A Phase II Study Of OSI-774 In Combination With Bevacizumab In Patients With Stage IV Breast Cancer
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically or cytologically confirmed carcinoma of the breast
- Metastatic (stage IV) disease
- Stable or progressive disease on or after at least 1 but no more than 2 prior
conventional chemotherapy regimens for metastatic breast cancer
- Prior high-dose chemotherapy with autologous stem cell or bone marrow
transplantation is considered 1 prior regimen when administered for metastatic
disease
- Prior adjuvant chemotherapy and/or hormonal therapy allowed, and do not count as
prior therapy
- Prior trastuzumab (Herceptin) required for HER2/neu-positive patients (3+ by
immunohistochemistry or positive by fluorescent in situ hybridization [FISH])
- Unidimensionally measurable disease
- At least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan
- No prior or concurrent brain metastases or primary brain tumor, as documented by CT
scan or MRI
- Hormone receptor status:
- Not specified
PATIENT CHARACTERISTICS:
Age
- 18 and over
Sex
- Male or female
Menopausal status
- Not specified
Performance status
- ECOG 0-2 OR
- Karnofsky 60-100%
Life expectancy
- More than 3 months
Hematopoietic
- WBC ≥ 3,000/mm^3
- Absolute neutrophil count ≥ 1,000/mm^3
- Platelet count ≥ 75,000/mm^3
- AST/ALT ≤ 2.5 times upper limit of normal
- No bleeding diathesis
- No coagulopathy
Hepatic
- Bilirubin normal
- AST/ALT ≤ 2.5 times upper limit of normal
- INR < 1.5 (for patients receiving warfarin)
Renal
- Creatinine normal OR
- Creatinine clearance ≥ 60 mL/min
- No grade 1 or greater proteinuria OR
- Urinary protein ≤ 500 mg/24 hours
Cardiovascular
- Ejection fraction normal by MUGA or echocardiogram
- No history of stroke
- No clinically significant cardiovascular disease (e.g., uncontrolled hypertension,
myocardial infarction, unstable angina pectoris)
- No New York Heart Association class II-IV heart disease
- No symptomatic congestive heart failure
- No serious cardiac arrhythmia requiring medication
- No grade II or greater peripheral vascular disease within the past year
- No transient ischemic attack within the past 6 months
- No cerebrovascular accident within the past 6 months
- No unstable angina within the past 6 months
- No myocardial infarction within the past 6 months
- No clinically significant peripheral artery disease within the past 6 months
- No other arterial thrombotic event within the past 6 months
Ophthalmologic
- No abnormalities of the cornea (e.g., dry eye syndrome or Sjögren's syndrome)
- No congenital ophthalmologic abnormality (e.g., Fuch's dystrophy)
- No abnormal slit-lamp examination using a vital dye (e.g., fluorescein or
Bengal-Rose)
- No abnormal corneal sensitivity test (Schirmer test or similar tear production test)
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective barrier contraception
- No significant traumatic injury within the past 28 days
- No prior allergic reaction attributed to compounds of similar chemical or biological
composition to erlotinib or bevacizumab
- No history of seizures not controlled with standard medical therapy
- No serious non-healing wound, ulcer, or bone fracture
- No ongoing or active infection
- No psychiatric illness or social situation that would preclude study compliance
- No other concurrent uncontrolled illness
- No gastrointestinal tract disease requiring IV alimentation
- Able to take oral medication
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Disease Characteristics
- More than 3 weeks since prior immunotherapy
- No prior cetuximab
Chemotherapy
- See Disease Characteristics
- More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin)
- No lifetime cumulative doxorubicin dose > 450 mg/m^2
- No lifetime cumulative epirubicin dose > 700 mg/m^2
- No lifetime cumulative doxorubicin HCl liposome dose > 550 mg/m^2
- No lifetime cumulative mitoxantrone dose > 140 mg/m^2
Endocrine therapy
- See Disease Characteristics
- More than 2 weeks since prior hormonal therapy
Radiotherapy
- More than 3 weeks since prior radiotherapy
Surgery
- More than 28 days since prior major surgery or open biopsy
- No prior surgery affecting gastrointestinal absorption
Other
- More than 3 weeks since prior investigational therapy
- No prior kinase insert domain-containing receptor (KDR) inhibitors (e.g., VEGF Trap,
SU5416, SU6668, ZD6474, PTK 757, IMC-1CII)
- No prior epidermal growth factor receptor-targeting therapy (e.g., gefitinib or
cetuximab)
- More than 10 days since prior full-dose oral or parenteral anticoagulants or
thrombolytic agents*
- No concurrent full-dose oral or parenteral anticoagulants or thrombolytic agents*
- No concurrent chronic daily aspirin (dose > 325 mg/day)
- No concurrent nonsteroidal anti-inflammatory medications known to inhibit platelet
function (e.g., cyclo-oxygenase-1 inhibitors)
- No other concurrent investigational or commercial anticancer agents or therapies
- No concurrent combination antiretroviral therapy for HIV-positive patients NOTE:
*Except for maintaining patency of preexisting, permanent indwelling IV catheters