Epothilone B in Treating Patients With CNS Metastases From Breast Cancer

OBJECTIVES:

Primary

• Determine the 3-month CNS-progression free survival of patients with CNS metastases secondary to breast cancer treated with epothilone B.

Secondary

• Determine the toxicity of this drug in these patients.
• Determine the CNS response rate and duration of CNS response in patients treated with this drug.
• Determine the systemic disease response rate and duration of systemic response in patients treated with this drug.
• Determine the overall survival of patients treated with this drug.

OUTLINE: This is a multicenter, open-label study.

Patients receive epothilone B IV over 20 minutes on day 1. Courses repeat every 21 days in the absence of disease progression, satisfactory response, or unacceptable toxicity.

After completion of study treatment, patients are followed periodically.

PROJECTED ACCRUAL: A total of 55 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed carcinoma of the breast
• CNS metastases (i.e., brain parenchymal lesions and/or leptomeningeal disease), meeting 1 of the following criteria:

• Recurrent or progressive CNS metastases after whole brain radiotherapy

• If only evaluable site of CNS progression has been previously treated with stereotactic radiosurgery, radiation necrosis must be excluded by radiographic (e.g., positron emission tomography scan or magnetic resonance spectroscopy) or histologic assessment
• Newly diagnosed, untreated, asymptomatic brain or leptomeningeal metastases
• Patient must be neurologically stable, as demonstrated by a stable dose of steroids and anticonvulsants for ≥ 1 week prior to obtaining baseline gadolinium-enhanced MRI of the brain and/or ≥ 1 week prior to beginning study treatment
• No CNS complications requiring urgent neurosurgical intervention (e.g., resection or shunt placement)
• Hormone receptor status not specified

PATIENT CHARACTERISTICS:

• Male or female
• Menopausal status not specified
• Karnofsky performance status 60-100%
• Life expectancy ≥ 3 months
• Absolute neutrophil count > 1,500/mm^3
• Hemoglobin > 9.0 g/dL
• Platelet count > 100,000/mm^3 (red blood cell transfusion and repeat evaluation allowed)
• Bilirubin < 1.5 times upper limit of normal (ULN)
• AST and ALT < 2.5 times ULN
• Alkaline phosphatase < 2.5 times ULN
• Creatinine < 1.5 times ULN
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 3 months after completion of study therapy
• No known hypersensitivity to epothilones
• No peripheral neuropathy > grade 1
• No unresolved diarrhea within the past 7 days

• Grade 0 diarrhea required at study entry
• No concurrent serious medical illness (e.g., HIV positivity or active hepatitis B or C)
• No severe cardiac insufficiency (e.g., New York Heart Association class III-IV heart disease) with uncontrolled and/or unstable cardiac or coronary artery disease
• No active or suspected acute or chronic uncontrolled infection, including abscess or fistulae
• No other malignancy within the past 3 years except curatively treated nonmelanoma skin cancer, prostate cancer, or carcinoma in situ of the cervix
• No history of noncompliance to medical regimens or inability or unwillingness to return for all scheduled visits
• No contraindications to MRI, including any of the following:

• Pacemaker
• Ferromagnetic implants
• Claustrophobia
• Extreme obesity

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 2 weeks since prior noncytotoxic drugs (e.g., small molecule-targeted drugs) and recovered
• More than 3 weeks since prior cytotoxic chemotherapy (6 weeks for nitrosoureas or mitomycin C) and recovered
• More than 3 weeks since prior intracranial surgery and recovered
• More than 4 weeks since prior radiotherapy and recovered
• More than 4 weeks since prior major surgery
• More than 28 days since prior investigational compounds or drugs
• No prior epothilones
• No concurrent known diarrheagenic agents
• No other concurrent anticancer agents, including investigational agents, biological agents, or chemotherapy
• No other concurrent experimental therapies
• Concurrent hormone therapy and/or trastuzumab (Herceptin®) allowed
• No concurrent Coumadin® or other agents containing warfarin

• Low dose Coumadin® (≤ 1 mg) for prophylactic maintenance of indwelling lines or ports allowed
• No concurrent radiotherapy for central metastases (e.g., vertebral or mediastinal metastases)

• Concurrent radiotherapy for local peripheral metastases not being used as marker lesions allowed
• No concurrent prophylactic hematopoietic growth factors during course 1
• No concurrent herbal or nontraditional medications