Multimodality Treatment for Women With Stage II, Stage III, or Stage IV Breast Cancer - Full Text View

Purpose

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining chemotherapy, monoclonal antibody therapy, and surgery may be a more effective treatment for breast cancer.

PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy, monoclonal antibody therapy, and surgery in treating women who have stage II, stage III, or stage IV breast cancer.

Condition	Intervention	Phase
Breast Cancer	Biological: trastuzumab Drug: cyclophosphamide Drug: doxorubicin hydrochloride Drug: paclitaxel Procedure: conventional surgery Radiation: Radiation Therapy	Phase 2

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety Study Intervention Model: Factorial Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Nonrandomized Ph II Study of Multimodality Therapy for Stg IIB, IIIA/B, or Initially Presenting Stg IV Breast Cancer w/ Four Cycles of AC Followed by 12 Weeks of Single Agent Paclitaxel w/ or w/o Herceptin Followed by Local Therapy Followed by Weekly Herceptin or No Additional Therapy

Resource links provided by NLM:

Genetics Home Reference related topics: breast cancer

MedlinePlus related topics: Breast Cancer Cancer

Drug Information available for: Cyclophosphamide Doxorubicin Doxorubicin hydrochloride Paclitaxel Trastuzumab

U.S. FDA Resources

Further study details as provided by UNC Lineberger Comprehensive Cancer Center:

Primary Outcome Measures:

To determine the cardiac and other toxicity of weekly Taxol given with weekly Herceptin when delivered immediately following four cycles of standard dose AC [ Time Frame: 15 weeks from start of treatment ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

To identify whether the addition of Taxol® with or without Herceptin® further decreases tumor size and the number of positive axillary lymph nodes beyond that achieved by conventional breast cancer adjuvant therapy (4AC). [ Time Frame: Six-and-one-half years from start of treatment ] [ Designated as safety issue: No ]
To determine the 10 year DFS and OS in patients receiving and not receiving Herceptin®, and determine whether the initial pathologic response in Neoadjuvant patients correlates with the eventual 5-year DFS or OS [ Time Frame: 10 years from date of last treatment ] [ Designated as safety issue: No ]

