Phase II Trial of Sorafenib and Paclitaxel for Measurable Metastatic HER2-Negative Breast Cancer
Inclusion Criteria
DISEASE CHARACTERISTICS:
Inclusion criteria:
- Histologically* confirmed breast cancer
- Stage IV (metastatic) disease
- Radiographic evidence of metastases NOTE: *Histological confirmation of the
actual metastasis is not required.
- Measurable disease by RECIST criteria defined as ≥ 1 unidimensionally measurable
lesion ≥ 20 mm by conventional techniques (i.e., physical examination, CT scan, MRI,
or x-ray) or ≥ 10 mm by spiral CT scan
- No prior radiotherapy unless growth has been documented following radiotherapy
- Primary tumor or metastatic tumor HER2-negative, defined as the following:
- Immunohistochemistry of 0 or 1+ OR the equivalent, if an automated quantitative
assay is used
- HER2 fluorescent in situ hybridization (FISH) assay negative as defined by a
HER2:chromosome 17 centromeric probe ratio < 1.8 (or < 2.2 if
immunohistochemistry is less than 3+ or equivalent) OR equivalent values for
negative FISH assays that do not normalize to chromosome 17
- Hormone-receptor positive (estrogen receptor-[ER] or progesterone receptor
[PgR]-positive) disease or hormone receptor-negative (ER- or PgR-negative) disease
- Tumor block from initial breast cancer primary or a biopsy of a metastatic site must
be available for correlative studies
- Brain metastases allowed provided the patient is stable after completion of treatment
(i.e., surgery and/or radiotherapy), asymptomatic, and off steroids with 2
consecutive stable brain scans at least 4 weeks after radiotherapy
Exclusion criteria:
- Bone-only or other nonmeasurable-only disease
- Newly diagnosed brain metastases
PATIENT CHARACTERISTICS:
Inclusion criteria:
- ECOG performance status 0-1
- Life expectancy > 6 months
- Menopausal status not specified
- WBC ≥ 3,000/mcL
- Absolute neutrophil count ≥ 1,500/mcL
- Platelets ≥ 100,000/mcL
- Total bilirubin < 1.5 times upper limit of normal (ULN)
- AST and ALT transaminases ≤ 2.5 times ULN (< 5 times ULN if liver involvement)
- Creatinine < 1.5 times ULN OR creatinine clearance > 60 mL/min
- INR < 1.5 OR PT/PTT normal
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception prior to and during (women and men)
and for at least 3 months after (men) study therapy
- Able to swallow and absorb oral medications
Exclusion criteria:
- Active or uncontrolled medical illness (e.g., active infection > CTCAE grade 2),
including any of the following:
- HIV or chronic hepatitis B or C
- Uncontrolled diabetes
- NYHA class II-IV uncompensated congestive heart failure
- Unstable angina (anginal symptoms at rest)
- New onset angina (i.e., began within the past 3 months)
- Coronary artery disease
- Myocardial infarction within the past 6 months
- Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy
- Evidence of bleeding diathesis or coagulopathy
- Pulmonary hemorrhage/bleeding event > CTCAE grade 2 within 4 weeks of first dose of
study drug
- Any other hemorrhage/bleeding event > CTCAE grade 3 within 4 weeks of first study
drug
- Thrombotic or embolic events (i.e., cerebrovascular accident), including transient
ischemic attacks within the past 6 months
- Hypertension that cannot be controlled with medication to ≤ 150/90 mm Hg
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to sorafenib tosylate
- Prior invasive cancer other than breast cancer except nonmelanoma skin cancer
- Chronic nonhealing wound or ulcer
PRIOR CONCURRENT THERAPY:
- No more than 1 prior chemotherapy regimen for metastatic breast cancer (MBC)
- At least 3 weeks since prior hormonal therapy for MBC or adjuvant or neoadjuvant
chemotherapy
- More than 1 year since adjuvant paclitaxel
- At least 4 weeks since major thoracic, abdominal, or pelvic surgery and recovered
- At least 3 weeks since prior and no concurrent investigational drugs
- Concurrent bisphosphonates allowed
- Concurrent anticoagulation agents (i.e., warfarin or heparin) allowed
- No anticipated need for or concurrent radiotherapy
- No concurrent Hypericum perforatum (St. John wort) or rifampin (rifampicin)
- No other concurrent anti-neoplastic drugs