Testing the Addition of Trastuzumab or Trastuzumab/Pertuzumab to the Usual Chemotherapy for HER2 Positive Endometrial Serous Carcinoma or Carcinosarcoma
Investigating the Addition of Investigational Medications to Chemotherapy for HER2 Positive Endometrial Cancer
Lisa Landrum, MD, PhD, MS
Primary Investigator
Brief description of study
Detailed description of study
Patients are randomized to 1 of 3 arms.
- ARM I: Patients receive paclitaxel intravenously (IV) over 3 hours and carboplatin IV over 30-60 minutes on day 1 of each cycle. Treatment repeats every 3 weeks for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients with stable disease (SD) or partial response (PR) who still have measurable disease after completion of cycle 6 may receive 4 additional cycles of this treatment at the discretion of the treating physician.
- ARM II: Patients receive paclitaxel IV over 3 hours, carboplatin IV over 30-60 minutes, and trastuzumab/hyaluronidase-oysk subcutaneously (SC) over 2-5 minutes on day 1 of each cycle. Treatment repeats every 3 weeks for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients with SD or PR who still have measurable disease after completion of cycle 6 may receive 4 additional cycles of this treatment at the discretion of the treating physician.
- MAINTENANCE: Patients receive trastuzumab/hyaluronidase-oysk SC over 2-5 minutes on day 1 of each cycle. Cycles repeat every 3 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity. Patients with SD or PR may continue maintenance therapy for up to 3 years from the start of treatment.
- ARM III: Patients receive paclitaxel IV over 3 hours, carboplatin IV over 30-60 minutes, and pertuzumab/trastuzumab/hyaluronidase-zzxf SC over 5-8 minutes on day 1 of each cycle. Treatment repeats every 3 weeks for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients with SD or PR who still have measurable disease after completion of cycle 6 may receive 4 additional cycles of this treatment at the discretion of the treating physician.
- MAINTENANCE: Patients receive pertuzumab/trastuzumab/ hyaluronidase-zzxf SC over 5 minutes on day 1. Cycles repeat every 3 weeks for up to 1 year in absence of disease progression or unacceptable toxicity. Patients with SD or PR may continue maintenance for up to 3 years from the start of treatment.
- Patients undergo echocardiography (ECHO) or multigated acquisition scan (MUGA) and computed tomography (CT) throughout the study and optionally undergo blood sample collection prior to treatment and prior to the first cycle of maintenance therapy and urine sample collection prior to treatment.
- After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
Eligibility of study
You may be eligible for this study if you meet the following criteria:
- Conditions: Endometrial Serous Adenocarcinoma, Uterine Corpus Carcinosarcoma, Cancer
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Age: 18 years or above
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Gender: Female
- Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IVB, non-recurrent, chemotherapy (chemo)-naive, HER2-positive endometrial serous carcinoma or endometrial carcinosarcoma
- Histologic confirmation of the original primary tumor is required. Submission of surgical pathology report (or endometrial biopsy pathology report in patients who never undergo hysterectomy) is required
- Patients must be within 8 weeks of primary surgery (or endometrial biopsy in patients who never undergo hysterectomy) at the time of study registration
- Patients may have measurable disease, non-measurable disease, or no measurable disease. In patients with measurable disease, lesions will be defined and monitored by RECIST v 1.1. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each lesion must be >= 10 mm when measured by computed tomography (CT) or magnetic resonance imaging (MRI). Lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
- For patients with uterine-confined (stage I) disease, the tumor must be invasive into the myometrium. Any amount of myoinvasion is acceptable for eligibility. Patients with non-invasive disease, endometrial intraepithelial carcinoma alone, or disease confined to a polyp will be excluded
- All patients must have tumors that are HER2 positive as defined by American Society of
Clinical Oncology (ASCO)/College of American Pathologists (CAP) 2018 Breast Cancer
guidelines (https://documents.cap.org/documents/algorithim-evaluation-her2.pdf. In
general HER2 positivity is defined as any of the following:
- 3+ immunohistochemistry (IHC),
- 2+ IHC with positive in situ hybridization (ISH)
- Average HER2 copy number >= 6.0 signals/cell
- Average HER2 copy number >= 4.0 and < 6.0 signals/cell, with concurrent IHC 3+
- HER2/CEP17 ratio >= 4.0 signals/cell
- HER2/CEP 17 ratio >= 2.0 and < 4.0, with concurrent IHC 3+ IHC and ISH testing will be done locally, at each participating institution and interpreted by local pathologists. Alternatively, patients could be eligible if next generation sequencing (NGS) demonstrates HER2 (ERBB2) amplification. NGS testing can be performed through any designated labs as per the National Cancer Institute (NCI) MATCH/NCI Combo-MATCH trial (https://ecog-acrin.org/nci-match-eay131-designated-labs).
Pathology report showing results of institutional HER2 testing (or NGS testing results)
must be submitted.
