Breast Cancer Clinical Trial
Official title:
A Phase I/II Pilot Study of Patients With Brain Metastasis Secondary to Breast Cancer Treated With Methotrexate and Carboplatin in Conjunction With Blood-Brain Barrier Disruption, With Concurrent Trastuzumab in HER-2 Positive Patients
RATIONALE: Osmotic blood-brain barrier disruption uses certain drugs, such as mannitol, to
open the blood vessels around the brain and allow tumor-killing substances to be carried
directly to the brain. Drugs used in chemotherapy, such as methotrexate and carboplatin,
work in different ways to stop the growth of tumor cells, either by killing the cells or by
stopping them from dividing. Monoclonal antibodies, such as trastuzumab, can block tumor
growth in different ways. Some block the ability of tumor cells to grow and spread. Others
find tumor cells and help kill them or carry tumor-killing substances to them. Trastuzumab
may also help methotrexate and carboplatin work better by making tumor cells more sensitive
to the drugs. Giving osmotic blood-brain barrier disruption together with methotrexate,
carboplatin, and trastuzumab may kill more tumor cells.
PURPOSE: This phase I/II trial is studying the side effects and best dose of carboplatin
when given together with methotrexate and trastuzumab after mannitol in treating women with
breast cancer that has spread to the brain.
OBJECTIVES:
Primary
- Determine the safety and toxicity associated with blood-brain barrier disruption
comprising transfemoral mannitol followed by methotrexate and carboplatin with or
without trastuzumab (Herceptin®) in women with brain metastasis secondary to breast
cancer. (Phase I)
- Determine if overall survival exceeds 5 months in patients with Human Epidermal growth
factor Receptor 2(HER2)-positive or HER2-negative disease treated with this regimen.
(Phase II)
Secondary
- Determine the overall survival of these patients.
- Compare the event-free and overall survival, steroid use, response rates, and time to
best response in patients with HER2-positive vs HER2-negative disease.
- Assess the quality of life of patients treated with this regimen.
- Assess the neuropsychological effects of this treatment regimen in these patients.
- Determine cerebrospinal fluid levels of trastuzumab before and after blood-brain
barrier disruption.
OUTLINE: This is a multicenter, phase I, pilot, dose-finding study of carboplatin followed
by a phase II, open-label study.
- Phase I: Patients undergo osmotic blood-brain barrier disruption (BBBD) comprising
mannitol by transfemoral catheterization followed by methotrexate intra-arterially (IA)
over 10 minutes and carboplatin IA over 10 minutes on days 1 and 2. Patients also
receive sodium thiosulfate IV over 15 minutes at 4 and 8 hours after each dose of
carboplatin; leucovorin calcium IV or orally every 6 hours on days 3-9; and
pegfilgrastim subcutaneously (SC) on day 4 or filgrastim (G-CSF) SC beginning on day 4
and continuing until blood counts recover (7-10 days). Patients with HER-2 positive
disease receive trastuzumab (Herceptin®) IV over 90 minutes within 48 hours prior to
BBBD and then weekly for 3 weeks (between BBBD therapy sessions). Treatment repeats
every 4 weeks for up to 12 months in the absence of disease progression or unacceptable
toxicity.
Cohorts of 3-6 patients receive decreasing doses of carboplatin and/or methotrexate if the
proposed dose is not well tolerated. Dose-limiting toxicity is defined as grade IV
hematologic toxicity with delay in subsequent treatment courses for 4 weeks OR grade III/IV
nonhematologic toxicity without recovery in 14 days during the course of treatment.
- Phase II: Patients undergo BBBD as in phase I and receive carboplatin and methotrexate
at the doses determined in phase I. Patients also receive sodium thiosulfate,
leucovorin calcium, and pegfilgrastim or G-CSF as in phase I. Patients with
HER2-positive disease also receive trastuzumab as in phase I.
Neuropsychological assessment is performed at baseline, every 6 months during treatment,
every 6 months for 1 year, and then annually thereafter. Quality of life is assessed at
baseline, every 3 months during treatment, at the completion of study treatment, every 6
months for 1 year, and then annually thereafter.
After completion of study therapy, patients are followed periodically.
PROJECTED ACCRUAL: A total of 78 patients will be accrued for this study.
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