Randomized Phase II Trial of Anastrozole Combined With Novel Agent ZD6474 in the Neoadjuvant Treatment of Postmenopausal Patients With Hormone Receptor-Positive Breast Cancer
The use of adjuvant chemotherapy and endocrine therapy has had a significant impact on
breast cancer survival. However, not all patients will benefit from each of these therapies.
Increasing data suggests that patients with hormone receptor-positive breast cancer derive
marginal benefit from the addition of adjuvant chemotherapy. Identification and
characterization of cellular signaling pathways active in the pathogenesis of breast cancer
has lead to the development of multiple targeted therapies that hold enormous promise for
patients with less toxicity than conventional chemotherapy. Treatment strategies employing
neoadjuvant therapy have found that pCR is predictive for ultimate outcome. Due to this, the
use of neoadjuvant therapy has become an intense area of investigation in operable breast
cancer. In the IMPACT trial, the aromatase inhibitor anastrozole was found to improve
eligibility for breast conservation and was associated with a favorable clinical objective
response after 12 weeks of therapy.
In this proposed study, we plan to study the combination of ZD6474, a dual inhibitor of EGFR
and VEGFR-2, with anastrozole in the neoadjuvant setting for patients with Stage I-III
breast cancer. The aim is to overcome mechanisms of resistance and simultaneously block
multiple critical signaling pathways known to stimulate breast cancer. The two agents have
non-overlapping toxicities and are both administered orally, allowing for a more tolerable
treatment regimen. By using this combination in the neoadjuvant setting, we will target the
critical signaling pathways early and follow tumor responses during therapy, allowing for
prompt evaluation of the effectiveness of this treatment strategy. Pathologic tumor
specimens obtained at the time of definitive surgery will be evaluated for pathologic
complete response thus adding to the body of literature. By examining molecular markers such
as ER, PR, EGFR, and Ki-67 pre- and post-treatment, we hope to correlate modulations in
these biomarkers to response. Finally, using a novel second generation functional breast
MRI we will investigate the ability of MRI to predict response to antiangiogenic therapy.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Tumor Objective Response Rate by Ultrasound
unknown
No
Dr. Ellie Guardino MD/PhD
Principal Investigator
Stanford University
United States: Institutional Review Board
BRSADJ0008
NCT00481845
January 2008
December 2011
Name | Location |
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Stanford University School of Medicine | Stanford, California 94305-5317 |