Phase II Study With the Trifunctional Antibody Ertumaxomab to Treat Metastatic Breast Cancer After Progression on Trastuzumab Therapy

Phase II Study Of The Trifunctional Bispecific Anti-HER-2/Neu x Anti-CD3 Antibody Ertumaxomab In Patients With HER-2/Neu Overexpressing (3+ Or 2+/FISH+) Metastatic Breast Cancer Progressing After Trastuzumab Treatment

This study has the purpose to demonstrate clinical efficacy of the investigational new drug ertumaxomab in patients with human epidermal growth factor receptor-2 (HER-2/neu) overexpressing (3+ or 2+ with a positive Fluorescence In Situ Hybridization (FISH) test result) metastatic breast cancer progressing after trastuzumab treatment.

Ertumaxomab is a trifunctional bispecific antibody targeting Her-2/neu on tumor cells and CD3 on T cells. Trifunctional antibodies represent a new concept for targeted anticancer therapy. This new antibody class has the capability to redirect T cells and accessory immune effector cells (e.g. macrophages, dendritic cells [DCs] and natural killer [NK] cells) to the tumor site. According to preclinical data, trifunctional antibodies activate these immune cells, which can trigger a complex anti-tumor immune response.

Study Overview

• Status: Terminated
• Conditions: Advanced Breast Cancer; Metastatic Breast Cancer
• Intervention / Treatment: Drug: ertumaxomab

Detailed Description

This study is an open-label, non-randomized, uncontrolled, two-stage phase II study evaluating the efficacy and safety of ertumaxomab. Ertumaxomab will be administered three times at 7 day intervals by constant rate 3 hour intravenous (i.v.) infusions according to the following dose schedule: 10 µg (day 0); 100 µg (day 7 ± 1 day) and 100 µg (day 14 ± 1 day) (flat doses).

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada
  • Quebec
    • Montreal, Quebec, Canada
• United States
  • Minnesota
    • Minneapolis, Minnesota, United States
  • New Hampshire
    • Lebanon, New Hampshire, United States
  • New York
    • New York, New York, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Key Inclusion Criteria:

• Women ≥ 18 years, Negative pregnancy test at screening and life expectancy of at least 3 months
• metastatic (stage IV) and not curable adenocarcinoma of the breast
• Measurable disease, defined as at least one lesion that is measurable in one dimension (RECIST)
• HER-2 overexpression 3+ or 2+ FISH positive
• Patients must have received one prior therapy with trastuzumab as last treatment before entry into the study. If trastuzumab was given as single agent treatment, patients must have received prior chemotherapy for metastatic disease
• Trastuzumab has been discontinued before study entry
• disease had progressed during or after trastuzumab therapy
• Eastern Cooperative Oncology Group (ECOG)performance score of ≤ 2
• Adequate hematological, liver and kidney function

Key Exclusion Criteria:

• Women who are pregnant or breast feeding
• Any history or symptoms indicative of brain or central nervous system metastases
• Prior diagnosis of any malignancy not cured by surgery alone less than 5 years before study entry (except in situ carcinoma of the cervix or adequately treated basal cell carcinoma of the skin)
• Human anti-murine antibody positive or hypersensitivity to murine proteins and any other component of the study drug
• Known autoimmune diseases, Human immunodeficiency virus (HIV), hepatitis B or C infection as well as other acute or chronic infection or other concurrent non-malignant co-morbidities that are uncontrolled
• Any concurrent chemotherapy, hormonal therapy, immunotherapy or corticoid therapy
• Concurrent antibiotic treatment
• Any concurrent investigational treatment for metastatic disease

Cardiovascular exclusion criteria:

• Unstable or uncontrolled pectorial angina
• Myocardial infarction during the last 6 months
• Valvular heart disease that requires treatment
• Cardiomyopathy (congestive, hypertrophic or restrictive)
• Acute myocarditis
• Congestive heart failure (CHF): dyspnea, clinically or radiologically diagnosed
• Left ventricular ejection fraction (LVEF)outside institution's normal range based on echocardiography at rest
• Left ventricular diameter > 56 mm based on M-mode echocardiography at rest
• Arrhythmias that require treatment (atrioventricular block II/III degree, atrial fibrillation, ventricular tachycardia)
• Poorly or uncontrolled hypertension, asthma, seizures, allergies, pulmonary dysfunction

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Clinical Efficacy Measured by Objective Response Rate (Best Response During the Course of the Study)	patients are monitored for 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of Response	The study was prematurely terminated, therefore no participants were analyzed	patients are monitored for 6 months
Clinical Benefit Rate	The study was prematurely terminated, therefore no participants were analyzed	patients are monitored for 6 months

Collaborators and Investigators

• Sponsor: Neovii Biotech
• Collaborators: Fresenius Biotech North America
• Investigators: Principal Investigator: Gary Schwartz, MD, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center; Lebanon, NH

Publications and helpful links

General Publications

• Ruf P, Lindhofer H. Induction of a long-lasting antitumor immunity by a trifunctional bispecific antibody. Blood. 2001 Oct 15;98(8):2526-34. doi: 10.1182/blood.v98.8.2526.
• Riesenberg R, Buchner A, Pohla H, Lindhofer H. Lysis of prostate carcinoma cells by trifunctional bispecific antibodies (alpha EpCAM x alpha CD3). J Histochem Cytochem. 2001 Jul;49(7):911-7. doi: 10.1177/002215540104900711.
• Zeidler R, Mysliwietz J, Csanady M, Walz A, Ziegler I, Schmitt B, Wollenberg B, Lindhofer H. The Fc-region of a new class of intact bispecific antibody mediates activation of accessory cells and NK cells and induces direct phagocytosis of tumour cells. Br J Cancer. 2000 Jul;83(2):261-6. doi: 10.1054/bjoc.2000.1237.
• Zeidler R, Reisbach G, Wollenberg B, Lang S, Chaubal S, Schmitt B, Lindhofer H. Simultaneous activation of T cells and accessory cells by a new class of intact bispecific antibody results in efficient tumor cell killing. J Immunol. 1999 Aug 1;163(3):1246-52.
• Kiewe P, Hasmuller S, Kahlert S, Heinrigs M, Rack B, Marme A, Korfel A, Jager M, Lindhofer H, Sommer H, Thiel E, Untch M. Phase I trial of the trifunctional anti-HER2 x anti-CD3 antibody ertumaxomab in metastatic breast cancer. Clin Cancer Res. 2006 May 15;12(10):3085-91. doi: 10.1158/1078-0432.CCR-05-2436.

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): December 1, 2009
• Study Completion (Actual): December 1, 2009

Study Registration Dates

• First Submitted: August 28, 2007
• First Submitted That Met QC Criteria: August 28, 2007
• First Posted (Estimate): August 29, 2007

Study Record Updates

• Last Update Posted (Estimate): April 29, 2011
• Last Update Submitted That Met QC Criteria: April 28, 2011
• Last Verified: April 1, 2011

More Information

Terms related to this study

• Keywords: Breast Cancer; Immunotherapy; Metastatic breast cancer; drug therapy; Her-2/neu; Antineoplastic Protocols; Stage IV breast cancer; Advanced breast cancer; investigational drug; Her-2/neu expressing breast cancer; Trastuzumab refractory
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms
• Other Study ID Numbers: IV-ERT-BC-04