Chemotherapy and Stem Cell Transplantation in Treating Patients With Stage IIIB Breast Cancer
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Purpose
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells.
PURPOSE: This phase II trial is studying how well chemotherapy and stem cell transplantation work in treating patients with stage IIIB breast cancer.
| Condition | Intervention | Phase |
|---|---|---|
|
Breast Cancer |
Biological: filgrastim Drug: cisplatin Drug: cyclophosphamide Drug: doxorubicin hydrochloride Drug: melphalan Drug: mesna Drug: paclitaxel Drug: tamoxifen citrate Procedure: bone marrow ablation with stem cell support Procedure: conventional surgery Procedure: peripheral blood stem cell transplantation |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Dose-Intense Chemotherapy and Stem Cell Rescue in the Treatment of Inflammatory Breast Carcinoma |
- Time to progression at year 5 [ Designated as safety issue: No ]
- Feasibility at year 5 [ Designated as safety issue: No ]
- Overall survival at year 5 [ Designated as safety issue: No ]
| Estimated Enrollment: | 60 |
| Study Start Date: | May 1997 |
| Estimated Primary Completion Date: | March 2013 (Final data collection date for primary outcome measure) |
OBJECTIVES:
- Determine the effectiveness of neoadjuvant dose intensive sequential chemotherapy, followed by surgical resection, adjuvant therapy, and tandem high dose chemotherapy and stem cell rescue in patients with inflammatory stage IIIB breast cancer.
- Determine the clinical and pathological remission rate (complete, partial, and overall) following neoadjuvant dose dependent sequential chemotherapy in patients with inflammatory stage IIIB breast cancer.
- Determine the relapse and survival rate of these patients with the above therapy.
- Determine the potential correlations between inflammatory features and hereditary background.
OUTLINE: Patients are stratified according to those who have had no more than 1 cycle of neoadjuvant chemotherapy (stratum 1) and those who have had more than 1 cycle of neoadjuvant chemotherapy and/or modified radical mastectomy (stratum 2).
Patients in stratum 1 receive doxorubicin IV over 96 hours on days 1-4, 15-19, and 29-32. Paclitaxel is infused over 96 hours on days 43-47 and 57-60. Filgrastim (G-CSF) is administered on days 5-10, 20-25, 33-38, 48-55, and 61-68, and beyond if the granulocyte count is less than 1000/mm^3. A modified radical mastectomy is performed between days 70 and 80. All stratum 1 and stratum 2 patients then receive paclitaxel IV for 96 hours on days 100-104, and cyclophosphamide IV on day 121. Filgrastim is administered at one dose on days 105-110 and days 122-127 and at a higher dose on days 110-116 and days 128-135. Stem cells are harvested from the patient on days 113-116 and days 132-135.
High-dose chemotherapy is then administered to all patients in the study. Course 1 starts with doxorubicin IV on days -7 to -3. Paclitaxel IV is administered for 24 hours on day -2. Filgrastim is administered by IV on day -1 and continued until the granulocyte count is greater than 1000/mm^3 for 3 days. Peripheral stem cells are reinfused on day 0. Course 2 starts 4-6 weeks after the start of course 1 with melphalan and cisplatin being infused on day -11. Filgrastim is administered IV on days -10 to -6. Melphalan and cisplatin are administered again on day -4. Stem cells are infused on day -3 and on day 0. Filgrastim is then administered until the granulocyte count is at least 1000/mm^3 for 3 days.
Radiation therapy is started 4-7 weeks after the beginning of course 2. Tamoxifen is started within 2 weeks of discharge following course 2 in patients with hormone receptor positive tumors.
Patients are followed every 3 months for two years and then annually for the next three years.
PROJECTED ACCRUAL: Approximately 60 patients will be accrued, at a rate of about 15 per year.
Eligibility| Ages Eligible for Study: | up to 60 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
- Histologically proven stage IIIB breast cancer with dermal/epidermal invasion or clinical features of inflammation, erythema, pain or hypersensitivity, edema, or thickening of the skin
- Diagnosis within the past 6 months
PATIENT CHARACTERISTICS:
Age:
- 60 and under
Performance status:
- Karnofsky 80-100%
Life expectancy:
- Not specified
Hematopoietic:
- Absolute neutrophil count at least 1,500/mm^3
- Platelet count at least 100,000/mm^3
Hepatic:
- Bilirubin less than 1.5 mg/dL
- SGOT or SGPT no greater than 1.5 times the upper limit of normal
Renal:
- Creatinine less than 1.2 mg/dL
- Creatinine clearance at least 80 mL/min
- No history of hemorrhagic cystitis
Cardiovascular:
- Left ventricular fraction at least 55% on MUGA scan
- No previous valvular heart disease or arrhythmia
Pulmonary:
- FEV_1 at least 60% predicted
- Room air pO_2 greater than 85 mmHg
- Room air pCO_2 no greater than 43 mmHg
- DLCO at least 60% of the lower limit of predicted value
Other:
- No history of malignant disease in the past 5 years, except for squamous or basal cell skin cancer and stage I or in situ cervical cancer
- No organic CNS dysfunction
- Not pregnant
- No known and potentially disabling psychosocial history
- Not positive for hepatitis B or HIV
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- Not specified
Chemotherapy:
Stratum 1:
- No more than one cycle of chemotherapy
Stratum 2:
- No greater than 225 mg/m^2 doxorubicin and no greater than 250 mg/m^2 paclitaxel during previous chemotherapy
Endocrine therapy:
- Not specified
Radiotherapy:
- No prior radiation to the left chest wall
Surgery:
- Modified radical mastectomy allowed
Contacts and Locations| United States, California | |
| City of Hope Comprehensive Cancer Center | |
| Duarte, California, United States, 91010-3000 | |
| Principal Investigator: | George Somlo, MD | City of Hope Medical Center |
More Information
Additional Information:
No publications provided
| Responsible Party: | City of Hope Medical Center |
| ClinicalTrials.gov Identifier: | NCT00003042 History of Changes |
| Other Study ID Numbers: | 96139, P30CA033572, CHNMC-96139, NCI-G97-1288, CDR0000065672 |
| Study First Received: | November 1, 1999 |
| Last Updated: | November 21, 2012 |
| Health Authority: | United States: Federal Government |
Keywords provided by City of Hope Medical Center:
|
stage IIIB breast cancer inflammatory breast cancer |
Additional relevant MeSH terms:
|
Breast Neoplasms Inflammatory Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Cisplatin Cyclophosphamide Doxorubicin Melphalan Tamoxifen Paclitaxel Lenograstim Antineoplastic Agents Therapeutic Uses |
Pharmacologic Actions Radiation-Sensitizing Agents Physiological Effects of Drugs Immunosuppressive Agents Immunologic Factors Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Myeloablative Agonists Antibiotics, Antineoplastic Antineoplastic Agents, Hormonal Selective Estrogen Receptor Modulators Estrogen Receptor Modulators Hormone Antagonists |
ClinicalTrials.gov processed this record on May 19, 2013