Overview

This trial is active, not recruiting.

Condition neoplasms, breast
Treatments lapatinib, trastuzumab, paclitaxel
Phase phase 3
Targets HER2, AKT, CDK, EGFR, ERK
Sponsor GlaxoSmithKline
Collaborator Breast International Group
Start date January 2008
End date May 2010
Trial size 455 participants
Trial identifier NCT00553358, EGF106903

Summary

This is a randomised, open label multicenter Phase III study comparing the efficacy of neoadjuvant lapatinib plus paclitaxel, versus trastuzumab plus paclitaxel, versus concomitant lapatinib and trastuzumab plus paclitaxel given as neoadjuvant treatment in HER2/ErbB2 over-expressing and/or amplified primary breast cancer.

Patients will be randomised to receive either: lapatinib 1500 mg daily, trastuzumab 4 mg/kg intravenous (IV) load followed by 2 mg/kg IV weekly, or lapatinib 1000 mg daily with trastuzumab 4 mg/kg IV load followed by 2 mg/kg IV weekly for a total of 6 weeks. After this biological window, patients on monotherapy arms will continue on the same targeted therapy plus weekly paclitaxel 80 mg/m^2 for a further 12 weeks, up to definitive surgery. In the combination arm, patients will receive lapatinib 750 mg daily in combination with trastuzumab 2 mg/kg IV plus weekly paclitaxel 80mg/m^2 IV for a further 12 weeks, up to definitive surgery. After surgery, patients will receive three courses of adjuvant chemotherapy with 5-Fluorouracil Epirubicin Cyclophosphamide (FEC) followed by the same targeted therapy as in the biological window of the neoadjuvant setting for a further 34 weeks (in the combination arm, lapatinib dose will be 1000 mg daily in combination with trastuzumab). The planned total duration of the anti-HER2 therapy will be one year.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification safety/efficacy study
Intervention model parallel assignment
Masking open label
Primary purpose treatment
Arm
(Experimental)
1500 mg lapatinib for 6 weeks followed by lapatinib plus weekly paclitaxel for an additional 12 weeks. After definitive surgery, 3 cycles of adjuvant FEC followed by 34 weeks of adjuvant lapatinib.
lapatinib Lapatinib
Small molecule receptor tyrosine kinase inhibitor
paclitaxel
antimicrotubule agent
(Active Comparator)
4 mg/kg IV loading dose followed by 2 mg/kg IV weekly trastuzumab for 6 weeks followed by 2 mg/kg trastuzumab plus weekly paclitaxel for an additional 12 weeks. After definitive surgery, 3 cycles of adjuvant FEC followed by 34 weeks of adjuvant trastuzumab (8 mg/kg loading dose followed by 6 mg/kg every 3 weeks).
trastuzumab
Therapeutic Monoclonal Antibody
paclitaxel
antimicrotubule agent
(Experimental)
1000 mg lapatinib plus 4 mg/kg IV loading dose followed by 2 mg/kg IV weekly trastuzumab for 6 weeks, followed by 750 mg lapatinib plus 2 mg/kg IV weekly trastuzumab plus weekly paclitaxel for an additional 12 weeks. After definitive surgery, 3 cycles of adjuvant FEC followed by 34 weeks of adjuvant lapatinib (1000 mg) in combination with trastuzumab (8 mg/kg loading dose followed by 6 mg/kg every 3 weeks).
lapatinib Lapatinib
Small molecule receptor tyrosine kinase inhibitor
trastuzumab
Therapeutic Monoclonal Antibody
paclitaxel
antimicrotubule agent

Primary Outcomes

Measure
Number of Participants With Pathological Complete Response (pCR) at the Time of Surgery
time frame: Weeks 20 to 22

Secondary Outcomes

Measure
Number of Participants With Overall Response at Week 6
time frame: Week 6
Number of Participants With Overall Response at the Time of Surgery
time frame: Time of surgery (Weeks 20 to 22)
Number of Participants With Negative Lymph Nodes at the Time of Surgery
time frame: Time of surgery (Weeks 20 to 22)
Number of Participants With Actual Indicated Surgery
time frame: At surgery (Weeks 20 to 22)
Estimate of Treatment Contrast for Change From Baseline in Tumor Size at Week 6 and at Surgery
time frame: Week 6 and surgery (Weeks 20 to 22)
Number of Participants Starting Paclitaxel Before Completing 6 Weeks of Treatment With Either Lapatinib or Trastuzumab
time frame: Week 6
Overall Survival
time frame: Following surgery, every 12 months until Year 10
Disease-free Survival (DFS)
time frame: Following surgery, every 12 months until Year 10
Number of Participants With Metabolic Response of Complete Response (mCR), Partial Response (mPR), or Stable Disease (mSD) as Determined by Positron Emission Tomography/Computed Tomography (PET/CT)
time frame: Baseline, Week 2, and Week 6
Number of Participants With the Indicated Biomarker Expression
time frame: Baseline, Week 2, and at surgery (Weeks 20 to 22)
Number of Circulating Tumor Cells (CTC) in the Bloodstream
time frame: Baseline, Week 2 of neo-adjuvant phase (Weeks 1-34), at surgery (Weeks 20 to 22), Week 10 of adjuvant phase, 6 months after completion of adjuvant treatment, and at recurrence