Enrollment:	82
Study Start Date:	December 1998
Estimated Study Completion Date:	May 2015
Primary Completion Date:	March 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Neo-adjuvant Herceptin with radiation Chemotherapy followed by Taxol plus Herceptin followed by surgery followed by radiation followed by additional Herceptin	Biological: trastuzumab infusion 4 mg/kg load week 1; 2 mg/kg weekly thereafter for 12 weeks Other Name: Herceptin Drug: cyclophosphamide 600 mg/m2, intravenous infusion every 3 weeks for four cycles Drug: doxorubicin hydrochloride 60 mg/m2 intravenously, 5-10 minutes, every 3 weeks, up to 12 weeks Other Name: Adriamycin Drug: paclitaxel 90 mg/m2 weekly, intravenously 1 hour after herceptin, given weekly up to 12 weeks or 175 mg/m2, intravenously every 3 weeks, up to 12 weeks (only if not receiving Herceptin®) Other Name: Taxol Procedure: conventional surgery Surgical excision will take place 12-13 weeks for the neo-adjuvant herceptin setting and 12-13 weeks in the non-herceptin setting. Surgery will take place prior to chemotherapy in the adjuvant herceptin setting Radiation: Radiation Therapy All patients undergoing breast-conserving surgery will undergo adjuvant (after surgery) whole breast radiation therapy. If the patient undergoes mastectomy, postmastectomy radiotherapy to the chest wall, supraclavicular region and axilla will be administered at the discretion of the treating radiation oncologist
Experimental: Neo-adjuvant Herceptin without radiation Chemotherapy followed by Taxol plus Herceptin followed by surgery followed by additional Herceptin	Biological: trastuzumab infusion 4 mg/kg load week 1; 2 mg/kg weekly thereafter for 12 weeks Other Name: Herceptin Drug: cyclophosphamide 600 mg/m2, intravenous infusion every 3 weeks for four cycles Drug: doxorubicin hydrochloride 60 mg/m2 intravenously, 5-10 minutes, every 3 weeks, up to 12 weeks Other Name: Adriamycin Drug: paclitaxel 90 mg/m2 weekly, intravenously 1 hour after herceptin, given weekly up to 12 weeks or 175 mg/m2, intravenously every 3 weeks, up to 12 weeks (only if not receiving Herceptin®) Other Name: Taxol Procedure: conventional surgery Surgical excision will take place 12-13 weeks for the neo-adjuvant herceptin setting and 12-13 weeks in the non-herceptin setting. Surgery will take place prior to chemotherapy in the adjuvant herceptin setting Radiation: Radiation Therapy All patients undergoing breast-conserving surgery will undergo adjuvant (after surgery) whole breast radiation therapy. If the patient undergoes mastectomy, postmastectomy radiotherapy to the chest wall, supraclavicular region and axilla will be administered at the discretion of the treating radiation oncologist
Experimental: Non-Herceptin with radiation Chemotherapy followed by Taxol followed by surgery followed by radiation	Drug: cyclophosphamide 600 mg/m2, intravenous infusion every 3 weeks for four cycles Drug: doxorubicin hydrochloride 60 mg/m2 intravenously, 5-10 minutes, every 3 weeks, up to 12 weeks Other Name: Adriamycin Drug: paclitaxel 90 mg/m2 weekly, intravenously 1 hour after herceptin, given weekly up to 12 weeks or 175 mg/m2, intravenously every 3 weeks, up to 12 weeks (only if not receiving Herceptin®) Other Name: Taxol Procedure: conventional surgery Surgical excision will take place 12-13 weeks for the neo-adjuvant herceptin setting and 12-13 weeks in the non-herceptin setting. Surgery will take place prior to chemotherapy in the adjuvant herceptin setting Radiation: Radiation Therapy All patients undergoing breast-conserving surgery will undergo adjuvant (after surgery) whole breast radiation therapy. If the patient undergoes mastectomy, postmastectomy radiotherapy to the chest wall, supraclavicular region and axilla will be administered at the discretion of the treating radiation oncologist
Experimental: Non-Herceptin without radiation Chemotherapy followed by Taxol followed by surgery	Drug: cyclophosphamide 600 mg/m2, intravenous infusion every 3 weeks for four cycles Drug: doxorubicin hydrochloride 60 mg/m2 intravenously, 5-10 minutes, every 3 weeks, up to 12 weeks Other Name: Adriamycin Drug: paclitaxel 90 mg/m2 weekly, intravenously 1 hour after herceptin, given weekly up to 12 weeks or 175 mg/m2, intravenously every 3 weeks, up to 12 weeks (only if not receiving Herceptin®) Other Name: Taxol Procedure: conventional surgery Surgical excision will take place 12-13 weeks for the neo-adjuvant herceptin setting and 12-13 weeks in the non-herceptin setting. Surgery will take place prior to chemotherapy in the adjuvant herceptin setting Radiation: Radiation Therapy All patients undergoing breast-conserving surgery will undergo adjuvant (after surgery) whole breast radiation therapy. If the patient undergoes mastectomy, postmastectomy radiotherapy to the chest wall, supraclavicular region and axilla will be administered at the discretion of the treating radiation oncologist

Detailed Description:

OBJECTIVES:

Determine the cardiac and other toxicity of paclitaxel when administered with trastuzumab (Herceptin) after doxorubicin and cyclophosphamide in women with stage IIB, IIIA, IIIB, IIIC, or previously untreated stage IV breast cancer.
Determine whether the addition of paclitaxel with or without trastuzumab to conventional breast cancer adjuvant therapy (doxorubicin and cyclophosphamide) further decreases tumor size and the number of positive axillary nodes in these patients.
Determine the 5-year disease-free survival and overall survival of patients treated with these regimens.
Determine whether the initial pathologic response in patients receiving neoadjuvant therapy correlates with the eventual 5-year disease-free survival or overall survival.
Compare the number of patients eligible for breast-conserving cancer surgery after treatment with doxorubicin and cyclophosphamide vs paclitaxel and trastuzumab.
Correlate clinical and radiographic response rate with pathologic response rate in the primary tumor and axillary lymph nodes and determine which parameter best determines the pathologic response rate in patients treated with these regimens.

OUTLINE: Patients are assigned to receive either neoadjuvant therapy (HER-2 overexpressing and nonoverexpressing patients) or adjuvant therapy (HER-2 overexpressing patients only).

