An Open-Label Study to Characterize the Incidence and Severity of Diarrhea in Patients with Early-Stage HER2+ Breast Cancer Treated with Neratinib and Loperamide or other prophylactic measures.
This is an open-label, Phase 2 study that will investigate the incidence and severity of diarrhea in early-stage HER2+ breast cancer patients receiving neratinib with loperamide, alone and in combination with an anti-inflammatory treatment or a bile acid sequestrant treatment, or neratinib dose escalation, who have previously undergone a course of trastuzumab therapy in the adjuvant setting. Patients will receive: * Neratinib 240 mg orally once daily with food for thirteen 28-day cycles. * Loperamide daily for two 28-day cycles and then as needed. * Amendment 3, an anti-inflammatory treatment for one cycle and loperamide to be administered daily for two 28-day cycles and then as needed. Closed to enrollment. * Amendment 4, colestipol for one cycle and loperamide to be administered one cycle and then as needed. Closed to enrollment. * Amendment 5, colestipol for one cycle and loperamide as needed. Closed to enrollment. * Amendment 6/6.1, 120 mg neratinib for Week 1 (C1D1-C1D7), followed by 160 mg neratinib for Week 2 (C1D8-C1D14), followed by 240 mg neratinib for Week 3 and thereafter (C1D15 to end of treatment). Loperamide as needed. Closed to enrollment. * Amendment 7/7.1, 160 mg neratinib for the first 2 weeks (C1D1 - C1D14), followed by 200 mg neratinib for the next 2 weeks (C1D15 - C1D28), followed by 240 mg neratinib thereafter (C2D1 to end of treatment). Loperamide as needed.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
563
2 g twice daily with or without food for one 28 day cycle
Percentage of Patients With Grade 3 or Higher Diarrhea, According to NCI CTCAE v4.0.
The primary objective of this study is to characterize the percentage of patients with Grade 3 or higher diarrhea in patients with early-stage HER2 overexpressed/amplified (HER2+) breast cancer treated with neratinib when administered with intensive loperamide prophylaxis, after prior treatment with trastuzumab. Grade 3: Increase of \>=7 stools per day over baseline; incontinence; hospitalization indicated; severe increase in ostomy output compared to baseline; limiting self care ADL. Grade 4: Life-threatening consequences; urgent intervention indicated. Grade 5: Death.
Time frame: From first dose of investigational product through 28 days after last dose, up to 15.5 months.
Percentage of Patients With Diarrhea by Grade, According to the National Cancer Institute Common Terminology Criteria (NCI CTCAE), Version 4.0.
Assess the percentage of patients with diarrhea after the administration of an anti-inflammatory agent, a bile acid sequestrant, or following two different dose-escalation regimens of neratinib, by maximum CTC grade. Grade 1: an increase of \<4 stools per day over baseline; mild increase in ostomy output compared to baseline. Grade 2: Increase of 4 - 6 stools per day over baseline; moderate increase in ostomy output compared to baseline. Grade 3: Increase of \>=7 stools per day over baseline; incontinence; hospitalization indicated; severe increase in ostomy output compared to baseline; limiting self care ADL. Grade 4: Life-threatening consequences; urgent intervention indicated. Grade 5: Death.
Time frame: From first dose of investigational product through 28 days after last dose, up to 15.5 months.
Percentage of Patients With Serious Adverse Events and Other Adverse Events of Special Interest
Assess the percentage of patients with serious adverse events (SAEs) and other adverse events of special interest (AESI). AESIs were selected based on the known safety profile of neratinib as well as typical key body system toxicity concerns generally reviewed for any new drug. These AESIs were grouped into the following categories: gastrointestinal toxicity (diarrhea and stomatitis), hepatotoxicity, pulmonary toxicity (interstitial lung disease), cardiac toxicity (LVEF decreased), and dermatologic toxicity (rash and nail disorders). The AESIs were analyzed by searching the clinical database for all TEAEs and SAEs using either Standardized MedDRA Queries (SMQs) or, if an applicable SMQ did not exist, a Sponsor-defined list of MedDRA preferred terms.
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9 mg extended release tablets once daily with or without food for 28 days
Alabama Oncology
Birmingham, Alabama, United States
Compassionate Care Research Group Inc.
Corona, California, United States
St. Joseph Heritage Healthcare
Fullerton, California, United States
Ronald Reagan UCLA Medical Center
Los Angeles, California, United States
Emad Ibrahim, M.D., Inc.
Redlands, California, United States
Torrance Memorial Physician Network Cancer Care Associates
Redondo Beach, California, United States
Compassionate Care Research Group Inc.
Riverside, California, United States
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California, United States
The Oncology Institute of Hope and Innovation
Santa Ana, California, United States
Cancer Center of Santa Barbara with Sansum Clinic
Santa Barbara, California, United States
...and 48 more locations
Time frame: From first dose of investigational product through 28 days after last dose, up to 15.5 months.