Metastatic Breast Cancer
Conditions
Keywords
breast cancer, Phase I clinical trial, cancer stem cells, agents with other mechanisms of action, Notch inhibitors
Brief summary
New and better therapies for locally advanced and metastatic breast cancer are needed because, even if standard treatment is successful in shrinking the cancer, there is still a high chance that the cancer will recur. Recent research suggests that breast tumors have a small number of cells in them that are breast cancer stem cells, which are very resistant to standard treatment. It is thought that the reason that many patients cannot be cured of their breast cancers is that the stem cells are unable to be killed and remain in the body after standard treatment. Laboratory research has shown that a new drug, MK-0752, can target stem cells and prevent tumor recurrences when the drug is combined with docetaxel, a chemotherapy drug commonly used to treat breast cancer. We know that MK-0752 is safe when given by itself to people. We do not know if treatment with MK-0752 and docetaxel combined is safe or if it will kill breast cancer stem cells in people with breast cancer. This clinical trial is being done to determine the safety of several doses of MK-0752 in combination with docetaxel. Preliminary data about the effectiveness of MK-0752 in combination with docetaxel will be collected. Also, tumor biopsy samples will be taken from some patients who have tumors that can be easily biopsied. The samples will be used to perform research tests to help determine if the breast cancer stem cells are being killed by the drug combination.
Detailed description
Purpose-Accumulating evidence supports the existence of breast cancer stem cells (BCSCs), which are characterized by their capacity to self-renew and divide indefinitely, and resistance to conventional therapies. The Notch pathway is important for stem cell renewal, and is a potential target for BCSC-directed therapy. Experimental Design-Using human breast tumorgraft studies, we evaluated the impact of gamma secretase inhibitors (GSI) on the BCSC population and the efficacy of combining GSI with docetaxel treatment. The mouse experimental therapy paralleled a concurrent clinical trial in advanced breast cancer patients, designed to determine the maximally tolerated dose of the GSI, MK-0752, administered sequentially with docetaxel, and to evaluate BCSC markers in serial tumor biopsies.
Interventions
DRUGMK-0752, Docetaxel, Pegfilgrastim
MK-0752 in escalating doses of 300, 450, 600, and 800 mg given orally on days 1-3, followed by docetaxel 80 mg/m2 day 8 and pegfilgrastim 6 mg SQ on day 9
Sponsors
Baylor College of Medicine
Ohio State University
Dana-Farber Cancer Institute
Weill Medical College of Cornell University
Merck Sharp & Dohme LLC
University of Michigan Rogel Cancer Center
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
* Men or women with metastatic (Stage IV) breast cancer, or with locally advanced breast cancer (Stages IIIA \> 10 cm, or Stages IIIB and IIIC) that did not respond to first-line anthracycline-based chemotherapy, for whom docetaxel is a recommended therapy * Presence of measurable or evaluable disease * Adequate organ function * Ability to swallow intact study drug capsules * Zubrod Performance Status of 0-1 with at least a 3 month life expectancy * Appropriate time must have elapsed since prior anti-neoplastic therapy with resolution of acute toxicity
Exclusion criteria
* Concurrent treatment with hormonal therapy intended to treat cancer * Radiotherapy within 7 days prior to first dose * Symptomatic central nervous system, and/or epidural metastases or symptomatic carcinomatous meningitis or with radiation treatment completed within the past 8 weeks * Serious comorbid illness which will limit the ability of the patient to safely receive anticancer treatment * Patients who are pregnant or nursing * Confounding factors present to provide misinterpretation of data (i.e., concurrent malignancy)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Dose Limiting Toxicity (DLT) | first 21 days | The number of DLTs experienced by participants within the first 21 days. DLTs were defined as toxicities possibly, probably, or definitely related to the study drug observed during the first 2 cycles (first 42 days) as follows: 1. Non-hematologic toxicity Grade ≥3 by the NCI CTCAE version 3.0. 2. ANC\<1000 for more than 7 days despite use of pegfilgrastim. 3. Platelet count \<25,000 for more than 7 days, or associated with bleeding, or less than 10,000 at any time. |
| Maximum Tolerated Dose (MTD) | Up to 3 years | The Maximum Tolerated Dose (MTD) for MK-0752 will be determined. Dose levels were: Level 1: 300 mg MK-0752 by mouth days 1-3; Level 2: 450 mg MK-0752 by mouth days 1-3; Level 3: 600 mg MK-0752 by mouth days 1-3; Level 4: 800 mg MK-0752 by mouth days 1-3. |
Countries
United States
Participant flow
Recruitment details
Eligible subjects included men or women with metastatic (Stage IV)breast cancer, or with locally advanced breast cancer (Stages IIIA\> 10cm, or stages IIIB and IIIC) that did not respond to first-line anthracycline-based chemotherapy.
