Overall Survival | 12 months | 9 participants surviving |
| Cetuximab | Overall Survival | 16 months | 8 participants surviving |
| Cetuximab | Overall Survival | 20 months | 8 participants surviving |
| Cetuximab | Overall Survival | 24 months | 6 participants surviving |
| Cetuximab | Overall Survival | 36 months | 1 participants surviving |
| Cetuximab | Overall Survival | 40 months | 0 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 32 months | 3 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 16 months | 23 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 28 months | 4 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 40 months | 0 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | Baseline | 71 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 20 months | 19 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 4 months | 56 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 36 months | 2 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 8 months | 41 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 24 months | 8 participants surviving |
| Cetuximab and Carboplatin After Cetuximab Alone | Overall Survival | 12 months | 30 participants surviving |
Secondary
Progression-Free Survival
Time to disease progression of cetuximab or cetuximab + carboplatin as indicated by radiographic assessment
Time frame: Every four months until progression, death of any cause, or end of data collection up to 40 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Cetuximab | Progression-Free Survival | 4 months | 4 participants |
| Cetuximab | Progression-Free Survival | 24 months | 1 participants |
| Cetuximab | Progression-Free Survival | Baseline | 31 participants |
| Cetuximab | Progression-Free Survival | 28 months | 1 participants |
| Cetuximab | Progression-Free Survival | 8 months | 2 participants |
| Cetuximab | Progression-Free Survival | 32 months | 1 participants |
| Cetuximab | Progression-Free Survival | 16 months | 1 participants |
| Cetuximab | Progression-Free Survival | 36 months | 1 participants |
| Cetuximab | Progression-Free Survival | 12 months | 2 participants |
| Cetuximab | Progression-Free Survival | 40 months | 0 participants |
| Cetuximab | Progression-Free Survival | 20 months | 1 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 40 months | 0 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 12 months | 7 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | Baseline | 71 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 4 months | 27 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 16 months | 7 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 20 months | 6 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 24 months | 6 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 28 months | 1 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 32 months | 1 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 36 months | 1 participants |
| Cetuximab and Carboplatin After Cetuximab Alone | Progression-Free Survival | 8 months | 11 participants |