TBCRC 018: Phase II study of iniparib in combination with irinotecan to treat progressive triple negative breast cancer brain metastases

Carey Anders, Allison M. Deal, Vandana Abramson, Minetta C. Liu, Anna M. Storniolo, John T. Carpenter, Shannon Puhalla, Rita Nanda, Amal Melhem-Bertrandt, Nancy U. Lin, P. Kelly Marcom, Catherine Van Poznak, Vered Stearns, Michelle Melisko, J. Keith Smith, Olga Karginova, Joel Parker, Jonathan Berg, Eric P. Winer, Amy PetermanAleix Prat, Charles M. Perou, Antonio C. Wolff, Lisa A. Carey

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Nearly half of patients with advanced triple negative breast cancer (TNBC) develop brain metastases (BM) and most will also have uncontrolled extracranial disease. This study evaluated the safety and efficacy of iniparib, a small molecule anti-cancer agent that alters reactive oxygen species tumor metabolism and penetrates the blood brain barrier, with the topoisomerase I inhibitor irinotecan in patients with TNBC-BM. Eligible patients had TNBC with new or progressive BM and received irinotecan and iniparib every 3 weeks. Time to progression (TTP) was the primary end point; secondary endpoints were response rate (RR), clinical benefit rate (CBR), overall survival (OS), toxicity, and health-related quality of life. Correlative endpoints included molecular subtyping and gene expression studies on pre-treatment archival tissues, and determination of germline BRCA1/2 status. Thirty-seven patients began treatment; 34 were evaluable for efficacy. Five of 24 patients were known to carry a BRCA germline mutation (4 BRCA1, 1 BRCA2). Median TTP was 2.14 months and median OS was 7.8 months. Intracranial RR was 12 %, while intracranial CBR was 27 %. Treatment was well-tolerated; the most common grade 3/4 adverse events were neutropenia and fatigue. Grade 3/4 diarrhea was rare (3 %). Intrinsic subtyping revealed 19 of 21 tumors (79 %) were basal-like, and intracranial response was associated with high expression of proliferation-related genes. This study suggests a modest benefit of irinotecan plus iniparib in progressive TNBC-BM. More importantly, this trial design is feasible and lays the foundation for additional studies for this treatment-refractory disease.

Original languageEnglish (US)
Pages (from-to)557-566
Number of pages10
JournalBreast Cancer Research and Treatment
Volume146
Issue number3
DOIs
StatePublished - Aug 2014

Keywords

  • Brain metastases
  • Breast cancer
  • Iniparib
  • Irinotecan
  • Phase II
  • Triple negative

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Anders, C., Deal, A. M., Abramson, V., Liu, M. C., Storniolo, A. M., Carpenter, J. T., Puhalla, S., Nanda, R., Melhem-Bertrandt, A., Lin, N. U., Kelly Marcom, P., Van Poznak, C., Stearns, V., Melisko, M., Smith, J. K., Karginova, O., Parker, J., Berg, J., Winer, E. P., ... Carey, L. A. (2014). TBCRC 018: Phase II study of iniparib in combination with irinotecan to treat progressive triple negative breast cancer brain metastases. Breast Cancer Research and Treatment, 146(3), 557-566. https://doi.org/10.1007/s10549-014-3039-y