HER2-positive Breast Cancer, Recurrent Breast Cancer, Stage IV Breast Cancer
Conditions
Brief summary
This phase II trial studies how well capecitabine, cyclophosphamide, lapatinib ditosylate, and trastuzumab work in treating patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. Drugs used in chemotherapy, such as capecitabine and cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving capecitabine and cyclophosphamide daily may kill more tumor cells. Lapatinib ditosylate may stop the growth of tumor cells by blocking some of the enzymes needed for growth. Monoclonal antibodies, such as trastuzumab, can block tumor growth in different ways. Some block the ability of the tumor to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving capecitabine, cyclophosphamide, lapatinib ditosylate, and trastuzumab together may be an effective treatment for breast cancer.
Detailed description
PRIMARY OBJECTIVES: I. To estimate the progression free survival (PFS). SECONDARY OBJECTIVES: I. To evaluate the overall response rate (ORR). II. To evaluate the clinical benefit rate (CBR; complete response, partial response, and stable disease for \>= 24 weeks). III. To estimate the overall survival (OS). IV. To assess the safety and tolerability. OUTLINE: Patients receive capecitabine orally (PO) once daily (QD), cyclophosphamide PO QD, and lapatinib ditosylate PO QD on days 1-21 and trastuzumab intravenously (IV) on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year.
Interventions
DRUGcapecitabine
Given PO
DRUGcyclophosphamide
Given PO
DRUGlapatinib ditosylate
Given PO
BIOLOGICALtrastuzumab
Given IV
OTHERlaboratory biomarker analysis
Correlative studies
Sponsors
National Cancer Institute (NCI)
University of Southern California
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed HER2-positive metastatic breast cancer * HER2 overexpression of tumor by either immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH); tumors tested by IHC must be 3+ positive; tumors tested by FISH must have a ratio of HER2: chromosome enumeration probe (CEP)17 \> 2.0; when both tests are performed, the FISH result must be positive * Prior trastuzumab use in the adjuvant or metastatic setting * No more than two prior cytotoxic chemotherapeutic regimens for metastatic breast cancer. In addition, prior Trastuzumab emtansine (TDM-1, Kadcyla) is allowed. * Eastern Cooperative Oncology Group (ECOG) performance status of =\< 2 * Absolute neutrophil count (ANC) \>= 1500/mm\^3 * Platelets \>= 100,000/mm\^3 * Hemoglobin \>= 9 g/dL * Bilirubin =\< 1.5 x upper limit of normal (ULN) * Serum creatinine =\< 1.5 x ULN or calculated creatinine clearance \>= 60 ml/min * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =\< 2.5 x ULN * Fully recovered from toxicity due to prior therapy * Capable of understanding the informed consent and complying with the protocol and signed the informed consent document prior to any study-specific screening procedures or evaluations being performed * Must be able to swallow pills * May have either measurable or non-measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria * Sexually active participants must agree to use a medically accepted barrier method of contraception (i.e. male condom or female condom) during the course of the study and for 3 months following discontinuation of study treatments; for participants of childbearing potential, a barrier method and a second method of contraception must be used * Participants of childbearing potential must have a negative pregnancy test at screening and enrollment; participants of childbearing potential are defined as premenopausal females capable of becoming pregnant, i.e. females who have had any evidence of menses in the past 12 months with the exception of those who had prior hysterectomy (oophorectomy or surgical sterilization); however, women who have been amenorrheic for \>= 12 months are still considered to be of childbearing potential if the amenorrhea is possibly due to any other cause including prior chemotherapy, antiestrogens, or ovarian suppression
Exclusion criteria
* Prior treatment with capecitabine or lapatinib * Radiation therapy within 2 weeks before the first dose of study treatment * Hormonal therapy within 2 weeks before the first dose of study treatment * Cytotoxic chemotherapy (including investigational cytotoxic chemotherapy) within 3 weeks before the first dose of study treatment * Biologic therapy (including antibodies \[other than trastuzumab\], immune modulators, cytokines) within 4 weeks before the first dose of study treatment; Note: there is no washout period required for trastuzumab * Any other type of investigational agent within 4 weeks before the first dose of study treatment * Major surgery, or not recovered from major surgery within 4 weeks before the first dose of study treatment * Untreated, symptomatic, or progressive brain metastases; participants must have no radiographic or