Irinotecan and Temozolomide in Treating Patients With Breast Cancer Who Have Received Previous Treatment for Brain Metastases

University of California, San Francisco30 enrolled

Overview

RATIONALE: Drugs used in chemotherapy, such as irinotecan and temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells. PURPOSE: This phase II trial is studying the side effects of giving irinotecan together with temozolomide and to see how well it works in treating patients with breast cancer who have received previous treatment for brain metastases.

OBJECTIVES: Primary * To evaluate the objective response rate systemically and in the CNS to the combination of irinotecan hydrochloride and temozolomide among patients with breast cancer and progressive brain metastases that have progressed after previous treatment for brain metastases. * To determine the toxicities associated with the combination of irinotecan hydrochloride and temozolomide in breast cancer patients with progressive brain metastases. Secondary * To evaluate the time to first progression at any site (CNS or extra-CNS) in patients treated with the combination of irinotecan hydrochloride and temozolomide. * To evaluate the overall survival of patients treated with the combination of irinotecan hydrochloride and temozolomide for brain metastases. OUTLINE: Patients receive irinotecan IV on days 1 and 15 and oral temozolomide on days 1-7 and 15-21. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study therapy, patients are followed every 4 weeks.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 120 Years

Medical Language ↔ Plain English

DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed breast cancer with radiographically confirmed metastases to the brain * Extracranial metastases allowed * Must have demonstrated progression of brain metastases after prior treatment for brain metastases, including any of the following: * External beam radiotherapy * Brachytherapy * Stereotactic radiosurgery * Surgery * Chemotherapy * Treatments with investigational drugs, biologics, or devices * Disease progression in the CNS must meet ≥ 1 of the following criteria: * New lesions in the CNS on an imaging study (contrast-enhanced CT scan or MRI) * Progressive lesions on an imaging study (contrast-enhanced CT scan or MRI) * New or progressive lesions that do not meet measurable disease definition allowed * Leptomeningeal disease allowed if concurrent progression or parenchymal brain metastases * Not a candidate for surgical resection and/or further stereotactic radiosurgery * Hormone receptor status not specified PATIENT CHARACTERISTICS: * Menopausal status not specified * ECOG performance status 0-2 * Life expectancy ≥ 1 month * Hemoglobin ≥ 10 g/dL (transfusion allowed) * ANC ≥ 1,500/mm³ * Granulocyte count ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Creatinine ≤ 1.5 mg/dL * Total bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST and ALT ≤ 3 times ULN * Must be able to swallow and retain oral medications * No other active malignancy except for any of the following: * Curatively treated basal or squamous cell carcinoma of the skin * Carcinoma in situ of the cervix * Other malignancies considered disease-free * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No history of immediate or delayed-type hypersensitivity reaction to gadolinium contrast agents or other contraindication to gadolinium contrast * No other known contraindication to MRI including, but not limited to, any of the following: * Cardiac pacemaker * Implanted cardiac defibrillator * Brain aneurysm clips * Cochlear implant * Ocular foreign body * Shrapnel * No active or uncontrolled infection PRIOR CONCURRENT THERAPY: * See Disease Characteristics * Recovered from the side effects of prior chemotherapy, surgery, or radiotherapy for extracranial disease or brain metastases * Concurrent trastuzumab, bisphosphonate, and/or corticosteroid therapy allowed * At least 1 week since prior or on current stable dose of corticosteroid therapy * Patients on an enzyme-inducing anti-epileptic agent (EIAE) or valproic acid are eligible if they are switched to an alternate non-EIAE medication * Concurrent coumadin allowed * No prophylactic use of filgrastim (G-CSF) during first course of treatment

Outcomes

Primary Outcomes

Number of Patients With Objective Treatment Response (Complete or Partial) in the CNS

Imaging was performed at 8-week intervals to assess response to treatment. Patients with known or suspected leptomeningeal disease were deemed to have a complete response if CSF cytology converted to negative (if positive at baseline) and all meningeal enhancement or nodularity of brain and/or spine MRI resolved. A modified RECIST 1.0 criteria was used to assess CNS response for patients with new or progressing brain metastases. In this modified RECIST criteria, CNS lesions \<1cm were not considered measurable, but were considered evaluable for response and progression. Progressive disease for patients with lesions \<1 cm was defined as follows: growth of a lesion from less than or equal to 5 mm to greater than or equal to 10mm; or, growth of a 6-9 mm lesion by at least 5 mm in the case of non-target parenchymal brain metastases.

Time frame: Baseline scan prior to study entry was performed within 14 days of cycle 1 day 1, then every 8 weeks from then until disease progression or up to 2 years

Number of Patients Experiencing a Clinical Benefit

The number of patients experiencing a clinical benefit is the sum of patients with an objective response plus patients with stable disease at ≥ 16 weeks from cycle 1 day 1 (first day of treatment). If a patient did not come back for a follow up scan after clinical deterioration, then they were only considered stable up to the time of the last scan they had per protocol.

Time frame: From 1 day 1 (first day of treatment) every 8 weeks until scan shows disease progression or up to 2 years

Secondary Outcomes

Time to First Progression in CNS

Imaging at 8-week intervals to assess response to treatment. A modified RECIST 1.0 criteria was used to assess response and time to progression in the CNS for patients with progressing brain metastases. In this modified RECIST criteria, CNS lesions \<1cm were not considered measurable, but were considered evaluable for response and progression. Progressive disease for patients with lesions \<1 cm was defined as follows: growth of a lesion from less than or equal to 5 mm to greater than or equal to 10mm; or, growth of a 6-9 mm lesion by at least 5 mm in the case of non-target parenchymal brain metastases. If patient did not come back for a follow up scan after clinical deterioration, patient was only considered stable up to the time of the last scan per protocol and time to progression would be from cycle 1 day 1 to the last scan they completed that was stable.

Time frame: Baseline scan prior to study entry was performed within 14 days of cycle 1 day 1, then every 8 weeks from then until disease progression or up to 2 years

Overall Time of Survival

Time from initiation of study participation until death

Time frame: Time from initiation of study participation until death or up to 3 years

Number of Patients Whose Circulating Tumor Cells (CTCs) Decreased From >5 to <5 CTCs Per 7.5 mL

CTCs were measured in blood using the Cellsearch(R) assay in 14 of the 20 patients measured at baseline

Time frame: CTCs drawn on cycle 1 day 1, collection at 8 week intervals on patients who did not progress on their 8 week scans up to 2 years