FASN Inhibitor TVB-2640 and Trastuzumab in Combination With Paclitaxel or Endocrine Therapy for the Treatment of HER2 Positive Metastatic Breast Cancer

Inclusion Criteria:

PRE-REGISTRATION INCLUSION CRITERIA

Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) criteria that is:

A non-nodal lesion is considered measurable if its longest diameter can be accurately measured as >= 1.0 cm with computed tomography (CT) scan, CT component of a positron emission tomography (PET)/CT, or magnetic resonance imaging (MRI) and/or
A malignant lymph node is considered measurable if its short axis is > 1.5 cm when assessed by CT scan (CT scan slice thickness recommended to be no greater than 5 mm)
Note: tumor lesions in a previously irradiated area are not considered measurable disease; disease that is measurable by physical examination only is not eligible
Received =< four (4) prior chemotherapy regimens in the metastatic setting

Cohort A one of the following must be true:

Distant disease progression during administration of combination therapy with taxane based chemotherapy and anti-HER2 therapy (trastuzumab or pertuzumab) for metastatic disease

Note: patients who began treatment with this combination and discontinued taxane-based chemotherapy due to intolerability before distant disease progression are eligible

Distant disease progression during administration or within 180 days of discontinuing combination therapy with taxane based chemotherapy and anti-HER2 therapy (trastuzumab or pertuzumab) in the adjuvant disease

Note: patients who began treatment with this combination and discontinued taxane-based chemotherapy due to intolerability before distant disease progression are eligible
For patient who received taxane based chemotherapy and anti-HER2 therapy (trastuzumab or pertuzumab) in the neo-adjuvant setting and underwent surgical resection of primary breast disease: distant disease progression during or within 180 days of discontinuing anti-HER2 therapy (trastuzumab or pertuzumab) in the adjuvant setting

Cohort B (one of the following must be true):

Distant disease progression during administration of combination therapy with endocrine therapy and anti-HER2 therapy (trastuzumab or pertuzumab) for metastatic disease; permissible endocrine therapies include an aromatase inhibitor or fulvestrant

NOTE: Tamoxifen is not permissible

Distant disease progression during administration of combination therapy with endocrine therapy and anti-HER2 therapy (trastuzumab or pertuzumab) in the adjuvant setting; permissible endocrine therapies include an aromatase inhibitor or fulvestrant

NOTE: Tamoxifen is not permissible

Willingness to provide mandatory tumor tissue specimens for correlative research

NOTE: If insufficient or no tissue is obtained by the pre-registration biopsy, an archival tissue specimen (preferably from a metastatic site) from procedure performed =< 2 years prior to pre-registration must be available to submit for Central Laboratory review prior to registration

Exception: If there is no medically safe site for biopsy, Study Chair (Dr. Haddad) may waive this requirement
REGISTRATION INCLUSION CRITERIA
Registration must be completed =< 28 days of pre-registration
Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
Histological confirmation of HER2-positive advanced breast cancer; HER2+ is defined by 2013 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines
For Cohort B only: Histologic confirmation of ERalpha positive disease (>= 1% expression)
Hemoglobin >= 9.0 g/dL (obtained =< 14 days prior to registration)
Absolute neutrophil count (ANC) >= 1500/mm^3 (obtained =< 14 days prior to registration)
Platelet count >= 100,000/mm^3 (obtained =< 14 days prior to registration)
Direct bilirubin =< 1.5 x upper limit of normal (ULN) (obtained =< 14 days prior to registration)
Aspartate transaminase (AST) =< 3 x ULN (=< 5 x ULN for patients with liver involvement) (obtained =< 14 days prior to registration)
Calculated creatinine clearance >= 45 ml/min using the Cockcroft-Gault formula (obtained =< 14 days prior to registration)
Cardiac ejection fraction (left ventricular ejection fraction [LVEF]) >= 50% by echocardiogram =< 28 days prior to registration
Provide written informed consent
Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)

Negative urine pregnancy test done =< 7 days prior to registration, for women of childbearing potential only

NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

Patient and his/her partner agree to use adequate contraception after providing written informed consent through 3 months after the last dose of TVB-2640, as follows:

