Brain Metastases, Breast Cancer
Conditions
Keywords
breast cancer, brain metastasis, Palbociclib, CDK4/6 inhibitor, pyrotinib, fulvestrant, trastuzumab, HER2-positive, ER/PR positive, hormonal receptor positive
Brief summary
The objective of this study is to evaluate the efficacy of combination of palbociclib, trastuzumab and pyrotinib with fulvestrant in ER/PR positive and HER2-positive breast cancer patients with brain metastasis.
Interventions
DRUGPalbociclib, Trastuzumab, Pyrotinib and Fulvestrant
ER/PR positive, HER2-positive breast cancer patients with brain metastatic lesions receive palbociclib PO daily on days 1-21, combined with trastuzumab IV every three weeks, pyrotinib PO daily and fulvestrant IM every 4 weeks. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Sponsors
Sun Yat-sen University
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
1. Age greater than 18 years old 2. Female patients aged 18 years or older 3. Histologically confirmed ER/PR positive, HER2-positive metastatic breast cancer (ER/PR≥1% by IHC; HER-2 3+ by immunohistochemistry (IHC); if IHC score of 2, fluorescence in situ hybridization (FISH) ratio must be greater than 2.0; if FISH less than 2.0, HER2 copy number must be greater than 6; NOTE: Brain lesions are not required to have pathologic confirmation) 4. Patients must have a life expectancy of at least 12 weeks at the time of registration 5. Eastern Cooperative Oncology Group (ECOG) performance status \>= 2 6. Measurable disease in the brain, defined as at least 1 lesion measuring \>= 10 mm on MRI at the time of registration 7. If patients are on corticosteroids, they must have been on a stable or decreasing dose \>= 5 days prior to obtaining their baseline gadolinium (Gd)-magnetic resonance imaging (MRI) of brain; this MRI is to be obtained within 28 days of registration; NOTE: If patient needs escalation of steroids prior to therapy, or are on unstable doses of steroids they are not eligible 8. Patients who have a history of hypersensitivity reaction to one of the compounds or incorporated substances used in this protocol; AND/OR patients who have had prior exposure to fulvestrant, everolimus, pyrotinib or CDK4/6 inhibitors and had a disease progression during treatment are not eligible. 9. Patients must not have received systemic therapy within 2 weeks of initiating palbociclib; NOTE: For patients on trastuzumab, they can remain on the drug; no break or washout period required 10. Patients must exhibit adequate bone marrow, liver, and renal function, within 14 days prior to registration, defined as: 11. Absolute neutrophil count (ANC) \>= 1,000/mm\^3 (growth factor support is permitted) 12. Platelets \>= 50,000/mm\^3 (may be reached by transfusion) 13. Hemoglobin \>= 10 gm/dl (may be reached by transfusion) 14. Glutamate pyruvate transaminase (GPT)/glutamate oxaloacetate transaminase (GOT) \< 3 x upper limit of normal (ULN) (or \< 5 x ULN in case of liver metastasis) 15. Bilirubin \< 3 x ULN (or \< 5 x ULN in case of liver metastasis) 16. Creatinine \< 1.5 x ULN 17. Women of childbearing age must have a serum pregnancy test within 7 days before enrollment, and the result should be negative, and are willing to use a medically recognized high-efficiency contraceptive during the study period and within 1 year after the last administration of the study drug. 18. Has not undergone a hysterectomy or bilateral oophorectomy 19. Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for \> 12 months) 20. Female patients must have a negative urine pregnancy test within 7 days prior to registration; if urine test is positive, it should be followed by serum pregnancy test 21. Patients must sign an informed consent prior to registration and before undergoing any study-specific procedures indicating that they are aware of the investigational nature of this study 22. Patient must have the ability to comply with all study requirements
Exclusion criteria
1. Any uncontrolled neurological symptom attributed to CNS metastasis 2. Brain metastasis must not be impending herniation or other significant vasogenic edema requiring increasing steroid doses; lesions must not have frank hemorrhage 3. Patients with leptomeningeal disease are not eligible for participation 4. Patients have been treated with WBRT. The selected intracranial target lesion has received local treatment (surgical resection or SRS). Acute effects related to surgery or SRS have not recover 5. Any significant medical illnesses or infection that, in the investigator's opinion, cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy are not eligible for participation 6. Known human immunodeficiency virus (HIV) positive status 7. Known active hepatitis B and/or C 8. Patients who have a history of hypersensitivity reaction to one of the compounds or incorporated substances used in this protocol; AND/OR patients who have had prior exposure to compounds of similar chemical or biologic composition to palbociclib or lapatinibpyrotinib and PD during treatment are not eligible. 9. Patients being treated with any other experimental agents/clinical trials are not eligible for participation; if the patient is on any investigational agent, a wash-out period of minimum 2 weeks prior to registration is mandatory for the patient to be eligible for the study 10. Inability to swallow capsules, malabsorption syndrome or gastrointestinal disease that severely affects the absorption of study drugs, major resection of the stomach or small bowel, or gastric bypass procedure 11. Patients who have an uncontrolled intercurrent illness including, but not limited to any of the following, are not eligible: 12. Ongoing or active infection requiring systemic treatment 13. Symptomatic congestive heart failure 14. Unstable angina pectoris 15. Cardiac arrhythmia: except atrial fibrillation (AF) and supraventricular tachycardia (SVT) that are controlled by medication 16. Psychiatric illness/social situations that would limit compliance with study requirements 17. Any other illness or condition that the treating investigator feels would interfere with study compliance or would compromise the patient's safety or study endpoints
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective response rate in the CNS | Up to 3 years | Assess the response rate in the CNS by MRI according to modified Response Assessment in modified RECIST 1.1 criteria. Objective CNS response is defined as at least 30% decrease in the sum of diameters of CNS target lesions in the absence of new lesions (defined as ≥ 6 mm), increased steroid use, progressive neurological symptoms, and progressive extra-CNS disease as assessed by RECIST 1.1. Confirmatory scans are not required. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Up to 3 years | OS is defined as the time from treatment initiation until death due to any cause |
| Progression Free Survival | Up to 3 years | PFS is defined as the time from treatment initiation to documented disease progression |
| Time to CNS progression | Up to 3 years | Time to CNS progression will be defined as the time from treatment initiation to documented disease progression (modified RECIST 1.1 criteria) in the CNS |
| Time to radiotherapy | Up to 3 years | Time to radiotherapy is defined as the time from the date of inclusion to the date of event defined as the initiation of radiotherapy |
| Overall Response Rate | Up to 3 years | Evaluate systemic ORR defined as partial response or complete response assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in quality of life in patients receiving study drug combination | At baseline, 2 months and 4 months | Quality of life measures will be assessed at baseline, 2 months and 4 and will be collected using patient reported outcome questionnaires: Functional Assessment of Cancer Therapy-Brain (FACT-Br), EORTC QLQ-BR23 |
Countries
China
Outcome results
None listed