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Despite these initial positive signals in recent statistics, breast cancer continues to claim a substantial number of lives approximately 500,000 deaths worldwide in 2005 Thus the current treatment paradigm - surgery, radiation and systemic chemo and or hormonal therapy and biological therapies -still fails to cure a significant number of women with early breast cancer and new treatment strategies are needed to improve current results both in early and advance disease.
Recurrent or metastatic breast cancer is an incurable malignancy with a median survival of 20-24 months [Hortobagyi , 1998] and this has not changed significantly over the last decade with fewer than 20% of patients still alive at 5 years after a diagnosis of recurrence. Although there have been small improvements in survival with the new therapies, metastatic breast cancer remains an incurable and, ultimately, fatal disease. The introduction of novel combination therapies have the potential to target different pathways in the cancer cell, leading to improved efficacy. Further studies to optimize combination therapy, while ameliorating AEs, are critically important to patients with metastatic breast cancer.
Lapatinib is an oral tyrosine kinase inhibitor which potently inhibits both EGFR and HER2[Spector, 2005]. Lapatinib in combination with capecitabine is approved in more than 20 countries for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2. All patients in the study leading to the lapatinib approval had received prior therapy including an anthracycline, a taxane, and trastuzumab.
The relevance of the HER2/neu target in breast cancer, combined with the promising preclinical and clinical data regarding the use of lapatinib, provide the rationale for a formal evaluation of this agent combined with other non taxane agents as gemcitabine or vinorelbine after progression on taxanes and trastuzumab based therapies in metastatic disease setting as these chemotherapy options are used in daily practice in this subset of patients.
This is a randomized phase II, open label,multicentric , international, 3 arms treatment study in patients with confirmed HER2+ metastatic breast cancer after taxane progression . The main objective is to investigate the (CBR) and safety in 3 different combinations of Lapatinib therapy (plus capecitabine or gemcitabine or vinorelbine) and to determine whether either, or both, of Lapatinib /Vinorelbine or Lapatinib/Gemcitabine can be considered a reasonable alternative to the established Lapatinib/Capecitabine standard combination . The decision as to whether to study either of the new combinations further will be based on both the toxicity and the efficacy profiles.
In areas where trastuzumab is available with no barriers to access, all patients must have received trastuzumab in the adjuvant or metastatic setting . However, in countries where trastuzumab is not approved or is not available to patients due to reimbursement or other considerations, trastuzumab naïve patients are allowed considering the efficacy data of Lapatinib in this subset of patients.
This trial uses a design to ensure a selection of one or more of the better treatment combination for additional clinical Approximately (165), who meet the criteria for efficacy analysis as defined, will be enrolled in the study in a single stage process. The sample size will be accrued in 16 months, with further follow-up for a 24 months study period from randomization or until progression.
The study includes a Screening/Baseline Period, a Treatment Period and a post-treatment Follow-Up Period. Patients will continue to receive investigational products until disease progression or early discontinuation from investigational product for other reasons. Patients who discontinue investigational product(s) without disease progression will continue to be evaluated for efficacy until progression or until receiving the first subsequent anti-cancer therapy. Once progression is documented, all patients will be followed for survival at approximately 3-month intervals until death.
Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Lapatinib Vinorelbine, Lapatinib Capecitabine, Gemcitabine Lapatinib
Dr. Carlos Alberto Sampaio
Grupo Latino Americano de Investigacoes Clinicas em Oncologia
Published on BioPortfolio: 2014-08-27T03:16:38-0400
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