Neoadjuvant therapy: Patients assigned to receive neoadjuvant therapy receive one of two treatment regimens.
- Regimen I (HER-2 nonoverexpressing patients or HER-2 overexpressing patients who refuse trastuzumab (Herceptin) therapy): Patients receive doxorubicin IV and cyclophosphamide IV over 30 minutes and paclitaxel IV over 3 hours on day 1 every 3 weeks for a total of 4 courses. Patients then undergo surgery with or without adjuvant radiotherapy and/or oral tamoxifen.
- Regimen II (HER-2 overexpressing patients only): Patients receive doxorubicin and cyclophosphamide as in regimen I. After completion of course 4, patients receive paclitaxel IV and trastuzumab IV over 90-150 minutes weekly on weeks 13-24. Patients then undergo surgery with or without adjuvant radiotherapy. Patients then receive trastuzumab IV over 30 minutes weekly on weeks 29-69 if they did not receive radiotherapy or on weeks 36-76 if they did receive radiotherapy.
Adjuvant therapy: Patients who are assigned to receive adjuvant therapy (HER-2 overexpressing patients only) receive doxorubicin IV and cyclophosphamide IV over 30 minutes on day 1 every 3 weeks for a total of 4 courses. After completion of course 4, patients receive paclitaxel IV and trastuzumab IV over 90 minutes weekly on weeks 13-24. Patients then may undergo radiotherapy followed by trastuzumab IV over 30 minutes weekly on weeks 29-69 if they did not receive radiotherapy or on weeks 36-76 if they did receive radiotherapy.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually for 5 years.

PROJECTED ACCRUAL: A total of 125 patients (100 in the neoadjuvant group and 25 in the adjuvant group) will be accrued for this study within 5 years.

Eligibility

Genders Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

Histologically confirmed stage IIB, IIIA, IIIB, IIIC, or previously untreated stage IV primary carcinoma of the breast
- Fine needle aspiration, core needle biopsy, or incisional biopsy allowed
- No excisional biopsy
- Any of the following:
  - T2, N1 or T3, N0
  - Any T with N2 (including axillary lymph nodes matted to one another) or N3
  - Any T4, including inflammatory breast cancer
  - Adjuvant patients with at least 4 positive lymph nodes and HER-2 overexpressing tumor
  - Supraclavicular or infraclavicular positive lymph nodes without distant metastases
  - Distant metastases with measurable disease in breast or lymph nodes
Synchronous bilateral primary breast cancer allowed if the more serious cancer meets entry criteria
Measurable or evaluable disease
Hormone receptor status:
- Not specified

PATIENT CHARACTERISTICS:

Age:

Not specified

Sex:

Female

Menopausal status:

Not specified

Performance status:

Not specified

Life expectancy:

Not specified

Hematopoietic:

WBC greater than 3,000/mm^3
Platelet count greater than 100,000/mm^3
Hemoglobin greater than 9 g/dL

Hepatic:

Bilirubin less than 1.5 times normal

Renal:

Creatinine less than 1.5 times normal

Cardiovascular:

LVEF normal by resting nuclear ventriculogram

Other:

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No other prior malignancies except:
- Effectively treated squamous cell or basal cell skin cancer
- Carcinoma in situ of the cervix that has been curatively treated by surgery alone
- Nonbreast malignancy from which patient has been disease-free for 5 years and is at low risk of recurrence

PRIOR CONCURRENT THERAPY:

Biologic therapy:

Not specified

Chemotherapy:

Not specified

Endocrine therapy:

Not specified

Radiotherapy:

No prior radiotherapy

Surgery:

Not specified

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00006110

Locations

United States, North Carolina
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States, 27599-7305
Comprehensive Cancer Center at Wake Forest University
Winston-Salem, North Carolina, United States, 27157-1082

Sponsors and Collaborators

UNC Lineberger Comprehensive Cancer Center

Investigators

Study Chair:

Lisa A. Carey, MD

UNC Lineberger Comprehensive Cancer Center

More Information

Additional Information:

Clinical trial summary from the National Cancer Institute's PDQ® database This link exits the ClinicalTrials.gov site

No publications provided

Responsible Party:	UNC Lineberger Comprehensive Cancer Center
ClinicalTrials.gov Identifier:	NCT00006110 History of Changes
Other Study ID Numbers:	LCCC 9818, UNC-9818, NCI-G00-1836
Study First Received:	August 3, 2000
Last Updated:	April 20, 2012
Health Authority:	United States: Institutional Review Board

Keywords provided by UNC Lineberger Comprehensive Cancer Center:

stage II breast cancer
stage IV breast cancer
stage IIIA breast cancer

stage IIIB breast cancer
stage IIIC breast cancer
inflammatory breast cancer

Additional relevant MeSH terms:

Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Cyclophosphamide
Trastuzumab
Doxorubicin
Paclitaxel
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions

Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antibiotics, Antineoplastic
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Antineoplastic Agents, Phytogenic

ClinicalTrials.gov processed this record on May 19, 2013