Use of PRO Onc Assay to Assess HER2 in Patients With Metastatic Breast Cancer

Use of the PRO Onc Assay to Assess HER2 Overexpression and Activation in Patients With Metastatic Breast Cancer Whose Tumors Are HER2-Negative by Standard FISH Testing

This trial will evaluate the clinical significance of the PRO Onc assay and will assess the efficacy of HER2-targeted therapy in patients with HER2-negative breast cancer who have been identified as having HER2 overexpression/activation by the PRO Onc Assay.

Study Overview

• Status: Completed
• Conditions: Breast Cancer
• Intervention / Treatment: Procedure: PRO Onc Assay and Treatment; Drug: Trastuzumab; Drug: Pertuzumab

Detailed Description

This two-part trial is designed to evaluate the clinical significance of the PRO Onc assay when used in patients with metastatic HER2-negative breast cancer. The first part of this study will determine the incidence of HER overexpression/activation, as determined by the PRO Onc assay, in patients previously judged to have HER2-negative breast cancer by FISH analysis. Blood specimens will be obtained from patients with HER2-negative breast cancer; CTCs will then be isolated and tested for HER2 overexpression/activation using the PRO Onc Assay. When clinically indicated, fine needle aspiration biopsy will also be obtained and submitted for the PRO Onc Assay. If the incidence of HER2 overexpression/activation, as determined by the PRO Onc Assay, is >10%, the study will proceed to Part 2. Part 2 of this study will assess the efficacy of HER2-targeted therapy in a group of patients with HER2-negative breast cancer who are identified as having HER2 overexpression/activation by the PRO Onc Assay. Patients will be treated with either trastuzumab or pertuzumab. Patients who progress during the first 8 weeks will have HER2-targeted treatment discontinued and will be removed from study. After 8 weeks, patients who have stable disease will be allowed to add chemotherapy to HER2-targeted therapy. Patients who have an objective response to single-agent, HER2-targeted therapy after 8 weeks will continue single-agent therapy.

• Study Type: Interventional
• Enrollment (Actual): 283
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Florida
    • Fort Myers, Florida, United States, 33916
      • Florida Cancer Specialists
    • St. Petersburg, Florida, United States, 33705
      • Florida Cancer Specialists
  • Ohio
    • Cincinnati, Ohio, United States, 45242
      • Oncology Hematology Care, Inc.
  • Tennessee
    • Chattanooga, Tennessee, United States, 37404
      • Chattanooga Oncology Hematology Associates
    • Nashville, Tennessee, United States, 37023
      • Tennessee Oncology, PLLC
  • Texas
    • Fort Worth, Texas, United States, 76104
      • Center for Cancer and Blood Disorders
  • Virginia
    • Richmond, Virginia, United States, 23230
      • Virginia Cancer Institute

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

Inclusion Criteria:

Part I

1. Women with HER2-negative breast cancer, as defined by FISH testing. (FISH testing may have been performed on the primary tumor, or subsequently on a biopsy of a metastatic lesion.)
2. Patients should be currently receiving chemotherapy, or scheduled to start chemotherapy (second-line or subsequent), for HER2-negative metastatic breast cancer.
3. To begin protocol treatment, patients must have progressed after at least 1 previous chemotherapy regimen for metastatic breast cancer.
4. Patients who are ER/PR positive or negative are eligible. ER/PR positive patients should be refractory to hormonal therapy, or not good candidates for hormonal therapy due to clinical features.
5. ECOG performance status of 0, 1 or 2.
6. Adequate recovery from recent surgery; ≥ 1 week must have elapsed from the time of a minor surgery; ≥ 4 weeks must have elapsed from the time of a major surgery.
7. Patients must have measurable disease per RECIST criteria.

8. Laboratory values as follows: Absolute neutrophil count (ANC) ≥1500/μL Hemoglobin (Hgb) ≥10 g/dL Platelets ≥100,000/L AST or ALT and alkaline phosphatase (ALP) must be <2.5 x ULN, or <5 x ULN in patients with liver metastases. Total bilirubin <1.5 x the institutional ULN Serum creatinine <1.5 x institutional ULN or calculated creatinine clearance ≥45 mL/min

   Patients from Part 1 who have HER2 overexpression/activation identified by the PRO Onc Assay may enter the treatment portion of Part 2, if they meet all Part 2 eligibility criteria.

