Breast Cancer Clinical Trial
My Pathway: A Study Evaluating Herceptin/Perjeta, Tarceva, Zelboraf/Cotellic, Erivedge, Alecensa, and Tecentriq Treatment Targeted Against Certain Molecular Alterations in Participants With Advanced Solid Tumors
Summary
This multicenter, non-randomized, open-label study will evaluate the efficacy and safety of six treatment regimens in participants with advanced solid tumors for whom therapies that will convey clinical benefit are not available and/or are not suitable options per the treating physician's judgment.
Eligibility Criteria
General Inclusion Criteria:
Life expectancy greater than or equal to (≥) 12 weeks
Histologically documented metastatic cancer (solid tumors, not including hematologic malignancies)
Participants who have received standard first-line therapy for metastatic cancer (except for the tumors for which no first-line therapy exists) and in whom a trial of targeted therapy is considered the best available treatment option. Eligible participants should not have available therapies that will convey clinical benefit and/or are not suitable options per the treating physician's judgment
No previous treatment with the specific assigned study drug or any other drug sharing the same target
Measurable disease by RECIST v1.1
Eastern Cooperative Oncology Group Performance Status (ECOG PS) score of 0 or 1 (For patients enrolling in the atezolizumab arm, ECOG score must be documented within 7 days prior to first treatment and confirmation of ECOG PS must be entered into the interactive web response system [IWRS] prior to initiation of treatment)
Adequate hematologic, renal, and liver function as defined by the protocol
If applicable, use of contraception methods or abstinence as defined by the protocol
Study-Drug Specific Inclusion Criteria:
Trastuzumab plus Pertuzumab
Molecular testing results from clinical laboratory improvement amendments (CLIA)-certified laboratories (using tissue and/or blood) demonstrating HER2 overexpression or amplification. Participants must have one of the following tumor types: biliary cancer, salivary cancer, or bladder cancer
a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment)
Left ventricular ejection fraction (LVEF) greater than (>) 50 percent (%) or above the lower limit of the institutional normal range, whichever is lower
Availability of an archival or new pre-treatment tissue sample is required if molecular testing was not performed by Foundation Medicine. Any available tumor tissue sample can be submitted. The tissue sample must be submitted within 4 weeks after enrollment
Erlotinib
Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating EGFR-activating mutations
Vemurafenib plus Cobimetinib
Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating BRAF V600 mutations a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment)
Vismodegib
Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating hedgehog pathway relevant mutation (activating mutation of smoothened [SMO] or loss-of-function mutation of protein patched homolog-1 [PTCH-1])
a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment)
All non-hematological adverse events related to any prior chemotherapy, surgery, or radiotherapy must have resolved to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Grade less than or equal to (≤) 2 prior to starting therapy
Alectinib
Molecular testing results from CLIA-certified laboratories (using tissue and/or blood) demonstrating anaplastic lymphoma kinase (ALK) gene rearrangements, ALK mutations, ALK copy number gain or (for melanoma only) increased ALK expression or presence of ALK-alternative transcription initiation transcript (ALKATI) a) For participants screened using a blood assay: obtain tissue-based testing result confirming study eligibility (within first 4 weeks after enrollment)
Atezolizumab
Molecular testing results from CLIA-certified laboratories (using tissue) demonstrating elevated tissue tumor mutational burden (tTMB ≥10 mutations/ Megabase [Mb])
For patients where molecular testing was not performed using Foundation Medicine, submission of an archival or new pretreatment tissue sample is mandatory. For patients where molecular testing was performed using Foundation Medicine, submission of an archival or new pretreatment tissue sample is required, if available. The tissue sample must be submitted within 4 weeks after enrollment
General Exclusion Criteria:
Participants with hematologic malignancies
