Tolerability of the Combination of Lapatinib and Trastuzumab in Adults Age 60 or Older With HER2 Positive Locally Advanced or Metastatic Breast Cancer
Limited evidence exists to guide the risks and benefits of cancer therapy in the older
adult. Adults age 70 and older make up only 20% of subjects enrolled in FDA registration
trials but 46% of all patients with cancer. Dose-finding studies specifically for older
adults are not routinely performed. This is despite changes in drug metabolism, absorption,
and distribution with increasing age. Trastuzumab is a monoclonal humanized antibody
directed to the extracellular domain of the HER2 receptor. It is FDA-approved in combination
with chemotherapy and as a single agent in MBC. Lapatinib is a tyrosine kinase inhibitor
that binds to the intracellular domain of both the HER2 receptor and the EGFR receptor, thus
inactivating downstream signaling essential to tumor proliferation. A recently reported
phase III study demonstrated a survival benefit for the combination of lapatinib with
trastuzumab in patients who had received multiple prior therapies. Anti-HER2 agents have not
been well studied in older adults due to poor enrollment of older adults in the relevant
clinical trials. In the pivotal trial of lapatinib, for example, only 17% of adults were 65
years or older and only 1% were 75 or older. This a multi-center study to evaluate the
toxicity and efficacy of lapatinib and trastuzumab in patients age 60 and older. A detailed
evaluation of toxicity will be performed with a specific focus on cardiac toxicity, as
measured by clinical and imaging criteria.
Interventional
Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Grade 3 or higher toxicities (as defined by NCI CTCAE v.4.0)
Until 30 days after last dose of treatment
Yes
Arti Hurria, MD
Principal Investigator
City of Hope Medical Center
United States: Institutional Review Board
10112
NCT01273610
April 2011
Name | Location |
---|---|
City of Hope Medical Center | Duarte, California 91010 |
Case Western Reserve University | Cleveland, Ohio 44106 |
Thomas Jefferson University | Philadelphia, Pennsylvania 19107-6541 |
South Pasadena Cancer Center | South Pasadena, California 91030 |
Lineberger Comprehensive Cancer Center, University of North Carolina | Chapel Hill, North Carolina 27599 |