Chemotherapy Plus Surgery in Treating Women With Breast Cancer
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining surgery with chemotherapy may kill more tumor cells. It is not yet known which treatment regimen is more effective for breast cancer.
PURPOSE: Randomized phase III trial to study the effectiveness of chemotherapy plus surgery in treating women who have breast cancer.
Drug: CMF regimen
Drug: doxorubicin hydrochloride
Drug: tamoxifen citrate
Procedure: conventional surgery
Radiation: radiation therapy
|Study Design:||Allocation: Randomized
Primary Purpose: Treatment
|Official Title:||European Cooperative Study of Chemotherapy and Surgery Comparing Adjuvant Doxorubicin Followed by CMF vs. Adjuvant Doxorubicin/Paclitaxel Followed by CMF vs. Primary Doxorubicin/Paclitaxel Followed by CMF in Women With Operable Breast Cancer and T>2 cm|
|Study Start Date:||October 1996|
|Study Completion Date:||March 2009|
- Evaluate whether 8 courses of primary chemotherapy before adequate surgery of breast tumor and locoregional radiotherapy plus tamoxifen for 5 years improves the disease-free and overall survival in women with operable breast carcinoma and tumor at diagnosis greater than 2 cm in diameter.
- Assess whether, in the postoperative arms, the addition of paclitaxel to doxorubicin before CMF (cyclophosphamide, methotrexate, and fluorouracil) improves disease-free and overall survival in these patients.
- Define the incidence of pathologic complete response (CR) induced by 8 courses of primary chemotherapy containing paclitaxel.
- Assess whether a pathologic CR is an independent predictor of disease-free and overall survival.
- Evaluate the effects of primary chemotherapy on the rate and quality of breast conserving surgery.
OUTLINE: This is a randomized, multicenter study. Patients are stratified by center, tumor diameter at mammography, nuclear or histological grade, and estrogen/progesterone receptor status. Patients are randomized to one of three treatment arms.
- Arm I: Patients receive doxorubicin IV over 15 minutes once every 3 weeks for 4 courses. Beginning 21 days after the last administration of doxorubicin, patients receive cyclophosphamide IV, methotrexate IV, and fluorouracil IV on days 1 and 8. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
- Arms II and III: Patients receive doxorubicin IV over 15 minutes and paclitaxel IV over 3 hours once every 3 weeks for 4 courses. Beginning 21 days after the last administration of doxorubicin and paclitaxel, patients receive cyclophosphamide IV, methotrexate IV, and fluorouracil IV on days 1 and 8. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
All patients have either mastectomy or breast conserving surgery; patients with unclear surgical margins may have second surgery (re-resection or total mastectomy) or radiotherapy. Lymph node axillary dissection is performed up to at least the second level. For patients in the 2 adjuvant arms (arms I and II), adjuvant chemotherapy starts by day 21 after surgery. For patients in the primary chemotherapy arm (arm III), surgery is performed by day 28 after the last course of chemotherapy or at resolution of all possible hematological or infective complications.
At the end of the combined surgery plus chemotherapy approach (i.e., after the last course of CMF (arms I and II) or after surgery (arm III)), patients enrolled after June 30, 2000 with estrogen or progesterone receptor positive disease receive oral tamoxifen daily for 5 years.
All patients who have breast conserving surgery receive postoperative irradiation within 4 weeks after completing chemotherapy and surgery (i.e., within 4 weeks from last dose of adjuvant chemotherapy (arms I and II) or from surgery (arm III)). All patients who have mastectomy and have pT4 disease must receive irradiation to the chest wall.
Patients are followed at 6, 12, 18, and 24 months, and then annually thereafter.
PROJECTED ACCRUAL: A total of 450 patients per arm will be accrued for this study within 5 years.
|Kaiser Franz Josef Hospital|
|Vienna, Austria, A-1100|
|Ostrava-Poruba, Czech Republic, 70852|
|University of Tartu|
|Tartu, Estonia, 51003|
|Frauenklinik Vom Roten Kreuz|
|Munich, Germany, 80637|
|Budapest, Hungary, 1082|
|Budapest, Hungary, 1145|
|Perugia, Italy, 06122|
|Ospedale St. Santa Chiara|
|Pisa, Italy, 56100|
|Centro di Riferimento Oncologico - Aviano|
|Trento, Italy, 38100|
|Universita Degli Studi di Udine|
|Udine, Italy, 33100|
|Ospedale San Bortolo|
|Vicenza, Italy, 36100|
|Latvian Cancer Center|
|Riga, Latvia, 1079|
|Regional Center of Oncology|
|Bydgoszcz, Poland, 85-796|
|Krakow (Cracow), Poland, 31-826|
|Szpital Kliniczny NR 1|
|Poznan, Poland, PL-61-878|
|Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology|
|Warsaw, Poland, 02-781|
|Moscow Clinical Dispenser|
|Moscow, Russian Federation, 129128|
|N. A. Semashko Central Clinical Hospital|
|Moscow, Russian Federation, 129128|
|Russian Academy of Medical Sciences Cancer Research Center|
|Moscow, Russian Federation, 115478|
|Regional Oncology Clinic|
|Murmansk, Russian Federation, 183047|
|Petrov Research Institute of Oncology|
|Saint Petersburg, Russian Federation, 197758|
|St. Elizabeth Cancer Institute Hospital|
|Bratislava, Slovakia, SK-81250|
|Hospital de la Santa Cruz I Sant Pau|
|Barcelona, Spain, 08025|
|Hospital General Universitari Vall d'Hebron|
|Barcelona, Spain, 08035|
|Hospital Universitario 12 de Octubre|
|Madrid, Spain, 28041|
|Hospital Clinico Universitario - Malaga|
|Malaga, Spain, 29010|
|Instituto Valenciano De Oncologia|
|Valencia, Spain, 46009|
|Hospital Clinico Universitario de Valencia|
|Valencia, Spain, 46010|
|Study Chair:||Gianni Bonadonna, MD||Fondazione IRCCS Istituto Nazionale dei Tumori, Milano|