Concurrent administration of any other anti-cancer therapy (except male participants with prostate cancer receiving androgen blockade): Bisphosphonates and denosumab are allowed; Most recent anti-cancer therapy ≤28 days and have not recovered from the side effects, excluding alopecia; Radiation therapy within ≤14 days
Active or untreated brain metastases
History of carcinomatous meningitis
Uncontrolled concurrent malignancy (early stage is allowed if not requiring active therapy or intervention)
Pregnant or breastfeeding women, or intending to become pregnant during the study
Any significant cardiovascular events within 6 months prior to study entry
Pulmonary embolism within 30 days prior to study entry
History or presence of clinically significant ventricular or atrial dysrhythmia >Grade 2 per NCI CTCAE v4.0
Any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results
Psychological, familial, sociological, or geographical conditions that do not permit compliance with the protocol
Study-Drug Specific Exclusion Criteria:
Trastuzumab plus Pertuzumab
Previous treatment with any HER2-targeted therapy
Erlotinib
Non-small cell lung cancer (NSCLC) or pancreatic cancer identified by exon 19 deletions or exon 21 L858R substitution mutations
EGFR amplifications in the absence of EGFR-activating mutations
Cancers with exon 20 mutations
Previous treatment with erlotinib or any other EGFR inhibitor
Inability to swallow pills
Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of erlotinib
Vemurafenib plus Cobimetinib
Malignant melanoma, papillary thyroid cancer, colorectal cancer, or hematologic malignancy including multiple myeloma
LVEF below institutional lower level of normal (LLN) or below 50%, whichever is lower
History of or evidence of retinal pathology on ophthalmologic examination that is considered a risk factor for neurosensory retinal detachment, retinal vein occlusion (RVO), or neovascular macular degeneration
Presence of any of the following conditions, which are risk factors for RVO: Uncontrolled glaucoma with intraocular pressure >21 millimetres of mercury (mm Hg); Serum cholesterol ≥Grade 2; Hypertriglyceridemia ≥Grade 2; Hyperglycemia (fasting) ≥Grade 2; Grade ≥2 uncontrolled hypertension (participants with a history of hypertension controlled with anti-hypertensive medication to Grade =1 are eligible)
Prior or concurrent malignancy with known RAS mutation
Previous treatment with vemurafenib or any other BRAF inhibitor (prior sorafenib is allowed)
Previous treatment with cobimetinib or any other mitogen-activated protein/extracellular signal-regulated kinase (MEK) inhibitor
Prior treatment with a RAF inhibitor
Inability to swallow pills
Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of vemurafenib
History of congenital long QT syndrome or mean (average of triplicate measurements) corrected QT (QTc) measured using Fridericia's method ≥450 millisecond (ms) at baseline or uncorrectable abnormalities in serum electrolytes (sodium, potassium, calcium, magnesium, phosphorus)
Vismodegib
Basal cell carcinoma of the skin, medulloblastoma, small-cell lung cancer, or hematologic malignancies
Previous treatment with vismodegib or any other hedgehog pathway inhibitor
Inability to swallow pills
Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of vismodegib
Alectinib
ALK-positive NSCLC, neuroblastoma, and childhood tumors
Previous treatment with alectinib or any other ALK inhibitor
Participants with symptomatic bradycardia
Administration of strong/potent cytochrome P3A4 (CYP3A4) inhibitors or inducers within 14 days prior to the first dose of study treatment and while on treatment with alectinib
Inability to swallow pills
Refractory nausea and vomiting, malabsorption, external biliary shunt, or significant bowel resection that would preclude absorption of alectinib
Atezolizumab
History of leptomeningeal disease
Uncontrolled tumor pain
Asymptomatic metastatic lesions that would likely cause functional deficits or intractable pain with further growth (e.g., epidural metastasis that is not currently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to enrollment
Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Patients with indwelling catheters are allowed
Uncontrolled or symptomatic hypercalcemia
Previous treatment with atezolizumab or another programmed death-1 (PD-1)/PD-L1 inhibitor
History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
Known hypersensitivity to biopharmaceutical agents produced in Chinese hamster ovary cells
Known allergy or hypersensitivity to any component of the atezolizumab formulation
Active or history of autoimmune disease or immune deficiency
Prior allogeneic stem cell or solid organ transplantation
