A Phase II Study of Letrozole in Combination With Bevacizumab in Patients With Estrogen Receptor- and/or Progesterone Receptor-Positive Unresectable Locally Advanced and/or Metastatic (Stage IV) Breast Cancer
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically or cytologically confirmed carcinoma of the breast
- Locally advanced or metastatic (stage IV) disease
- Unresectable disease
- Measurable or nonmeasurable disease
- May have had stable or progressive disease after ≤ 2 prior conventional chemotherapy
regimens for treatment of locally advanced or metastatic breast cancer
- Prior chemotherapy in the adjuvant or metastatic setting is not required
- Any number of prior neoadjuvant or adjuvant chemotherapy regimens allowed
- Prior treatment with high-dose chemotherapy and autologous stem cell or bone
marrow transplantation is considered 1 regimen when administered for metastatic
disease (including induction chemotherapy and preparative regimen)
- May have had stable or responding disease on prior nonsteroidal aromatase inhibitors
(e.g., letrozole, anastrozole, or aminogluthemide)
- Any prior aromatase inhibitor-related toxicity ≥ grade 3 must have resolved ≥ 4
weeks before the start of study treatment
- May have had disease progression on other prior hormonal therapy (e.g., selective
estrogen receptor modulators [SERMs], receptor downregulators [SERDs], or ovarian
suppression) in the adjuvant or metastatic setting
- No history or evidence of primary brain tumor or brain metastases by CT scan or MRI
- Must have estrogen receptor- and/or progesterone receptor-positive tumor
PATIENT CHARACTERISTICS:
- Rendered postmenopausal with ovarian suppression (ovarian suppression with a depot
LH-RH agonist allowed) prior to the start of study treatment OR is already
postmenopausal, as defined by 1 of the criteria:
- No spontaneous menses for ≥ 12 months if the patient is ≥ 50 years old
- Amenorrheic for ≥ 12 months if the patient is < 50 years old, with serum
estradiol and follicle-stimulating hormone (FSH) levels within the institutional
postmenopausal range
- Bilateral oophorectomy
- At least 28 days since surgical oophorectomy
- Patients who have had prior hysterectomy but intact ovaries must be ≥ 55 years
old, or have serum estradiol and FSH levels within the postmenopausal range
- Ongoing ovarian suppression with a depot LH-RH agonist
- ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
- Life expectancy > 3 months
- Female only
- Absolute neutrophil count ≥ 1,000/mm^3
- Platelet count ≥ 75,000/mm^3
- WBC ≥ 2,500/mm^3
- AST and ALT ≤ 2.5 times upper limit of normal
- Bilirubin normal
- Creatinine normal OR creatinine clearance ≥ 60 mL/min
- No proteinuria at baseline
- Patients who unexpectedly have ≥ +1 proteinuria must undergo a 24-hour urine
collection that demonstrates ≤ 500 mg of protein over 24 hours
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No presence of bleeding diathesis or coagulopathy
- No history of allergic reaction to compounds of similar chemical or biologic
composition to letrozole or bevacizumab
- No serious, nonhealing wound, ulcer, or bone fracture
- No unstable angina pectoris
- No serious cardiac arrhythmia requiring medication
- No uncontrolled hypertension
- No myocardial infarction
- No New York Heart Association class II-IV congestive heart failure
- No peripheral vascular disease ≥ grade II within the past year
- No other clinically significant cardiovascular disease
- No history or evidence of other CNS disease by CT scan or MRI, including seizures not
controlled with standard medical therapy or stroke
- No gastrointestinal tract disease resulting in an inability to take oral medication
- No requirement for IV alimentation
- No significant traumatic injury within the past 28 days
- No psychiatric illness or social situation that would preclude study compliance
- No other uncontrolled intercurrent illness
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior steroidal aromatase inhibitors (e.g., exemestane) unless administered in the
adjuvant setting (not for metastatic disease) and ≥ 12 months have elapsed since last
treatment
- Any number of prior immunotherapies (e.g., trastuzumab [Herceptin^®] or vaccines) in
the adjuvant or metastatic setting allowed
- More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
- More than 3 weeks since prior radiotherapy
- More than 3 weeks since prior immunotherapy
- More than 3 weeks since prior investigational therapy
- More than 2 weeks since prior hormonal therapy except letrozole therapy or a
luteinizing hormone-releasing hormone (LH-RH) agonist for ovarian suppression
- No prior surgical procedures affecting absorption
- More than 28 days since prior major surgery or open biopsy
- At least 24 hours since prior placement of indwelling catheters
- At least 10 days since prior and no concurrent full-dose oral or parenteral
anticoagulants or thrombolytic agents except as required to maintain patency of
preexisting, permanent indwelling IV catheters
- Patients receiving warfarin should have INR < 1.5
- No prior bevacizumab
- No other prior KDR inhibitors (e.g., vascular endothelial growth factor [VEGF] Trap,
SU5416, SU6668, ZD6474, vatalanib, AEE788, or IMC-1CII)
- No other concurrent investigational agent
- No concurrent chronic daily treatment with aspirin (> 325 mg/day) or nonsteroidal
anti-inflammatory medications known to inhibit platelet function (e.g.,
cyclooxygenase-1 inhibitors)
- Concurrent bisphosphonates (e.g., zoledronate or pamidronate) or growth factors
allowed
- No other concurrent anticancer agents or therapies