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A Randomized Phase II Trial of Combination Anastrozole (NSC #719344) Plus ZD1839 (Iressa, NSC #715055, IND #61187) and of Combination Fulvestrant (NSC #719276) Plus ZD1839 in the Treatment of Postmenopausal Women With Hormone Receptor-Positive Metastatic Breast Cancer


Phase 2
18 Years
N/A
Open (Enrolling)
Female
Breast Cancer

Thank you

Trial Information

A Randomized Phase II Trial of Combination Anastrozole (NSC #719344) Plus ZD1839 (Iressa, NSC #715055, IND #61187) and of Combination Fulvestrant (NSC #719276) Plus ZD1839 in the Treatment of Postmenopausal Women With Hormone Receptor-Positive Metastatic Breast Cancer


OBJECTIVES:

- Compare the antitumor activity of anastrozole and gefitinib vs fulvestrant and
gefitinib in postmenopausal women with recurrent or metastatic hormone
receptor-positive breast cancer.

- Compare the safety of these regimens in these patients.

- Compare the interaction of biological predictors of response in patients treated with
these regimens.

OUTLINE: This is a randomized, open-label study. Patients are stratified according to prior
hormonal therapy (yes vs. no) and dominant site of disease (soft tissue/lymph nodes vs. bone
vs. visceral). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive oral anastrozole and oral gefitinib once daily on days 1-28.

- Arm II: Patients receive fulvestrant intramuscularly on day 1 and oral gefitinib once
daily on days 1-28.

Courses in both arms repeat every 28 days in the absence of disease progression or
unacceptable toxicity.

Patients are followed every 3 months for 2 years and then every 6 months for 1 year.

ACCRUAL: A total of 148 patients (74 per treatment arm) were accrued for this study.

Inclusion Criteria


Inclusion criteria:

- Histologically confirmed adenocarcinoma of the breast (Recurrent or metastatic
disease)

- Measurable disease

- Patients with available tissue blocks from either the primary or metastatic site must
submit the tissue for epidermal growth factor receptor analysis

- Estrogen and/or progesterone receptor positive

- Age>=18

- Female

- Postmenopausal, defined by 1 of the following:

- Prior bilateral oophorectomy or bilateral ovarian irradiation

- No menstrual period for at least 12 months

NOTE: If age 55 and under and on tamoxifen within the past 6 months, must have an
estradiol level in the postmenopausal range

- ECOG performance status of 0-2

- Adequate hematopoietic, hepatic, renal functions defined by the following within 2
weeks prior to randomization:

- Neutrophil count at least 1,500/mm^3

- Platelet count at least 100,000/mm^3

- Bilirubin no greater than 1.25 times upper limit of normal (ULN)

- Serum glutamic-pyruvic transaminase (ALT) and Serum glutamic-oxaloacetic (AST)
no greater than 2.5 times ULN (5 times ULN if liver metastases are present)

- International normalized ratio of prothrombin time (INR), prothrombin time (PT),
and partial thromboplastin time (PTT) normal

- Creatinine clearance at least 30 mL/min

- More than 3 weeks since prior trastuzumab (Herceptin®)

- More than 3 weeks since prior chemotherapy

- More than 3 months since prior luteinizing hormone-releasing hormone agonists or
antagonists (patients 55 years old and under)

- Recovered from prior radiotherapy

- Concurrent radiotherapy to painful sites of bony disease or areas of impending
fracture is allowed provided the following conditions are met:

- Therapy was initiated prior to study entry

- Sites of measurable disease outside the radiotherapy port are available for
disease evaluation

- Concurrent bisphosphonates for hypercalcemia or bone metastases are allowed

Exclusion Criteria:

- Pregnant or nursing

- Untreated ocular inflammation or infection

- Medical or psychiatric condition that would preclude study compliance, ability to
give informed consent, or assessment of response or anticipated toxic effects

- History of central nervous system (CNS) metastasis

- Other invasive malignancies within the past 5 years except curatively treated basal
cell or squamous cell skin cancer or carcinoma in situ of the cervix