other signs of progression in the brain for \>= 1 month after completion of local therapy; any corticosteroid use for brain metastases must have been discontinued without the subsequent appearance of symptoms for \>= 4 weeks prior to first study treatment * Uncontrolled significant intercurrent illness that would preclude the patient from study participation per investigator assessment * Left ventricular ejection fraction (LVEF) =\< 50% as documented by multi gated acquisition scan (MUGA) or echocardiogram performed within 28 days prior to the first study treatment * Currently receiving anticoagulation with therapeutic doses of warfarin (low-molecular weight heparin is permitted) * Pregnant or breastfeeding * Known to be positive for the human immunodeficiency virus (HIV) (a test for HIV at screening is not required) * Have acute or currently active/requiring anti-viral therapy hepatic or biliary disease (with the exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment) * Previously identified allergy or hypersensitivity or intolerance to components of the study treatment formulation (cyclophosphamide, capecitabine, lapatinib \[lapatinib ditosylate\], trastuzumab) * Any other diagnosis of malignancy or evidence of malignancy (except non-melanoma skin cancer, in-situ carcinoma of the cervix) within 2 years prior to screening for this study * Unable or unwilling to abide by the study protocol or cooperate fully with the investigator or designee
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | From study entry to the date of first documented disease progression (assessed every 6 weeks) or death due to any cause, whichever came first, approximately 63 months. | PFS was defined as duration of time from the first dose of study drug to the first documentation of Progressive Disease (PD) by investigator assessment using RECIST 1.1 or death on study due to any cause on or before the data cutoff date, whichever occurred first. PD: \>=20% increase (\>=5 mm absolute increase) in the sum of target lesion measurements, compared to the smallest sum on study (including baseline), or unequivocal progression of non-target lesions, evaluated as a whole, such that it is clear that treatment has failed and disease is progressing, regardless of the status of the target lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate (ORR) | From study entry until disease progression/recurrence (maximum duration: 351 weeks) | Overall response rate (ORR) is complete response (CR) + partial response (PR) recorded from study entry until disease progression based on RECIST v1.1 criteria. Per RECIST 1.1 for target lesions: CR is complete disappearance of all target lesions and PR is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions. |
| Clinical Benefit Rate (CBR) | From study entry until the date of the first documented disease progression of date of death whichever came first, assessed for approximately 351 weeks | Participants with a best response of CR, PR, or stable disease (SD) sustained for ≥24 weeks, as assessed using RECIST v1.1. CR: Disappearance of all non-nodal target and non-target lesions, including target and non-target lymph nodes reduction to \<10 mm in short axis. PR: \>=30% decrease in sum of diameters of target lesions, compared to the sum at baseline. SD: Neither PR nor progression of disease (PD) criteria met. SD follow PR only when sum increases by less than 20% from the nadir, but previously seen 30% decrease from baseline no longer hold. PD: \>=20% increase (\>=5 mm absolute increase) in the sum of target lesion measurements, compared to the smallest sum on study (including baseline), or unequivocal progression of non-target lesions, evaluated as a whole, such that it is clear that treatment has failed and disease is progressing, regardless of the status of the target lesions. |
| Overall Survival (OS) | From study entry until death from any cause or date of last contact (up to 70 months) | OS is the duration from study entry to death. Participants last known to be alive are censored at date of last contact. |
| Number of Participants With Any Adverse Events as a Measure of Safety and Tolerability | ****Time Frame: Adverse events were collected from first dose of study treatment up to 30 days after last dose of treatment, up to 63 months (number or treatment given ranged from 2 cycles to 85 cycles). | Assessment based on CTCAE version 4.0 toxicity criteria. For the detailed list of adverse events see the adverse event module. |
Countries
United States
Participant flow
Recruitment details
The study began recruiting in July 2013 and ended May 2017. Subjects were recruited from Los Angeles County + University of Southern California (LAC+USC) Healthcare Network and the Keck Medical Center of USC, Norris Comprehensive Cancer Center in Los Angeles, California.
Pre-assignment details
There were no pre-assignment criteria. All subjects were given the same treatment.