Sites must submit all results available (IHC, ISH, and NGS)
- Additionally, patients must have the following histologic types to be eligible:
- Serous adenocarcinoma (may include =< 10% non-serous histology)
- Carcinosarcoma with serous epithelial component (only the serous component needs
to be HER2 positive; may include =< 10% non-serous histology)
- In cases where determination of serous is equivocal or challenging, aberrant p53
immunohistochemistry (IHC) (defined as overexpression of p53 compared to internal
controls) will be sufficient for inclusion
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
- Age >= 18
- Platelets >= 100,000/mcl (within 14 days prior to registration)
- Absolute neutrophil count (ANC) >= 1,500/mcl (within 14 days prior to registration)
- Creatinine =< 1.5 x institutional/laboratory upper limit of normal (ULN) or estimated
Glomerular filtration rate (eGFR) >= 50 mL/min using either the Cockcroft-Gault
equation, the Modification of Diet in Renal Disease Study, or as reported in the
comprehensive metabolic panel/basic metabolic panel (eGFR). (within 14 days prior to
registration)
- Total serum bilirubin level =< 1.5 x ULN (patients with known Gilbert's disease who
have bilirubin level =< 3 x ULN may be enrolled) (within 14 days prior to
registration)
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN (within
14 days prior to registration)
- Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral
therapy with undetectable viral load within 6 months of registration are eligible for
this trial
- Although the uterus will have been removed in the vast majority of patients, for
patients of child-bearing potential: negative urine or serum pregnancy test. If the
urine test is positive or cannot be confirmed as negative, a serum pregnancy test is
required. Patients will be considered of non-reproductive potential if they are
either:
- Postmenopausal (defined as at least 12 months with no menses without an
alternative medical cause; in women < 45 years of age, a high follicle
stimulating hormone [FSH] level in the postmenopausal range may be used to
confirm a postmenopausal state in women not using hormonal contraception or
hormonal replacement therapy. In the absence of 12 months of amenorrhea, a single
FSH measurement is insufficient); OR
- Have had a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy or
bilateral tubal ligation/occlusion at least 6 weeks prior to registration
- Have a congenital or acquired condition that prevents childbearing
- Patients with a prior or concurrent malignancy whose natural history or treatment does
not have the potential to interfere with the safety or efficacy assessment of the
investigational regimen are eligible for this trial.
- Patients with evidence of chronic hepatitis B virus (HBV) infection must have an
undetectable HBV viral load on suppressive therapy, if indicated
- Patients with a history of hepatitis C virus (HCV) infection must have been treated
and cured. For patients with HCV infection who are currently on treatment, they are
eligible if they have an undetectable HCV viral load
- Patients with treated brain metastases are eligible if follow-up brain imaging after
central nervous system (CNS)-directed therapy shows no evidence of progression
- The patient or a legally authorized representative must provide study-specific
informed consent prior to study entry and, for patients treated in the United States
(U.S.), authorization permitting release of personal health information
Exclusion Criteria:
- Prior Therapy:
- Patients must NOT have received prior chemotherapy, biologic therapy, or targeted
therapy for treatment of endometrial carcinoma
- Patients must NOT have received prior radiation therapy for treatment of
endometrial carcinoma. Prior radiation includes external beam pelvic radiation
therapy, external beam extended field pelvic/para-aortic radiation therapy,
and/or intravaginal brachytherapy
- NOTE: Vaginal brachytherapy for treatment of endometrial cancer is permitted
during study treatment. Planned use of vaginal brachytherapy must be
declared at time of registration
- Patients may have received prior hormonal therapy for treatment of endometrial
carcinoma. All hormonal therapy must be discontinued at least one week prior to
registration
- Patients may not have a planned interval cytoreduction or hysterectomy, prior to
documentation of progression, after study registration
- Patients may not have planned external beam radiotherapy, prior to documentation of
progression, after study registration
- Significant cardiovascular disease including:
- Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 90 mm
Hg despite antihypertensive medications
- Myocardial infarction or unstable angina within 6 months prior to registration
- New York Heart Association functional classification II, III or IV
- Serious cardiac arrhythmia requiring medication. This does not include
asymptomatic, atrial fibrillation with controlled ventricular rate
- Significant lung disease: dyspnea at rest grade 2 or greater (resulting from extensive
tumor involvement or other causes), pneumonitis grade 2 or greater, interstitial lung
disease grade 2 or greater, idiopathic pulmonary fibrosis, cystic fibrosis,
Aspergillosis, active tuberculosis, or history of opportunistic infections
(pneumocystis pneumonia or cytomegalovirus pneumonia)
- Patients with uncontrolled intercurrent illness including, but not limited to: ongoing
or active infection (except for uncomplicated urinary tract infection), uncontrolled
interstitial lung disease, symptomatic congestive heart failure, or psychiatric
illness/social situations that would limit compliance with study requirements
- Treatment with strong CYP2C8 or CYP3A4 inhibitors or inducers within 14 days or 5
drug-elimination half-lives, whichever is longer, prior to registration
- Women who are unwilling to discontinue nursing
This study investigates the effectiveness of adding investigational medications to the usual chemotherapy for patients with HER2 positive endometrial cancer. HER2 positive means that cancer cells have more HER2 receptors, which are molecules on the cell surface. The investigational medications are designed to attach to these HER2 receptors and block signals that tell cancer cells to grow, potentially shrinking the tumors.
Participants in this study will be placed into one of three study arms. In each arm, patients will receive chemotherapy with paclitaxel and carboplatin. Some patients will also receive investigational medications by injection under the skin. The study will include regular scans and tests to monitor the cancer and the effect of the treatment. Patients may undergo echocardiography, CT scans, and optional blood and urine tests.
- Who can participate: Adults aged 18 and older with HER2 positive endometrial serous carcinoma or carcinosarcoma, who have not received prior chemotherapy or radiation for this cancer, may be eligible. Specific health criteria, including certain blood counts and organ function levels, must be met.
- Study details: Participants will receive chemotherapy with or without investigational medications. Some will receive a placebo resembling the investigational medicine but inactive. Regular health assessments and imaging tests are included.
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