History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan
Positive human immunodeficiency virus (HIV) test, active hepatitis B virus (HBV) infection, active hepatitis C virus (HCV) infection or active tuberculosis
Severe infection within 4 weeks prior to initiation of study treatment
Treatment with therapeutic oral or IV antibiotics within 2 weeks prior to initiation of study treatment
Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction, or cerebrovascular accident within 3 months prior to initiation of study treatment, unstable arrhythmia, or unstable angina
Major surgical procedure other than for diagnosis within 4 weeks prior to initiation of study treatment, or anticipation of need for a major surgical procedure during the course of the study
Treatment with a live, attenuated vaccine within 4 weeks prior to initiation of study treatment, or anticipation of need for such a vaccine during the course of the study or within 5 months after the final dose of atezolizumab
History of other malignancy within 5 years prior to screening, with the exception of those with a negligible risk of metastasis or death, such as adequately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, localized prostate cancer, ductal carcinoma in situ, or Stage I uterine cancer
Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the participant at high risk from treatment complications
Prior treatment with cluster of differentiation 137 (CD137) agonists or immune checkpoint blockade therapies
Treatment with systemic immunostimulatory agents within 4 weeks or five half-lives of the drug (whichever is longer) prior to randomization
Treatment with systemic immunosuppressive medication within 2 weeks prior to initiation of study treatment, or anticipation of need for systemic immunosuppressive medication during the course of the study
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There are 60 Locations for this study
Goodyear Arizona, 85338, United States
Phoenix Arizona, 85259, United States
Springdale Arkansas, 72762, United States
Culver City California, 90230, United States
Duarte California, 91010, United States
La Jolla California, 92093, United States
Rancho Mirage California, 92270, United States
San Francisco California, 94118, United States
Stanford California, 94305, United States
Vallejo California, 94589, United States
Aurora Colorado, 80045, United States
Fort Myers Florida, 33916, United States
Jacksonville Florida, 32224, United States
Orlando Florida, 32804, United States
Saint Petersburg Florida, 33705, United States
West Palm Beach Florida, 33401, United States
Athens Georgia, 30607, United States
Gainesville Georgia, 30501, United States
Newnan Georgia, 30265, United States
Chicago Illinois, 60611, United States
Chicago Illinois, 60637, United States
Zion Illinois, 60099, United States
Baltimore Maryland, 21287, United States
Rochester Minnesota, 55905, United States
Kansas City Missouri, 64132, United States
Middletown New Jersey, 07748, United States
Albuquerque New Mexico, 87102, United States
Albuquerque New Mexico, 87106, United States
Albuquerque New Mexico, 87109, United States
Albuquerque New Mexico, 87131, United States
Farmington New Mexico, 87401, United States
Harrison New York, 10604, United States
New York New York, 10021, United States
New York New York, 10032, United States
New York New York, 10065, United States
Chapel Hill North Carolina, 27599, United States
Durham North Carolina, 27710, United States
Winston-Salem North Carolina, 27157, United States
Fargo North Dakota, 58102, United States
Cincinnati Ohio, 45242, United States
Cleveland Ohio, 44106, United States
Cleveland Ohio, 44106, United States
Oklahoma City Oklahoma, 73104, United States
Portland Oregon, 97213, United States
Philadelphia Pennsylvania, 19104, United States
Philadelphia Pennsylvania, 19107, United States
Philadelphia Pennsylvania, 19124, United States
Pittsburgh Pennsylvania, 15232, United States
Willow Grove Pennsylvania, 19090, United States
Sioux Falls South Dakota, 57104, United States
Chattanooga Tennessee, 37404, United States
Germantown Tennessee, 38138, United States
Knoxville Tennessee, 37920, United States
Nashville Tennessee, 37203, United States
Nashville Tennessee, 37232, United States
Fort Worth Texas, 76104, United States
Houston Texas, 77030, United States
Richmond Virginia, 23229, United States
Tacoma Washington, 98405, United States
Madison Wisconsin, 53705, United States
Milwaukee Wisconsin, 53226, United States
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