Lapatinib Ditosylate and Capecitabine in Treating Patients With Stage IV Breast Cancer and Brain Metastases

A Multicenter Phase II Clinical Trial Assessing the Efficacy of the Combination of Lapatinib and Capecitabine in Patients With Non Pretreated Brain Metastasis From HER2 Positive Breast Cancer

RATIONALE: Lapatinib ditosylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Drugs used in chemotherapy, such as capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving lapatinib ditosylate together with capecitabine may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving lapatinib ditosylate together with capecitabine works in treating patients with stage IV breast cancer and brain metastases.

Study Overview

• Status: Completed
• Conditions: Breast Cancer; Metastatic Cancer
• Intervention / Treatment: Other: laboratory biomarker analysis; Drug: capecitabine; Drug: lapatinib ditosylate; Other: circulating tumor cell analysis

Detailed Description

OBJECTIVES:

Primary

• To assess the objective response rate by volumetric analysis of brain metastasis as assessed by MRI in patients with HER2-positive stage IV breast cancer treated with lapatinib ditosylate and capecitabine.

Secondary

• To document any toxicity evaluated by NCI CTC v3.0.
• To assess the time to radiotherapy.
• To document the time to disease progression in the central nervous system (CNS) of these patients.
• To evaluate the overall response rate for extra-CNS disease.
• To assess the clinical benefit (complete response, partial response, and stable disease for ≥ 6 months) for both CNS and extra-CNS disease in these patients.

Tertiary

• To evaluate serum proteomics and metabonomics markers as predictors of response.
• To evaluate the predictive value of circulating tumor cells (CTC) on response.

OUTLINE: This is a multicenter study.

Patients receive oral lapatinib ditosylate once daily. Patients also receive oral capecitabine twice daily on days 1-14. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically.

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Phase 2

Contacts and Locations

Study Locations

• France
  • Lyon, France, 69373
    • Centre Léon Bérard

Participation Criteria

Eligibility Criteria

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

Description

DISEASE CHARACTERISTICS:

• Histologically confirmed invasive breast cancer

  • Stage IV disease

• At least 1 measurable CNS lesion ≥ 10 mm on T1-weighted gadolinium-enhanced MRI

  • No single brain metastasis that could be treated by surgery
• HER-2 positive primary tumor as defined as IHC3+ or IHC2+ and FISH-positive
• Hormone receptor status: not specified

PATIENT CHARACTERISTICS:

• Menopausal status not specified
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2
• Life expectancy ≥ 3 months
• Absolute Neutrophil Count (ANC) ≥ 1,000/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 10g/dL
• Creatinine ≥ 1.5 times upper limit of normal (ULN)
• Albumin ≥ 2.5 g/dL
• Serum bilirubin ≤ 1.5 times ULN (unless due to Gilbert's syndrome)
• ASAT and ALAT ≤ 3 times ULN (≤ 5 times ULN with documented liver metastasis)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception 2 weeks before, during, and for 28 days after completion of study treatment (female) or for 1 week after completion of treatment (male)
• Able to swallow and retain oral medication
• Affiliated to a Social Security System
• No known contraindication to MRI
• No prior or active malignancy, unless disease free for ≥ 10 years

• No other concurrent severe and/or uncontrolled medical disease which could compromise study participation, including any of the following:

  • Infection
  • Cardiac disease (e.g., uncontrolled hypertension, congestive cardiac failure, ventricular arrhythmias, active ischemic heart disease, myocardial infarction within the past year, Left Ventricular EJection Fraction (LVEF) > grade 2)
  • Current active hepatic or biliary disease (except for Gilbert syndrome, asymptomatic gallstones, liver metastasis or stable chronic liver disease per investigator assessment)
  • Renal disease
  • Active gastrointestinal (GI) tract ulceration, malabsorption syndrome, active uncontrolled ulcerative colitis, or disease significantly affecting GI function
  • Severely impaired lung function (e.g., spirometry and diffusion capacity of lung for carbon monoxide (DLCO) ≤ 50% of normal, and O_2 saturation ≤ 88% at rest on room air)
• No known dihydropyrimidine dehydrogenase deficiency
• No significantly altered mental status prohibiting the understanding of the study, or with psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
• Not deprived of liberty or placed under the authority of a tutor

