PTK787 + Trastuzumab for HER2 Overexpressing Metastatic Breast Cancer

Phase 1

Terminated

Brief Summary: HER2 gene amplification increases VEGF production in breast cancers; combined inhibition of HER2 and VEGF enhances response in xenograft models. The upregulation of VEGF in HER2-overexpressing breast cancers may contribute to the aggressive phenotype observed in HER2-positive breast cancer. New therapeutics targeting VEGF and/or its receptors may enhance the efficacy of trastuzumab monotherapy.

This trial will investigate the safety and efficacy of combined HER2 and VEGF inhibition.

Detailed Description: OUTLINE: This is a multi-center study.

PTK787 daily plus trastuzumab 4 mg/kg IV week 1, followed by 2 mg/kg weekly with disease evaluation every other cycle.

Patients may continue treatment until disease progression or toxicity intervenes.

Performance Status: ECOG 0 or 1

Life Expectancy: Not specified

Hematopoietic:

* ANC \> 1500 mm3

* Platelets \> 100,000 mm3

* Hemoglobin \> 9 g/dL

* PTT and INR \< 1.5 x ULN

Hepatic:

* ALT and AST \< 3 x ULN (\< 5 x ULN in patients with known liver metastases)

* Alkaline phosphatase \< 2.5 x ULN

* Serum bilirubin \< 1.5 x ULN

Renal:

* Serum creatinine \< 1.5 x ULN

* Proteinuria \< 1+ by dipstick OR total urinary protein \< 500 mg/24 hours with measured creatinine clearance (CrCl) ≥ 50 mL/min

Cardiovascular:

* No clinically significant cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease and cardiac arrhythmias not well controlled with medication) or myocardial infarction within the last 6 months.

* LVEF \> LLN by MUGA or ECHO (obtained within 28 days prior to being registered for protocol therapy)

Pulmonary:

* Not specified

Recruitment & Eligibility

Inclusion Criteria

Histologic or cytologic diagnosis of breast cancer with evidence of measurable (1) unresectable, locally recurrent, or (2) metastatic disease. Locally recurrent disease must not be amenable to resection OR radiation with curative intent.
Patient's disease may not involve more than 3 metastatic sites. In addition, patient may not be symptomatic from pulmonary metastasis or have liver metastasis involving > 50% of parenchyma.
HER2 gene amplification by FISH. HER protein overexpression by immunohistochemistry will not be sufficient for entry.
Negative pregnancy test

Exclusion Criteria

No prior cytotoxic chemotherapy or trastuzumab for locally recurrent or metastatic disease.
No prior treatment with any VEGF inhibiting agents
No history or presence of central nervous system (CNS) disease.
No other forms of cancer therapy including radiation, chemotherapy and hormonal therapy within 21 days prior to being registered for protocol therapy.
No major surgery within 28 days prior to being registered for protocol therapy.
No uncontrolled hypertension (SBP > 170, DBP > 90), history of labile hypertension or history of poor compliance with antihypertensive therapy.
No requirement for therapeutic anticoagulation, regular aspirin (> 325 mg/day) or NSAID use.
No current breast feeding.
No impairment of gastrointestinal (GI) function that may significantly alter the absorption of PTK787.
No evidence of other serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator).

Arm && Interventions

Group	Intervention	Description
Single Group Assignment	PTK787	Trastuzumab + PTK787 for HER2 positive patients
Single Group Assignment	Trastuzumab	Trastuzumab + PTK787 for HER2 positive patients

Primary Outcome Measures

Name	Time	Method
Phase I Cohorts:	18 months
Phase II Cohorts:	18 months
The primary objective is to ensure the safety and tolerability of the combination of Trastuzumab and PTK787,	18 months
To assess response rate of PTK787 combined with trastuzumab in patients with newly diagnosed HER2 overexpressing	18 months

Secondary Outcome Measures

Name	Time	Method
Phase II Cohorts:	12 months
To assess the safety and tolerability of PTK787 combined with trastuzumab	12 months
To assess the time to progression and clinical benefit of PTK787 combined with trastuzumab	12 months

Locations (8): Fort Wayne Oncology & Hematology, Inc
🇺🇸
Fort Wayne, Indiana, United States
Indiana University Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Center for Cancer Care at Goshen Health System
🇺🇸
Goshen, Indiana, United States
Medical Consultants, P.C.
🇺🇸
Muncie, Indiana, United States
AP&S Clinic
🇺🇸
Terre Haute, Indiana, United States
Elkhart Clinic
🇺🇸
Elkhart, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
Arnett Cancer Care
🇺🇸
Lafayette, Indiana, United States