Alternate Title
Basic Trial Information
Objectives
Entry Criteria
Expected Enrollment
Outcomes
Outline
Trial Contact Information
Registry Information

Alternate Title

Ixabepilone and Hydroxychloroquine in Treating Patients With Metastatic Breast Cancer

Basic Trial Information

Phase	Type	Status	Age	Sponsor	Protocol IDs
Phase II, Phase I	Treatment	Active	18 and over	NCI	CINJ-040804 040804, CINJ-0220080205, NCT00765765

Objectives

Primary

1. To determine the recommended phase II dose of ixabepilone and hydroxychloroquine in patients with metastatic breast cancer. (Phase I)
2. To assess the antitumor activity, measured by tumor response rate, in patients who receive this regimen as a third-line treatment. (Phase II)

Secondary

1. To measure the duration of response for responding patients.
2. To measure the time to progressive disease.
3. To measure survival time.
4. To characterize the quantitative and qualitative toxicities of this regimen in these patients.
5. To develop pharmacodynamic markers for autophagy detection in patient specimens.
6. To characterize the effects of hydroxychloroquine on autophagy in patients in vivo.
7. To investigate whether the estrogen receptor, progesterone receptor, and/or HER2 status of breast tumors correlates with treatment response.

Entry Criteria

Disease Characteristics:

• Histologically or cytologically confirmed breast cancer
  • Histologic or cytologic elements can be established on metastatic tumor aspirate or biopsy
  • Metastatic disease
  • Measurable disease according to RECIST criteria



• Must have received 2 prior chemotherapy regimens for metastatic breast cancer



• Anthracycline-resistant (or treated with minimum cumulative doxorubicin dose of 240 mg/m² or epirubicin dose of 360 mg/m²) and taxane-resistant disease
  • Anthracycline resistance is defined as progression while on therapy or within 6 months in the adjuvant/neoadjuvant setting or 3 months in the metastatic setting
  • Taxane resistance is defined as progression while on therapy or within 12 months in the adjuvant/neoadjuvant setting or 4 months in the metastatic setting



• Hormone receptor status known



• No known CNS metastases or previously treated and now stable CNS metastases

Prior/Concurrent Therapy:

• See Disease Characteristics
• Prior radiation to tumor sites allowed provided:
  • Radiation was completed ≥ 3 weeks prior to study treatment
  • All radiation-related toxicities have resolved to ≤ grade 1
• No more than 3 prior chemotherapy regimens in the metastatic setting
• No prior ixabepilone or another epothilone
• No concurrent highly active antiretroviral therapy
• No other concurrent hydroxychloroquine for treatment or prophylaxis of malaria
• No other concurrent anticancer investigational or commercial agents or therapies

Patient Characteristics:

• Menopausal status not specified
• ECOG performance status 0-2
• ANC ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• Hemoglobin ≥ 9 g/dL
• Total bilirubin ≤ upper limit of normal (ULN)
  • If patient has Gilbert's disease, then patient must have isolated hyperbilirubinemia (e.g., no other liver function test abnormality), with maximum bilirubin ≤ 2 times ULN
• AST and ALT ≤ 2.5 times ULN, independently of liver metastases
• Alkaline phosphatase ≤ 2.5 times ULN
• Creatinine ≤ 1.5 times ULN OR calculated creatinine clearance ≥ 60 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No other active malignancy
  • History of basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix within the past 3 years allowed provided patient has been treated with curative intent
  • History of prior malignancy allowed provided patient has been treated with curative intent and has been disease free > 3 years
• None of the following conditions within the past 6 months:
  • Myocardial infarction
  • Stroke
  • Symptomatic peripheral vascular disease
• No unstable angina or NYHA class II-IV congestive heart failure
• No history of psoriasis or porphyria
• No history of hypersensitivity to 4-aminoquinoline compound
• No retinal or visual field changes from prior 4-aminoquinoline-compound use
• No history of G6PD deficiency
• No GI pathology that would interfere with drug bioavailability
• No motor or sensory neuropathy ≥ grade 2 (NCI CTCAE) at study entry
• No serious uncontrolled medical disorder or active infection at study entry
• No rheumatoid arthritis or systemic lupus erythematosus requiring active treatment
• No history of HIV
• No history of any condition (social or medical) that, in the opinion of the investigator, might interfere with the patient's ability to comply with the protocol or pose additional or unacceptable risk to the patient

Expected Enrollment

Outcomes

Recommended phase II dose of ixabepilone and hydroxychloroquine
Tumor response rate assessed using RECIST criteria

Duration of response
Time to progressive disease
Survival time
Toxicity
Pharmacodynamic markers for autophagy detection
Effects of hydroxychloroquine on autophagy
Correlation of estrogen receptor, progesterone receptor and/or HER2 status with treatment response

Outline

This is a multicenter, phase I dose-escalation study of ixabepilone followed by a phase II study.

During the first course, patients receive ixabepilone IV over 3 hours on day 1 and oral hydroxychloroquine twice daily on days 3-21. On all subsequent courses, patients receive ixabepilone IV over 3 hours on day 1 and oral hydroxychloroquine twice daily on days 1-21. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed every 6 months.

Trial Contact Information

Trial Lead Organizations

Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School

Vassil Karantza-Wadsworth, MD, Principal investigator		Ph: 732-235-5337 Email: karantva@umdnj.edu

U.S.A.
New Jersey
	Hamilton
	Cancer Institute of New Jersey at Hamilton
		Clinical Trials Office - Cancer Institute of New Jersey at Hamilton	Ph:  609-631-6946
	New Brunswick
	Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
		Clinical Trials Office - Cancer Institute of New Jersey	Ph:  732-235-8675

Registry Information
Official Title		Phase I/II Study of Ixabepilone in Combination with the Autophagy Inhibitor Hydroxychloroquine for the Treatment of Patients with Metastatic Breast Cancer
Trial Start Date		2009-02-05
Trial Completion Date		2011-08-01 (estimated)
Registered in ClinicalTrials.gov		NCT00765765
Date Submitted to PDQ		2008-09-13
Information Last Verified		2009-05-02
NCI Grant/Contract Number		CA72720

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