Afatinib Dimaleate in Treating Patients with Advanced Refractory Urothelial Cancer

Inclusion Criteria

• Patients must have locally advanced or metastatic urothelial cancer that is not amenable to surgical treatment
• Patients must have histologically or cytologically confirmed urothelial tract carcinoma; patients with urothelial carcinoma of the bladder, upper tract, or urethra are eligible
• Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques or as >= 10 mm with spiral computed tomography (CT) scan for the evaluation of measurable disease (Response Evaluation Criteria in Solid Tumors version 1.1 [RECIST v1.1]). Lesions that have been irradiated as the most recent line of treatment are not eligible as RECIST target lesions.
• Patients must have evidence of disease progression prior to enrollment
• All patients must have received a prior platinum-based chemotherapy regimen for treatment of urothelial cancer and must now be considered refractory to platinum-based chemotherapy; patients may have received the platinum-containing regimen either in the peri-operative or metastatic setting; patients may have received any number of additional prior therapies, and may have received prior immune therapies
• Patients must have tumor evidence of somatic genomic molecular alteration in EGFR, HER2, ERBB3, or ERBB4, from a test result generated in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory; the tumor tissue sample used to generate the qualifying report must be from a muscle-invasive or higher stage urinary tract cancer specimen (metastatic tissue is also acceptable); final determination about whether a specific tissue source or molecular genomic finding meets criteria as a qualifying result rests with the central study principal investigator (PI); germline genomic findings will not be returned to patients
• Patients must be 18 years of age or older
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• Absolute neutrophil count >= 1,000/mcL
• Platelets >= 100,000/mcL
• Hemoglobin >= 8.5 g/dL
• Total bilirubin =< 1.5 institutional upper limit of normal (IULN)
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X IULN
• Calculated creatinine clearance >= 30 mL/min by the modified Cockcroft and Gault formula OR glomerular filtration rate >= 30 mL/min/body surface area (BSA) by Modification of Diet in Renal Disease or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula
• Women and men of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
• Patients must have the ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Patients may not receive any other anti-cancer treatments while on study. Patients cannot have received another anti-cancer chemotherapy or immunotherapy or radiotherapy or investigational agent within 2 weeks prior to the first dose of study treatment
• Patients with untreated known brain metastases, or treated brain metastases that are clinically unstable
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or psychiatric illness/social situations that would limit compliance with study requirements
• Women known to be pregnant
• Women who are breastfeeding and who are unwilling to stop breastfeeding prior to study entry
• Patients with known prior human immunodeficiency virus (HIV)-positive status on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions; known prior HIV-positive patients with cluster of differentiation (CD)4+ =< 500/mm^3 are ineligible because of the potential increased risk of infection (HIV testing is not required as part of this study)
• Pre-existing interstitial lung disease
• Inability to take oral medications
• Prior therapy with afatinib