Pre-assignment details
There must b at least a 6 month interval since prior taxane therapy.
Participants by arm
| Arm | Count |
|---|---|
| MK-0752 and Docetaxel MK-0752 in escalating doses, orally days 1-3, followed by docetaxel 80 mg/m2 IV on day 8, and pegfilgrastim 6mg SQ day 9. Cycle repeated every 21 days. | 30 |
| Total | 30 |
Baseline characteristics
| Characteristic | MK-0752 and Docetaxel |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 5 Participants |
| Age, Categorical Between 18 and 65 years | 25 Participants |
| HER-2/neu status Negative | 28 Participants |
| HER-2/neu status Positive | 2 Participants |
| Metastatic sites (multiple sites possible) Bone | 12 Participants |
| Metastatic sites (multiple sites possible) Liver | 13 Participants |
| Metastatic sites (multiple sites possible) Lung/Pleura | 16 Participants |
| Metastatic sites (multiple sites possible) Lymph Nodes | 11 Participants |
| Metastatic sites (multiple sites possible) Other | 7 Participants |
| Metastatic sites (multiple sites possible) Skin | 5 Participants |
| Number of Metastatic Sites 0 | 4 participants |
| Number of Metastatic Sites 1 | 6 participants |
| Number of Metastatic Sites 2 | 6 participants |
| Number of Metastatic Sites >=3 | 14 participants |
| Number of Prior Metastatic Chemotherapy Regimens 0 | 7 Participants |
| Number of Prior Metastatic Chemotherapy Regimens 1 | 2 Participants |
| Number of Prior Metastatic Chemotherapy Regimens 2+ | 21 Participants |
| Prior Therapy For Metastatic Disease Chemotherapy | 7 Participants |
| Prior Therapy For Metastatic Disease Chemotherapy and Hormonal Therapy | 16 Participants |
| Prior Therapy For Metastatic Disease Hormonal Therapy | 0 Participants |
| Prior Therapy For Metastatic Disease None | 7 Participants |
| Region of Enrollment United States | 30 participants |
| Sex: Female, Male Female | 30 Participants |
| Sex: Female, Male Male | 0 Participants |
| Tumor Hormone Receptor Status ER negative and PgR negative | 12 Participants |
| Tumor Hormone Receptor Status ER positive/or PgR positive | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 30 / 30 |
| serious Total, serious adverse events | 16 / 30 |
Outcome results
Primary
Dose Limiting Toxicity (DLT)
The number of DLTs experienced by participants within the first 21 days. DLTs were defined as toxicities possibly, probably, or definitely related to the study drug observed during the first 2 cycles (first 42 days) as follows: 1. Non-hematologic toxicity Grade ≥3 by the NCI CTCAE version 3.0. 2. ANC\<1000 for more than 7 days despite use of pegfilgrastim. 3. Platelet count \<25,000 for more than 7 days, or associated with bleeding, or less than 10,000 at any time.
Time frame: first 21 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MK-0752 and Docetaxel | Dose Limiting Toxicity (DLT) | 5 Dose Limiting Toxicities |
Primary
Maximum Tolerated Dose (MTD)
The Maximum Tolerated Dose (MTD) for MK-0752 will be determined. Dose levels were: Level 1: 300 mg MK-0752 by mouth days 1-3; Level 2: 450 mg MK-0752 by mouth days 1-3; Level 3: 600 mg MK-0752 by mouth days 1-3; Level 4: 800 mg MK-0752 by mouth days 1-3.
Time frame: Up to 3 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| MK-0752 and Docetaxel | Maximum Tolerated Dose (MTD) | 600 mg |