A Phase I-II Study of Dasatinib in Combination With Weekly Paclitaxel for Patients With Metastatic Breast Carcinoma
- Female or male patients with diagnosis of invasive adenocarcinoma of the breast
confirmed at MSKCC.
- For the phase I portion, patients with any ER/PR/HER2 disease status, no longer
eligible for hormonal therapy or HER2-targeted therapy, will be eligible.
- For the phase II portion, there needs to be documentation of negative HER2 (IHC 0-1+
or FISH/CISH negative) status. Patients with any ER/PR disease status are eligible.
- A paraffin-embedded tissue block or unstained slides from prior surgery must be
- Evidence of recurrent or progressive locally advanced or metastatic breast cancer.
- For the phase I portion: at least one evaluable or measurable metastatic lesion ,
- For the phase II portion: at least one measurable metastatic lesion according to the
RECIST criteria which has not been irradiated (i.e. newly arising lesions in
previously irradiated areas are accepted). Ascites, pleural effusion, and bone
metastases are not considered measurable. Minimum indicator lesion size: > or = to 10
mm measured by spiral CT or > or = to 20 mm measured by conventional techniques.
For the phase I portion: Any number of prior endocrine or biologic therapies is permitted
. In addition, patients may be untreated in the metastatic setting or have received any
number of prior cytotoxic regimens.
For the phase II portion: 0-2 prior therapies for metastatic disease are allowed.
Prior taxane therapy, either in the adjuvant or in the metastatic setting, either deliver
weekly, q 2 weeks or q 3 weeks, will be permitted. Prior therapy with bevacizumab will be
allowed. All previous chemotherapy, radiotherapy and intravenous biphosphonates must have
been discontinued at least 3 weeks prior to study entry, 3 weeks also for trastuzumab and
bevacizumab. All acute toxic effects (excluding alopecia) of any prior therapy must have
resolved to NCI CTC (Version 3) Grade ≤1.
- Endocrine therapy with an aromatase inhibitor, SERM (ie, tamoxifen) or fulvestrant is
permitted, however it must be discontinued before enrolling in the study.
- ECOG performance status of 0 or 1.
- Age > or = to 18 years old. Adequate Organ Function
- Total bilirubin ≤ 1.5 times the institutional Upper Limit of Normal (ULN)
- Hepatic enzymes (AST, ALT ) ≤ 2.5 times the institutional ULN
- Serum Na, K+, Mg2+, Phosphate and Ca2+≥ Lower Limit of Normal (LLN)
- Serum Creatinine ≤ 1.5 time the institutional ULN
- Neutrophil count, Platelets, both Grade 0-1
- PT (INR) and PTT Grade 0-1, except for patients on Coumadin or low molecular weight
- Ability to take oral medication (dasatinib must be swallowed whole)
- Patient agrees to discontinue St. Johns Wort while receiving dasatinib therapy
- Patient agrees that IV biphosphonates will be withheld for the first 8 weeks of
dasatinib therapy due to risk of hypocalcemia. Concomitant Medications, any of the
following should be considered for exclusion:
Patient agrees to discontinue QT-prolonging agents strongly associated with Torsades de
Pointes including: (patients must discontinue drug ≥ 7 days prior to starting dasatinib)
- quinidine, procainamide, disopyramide
- amiodarone, sotalol, ibutilide, dofetilide
- erythromycin, clarithromycin
- chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
- cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone,
halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine.
- The concomitant use of H2 blockers or proton pump inhibitors with dasatinib is not
recommended. The use of antacids should be considered in place of H2 blockers or
proton pump inhibitors in patients receiving dasatinib therapy. If antacid therapy is
needed, the antacid dose should be administered at least 2 hours prior to or 2 hours
after the dose of dasatinib.
- Patient may not be receiving any potent CYP3A4 inhibitors. These are prohibited
(patients must discontinue drug ≥7 days prior to starting dasatinib) and include:
- itraconazole, ketoconazole, miconazole, coriconazole
- amprenavir, atazanavir, fosamprenavir, indinavir, nelfinavir, ritonavir
- ciprofloxacin, clarithromycin, diclofenac, doxycycline, enoxacin, imatinib, isoniazid
- ketamine, nefazodone, nicardipine, propofol, quinidine, telithromycin
Women of childbearing potential (WOCBP) must have:
- A negative serum or urine pregnancy test within 72 hours prior to the start of study
- Persons of reproductive potential must agree to use an adequate method of
contraception throughout treatment and for at least 4 weeks after study drug is
- Pregnant or nursing women may not participate. Patients of reproductive potential may
not participate unless they have agreed to use an effective method of contraception
and to continue contraception for 30 days from the date of the last study drug
administration. Postmenopausal woman must be amenorrheic for at least 12 months to be
considered of non-childbearing potential.
- Signed written informed consent including a HIPAA form according to institutional
- Life expectancy < 3 months.
- Prior severe allergic reaction to paclitaxel therapy.
- Presence of new or recurrent pleural effusion which is symptomatic and/or requiring
medical intervention (NCI CTC Grade 2, 3 or 4).
- Completion of previous chemotherapy regimen < 3 weeks prior to the start of study
- Prior hormonal therapy must be discontinued prior to treatment start. Biologic
therapy (eg, bevacizumab, trastuzumab) for the treatment of metastatic disease must
be discontinued > or = to 3 weeks from the start of protocol treatment.
Concurrent medical condition which may increase the risk of toxicity.
Patients may not have any clinically significant cardiovascular disease including the
- myocardial infarction or ventricular tachyarrhythmia within 6 months
- prolonged QTc >480 msec (Fridericia correction)
- ejection fraction less than institutional normal
- major conduction abnormality (unless a cardiac pacemaker is present)
- Patients with any cardiopulmonary symptoms of unknown cause (e.g. shortness of
breath, chest pain, etc.) should be evaluated by a baseline echocardiogram with or
without stress test as needed in addition to electrocardiogram (EKG) to rule out QTc
prolongation. The patient may be referred to a cardiologist at the discretion of the
principal investigator. Patients with underlying cardiopulmonary dysfunction should
be excluded from the study.
- Subjects with hypokalemia or hypomagnesemia if it cannot be corrected prior to
History of significant bleeding disorder unrelated to cancer, including:
Diagnosed congenital bleeding disorders (e.g., von Willebrand's disease)
- Diagnosed acquired bleeding disorder within one year (e.g., acquired antifactor VIII
- Ongoing or recent (≤ 3 months) significant gastrointestinal bleeding Other medical
condition which in the opinion of the Investigator might confer an unacceptable
increase in risk.
- Patients with symptomatic CNS metastases that remain untreated by radiation therapy
are excluded from this trial. The presence of asymptomatic brain metastases or brain
metastases that have been previously irradiated are not grounds for trial exclusion.
- History of uncontrolled seizures, central nervous system disorders or psychiatric
disability judged by the investigator to be clinically significant, precluding
informed consent, or interfering with compliance of oral drug intake.
- Presence of uncontrolled gastrointestinal malabsorption syndrome.
- Unwillingness to give written informed consent or unwillingness to participate or
inability to comply with the protocol for the duration of the study. Willingness and
ability to comply with scheduled visits, treatment plan, laboratory tests and other
study procedures are necessary for participation in this clinical trial.
- Concurrent radiotherapy is not permitted for disease progression on treatment on
protocol, but might allowed for pre-existing non-target lesions with approval from
the principal investigator of the trial.
- Patients with > Grade 1 neuropathy will be excluded form this trial.