This phase 0/II trial studies the effect of carbon C 14 oxaliplatin in tumor tissue and blood and the side effects and how well oxaliplatin works in treating patients with metastatic breast cancer. DNA analysis of tumor tissue and blood samples from patients receiving carbon C 14 oxaliplatin may help doctors predict how well patients will respond to treatment with oxaliplatin. Drugs used in chemotherapy, such as oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing.
PRIMARY OBJECTIVES: I. To detect the levels of oxaliplatin-deoxyribonucleic acid (DNA) adducts induced by oxaliplatin microdosing in tumor tissue and peripheral blood mononuclear cells (PBMC), and correlate the results with patient response to oxaliplatin-based chemotherapy. SECONDARY OBJECTIVES: I. Evaluate the efficacy of single agent oxaliplatin treatment (130mg/m\^2, 2 hr intravenously \[IV\] day 1; every 3 weeks) in pre-treated, metastatic breast cancer patients. II. Evaluate the toxicity of oxaliplatin microdose and chemotherapy treatment in this patient population. III. Determine the pharmacokinetic (PK) parameters of oxaliplatin microdosing and correlate with the PK parameters of therapeutic oxaliplatin. IV. Determine whether the pharmacokinetics of oxaliplatin microdosing affects oxaliplatin-induced DNA damage and, therefore, patient response to chemotherapy. V. Detect repair of DNA adducts in PBMC and correlate with patient response to oxaliplatin-based chemotherapy. VI. Correlate the adduct and patient response data to DNA repair genes, such as excision repair cross-complementing (ERCC)1 levels as measured by reverse transcriptase-polymerase chain reaction (RT-PCR). OUTLINE: PHASE 0: Patients receive carbon C 14 oxaliplatin IV over 2 minutes on day 1. PHASE II: Patients receive oxaliplatin IV over 2 hours on day 1. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for up to 6 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
UC Davis Comprehensive Cancer Center
Sacramento, California, United States
Threshold at which oxaliplatin-DNA adducts predict response to therapy
The concentration of oxaliplatin-DNA adducts induced will be characterized using descriptive statistics (graphical summaries, mean, standard deviation \[SD\], box plots) in PBMC and tumor for responders and non-responders to chemotherapy. The mean level of oxaliplatin-DNA adducts will be compared in responders to chemotherapy to that of non-responders using a 2-sample t-test at the 0.05 level (2-sided). The Youden index will be used to estimate and compute a 95% confidence interval for the optimal cut-point in oxaliplatin-DNA adduct levels to differentiate between responders and non-responders.
Time frame: Up to 6 months post-treatment
Response rate assessed using Response Evaluation Criteria in Solid Tumors (RECIST)
Will be analyzed primarily with respect to their association with level of oxaliplatin-DNA adducts. The distribution of clinical endpoints, including toxicity, will be summarized using frequencies for categorical data and Kaplan-Meier curves for survival data.
Time frame: Up to 6 months post-treatment
Progression-free survival
Will be analyzed primarily with respect to their association with level of oxaliplatin-DNA adducts. The distribution of clinical endpoints, including toxicity, will be summarized using frequencies for categorical data and Kaplan-Meier curves for survival data.
Time frame: From the date of enrollment to the date of first objective evidence of radiographic progression (soft tissue or bone lesion) or date of death due to any cause, whichever occurs first, assessed up to 6 months post-treatment
Overall survival
Will be analyzed primarily with respect to their association with level of oxaliplatin-DNA adducts. The distribution of clinical endpoints, including toxicity, will be summarized using frequencies for categorical data and Kaplan-Meier curves for survival data.
Time frame: From the first treatment to death or to the last treatment follow-up, assessed up to 6 months post-treatment
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NONE
Enrollment
1
Overall toxicity from both the carbon C 14 oxaliplatin microdose and the full dose oxaliplatin chemotherapy evaluated using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Will be analyzed primarily with respect to their association with level of oxaliplatin-DNA adducts. The distribution of clinical endpoints, including toxicity, will be summarized using frequencies for categorical data and Kaplan-Meier curves for survival data. Safety will be assessed through summaries of adverse events, the frequency of treatment discontinuations due to adverse events, and laboratory evaluations. Descriptive statistics will be used rather than inferential statistics.
Time frame: Up to 30 days post-treatment
PK parameters including maximum concentration (Cmax), half-life (t1/2), and area under the curve (AUC) from both micro- and therapeutic- dosing in the same patients
PK parameters from microdosing will be correlated with parameters from therapeutic dosing. Descriptive summaries (scatterplots, tables, mean, SD, correlation coefficient) of the relationship between the two sets of parameters will be presented.
Time frame: Pre-dose; 5, 15, and 30 minutes; and 2, 4, 8, 24, and 48 hours
Levels of oxaliplatin-DNA adducts in tumor and PBMC
Responders and non-responders will be compared using two-sample t-tests; if the half-lives are not normally distributed, Wilcoxon rank-sum tests will be used. The effect of half-life on progression-free survival will be explored using Cox proportional hazards models. Similar analyses will be performed for other PK parameters.
Time frame: Up to 48 hours
Repair of oxaliplatin-DNA monoadducts in PBMCs
Will be characterized using descriptive statistics (graphical summaries, mean, SD, box plots).
Time frame: Up to 48 hours
Messenger ribonucleic acid (mRNA) expression levels of ERCC1
Descriptive statistics, such as graphical summaries, mean, SD, box plots will be used for responders and non-responders.
Time frame: Up to 48 hours