A phase II study with lead-in safety cohort of cabazitaxel (C) plus lapatinib (L) as therapy for HER2+ metastatic breast cancer (MBC) with intracranial metastases (mets).

Authors

null

Denise A. Yardley

Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN

Denise A. Yardley , John D. Hainsworth , Erika Paige Hamilton , Lowell L. Hart , Mythili Shastry , Laura M. DeBusk , Howard A. Burris III

Organizations

Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, Florida Cancer Specialists/SCRI, Fort Myers, FL, Sarah Cannon Research Institute, Nashville, TN

Research Funding

Pharmaceutical/Biotech Company

Background: Although HER2-targeted therapy has improved outcomes in HER2+ breast cancer (BC) patients (pts), CNS mets continue to be a significant source of morbidity and mortality. Inability of drugs like trastuzumab to cross the blood-brain barrier (BBB) renders the CNS a sanctuary site for mets. L is a small molecule tyrosine kinase EGFR1/HER2 inhibitor that crosses the BBB and is active against CNS mets. C is a new taxane approved for prostate cancer that is also active in taxane-resistant metastatic breast cancer (MBC) and distinguishes itself by its ability to cross the BBB. The activity shown by C in taxane-resistant MBC as well as the CNS penetrance of both C and L make this an attractive combination for HER2+ MBC pts with CNS mets. Methods: This is an open-label, non-randomized, phase II study with a lead-in safety cohort (NCT01934894). Pts ≥ 18 yrs with HER2+ (by FISH or IHC 3+) MBC and CNS mets are eligible. Patients must have either at least 1 untreated measurable CNS lesion ≥ 5mm in longest dimension on MRI or at least 1 previously treated (by WBRT and or/SRS) CNS lesion with evidence of intra-cranial disease progression following WBRT or SRS. Pts must have had at least 1 prior HER2 therapy; first line MBC pts are eligible only if they progressed during or within 6 mos of adjuvant therapy. Prior treatment (tx) with C is not permitted. During the lead-in, cohorts of 3 pts will be treated with escalating doses of q 3 weeks (wks) C and daily L to determine the tolerability and optimal dose. Subsequent pts will be treated with the identified optimal dose combination. Each tx cycle is 3 wks and systemic and intra-cranial disease restaging will occur every 2 cycles for the first 8 cycles and then every 3 cycles until PD or unacceptable toxicity. The primary study objectives are to determine the safety and CNS ORR (ORR=CR+PR) of the combination of C and L in HER2+ MBC pts. Secondary objectives include evaluation of the clinical benefit rate ([CBR]CR+PR+SD ≥ 6 mos), 3- and 6-mo PFS rate for CNS mets, and response rate and CBR for extra-cranial mets. The trial is ongoing. Clinical trial information: NCT01934894.

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Abstract Details

Meeting

2014 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Breast Cancer - HER2/ER

Track

Breast Cancer

Sub Track

HER2+

Clinical Trial Registration Number

NCT01934894

Citation

J Clin Oncol 32:5s, 2014 (suppl; abstr TPS667)

DOI

10.1200/jco.2014.32.15_suppl.tps667

Abstract #

TPS667

Poster Bd #

123B

Abstract Disclosures