Alpha-TEA and Trastuzumab for the Treatment of Refractory HER2+ Metastatic Breast Cancer

• Status: Recruiting
• Trial end date: 2024-02-01
• Target enrollment: 0
• Participant gender: All

Summary

This phase I trial studies the side effects and best dose of alpha-TEA when given together with trastuzumab and to see how well they work for the treatment of HER2+ breast cancer that does not respond to treatment (refractory) and has spread to other places in the body (metastatic). Anti-cancer treatment, such as alpha-TEA, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Alpha-TEA may also alter cancer growth by stimulating the body's immune response against the tumor. Trastuzumab is a form of "targeted therapy" because it works by attaching itself to specific molecules (receptors) on the surface of cancer cells, known as HER2 receptors. When trastuzumab attaches to HER2 receptors, the signals that tell the cells to grow are blocked and the cancer cell may be marked for destruction by the body's immune system. Giving alpha-TEA and trastuzumab may work better for the treatment of HER2+ refractory and metastatic breast cancer compared to usual treatment.

• Phase: Phase 1
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Washington
• Collaborators: National Cancer Institute (NCI); Veana Therapeutics, Inc.
• Treatments: Acetic Acid; Antibodies; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Immunoglobulins; Trastuzumab; Trastuzumab biosimilar HLX02

Criteria

Inclusion Criteria:

• Patients with HER2/neu overexpressing metastatic breast, not considered curable by conventional therapies

• HER2 positivity will be defined per the 2018 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines (Journal of Clinical Oncology [JCO] 2018)

• Extra-skeletal disease that can be accurately measured >= 10 mm by standard imaging techniques within 28 days of treatment

• Patients must continue trastuzumab with or without pertuzumab dosing per standard of care through the entire study period

• Prior lapatinib in the metastatic setting is allowed, but not required

• Patients with estrogen receptor (ER) and / or progesterone receptor (PR) positive metastatic breast cancer are eligible and may continue anti-estrogen therapy for the duration of the study

• Patients must be at least 14 days post cytotoxic chemotherapy prior to enrollment

• Patients must be at least 14 days post immunosuppressant prior to enrollment

• Patients on bisphosphonates and/or endocrine therapy are eligible and can continue on this therapy concurrently

• Women who are having sex that can lead to pregnancy must have a negative pregnancy test and must avoid becoming pregnant while on alpha-TEA and for 4 weeks after the last dose of alpha-TEA. Men must avoid fathering a child while on alpha-TEA and for 4 weeks after the last dose of alpha-TEA

• Patients must have Eastern Cooperative Oncology Group (ECOG) performance status score of =< 2

• Patients must have recovered from major infections and/or surgical procedures, and in the opinion of the investigator, not have significant active concurrent medical illnesses precluding study treatment

• White blood cell (WBC) >= 2000/mm^3 (within 28 days prior to first treatment)

• Hemoglobin (Hgb) >= 8 mg/dl (within 28 days prior to first treatment)

• Estimated creatinine clearance (Crcl) by the Cockcroft-Gault (C-G) equation >= 60 mL/min (within 28 days prior to first treatment)

• Total bilirubin =< 1.5 x upper limit of normal (within 28 days prior to first treatment)

• Aspartate aminotransferase (AST) < 1.5 X upper limit of laboratory normal (within 28 days prior to first treatment)

• Alanine aminotransferase (ALT) < 1.5 X upper limit of laboratory normal (within 28 days prior to first treatment)

• Alkaline phosphatase < 2.5 X upper limit of laboratory normal (within 28 days prior to first treatment)

• International normalized ratio (INR) < 1.5 (within 28 days prior to first treatment)

• Prothrombin time (PT) < 16 seconds (within 28 days prior to first treatment)

• Partial thromboplastin time (PTT) < 38 seconds (within 28 days prior to first treatment)

• Ability to swallow capsules

• Patients must have adequate cardiac function as demonstrated by normal left ventricular ejection fraction (LVEF) >= the lower limit of normal for the facility on multi-gated acquisition (MUGA) scan or echocardiogram (ECHO) within 3 months of enrollment

• Must be off vitamin E supplements for at least two weeks prior to first dose of study drug

Exclusion Criteria:

• Patients with any of the following cardiac conditions:

• Restrictive cardiomyopathy

• Unstable angina within 6 months prior to enrollment

• New York Heart Association functional class III-IV heart failure

• Symptomatic pericardial effusion

• Right atrial enlargement on ECHO would not be allowed

• History of or active atrial fibrillation or supraventricular tachycardia

• History of documented cardiac arrhythmia

• Active cardiac ischemia. Patients with a history of ischemia ameliorated with stent placement or coronary artery bypass grafting and who have no evidence of ischemia by exercise or physiological stress testing are eligible

• Patients with any clinically significant autoimmune disease requiring active treatment

• Patients receiving any concurrent systemic immunosuppressants. Patients who require brief courses of steroids to manage allergic reaction to intravenous contrast used in radiographic studies are eligible

• Patients receiving strong inhibitors or inducers of CYP3A4/5

• Patients who are pregnant or breast-feeding

• Patients who are simultaneously enrolled in other treatment studies

• Active brain metastatic disease. Patients with brain metastases who have been treated with surgery, gamma-knife radiosurgery or radiation and no radiographic progression for at least 4 weeks and off steroids are eligible

• Any medical or psychiatric condition that in the opinion of the principal investigator (PI) would preclude compliance with study procedures

• Malabsorption state such as ulcerative colitis, previous surgical resection of > 20% of intestine or stomach

• Surgery or severe trauma within 4 weeks of study entry (minimally invasive procedures acceptable)

• Corrected QT interval (QTc) greater than 450 msec at (calculated using Bazett's formula), sick-sinus syndrome or other active cardiac disease

• Prior blood clot or need for ongoing anti-coagulation therapy

• Patient with abnormal thyroid function or who are euthyroid but on medication for thyroid disorders must be excluded