- Contraindication to intramuscular injections

- More than 2 prior chemotherapy regimens for metastatic disease

- Prior hormonal therapy for metastatic disease

- Prior estrogen receptor down-regulators (e.g., fulvestrant) in the adjuvant setting

- Prior aromatase inhibitors (e.g., anastrozole, letrozole, exemestane, or
aminoglutethimide) in the adjuvant setting

- Prior agents that target epidermal growth factor receptors

- Other concurrent hormonal therapy

- Concurrent chemotherapy

- Concurrent trastuzumab

- Concurrent cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inhibitors
(e.g., ketoconazole, erythromycin, or verapamil)

- Concurrent anticoagulants, except for thrombotic events in patients in arm I

- Concurrent medications that would alter the pharmacokinetics of gefitinib (e.g.,
phenytoin, carbamazepine, phenobarbital, rifampin, Hypericum perforatum [St. John's
wort], oxcarbazepine, rifapentine, modafinil, and griseofulvin)

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Clinical Benefit Rate

Outcome Description:

Clinical benefit = complete response (CR), partial response (PR), or stable disease (SD) lasting for at least 6 months, assessed per Response Evaluation Criteria of Solid Tumor (RECIST).CR=disappearance of all target and non-target lesions. PR= disappearance of or at least 30% decrease in the sum of the longest diameters of target lesions, with non-progressive disease in non-target lesions. SD= sum of the longest diameters of target lesions decrease <30% or increase <20%, with non-progressive disease in non-target lesions. 141 eligible, treated patients were included.

Outcome Time Frame:

assessed every 3 cycles while on treatment, assessed every 3 months when follow up <2 years, every 6 months between 2-3 years,no specific requirements after 3 years

Safety Issue:

No

Principal Investigator

Robert W. Carlson, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Stanford University

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2012-03148

NCT ID:

NCT00057941

Start Date:

September 2003

Completion Date:

Related Keywords:

  • Breast Cancer
  • recurrent breast cancer
  • stage IV breast cancer
  • metastatic breast cancer
  • postmenopausal women
  • hormone receptor-positive
  • Breast Neoplasms