Eligibility Criteria

Female participants at least 18 years old.

Inclusion Criteria: - Female gender; - Age ≥18 years; - Performance Status- Eastern Cooperative Oncology Group (ECOG) 0-1 - Histologically confirmed invasive breast cancer: - Primary tumour greater than 2 cm diameter, measured by clinical examination and mammography or echography, - Any N, - No evidence of metastasis (M0) (isolated supraclavicular node involvement allowed); - Over expression and/or amplification of HER2 in the invasive component of the primary tumour [Wolff et al 2006] and confirmed by a certified laboratory prior to randomisation - Known hormone receptor status. - Haematopoietic status: - Absolute neutrophil count ≥ 1,5 x 10^9/L, - Platelet count ≥ 100 x 10^9/L, - Hemoglobin at least 9 g/dl, - Hepatic status: - Serum total bilirubin ≤ 1.5 x upper limit of normal (ULN). In the case of known Gilbert's syndrome, a higher serum total bilirubin (< 2 x ULN) is allowed, - Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 times ULN, - Alkaline phosphatase ≤ 2.5 times ULN, - Renal status: - Creatinine ≤ 2.0 mg/dL, - Cardiovascular: - Baseline left ventricular ejection fraction (LVEF) ³ 50% measured by echocardiography (ECHO) or Multiple Gate Acquisition (MUGA) scan, - Negative serum pregnancy test, within 2-weeks (preferably 7 days) prior to randomization (For women of childbearing potential) - Fertile patients must use effective contraception (barrier method - condoms, diaphragm - also in conjunction with spermicidal jelly, or total abstinence. Oral, injectable, or implant hormonal contraceptives are not allowed) - Signed informed consent form (ICF) - Patient accepts to make available tumour samples for submission to central laboratory to conduct translational studies as part of this protocol Exclusion Criteria: - Received any prior treatment for primary invasive breast cancer; - Previous (less than 10 years) or current history of malignant neoplasms, except for curatively treated: - Basal and squamous cell carcinoma of the skin; - Carcinoma in situ of the cervix. - Patients with a prior malignancy diagnosed more than 10 years prior to randomisation may enter the study. Patients must have been curatively treated with surgery alone. Radiation therapy or systemic therapy (chemotherapy or endocrine) are NOT permitted. Prior diagnoses of breast cancer or melanoma are excluded. - Diagnosis of inflammatory breast cancer; - Bilateral cancer; - This criterion has been deleted from the protocol Version 1. Patients with multi-focal cancer are no longer excluded. - Known history of uncontrolled or symptomatic angina, clinically significant arrhythmias, congestive heart failure, transmural myocardial infarction, uncontrolled hypertension (≥180/110), unstable diabetes mellitus, dyspnoea at rest, or chronic therapy with oxygen; - Concurrent disease or condition that would make the subject inappropriate for study participation or any serious medical disorder that would interfere with the subject's safety; - Unresolved or unstable, serious adverse events from prior administration of another investigational drug; - Active or uncontrolled infection; - Dementia, altered mental status, or any psychiatric condition that would prevent the understanding or rendering of ICF; - Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel. Subjects with ulcerative colitis are also excluded; - Concurrent neoadjuvant cancer therapy (chemotherapy, radiation therapy, immunotherapy, biologic therapy other than the trial therapies); - Concurrent treatment with an investigational agent or participation in another therapeutic clinical trial; - Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to trastuzumab or lapatinib or their excipients; - Pregnant or lactating women; - Concomitant use of CYP3A4 inhibitors or inducers

Additional Information

Official title Neo ALTTO (Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimisation) Study: A Randomised, Multicenter Open-label Phase III Study of Neoadjuvant Lapatinib, Trastuzumab and Their Combination Plus Paclitaxel in Women With HER2/ErbB2 Positive Primary Breast Cancer
Trial information was received from ClinicalTrials.gov and was last updated in April 2014.
Information provided to ClinicalTrials.gov by GlaxoSmithKline.