Combination Chemotherapy Plus Biological Therapy in Treating Patients With Stage II or Stage III 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. Biological therapies use different ways to stimulate the immune system and stop tumor cells from growing. Combining chemotherapy with biological therapy may kill more tumor cells.
PURPOSE: This phase I/II trial is studying the side effects of giving chemotherapy together with biological therapy and to see how well they work in treating patients with stage II or stage III breast cancer.
| Condition | Intervention | Phase |
|---|---|---|
|
Breast Cancer |
Biological: aldesleukin Biological: filgrastim Biological: sargramostim Biological: therapeutic autologous lymphocytes Drug: cyclophosphamide Drug: doxorubicin hydrochloride Drug: paclitaxel |
Phase 1 Phase 2 |
| Study Type: | Interventional |
| Study Design: | Primary Purpose: Treatment |
| Official Title: | Combination of Chemotherapy With Taxol, Adriamycin, and Cytoxan (TAC), Multiple Infusions of Activated T Cells (ATC), Interleukin-2 (IL-2) and GM-CSF for High Risk Breast Cancer With and Without Her2/Neu Overexpression. (Phase I/II) |
- Toxicity [ Designated as safety issue: Yes ]
- Disease-free survival [ Designated as safety issue: No ]
- Overall survival [ Designated as safety issue: No ]
- Immune functions [ Designated as safety issue: No ]
| Estimated Enrollment: | 60 |
| Study Start Date: | January 2000 |
| Estimated Study Completion Date: | January 2007 |
| Primary Completion Date: | January 2007 (Final data collection date for primary outcome measure) |
OBJECTIVES:
- Determine the toxic effects of sequential paclitaxel (or other taxane), doxorubicin, and cyclophosphamide followed by immunotherapy with activated T cells, interleukin-2, and sargramostim (GM-CSF) in patients with high-risk stage II or III breast cancer.
- Determine the disease-free survival and overall survival of patients treated with this regimen.
- Determine the immune function of patients treated with this regimen.
OUTLINE: Patients are stratified according to number of positive lymph nodes (less than 4 nodes vs 4-9 nodes vs 10 or more nodes), type of taxane chemotherapy during study (paclitaxel vs other taxane), and prior treatment with 2 of 3 study chemotherapy agents (yes vs no).
Patients receive doxorubicin IV on day 1 and filgrastim (G-CSF) on days 3-10 of 3 consecutive 14-day courses. Patients then receive paclitaxel or another taxane IV on day 1 and G-CSF on days 3-10 of 3 consecutive 14-day courses. Patients then receive cyclophosphamide IV on day 1 and G-CSF on days 3-10 of 3 consecutive 14-day courses. Patients who enroll after previously receiving 2 of these 3 chemotherapy drugs may receive the third. Treatment continues in the absence of disease progression or unacceptable toxicity.
After recovery from chemotherapy, patients undergo peripheral blood mononuclear cell (PBMC) collection. The PBMC are treated ex vivo with monoclonal antibody OKT3 to form activated T cells (ATC). The ATC are expanded for up to 14 days in interleukin-2 (IL-2).
At 3-4 weeks after PBMC collection, patients receive ATC IV over 15-30 minutes weekly for 8 weeks. Patients also receive IL-2 subcutaneously (SC) daily and sargramostim (GM-CSF) SC twice weekly beginning 3 days before the first ATC infusion and continuing until 7 days after completion of ATC therapy.
Patients are followed every 3 months for 1 year and then annually thereafter.
PROJECTED ACCRUAL: A total of 40-60 patients will be accrued for this study within 4-5 years.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
- Histologically confirmed stage II or III adenocarcinoma of the breast
High-risk disease
- At least 4 positive lymph nodes
Fewer than 4 positive lymph nodes considered high-risk if one of the following is present:
- HER2/neu-positive disease
- Enlarged axillary nodes
- Extra capsular extension of tumor from lymph node
- Dermal lymphatic invasion
- Vascular invasion
- Bilateral disease
- Familial breast cancer
- T4 locally advanced disease
Clinically chemosensitive to prior paclitaxel (or other taxane), doxorubicin, and cyclophosphamide
- No relapse after chemotherapy
- No clinical evidence of brain metastases
Hormone receptor status:
- Estrogen and progesterone receptor status known
PATIENT CHARACTERISTICS:
Age:
- 18 and over
Sex:
- Female
Menopausal status:
- Not specified
Performance status:
- Karnofsky 70-100% OR
- ECOG 0-2
Life expectancy:
- At least 3 months
Hematopoietic:
- Granulocyte count at least 1,500/mm^3
- Platelet count at least 50,000/mm^3
- Hemoglobin greater than 8 g/dL
Hepatic:
- Bilirubin less than 1.5 times normal
- SGOT less than 1.5 times normal
Renal
- Creatinine less than 1.8 mg/dL
- Creatinine clearance at least 60 mL/min
- BUN less than 1.5 times normal
Cardiovascular:
- Ejection fraction at least 45% by MUGA
- No uncontrolled or significant cardiovascular disease
- No myocardial infarction within the past year
- No significant congestive heart failure
Pulmonary:
- FEV_1 at least 60% predicted
- DLCO at least 60% predicted
- FVC at least 60% predicted
Other:
- No other malignancy except curatively treated squamous cell carcinoma in situ of the cervix or basal cell skin cancer
- No other serious medical or psychiatric illness that would preclude study participation
- HIV negative
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- Not specified
Chemotherapy:
- See Disease Characteristics
- Prior standard chemotherapy with anthracyclines or combination chemotherapy involving a combination of taxanes, doxorubicin, and/or cyclophosphamide allowed
Endocrine therapy:
- No concurrent hormonal therapy for breast cancer
- Concurrent hormonal therapy for nondisease-related conditions (e.g., insulin for diabetes) allowed
- Concurrent steroids for adrenal failure, septic shock, or pulmonary toxicity allowed
Radiotherapy:
- Not specified
Surgery:
- Prior complete resection of tumor allowed
Other:
- Prior successful neoadjuvant therapy allowed
Contacts and Locations| United States, Rhode Island | |
| Roger Williams Medical Center | |
| Providence, Rhode Island, United States, 02908-4735 | |
| Study Chair: | Lawrence G. Lum, MD, DSc | Roger Williams Medical Center |
More Information
No publications provided
| Responsible Party: | Lawrence Lum, Roger Williams Medical Center |
| ClinicalTrials.gov Identifier: | NCT00022230 History of Changes |
| Other Study ID Numbers: | CDR0000068797, RWMC-0633846 |
| Study First Received: | August 10, 2001 |
| Last Updated: | August 9, 2011 |
| Health Authority: | United States: Federal Government |
Keywords provided by Roger Williams Medical Center:
|
stage II breast cancer stage IIIA breast cancer stage IIIB breast cancer stage IIIC breast cancer |
Additional relevant MeSH terms:
|
Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Cyclophosphamide Aldesleukin Doxorubicin Paclitaxel Lenograstim 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 Adjuvants, Immunologic Anti-HIV Agents Anti-Retroviral Agents Antiviral Agents |
ClinicalTrials.gov processed this record on May 16, 2013