Name

Location

Hurley Medical Center Flint, Michigan  48503
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
Beth Israel Deaconess Medical Center Boston, Massachusetts  02215
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Aurora Presbyterian Hospital Aurora, Colorado  80012
Boulder Community Hospital Boulder, Colorado  80301-9019
Penrose Cancer Center at Penrose Hospital Colorado Springs, Colorado  80933
CCOP - Colorado Cancer Research Program Denver, Colorado  80224-2522
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center Grand Junction, Colorado  81502
Sky Ridge Medical Center Lone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United Hospital Longmont, Colorado  80502
St. Mary - Corwin Regional Medical Center Pueblo, Colorado  81004
North Suburban Medical Center Thornton, Colorado  80229
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Hinsdale Hematology Oncology Associates Hinsdale, Illinois  60521
Joliet Oncology-Hematology Associates, Limited - West Joliet, Illinois  60435
Carle Cancer Center at Carle Foundation Hospital Urbana, Illinois  61801
Saint Anthony Memorial Health Centers Michigan City, Indiana  46360
Cedar Rapids Oncology Associates Cedar Rapids, Iowa  52403
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
Tufts-NEMC Cancer Center Boston, Massachusetts  02111
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Foote Hospital Jackson, Michigan  49201
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
Seton Cancer Institute - Saginaw Saginaw, Michigan  48601
St. John Macomb Hospital Warren, Michigan  48093
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Duluth Clinic Cancer Center - Duluth Duluth, Minnesota  55805-1983
CCOP - Duluth Duluth, Minnesota  55805
Miller - Dwan Medical Center Duluth, Minnesota  55805
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
Meeker County Memorial Hospital Lichfield, Minnesota  55355
Minnesota Oncology Hematology, PA - Maplewood Maplewood, Minnesota  55109
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
HealthEast Cancer Care at St. Joseph's Hospital St Paul, Minnesota  55102
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Minnesota Oncology Hematology, PA - Woodbury Woodbury, Minnesota  55125
HealthEast Cancer Care at Woodwinds Health Campus Woodbury, Minnesota  55125
MetroHealth Cancer Care Center at MetroHealth Medical Center Cleveland, Ohio  44109
St. Rita's Medical Center Lima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis Hospital Tulsa, Oklahoma  74136
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Penn State Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Geisinger Medical Group - Scenery Park State College, Pennsylvania  16801
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
Sanford Cancer Center at Sanford USD Medical Center Sioux Falls, South Dakota  57117-5039
Medical X-Ray Center, PC Sioux Falls, South Dakota  57105
Avera Cancer Institute Sioux Falls, South Dakota  57105
Dean Medical Center - Madison Madison, Wisconsin  53717
CCOP - Ochsner New Orleans, Louisiana  70121
CCOP - Columbus Columbus, Ohio  43206
Mercy Hospital Cancer Center - Scranton Scranton, Pennsylvania  18501
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
Overlook Hospital Summit, New Jersey  07902-0220
Carol G. Simon Cancer Center at Morristown Memorial Hospital Morristown, New Jersey  07962
Ochsner Cancer Institute at Ochsner Clinic Foundation New Orleans, Louisiana  70121
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
McCreery Cancer Center at Ottumwa Regional Ottumwa, Iowa  52501
Green Bay Oncology, Limited - Escanaba Escanaba, Michigan  49431
Dickinson County Healthcare System Iron Mountain, Michigan  49801
Our Lady of Mercy Medical Center Comprehensive Cancer Center Bronx, New York  10466
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
Chester County Hospital West Chester, Pennsylvania  19380
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
Adena Regional Medical Center Chillicothe, Ohio  54601
Doctors Hospital at Ohio Health Columbus, Ohio  43228
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Strecker Cancer Center at Marietta Memorial Hospital Marietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial Hospital Newark, Ohio  43055
Community Hospital of Springfield and Clark County Springfield, Ohio  45505
Genesis - Good Samaritan Hospital Zanesville, Ohio  43701
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West Jersey Voorhees, New Jersey  08043
Mount Carmel Health - West Hospital Columbus, Ohio  43222
Joan Karnell Cancer Center at Pennsylvania Hospital Philadelphia, Pennsylvania  19107
John Stoddard Cancer Center at Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Mercy Capitol Hospital Des Moines, Iowa  50307
Medical Oncology and Hematology Associates at John Stoddard Cancer Center Des Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer Center Des Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des Moines West Des Moines, Iowa  50266
Terrebonne General Medical Center Houma, Louisiana  70360
Mountainside Hospital Cancer Center Montclair, New Jersey  07042
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Mercy Medical Center Springfield, Ohio  45504
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Trinity Medical Center Moline, Illinois  61265-1291
Morton Hospital & Medical Center Taunton, Massachusetts  02780
Pottstown Memorial Regional Cancer Center Pottstown, Pennsylvania  19464
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler Savannah, Georgia  31405
Ochsner Health Center - Bluebonnet Baton Rouge, Louisiana  70809
Union Hospital Cancer Program at Union Hospital Elkton MD, Maryland  21921
Grant Medical Center Cancer Care Columbus, Ohio  43215
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Hematology and Oncology Associates of Northeastern Pennsylvania Scranton, Pennsylvania  18510
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Stanford Comprehensive Cancer Center - Stanford Stanford, California  94305
Shore Memorial Hospital - Somers Point Somers Point, New Jersey  08244
Alexian Brothers Radiation Oncology Elk Grove Village, Illinois  60007
Elmhurst Memorial Hospital Elmhurst, Illinois  60126
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus Moline, Illinois  61265
Hattiesburg Clinic, PA at Forrest General Hattiesburg, Mississippi  39401
Saints Memorial Cancer Center at Saints Memorial Medical Center Lowell, Massachusetts  01852
Hematology & Oncology Clinic Hattiesburg, Mississippi  39402
Fawcett Memorial Hospital Port Charlotte, Florida  33952
Bassett Healthcare Regional Cancer Program at Mary Imogene Bassett Hospital Cooperstown, New York  13326