Participants by arm
| Arm | Count |
|---|---|
| Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) Patients receive capecitabine by mouth (PO) everyday (QD), cyclophosphamide PO QD, and lapatinib ditosylate PO QD on days 1-21 and trastuzumab IV on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
capecitabine: Given PO
cyclophosphamide: Given PO
lapatinib ditosylate: Given PO
trastuzumab: Given IV
laboratory biomarker analysis: Correlative studies | 10 |
| Total | 10 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Withdrawal by Subject | 1 |
Baseline characteristics
| Characteristic | Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 3 Participants |
| Age, Categorical Between 18 and 65 years | 7 Participants |
| Breast cancer stage at diagnosis II | 5 Participants |
| Breast cancer stage at diagnosis III | 3 Participants |
| Breast cancer stage at diagnosis IV | 2 Participants |
| Cancer Histologic Type (from surgical excision) Ductal Infiltrating Carcinoma | 10 Participants |
| Cancer Histologic Type (from surgical excision) Other | 0 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status Status 0 | 4 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status Status1 | 6 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) White | 8 Participants |
| Region of Enrollment United States | 10 participants |
| Sex: Female, Male Female | 10 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 5 / 10 |
| other Total, other adverse events | 10 / 10 |
| serious Total, serious adverse events | 5 / 10 |
Outcome results
Primary
Progression Free Survival (PFS)
PFS was defined as duration of time from the first dose of study drug to the first documentation of Progressive Disease (PD) by investigator assessment using RECIST 1.1 or death on study due to any cause on or before the data cutoff date, whichever occurred first. PD: \>=20% increase (\>=5 mm absolute increase) in the sum of target lesion measurements, compared to the smallest sum on study (including baseline), or unequivocal progression of non-target lesions, evaluated as a whole, such that it is clear that treatment has failed and disease is progressing, regardless of the status of the target lesions.
Time frame: From study entry to the date of first documented disease progression (assessed every 6 weeks) or death due to any cause, whichever came first, approximately 63 months.
Population: All participants were included in the analysis. Statistical analysis was not performed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) | Progression Free Survival (PFS) | 13.7 months |
Secondary
Clinical Benefit Rate (CBR)
Participants with a best response of CR, PR, or stable disease (SD) sustained for ≥24 weeks, as assessed using RECIST v1.1. CR: Disappearance of all non-nodal target and non-target lesions, including target and non-target lymph nodes reduction to \<10 mm in short axis. PR: \>=30% decrease in sum of diameters of target lesions, compared to the sum at baseline. SD: Neither PR nor progression of disease (PD) criteria met. SD follow PR only when sum increases by less than 20% from the nadir, but previously seen 30% decrease from baseline no longer hold. PD: \>=20% increase (\>=5 mm absolute increase) in the sum of target lesion measurements, compared to the smallest sum on study (including baseline), or unequivocal progression of non-target lesions, evaluated as a whole, such that it is clear that treatment has failed and disease is progressing, regardless of the status of the target lesions.
Time frame: From study entry until the date of the first documented disease progression of date of death whichever came first, assessed for approximately 351 weeks
Population: All patients were included in the analysis. Statistical analysis was not performed.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) | Clinical Benefit Rate (CBR) | 7 Participants |
Secondary
Number of Participants With Any Adverse Events as a Measure of Safety and Tolerability
Assessment based on CTCAE version 4.0 toxicity criteria. For the detailed list of adverse events see the adverse event module.
Time frame: ****Time Frame: Adverse events were collected from first dose of study treatment up to 30 days after last dose of treatment, up to 63 months (number or treatment given ranged from 2 cycles to 85 cycles).
Population: All patients enrolled are included
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) | Number of Participants With Any Adverse Events as a Measure of Safety and Tolerability | 10 Participants |
Secondary
Overall Response Rate (ORR)
Overall response rate (ORR) is complete response (CR) + partial response (PR) recorded from study entry until disease progression based on RECIST v1.1 criteria. Per RECIST 1.1 for target lesions: CR is complete disappearance of all target lesions and PR is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. PR or better overall response assumes at a minimum incomplete response/stable disease (SD) for the evaluation of non-target lesions and absence of new lesions.
Time frame: From study entry until disease progression/recurrence (maximum duration: 351 weeks)
Population: All patients were included in the analysis. Statistical analysis was not performed.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) | Overall Response Rate (ORR) | 4 Participants |
Secondary
Overall Survival (OS)
OS is the duration from study entry to death. Participants last known to be alive are censored at date of last contact.
Time frame: From study entry until death from any cause or date of last contact (up to 70 months)
Population: All enrolled patients were included. Statistical analysis was not performed.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (Chemotherapy, Lapatinib Ditosylate, Trastuzumab) | Overall Survival (OS) | 29.6 Months |