Intrathecal Trastuzumab for Leptomeningeal Metastases in HER2+ Breast Cancer
Phase: Phase 1/Phase 2
Diagnosis: Breast: Metastatic
NCT ID: NCT01325207
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 13-159
The drug being studied is Trastuzumab, a medicine that is used to slow or stop the growth of cancerous tumors that are HER-2 positive. Patients are being asked to participate in this study because they have been diagnosed with having tumor cells in their spinal fluid. This study will investigate the safety and effects of this drug when given directly into the spinal fluid. Phase I/II Dose Escalation Trial to Assess Safety of Intrathecal Trastuzumab for the Treatment of Leptomeningeal Metastases in HER2 Positive Breast Cancer The purpose of this research study is to determine a safe dose of the drug Trastuzumab and then determine how effective this treatment is.
Brigham and Women's Hospital, Dana-Farber Cancer Institute, Beth-Israel Deaconess Medical Center
Nancy Lin, MD,
Dana-Farber Cancer Institute
Erik Uhlmann, MD,
Beth Israel Deaconess Medical Center
Dana-Farber Cancer Institute:
Breast Cancer Nursing Team, 617-632-3478
Beth-Israel Deaconess Medical Center:
Cancer Trials Call Center, 617-667-3060
- HER2 positive (IHC 3+ and/or FISH positive) breast cancer patients with
leptomeningeal metastases by MRI or CSF (if MRI is negative).
o Review will be performed for cases not reviewed at Northwestern for confirmation,
but will not preclude patients from entering the trial (pathology report is
sufficient for registration).
- Patients can have concomitant brain metastases as long as they do not require active
treatment or have been treated.
- Patients with leptomeningeal disease from ependymomas, gliomas, and medulloblastoma
will be eligible for phase I
- Life expectancy > 8 weeks
- Normal renal (creatinine < 1.5 ULN), liver (bilirubin < 1.5 x ULN, transaminases <
3.0 x ULN, except in known hepatic metastasis, wherein may be < 5 x ULN) and blood
counts (WBC > 3.0, Neutrophils > 1500, platelets >100 000, Hemoglobin > 10).
- LVEF > 50%
- KPS > 50
- Age > 18 years
- Cannot be on systemic agents (chemotherapy) that have CNS penetration unless they
develop leptomeningeal metastases while on these agent(s) and have controlled
systemic disease. May continue on IV trastuzumab, lapatinib or hormonal agents if
controlling systemic disease and developed LM while on therapy. Patients requiring
systemic chemotherapy are eligible but will not be able to start treatment until
after the first assessment by imaging and cytology.
- Patients may need a CSF flow study at the discretion of the treating principal
investigator. If a spinal block is seen by CSF flow study or MRI, it will need local
RT prior to treatment. Concurrent radiation is not allowed.
- Patients should be > 2 weeks from RT treatment and all effects of treatment should
- No limit on prior systemic or IT therapies.
- CSF sampling to document LM if not documented on MRI.
- Must be willing to have an Ommaya reservoir placed.
- NO history of any other cancer (except non-melanoma skin cancer or carcinoma in-situ
of the cervix) unless in complete remission and off all therapy for the disease for a
minimum of 3 years.
- Significant medical or psychiatric illness that would interfere with compliance and
ability to tolerate treatment as outlined in the protocol.
- Women of childbearing potential and sexually active males must commit to the use of
effective contraception while on study.
- Women may not be pregnant or breast-feeding.
- Ability to sign an informed consent; can be signed by family member or health care
proxy. Informed consent must be done prior to registration on study.
- All patients must have given signed, informed consent prior to registration on study.
- No known hypersensitivity to trial medications Note: The eligibility criteria listed
above are interpreted literally and cannot be waived.
- Any deviations from the inclusion criteria