A Study Inhibiting Telomerase to Reverse Trastuzumab Resistance in HER2+ Breast Cancer

Sponsor

Indiana University (Other)

Overall Status

Completed

CT.gov ID

NCT01265927

Collaborator

Breast Cancer Research Foundation (Other), Geron Corporation (Industry)

Enrollment

Location

Arm

Duration (Months)

0.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

A study to evaluate safety and biologic effects of giving GRN163L in combination with trastuzumab in patients diagnosed with HER2+ metastatic breast cancer that is resistant to therapy with trastuzumab.

Condition or Disease	Intervention/Treatment	Phase
Breast Neoplasms	Drug: GRN163L in combination with trastuzumab	Phase 1

Study Design

Study Type:

Interventional

Actual Enrollment :

10 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase I Study Inhibiting Telomerase to Reverse Trastuzumab Resistance in HER2+ Breast Cancer

Study Start Date :

Jan 1, 2011

Actual Primary Completion Date :

Aug 1, 2012

Actual Study Completion Date :

Oct 1, 2015

Arms and Interventions

Arm	Intervention/Treatment
Experimental: GRN163L + Trastuzumab	Drug: GRN163L in combination with trastuzumab GRN163L will be administered in escalating dose cohorts on Day 1 of each 21-day cycle prior to trastuzumab infusion. Trastuzumab will be a administered day 1 of each 21-day cycle after GRN163L. There will be a 30 minute observation period between the end of the GRN163L infusion and the beginning of the trastuzumab infusion. Other Names: Imetelstat Sodium Herceptin

Arm

Intervention/Treatment

Experimental: GRN163L + Trastuzumab

Drug: GRN163L in combination with trastuzumab

GRN163L will be administered in escalating dose cohorts on Day 1 of each 21-day cycle prior to trastuzumab infusion. Trastuzumab will be a administered day 1 of each 21-day cycle after GRN163L. There will be a 30 minute observation period between the end of the GRN163L infusion and the beginning of the trastuzumab infusion.

Other Names:

Imetelstat Sodium

Herceptin

Outcome Measures

Primary Outcome Measures

Determine the dose-limiting toxicity of GRN163L in combination with trastuzumab in patients with refractory HER2+ metastatic disease [End of Study]

Secondary Outcome Measures

Measure the concentration of trastuzumab and GRN163L from blood samples immediately before and after infusion on day 1, weekly during cycle 1, and immediately prior to cycle 2 [Until cycle 2]
PK data will be described using means, standard deviations, medians, minimums and maximums.
Tumor biopsy and bone marrow aspirate assayed for telomerase activity prior to treatment and immediately prior to planned cycle 2 [Until cycle 2]
Telomerase activity data will be described using means, standard deviations, medians, minimums and maximums.
Flow cytometry to compare cell cycle distribution in tumor and bone marrow prior to treatment and immediately prior to cycle 2. [Until cycle 2]
Marrow (and tumor when sufficient sample is available) will be analyzed via flow cytometry to determine cell distribution. Percentage of cells at each cycle will be described using means, standard deviations, medians, minimums and maximums.
Tumor samples analyzed for activation of HER2 family signaling protein activation (phosphorylation) status prior to treatment and immediately prior to cycle 2. [Until cycle 2]
HER2 family signaling protein activation will be described using means, standard deviations, medians, minimums and maximums.
Determine objective response rate (ORR) and progression free survival (PFS) of GRN163L in combination with trastuzumab in this patient population [End of Study]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Males or females 18 years or older at the time of consent.
ECOG performance status of 0-2 within 21 days of study registration.
Histologically or cytologically confirmed adenocarcinoma of the breast with locally recurrent or metastatic disease. NOTE: locally recurrent disease must not be amenable to surgery or radiation with curative intent.
Measurable or evaluable disease according to RECIST v1.1 within 35 days prior to study registration.
Disease must be amenable to biopsy (image-guided or via direct visualization of superficial lesions) with minimal risk to the patient. NOTE: Patients with disease limited to the lung and/or pleura are excluded.
Disease must be HER2+ as defined by IHC 3+ or FISH ratio > 2.0.
Resistant to trastuzumab as defined as (1) progression within 12 months of completing adjuvant/neoadjuvant trastuzumab or (2) progression on trastuzumab administered for metastatic disease.
Prior treatment with lapatinib or investigational HER2 targeted therapies is allowed but not required. There are no limits on the number of regimens or other prior anti-HER2 therapies patients have received.
LVEF ≥ Lower Limit of Normal based on MUGA or ECHO within 35 days prior to study registration
Females of childbearing potential and males must be willing to use an effective method of contraception from the time consent is signed until 6 months after treatment discontinuation. Methods of contraception include hormonal birth control (oral contraceptives, patch, injection, vaginal ring or implant), two barrier methods of birth control, abstinence and/or other methods as determined by the treating physician.
Females of childbearing potential must have a negative pregnancy test within 14 days prior to registration for protocol therapy.

NOTE: Females are considered of child bearing potential unless they are surgically sterile (they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are postmenopausal (> 12 months since last menses).

Laboratory values must be obtained within 21 days of study registration:

Absolute neutrophil count (ANC) ≥ 1.5 K/mm3
Platelets ≥ 100 K/mm3
Hemoglobin (Hgb) ≥ 9.0 g/dL (may be transfused)
Serum creatinine < 3.0 mg/dL
Total Bilirubin ≤ 1.5 x ULN
AST/SGOT ≤ 2.5 x ULN. If liver metastases is present, AST ≤ 5 x ULN
ALT, SGPT ≤ 2.5 x ULN. If liver metastases is present, ALT ≤ 5 x ULN

Exclusion Criteria:

No Investigational therapy within 4 weeks of study registration
No hormonal therapy within 2 weeks of study registration
No cytotoxic chemotherapy within 2 weeks of study registration.
No prior treatment with GRN163L
No prior history of severe reaction to trastuzumab, as determined by the treating physician.
No history of clinically significant cardiac dysfunction, including:

Current uncontrolled hypertension (systolic >150 mmHg and/or diastolic >100 mmHg), or unstable angina History of symptomatic CHF (Grade >3 by NCI CTCAE or Class >II by NYHA criteria [see Appendix IV]) or serious cardiac arrhythmia requiring treatment within 12 months of study registration, with the exceptions of atrial fibrillation and paroxysmal supraventricular tachycardia History of myocardial infarction within 6 months of study registration

No history of cerebrovascular accident within 12 months of study registration
No active CNS metastases. Patients with previously treated CNS metastases who do not require chronic steroids or anticonvulsants are eligible.
Prior radiation therapy must not have involved > 25% of bone marrow due to potential myelosuppression with GRN163L. See bone marrow chart in Appendix III

NOTE: Radiation therapy within 2 weeks of study registration is not allowed.