Phase II Trial of Capecitabine (Xeloda®) and Pegylated Interferon Alfa-2A(Pegasys®) for Recurrent or Progressive Brain Metastasis From Breast Carcinoma
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically or cytologically confirmed breast cancer that metastasized to the
brain, meeting all of the following criteria:
- Must have ≥ 1 inoperable brain metastases, meeting 1 of the following criteria:
- Progressive or recurrent disease after prior whole-brain or stereotactic
radiotherapy
- Ineligible for OR unwilling to be treated with radiotherapy
- At least 1 unidimensionally measurable brain metastasis by enhanced MRI within
the past 21 days
- No progression or development of central nervous system (CNS) metastasis during
prior treatment with capecitabine, fluorouracil, interferon alfa, or interferon
beta
- Systemic (i.e., outside the CNS system) cancer must be stable
- No progressive disease (e.g., liver, lymphangitic, or lung metastases)
- Hormone receptor status:
- Not specified
PATIENT CHARACTERISTICS:
Age
- 18 and over
Sex
- Male or female
Menopausal status
- Not specified
Performance status
- Karnofsky 70-100%
Life expectancy
- More than 12 weeks
Hematopoietic
- Absolute neutrophil count ≥ 1,500/mm^3
- Platelet count ≥ 100,000/mm^3
- Hemoglobin ≥ 10 mg/dL
- No history of idiopathic thrombocytopenic purpura
- No known uncontrolled coagulopathy
- No increased risk for anemia (e.g., thalassemia or spherocytosis)
- No medically problematic anemia
Hepatic
- aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT) ≤
2.5 times upper limit of normal (ULN) (5 times ULN for patients with concurrent liver
metastases )
- Bilirubin ≤ 1.5 times ULN
- Alkaline phosphatase ≤ 2.5 times ULN (5 times ULN for patients with concurrent liver
metastases; 10 times ULN for patients with concurrent bone metastases)
Renal
- Creatinine ≤ 1.5 times ULN OR
- Creatinine clearance ≥ 30 mL/min
Cardiovascular
- No congestive heart failure
- No symptomatic coronary artery disease
- No medically uncontrolled arrhythmia
- No other clinically significant cardiac disease
- No myocardial infarction within the past 12 months
Gastrointestinal
- No history of inflammatory bowel disease
- Must have intact upper gastrointestinal tract
- Able to swallow tablets
- No malabsorption syndrome
- No history of gastrointestinal bleeding
Immunologic
- No prior unanticipated severe reaction to fluoropyrimidine therapy, interferon,
pegylated interferon, or a pegylated moiety
- No known sensitivity to fluorouracil
- No serious uncontrolled infection
- No history of immunologically mediated disease
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 6 months after
completion of study treatment
- No known dihydropyrimidine dehydrogenase deficiency
- No history of depression characterized by a suicide attempt
- No history of hospitalization for psychiatric disease
- No history of other severe psychiatric disease
- No prior disability as a result of psychiatric disease
- No history of clinically significant psychiatric disability that would preclude study
compliance
- No other malignancy within the past 5 years except cured nonmelanoma skin cancer or
treated carcinoma in situ of the cervix
- No uncontrolled thyroid dysfunction (e.g., thyroid-stimulating hormone not in normal
range)
- No evidence of severe retinopathy (e.g., Cytomegalovirus (CMV) retinitis or macular
degeneration)
- No clinically relevant ophthalmologic disorders due to diabetes or hypertension
- No other serious uncontrolled medical conditions that would preclude study
participation
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Disease Characteristics
- At least 3 months since prior interferon alfa or interferon beta
Chemotherapy
- See Disease Characteristics
- At least 3 months since prior capecitabine or fluorouracil
Endocrine therapy
- Concurrent hormonal agents (e.g., tamoxifen, raloxifene, or anastrazole) for breast
cancer allowed
Radiotherapy
- See Disease Characteristics
Surgery
- More than 4 weeks since prior major surgery and recovered
Other
- More than 4 weeks since prior participation in another investigational drug study
- At least 4 weeks since prior and no concurrent brivudine or sorivudine
- No concurrent cimetidine
- No other concurrent investigational or commercial agents or therapies for this
malignancy