9. Life expectancy of ≥ 12 weeks.
10. Patient must be accessible for treatment and follow-up.
11. Patients must be able to understand the investigational nature of this study and give written informed consent prior to study entry.

Part II

1. Women with HER2-negative breast cancer, as defined by FISH testing. (FISH testing may have been performed on the primary tumor, or subsequently on a biopsy of a metastatic lesion.)
2. Patients should be currently receiving chemotherapy, or scheduled to start chemotherapy, for HER2-negative metastatic breast cancer.
3. Patients who are ER/PR positive or negative are eligible. ER/PR positive patients should be refractory to hormonal therapy, or not good candidates for hormonal therapy due to clinical features.
4. ECOG performance status of 0, 1 or 2.
5. Adequate recovery from recent surgery; ≥ 1 week must have elapsed from the time of a minor surgery; ≥ 4 weeks must have elapsed from the time of a major surgery.
6. Patients must have measurable disease per RECIST criteria.

7. Laboratory values as follows:

   • Absolute neutrophil count (ANC) ≥1500/μL
   • Hemoglobin (Hgb) ≥10 g/dL
   • Platelets ≥100,000/uL
   • AST or ALT and alkaline phosphatase (ALP) must be <2.5 x ULN, or <5 x ULN in patients with liver metastases.
   • Total bilirubin <1.5 x the institutional ULN
   • Serum creatinine <1.5 x institutional ULN or calculated creatinine clearance ≥45 mL/min
8. Life expectancy of ≥ 12 weeks.
9. Patient must be accessible for treatment and follow-up.
10. Patients must be able to understand the investigational nature of this study and give written informed consent prior to study entry.
11. Patients who are eligible for HER2-targeted treatment will begin this treatment at the first time a treatment change is necessary (i.e. at the next progression of metastatic breast cancer). This may occur immediately after PRO Onc assay results are received, or may be several months later, for patients responding well to their current chemotherapy.
12. Patients must continue to meet all inclusion and exclusion criteria for the Part 2 screening population at the time they are ready to start HER2-targeted treatment.
13. Ejection fraction ≥ 50%, as measured by echocardiogram (ECHO) or MUGA.

Exclusion Criteria:

Part I:

1. Patients currently responding to hormonal therapy.
2. Previous treatment with any HER2-targeted agent.
3. Patients with meningeal metastases.
4. Patients who are not considered likely candidates for subsequent therapy after next progression of metastatic breast cancer.
5. Women who are pregnant or lactating.
6. Patients with New York Heart Association class II or greater congestive heart failure.

7. Any of the following ≤6 months prior to starting study treatment:

   • myocardial infarction;
   • severe unstable angina;
   • ongoing cardiac dysrhythmia
8. Concurrent severe, intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit safety and compliance with study requirements.
9. Mental condition that would prevent patient comprehension of the nature of, and risk associated with, the study.
10. Use of any non-approved or investigational agent ≤ 30 days of administration of the first dose of study drug. Patients may not receive any other investigational or anti-cancer treatments while participating in this study.

Part II

1. Patients currently responding to hormonal therapy.
2. Previous treatment with any HER2-targeted agent.
3. Patients with meningeal metastases.
4. Patients with active brain metastases. Patients who have received radiation or surgery for brain metastases are eligible if there is no evidence of central nervous system (CNS) disease progression, and at least 4 weeks have elapsed since treatment. Ideally, patients should not still require use of seizure medication or steroids.
5. Patients who are not considered likely candidates for subsequent therapy after next progression of metastatic breast cancer.
6. Women who are pregnant or lactating.
7. Patients with New York Heart Association class II or greater congestive heart failure.

