Ovarian Cancer Clinical Trial
Lapatinib and Topotecan in Treating Patients With Ovarian Epithelial Cancer or Primary Peritoneal Cancer That Did Not Respond to Cisplatin or Carboplatin
Summary
RATIONALE: Lapatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving lapatinib together with topotecan may kill more tumor cells.
PURPOSE: This phase II trial is studying how well giving lapatinib together with topotecan works in treating patients with ovarian epithelial cancer or primary peritoneal cancer that did not respond to cisplatin or carboplatin.
Full Description
OBJECTIVES:
Primary
Determine the efficacy of lapatinib ditosylate and topotecan hydrochloride, in terms of response, in patients with platinum-resistant or refractory ovarian epithelial or primary peritoneal cavity carcinoma.
Secondary
Determine the overall survival time in patients treated with this regimen.
Determine the time to progression in patients treated with this regimen.
Assess the toxicity profile of this regimen in these patients.
Translational
Determine the expression patterns of epidermal growth factor receptor, HER2/neu, hypoxia-induced factor 1 alpha, CD31, breast cancer resistance protein, and topoisomerase I by immunohistochemistry using tumor tissue from primary debulking surgery.
Determine the feasibility of monitoring circulating tumor cells with specific biological markers to determine or follow response in these patients.
OUTLINE: This is a multicenter study.
Patients receive oral lapatinib ditosylate once daily on days 1-28 and topotecan hydrochloride IV over 30 minutes on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Blood samples are collected at baseline and on day 8 of course 1 (immediately after the topotecan infusion) and are evaluated for pharmacological studies. Tumor tissue samples obtained at debulking surgery are examined by immunohistochemistry for epidermal growth factor receptor, HER1, ErbB1, HER2/neu, ErbB2, hypoxia-induced factor 1 alpha, CD31, platelet endothelial cell adhesion molecule 1, topoisomerase I, and breast cancer resistance protein.
After the completion of study treatment, patients are followed periodically for 2 years.
PROJECTED ACCRUAL: A total of 39 patients will be accrued for this study.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed ovarian epithelial or primary peritoneal carcinoma
Must have one of the following:
Measurable disease
Evaluable disease AND a CA-125 value that has increased ≥ 2 times the nadir value established after debulking surgery and first-line chemotherapy, confirmed by a second measurement within the past 21 days
If a second measurement has not been done, it can be done ≥ 7 days but < 21 days prior to study treatment
Platinum-refractory and/or -resistant disease after first-line chemotherapy
Patients retreated with platinum agents (i.e., second relapse) are not eligible
Patients treated with first-line triplet therapy (e.g., on clinical trial GOG-182) are eligible
Must have had debulking surgery
Tissue blocks from this surgery must be available
No CNS metastases
PATIENT CHARACTERISTICS:
Eastern Cooperative Oncology Group (ECOG) performance status 0-2
Life expectancy ≥ 12 weeks
Absolute neutrophil count ≥ 1,500/mm³
Platelet count ≥ 100,000/mm³
Bilirubin ≤ 1.5 times upper limit of normal (ULN)
AST ≤ 3 times ULN (5 times ULN if there is liver involvement)
Creatinine ≤ 1.5 times ULN
Hemoglobin ≥ 9.0 g/dL
No uncontrolled infection
No New York Heart Association class III or IV heart failure
Left Ventricular Ejection Fraction (LVEF) ≥ 50% by echocardiogram
No seizure disorder
No other prior or concurrent malignancy in the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
No prior topotecan hydrochloride
More than 4 weeks since prior surgery or procedure involving the peritoneum or pleura
CA125 measurements used as basis for enrollment must be made outside of this 4-week window
More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered
More than 4 weeks since prior immunotherapy
More than 4 weeks since prior biologic therapy
More than 4 weeks since prior radiotherapy
No prior radiotherapy to > 25 % of bone marrow
No prior therapy with an anti-epidermal growth factor receptor or anti-HER2 tyrosine kinase inhibitors
No prior agents targeting topoisomerase I
No prior or concurrent human anti-mouse antibodies (HAMA) in patients with non-measurable disease
At least 14 days since prior and no concurrent herbal or dietary supplements
Vitamin supplements are allowed unless they include herbal additives
At least 14 days since prior and no concurrent CYP3A4 inducers, including any of the following:
Rifampin
Rifabutin
Rifapentine
Phenytoin
Carbamazepine
Phenobarbital
Efavirenz
Nevirapine
Cortisone (> 50 mg)
Hydrocortisone (> 40 mg)
Prednisone (> 10 mg)
Methylprednisolone (> 8 mg)
Dexamethasone (> 1.5 mg)
Oral doses of ≤ 1.6 mg of dexamethasone allowed
Modafinil
Hypericum perforatum (St. John's wort)
At least 7 days since prior and no concurrent CYP3A4 inhibitors, including any of the following:
Clarithromycin
Erythromycin
Troleandomycin
Itraconazole
Ketoconazole
Fluconazole (> 150 mg daily)
Voriconazole
Delaviridine
Nelfinavir
Amprenavir
Ritonavir
Indinavir
Saquinavir
Lopinavir
Verapamil
Diltiazem
Nefazodone
Fluvoxamine
Cimetidine
Aprepitant
Grapefruit or grapefruit juice
At least 6 months since prior and no concurrent amiodarone
No concurrent participation in another study involving a pharmacologic agent (e.g., drugs, biologics, immunotherapy, gene therapy) for symptom control or therapeutic intent
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There are 3 Locations for this study
Scottsdale Arizona, 85254, United States
Jacksonville Florida, 32224, United States
Rochester Minnesota, 55905, United States
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