For women: Compliant with a medically-approved contraceptive regimen during and for 3 months after the treatment period or documented to be surgically sterile or postmenopausal
For men: Compliant with a medically-approved contraceptive regimen during and for 3 months after the treatment period or documented to be surgically sterile; men whose sexual partners are of child-bearing potential must agree to use 2 methods of contraception prior to study entry, during the study, and for 3 months after the treatment period
Willingness to provide mandatory tumor tissue and/or blood specimens for correlative research

Exclusion Criteria:

PRE-REGISTRATION EXCLUSION CRITERIA
Patients who previously discontinued trastuzumab due to unacceptable cardiac toxicity
Patients with a history of LVEF decline to below 50% during or after prior trastuzumab or other HER2 directed therapy =< 6 months prior to pre-registration
Patients with any class of New York Heart Association (NYHA) congestive heart failure (CHF) or heart failure with preserved ejection fraction (HFPEF)
Patients with a history of known coronary artery disease or a myocardial infarction within 12 months prior to pre-registration
Patients with persistently uncontrolled hypertension (systolic blood pressure [BP] > 160 mm Hg or diastolic BP > 100 mm Hg) despite optimal medical therapy
Patients with known unstable angina pectoris
Patients with a known history of serious cardiac arrhythmias requiring treatment (exception: controlled atrial fibrillation, paroxysmal supraventricular tachycardia)
Patients with a prolonged corrected QT interval (QTc) interval (>= 450 ms)

Leptomeningeal disease or uncontrolled brain metastasis

NOTE: Metastases treated by surgery and/or radiotherapy such that patient is neurologically stable and off steroids >= 4 weeks prior to preregistration are eligible

Failure to recover from acute, reversible effects of prior therapy regardless of interval since last treatment

EXCEPTION: Grade 1 peripheral (sensory) neuropathy that has been stable for at least 3 months since completion of prior treatment
Tumors involving spinal cord or heart

Visceral crisis or lymphangitic spread

NOTE: Visceral crisis is not the mere presence of visceral metastases, but implies severe organ dysfunction as assessed by symptoms and signs, laboratory studies, and rapid progression of disease

Uncontrolled intercurrent non-cardiac illness including, but not limited to,

Ongoing or active infection
Psychiatric illness/social situations
Dyspnea at rest due to complications of advanced malignancy or other disease that requires continuous oxygen therapy
Or any other conditions that would limit compliance with study requirements

Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy

NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
History of myocardial infarction =< 6 months, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
Prior history of hypersensitivity, drug or radiation-induced, or other immune-mediated pneumonitis
Patient is unable to swallow oral medications or has impairment of gastrointestinal (GI) function or GI disease that may significantly alter drug absorption (e.g. active inflammatory bowel disease, uncontrolled nausea, vomiting, diarrhea, or malabsorption syndrome); note: concomitant therapy with proton pump inhibitors and/or H2-receptor antagonists is permissible
Patient has a history of clinically significant dry eye (xerophthalmia) or other corneal abnormality, or if a contact lens wearer, does not agree to abstain from contact lens use from baseline through the last TVB-2640 dose
Patients with a history of intolerance to trastuzumab (i.e. a grade 3 or 4 infusion reaction) are excluded; Note: patients with a history of mild infusion reaction to trastuzumab who have previously been successfully re-challenged after an infusion reaction with or without prophylactic medication are allowed

Other invasive malignancy =< 3 years prior to pre-registration

EXCEPTIONS: Non-melanoma skin cancer, papillary thyroid cancer, or carcinoma-in-situ of the cervix which has been adequately treated
NOTE: If there is a history of prior malignancy, patients must not be receiving other treatment for their cancer and the disease must be inactive/stable
REGISTRATION EXCLUSION CRITERIA

Any of the following:

Pregnant women
Nursing women
Men or women of childbearing potential who are unwilling to employ adequate contraception

Any of the following therapies prior to registration:

Chemotherapy =< 3 weeks
Immunotherapy =< 3 weeks
Biologic therapy =< 3 weeks
Monoclonal antibodies =< 3 weeks
Radiation therapy =< 2 weeks
CDK 4/6 inhibitors =< 4 weeks
mTOR inhibitors =< 4 weeks