Kinases are a group of proteins that are important in how cancer cells grow. HER2 is a kind of kinase. This study looks at a new approach to identifying kinases, which may help target therapy more precisely. LCCC1214 is a randomized, multiarm, multicenter, open-label window trial designed to explore the kinome response in Stage I-IV HER2 positive (HER2+) breast cancer patients scheduled to undergo definitive surgery (either lumpectomy, mastectomy or surgical resection of oligometastatic disease). Patients will initiate dosing with either a single HER2-directed agent or a combination of two HER2-directed agents, one week prior to surgery. Forty patients will be randomized to one of four study groups: A) single dose trastuzumab; B) single dose pertuzumab; C) combination single dose trastuzumab plus single dose pertuzumab; or D) combination single dose trastuzumab plus lapatinib daily for 7 days. Pre- and post- dosing tissue will be analyzed for kinome response and resistant signatures. The initiation of study drug will be defined by the surgical schedule; there will be no delays in standard treatment for the purposes of this study.
Until recently, our understanding of the kinome has been limited to just 5-10% of the genome-encoded kinases. This limited knowledge prevents a thorough understanding of resistance mechanisms, and precludes individualizing HER2-targeted therapy in HER2+ disease. Fortunately, we have now developed a chemical proteomics approach to define comprehensive kinome activity in cells and tumors (MIB/MS).\[1\] We hypothesize that our proteomics approach can be used to characterize the heterogeneity of the kinome activation profiles in HER2+ breast cancer and permit us to identify if adaptive response to HER2 inhibition differs depending on the anti-HER2 drug mechanism of action. This will allow rational prediction of new combinatorial therapies in future clinical trials. To explore kinome activation in this population, we propose a window trial in stage I-IV HER2+ patients scheduled to undergo definitive surgery (either lumpectomy, mastectomy or surgical resection of oligometastatic disease). Enrolled patients will be randomized to one of four treatment arms; A) single dose trastuzumab; B) single dose pertuzumab; C) combination trastuzumab + pertuzumab for one dose each; or D) combination single dose trastuzumab plus lapatinib daily for one week. Dosing in each arm will be initiated 7 days prior to surgery, with pre- and post-dosing tissue samples analyzed for kinome response and resistant signatures. To ensure adequate levels of trastuzumab and pertuzumab at the time of surgery, a loading dose of each agent (8 mg/kg IV for trastuzumab, and 840 mg IV fixed dose for pertuzumab) were chosen. The dose of lapatinib was based on prior studies of lapatinib administered in combination with trastuzumab. Given the varied pharmacokinetic profiles of the three agents and limited dosing, we expect exposure levels of the agents to be different relative to respective steady state levels. Therefore qualitative rather than quantitative measures will be key.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
26
8 mg/kg IV, single dose
840 mg IV single dose
1000 mg daily for 7 days
University of Alabama at Birmingham
Birmingham, Alabama, United States
IU Simon Cancer Center
Indianapolis, Indiana, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Lineberger Comprehensive Cancer Center, UNC
Chapel Hill, North Carolina, United States
MD Anderson
Houston, Texas, United States
difference in kinome activation pre and post treatment
To identify differential kinome activation before and after treatment with a single dose of trastuzumab, pertuzumab, the combination of trastuzumab + pertuzumab, or the combination of single dose trastuzumab+once daily lapatinib for 7 days, in patients with HER2+ breast cancer
Time frame: 7-10 days prior to surgery and at surgery
predictability in kinome activation
to see if different kinase activation patterns can predict the optimal HER2 inhibition for treatment.
Time frame: kinoming analysis of tissue will be done after subject participation, which will last from 7-10 days prior to surgery.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.