PRIOR CONCURRENT THERAPY:

• At least 2 weeks since prior breast cancer treatment (e.g., trastuzumab, chemotherapy, immunotherapy or biological response modifiers, endocrine therapy, or radiotherapy)
• More than 30 days since prior investigational drugs
• More than 14 days since prior and no concurrent strong inhibitors or inducers of the cytochrome P450 isoenzyme 3A4 (CYP3A4) (i.e., clarithromycin, ketoconazole, itraconazole, voriconazole, ritonavir)
• No prior whole brain radiotherapy (WBRT) or brain stereotactic radiotherapy
• No prior treatment with capecitabine and/or lapatinib ditosylate
• No prior resection of the stomach or small bowel
• No concurrent systemic treatment or radiation therapy for breast cancer (except corticosteroid, bisphosphonates, or mannitol)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lapatinib + capecitabine; lapatinib 1250mg/day + capecitabine 2000mg/m2/day	Other: laboratory biomarker analysis; Drug: capecitabine; Drug: lapatinib ditosylate; Other: circulating tumor cell analysis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Objective response rate	february 2012

Secondary Outcome Measures

Outcome Measure	Time Frame
Toxicity as assessed by NCI CTC v3.0	february 2012
Time to radiotherapy	february 2012
Time to disease progression	february 2012
Overall response rate	february 2012
Clinical benefit (complete response, partial response, and stable disease for at least 6 months)	february 2012
Evaluation of serum proteomics and metabonomics markers as predictors of response	may 2012
Evaluation of the predictive value of circulating tumor cells on response	february 2012

Collaborators and Investigators

• Sponsor: UNICANCER
• Investigators: Principal Investigator: Thomas BACHELOT, MD, Centre Léon Bérard

Publications and helpful links

General Publications

• Pierga JY, Bidard FC, Cropet C, Tresca P, Dalenc F, Romieu G, Campone M, Mahier Ait-Oukhatar C, Le Rhun E, Goncalves A, Leheurteur M, Domont J, Gutierrez M, Cure H, Ferrero JM, Labbe-Devilliers C, Bachelot T. Circulating tumor cells and brain metastasis outcome in patients with HER2-positive breast cancer: the LANDSCAPE trial. Ann Oncol. 2013 Dec;24(12):2999-3004. doi: 10.1093/annonc/mdt348. Epub 2013 Sep 6.
• Bachelot T, Romieu G, Campone M, Dieras V, Cropet C, Dalenc F, Jimenez M, Le Rhun E, Pierga JY, Goncalves A, Leheurteur M, Domont J, Gutierrez M, Cure H, Ferrero JM, Labbe-Devilliers C. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol. 2013 Jan;14(1):64-71. doi: 10.1016/S1470-2045(12)70432-1. Epub 2012 Nov 2.

Study record dates

Study Major Dates

• Study Start: April 1, 2009
• Primary Completion (Actual): February 1, 2012

Study Registration Dates

• First Submitted: August 26, 2009
• First Submitted That Met QC Criteria: August 26, 2009
• First Posted (Estimate): August 27, 2009

Study Record Updates

• Last Update Posted (Estimate): January 18, 2013
• Last Update Submitted That Met QC Criteria: January 17, 2013
• Last Verified: January 1, 2013

More Information

Terms related to this study

• Keywords: stage IV breast cancer; male breast cancer; HER2-positive breast cancer; tumors metastatic to brain
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Central Nervous System Neoplasms; Nervous System Neoplasms; Breast Neoplasms; Brain Neoplasms; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Protein Kinase Inhibitors; Capecitabine; Lapatinib
• Other Study ID Numbers: CDR0000642631; EU-20940; GEP 02-0801; 2008-001084-10 (EudraCT Number)