8. Any of the following ≤6 months prior to starting study treatment:

   • myocardial infarction;
   • severe unstable angina;
   • ongoing cardiac dysrhythmia.
9. Concurrent severe, intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit safety and compliance with study requirements.
10. Mental condition that would prevent patient comprehension of the nature of, and risk associated with, the study.
11. Use of any non-approved or investigational agent ≤ 30 days of administration of the first dose of study drug. Patients may not receive any other investigational or anti-cancer treatments while participating in this study.
12. Past or current history of neoplasm other than the entry diagnosis with the exception of treated non-melanoma skin cancer or carcinoma in situ of the cervix, or other cancers cured by local therapy alone and a DFS ≥5 years.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: PRO Onc Assay and Treatment; Blood specimens tested for circulating tumor cells followed by systemic treatment based on assay results with either trastuzumab or pertuzumab

Procedure: PRO Onc Assay and Treatment; Patients with HER2-negative metastatic breast cancer will be identified, and blood specimens will be obtained from each participant. The PRO Onc Assay will be performed on CTCs isolated from these specimens. When clinically indicated, fine needle aspiration biopsy will also be obtained and submitted for the PRO Onc Assay.; Other Names: blood draw; fine needle aspiration; circulating tumor cells; Drug: Trastuzumab; 8 mg/kg IV loading dose, followed by 6 mg /kg IV every 3 weeks until progressive disease or unacceptable toxicity with evaluations performed every 8 weeks; Other Names: Herceptin; Drug: Pertuzumab; 840 mg IV loading dose, followed by 420 IV every 3 weeks until progressive disease or unacceptable toxicity with evaluations performed every 8 weeks; Other Names: Perjeta

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Part II: Objective Response Rate of HER2-negative Metastatic Breast Cancer (by FISH Testing)	The percentage of HER2-negative metastatic breast cancer (MBC) patients having an objective benefit from treatment per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI or CT: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. Includes patients with HER2 overexpression/activation as detected by PRO Onc Assay.	18 months
Part II: Objective Response Rate of Trastuzumab Therapy	The percentage of patients having an objective benefit from treatment per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI or CT: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. Includes patients with HER2 overexpression as identified by the PRO Onc Assay.	18 months
Part II: Objective Response Rate of Pertuzumab Therapy	The percentage of patients with HER2 activation (no overexpression) as identified by the PRO Onc Assay who experience an objective benefit from treatment, per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI or CT: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.	18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Part 1: The Incidence of HER2 Overexpression/Activation as Measured by the PRO Onc Assay	Includes patients with HER2-negative metastatic breast cancer (MBC) as determined by FISH testing.	12 months
Part I: The Incidence of Isolation of Circulating Tumor Cells (CTCs) From Blood Specimens	Percentage of HER2-negative MBC patients (identified by FISH testing) having CTCs present in blood specimens.	12 months

Collaborators and Investigators

• Sponsor: SCRI Development Innovations, LLC
• Collaborators: Genentech, Inc.; Prometheus Laboratories
• Investigators: Study Chair: John D. Hainsworth, M.D., SCRI Development Innovations, LLC

Publications and helpful links

General Publications

• Hainsworth JD, Murphy PB, Alemar JR, Daniel BR, Young RR, Yardley DA. Use of a multiplexed immunoassay (PRO Onc assay) to detect HER2 abnormalities in circulating tumor cells of women with HER2-negative metastatic breast cancer: lack of response to HER2-targeted therapy. Breast Cancer Res Treat. 2016 Nov;160(1):41-49. doi: 10.1007/s10549-016-3969-7. Epub 2016 Sep 8.

Study record dates

Study Major Dates

• Study Start: January 1, 2011
• Primary Completion (Actual): July 1, 2014
• Study Completion (Actual): July 1, 2014

Study Registration Dates

• First Submitted: January 12, 2010
• First Submitted That Met QC Criteria: January 12, 2010
• First Posted (Estimate): January 13, 2010

Study Record Updates

• Last Update Posted (Estimate): January 29, 2016
• Last Update Submitted That Met QC Criteria: December 22, 2015
• Last Verified: December 1, 2015

More Information

Terms related to this study

• Keywords: Breast Cancer; Metastatic; PRO Onc Assay; FISH Testing; HER Negative; HER Overexpression; HER Activation
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Antineoplastic Agents; Antineoplastic Agents, Immunological; Trastuzumab; Pertuzumab
• Other Study ID Numbers: SCRI BRE 166