Comparative Study on Two Post-operative Adjuvant Chemotherapy Regimens for Treating Triple-negative Breast Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by China Breast Cancer Clinical Study Group
Sponsor:
Information provided by (Responsible Party):
Zhimin Shao, MD, China Breast Cancer Clinical Study Group
ClinicalTrials.gov Identifier:
NCT01642771
First received: July 4, 2012
Last updated: June 25, 2014
Last verified: June 2014
  Purpose

Recent clinical studies showed that triple-negative breast cancer patients (ER-/PR-/HER2-) may benefit more from Capecitabine chemotherapy. However, the optimum post-operative adjuvant Capecitabine chemotherapy regimen has not been determined for Chinese population with triple-negative breast cancer. Thus it's necessary to conduct a multi-center Phase III clinical trial to verify efficacy and safety of Capecitabine in the treatment of triple-negative breast cancer. In this study, a prospective, randomized, open, multi-center Phase III clinical study was conducted to compare efficacy and safety of sequential Docetaxel followed by Fluorouracil/Epirubicin/Cyclophosphamide (FEC) and sequential Docetaxel and Capecitabine followed by Capecitabine/Epirubicin/Cyclophosphamide (XEC) as post-operative adjuvant chemotherapy in the treatment of triple-negative breast cancer in Chinese population.


Condition Intervention Phase
Breast Cancer
Drug: 5-Fu/epirubicin/CTX following Docetaxel
Drug: Docetaxel/capecitabine followed by XEC
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Prospective, Randomized, Open, Multi-center Phase III Clinical Study Comparing Efficacy and Safety of Sequential T-FEC and TX-XEC as Post-operative Adjuvant Chemotherapy Options for the Treatment of Triple-negative Breast Cancer

Resource links provided by NLM:


Further study details as provided by China Breast Cancer Clinical Study Group:

Primary Outcome Measures:
  • 5-year disease free survival [ Time Frame: 5 year after the completion of chemotherapy ] [ Designated as safety issue: No ]
    Including local relapse, distant metastasis, contralateral breast cancer, second primary cancer or death from any cause


Secondary Outcome Measures:
  • Number of Participants with Adverse Events as a Measure of Safety [ Time Frame: Within 5 years after the completion of chemotherapy ] [ Designated as safety issue: Yes ]
    Safety will be evaluated based on adverse events observed and the number of participants with adverse events. Blood biological tests shall also be conducted for further examination.

  • FACT-B scale scores as a Measure of living quality [ Time Frame: Baseline, Week 0 ] [ Designated as safety issue: No ]
    FACT-B scale scores of participants would be assessed to reflect their living quality.

  • 5-year relapse free survival, distant disease free survival and overall survival as measures of efficacy [ Time Frame: Within 5 years after the completion of chemotherapy ] [ Designated as safety issue: No ]

    Disease relapse shall be considered as the endpoint of relapse free survival and the period between surgery and disease relapse shall be recorded as a measure of efficacy.

    Also disease distant metastasis shall be considered as the endpoint of distant disease free survival and the period between surgery and Disease distant metastasis shall be recorded as a measure of efficacy.


  • FACT-B scale scores as a Measure of living quality [ Time Frame: Week 9 ] [ Designated as safety issue: No ]
    FACT-B scale scores of participants would be assessed to reflect their living quality.

  • FACT-B scale scores as a Measure of living quality [ Time Frame: Week 18 ] [ Designated as safety issue: No ]
    FACT-B scale scores of participants would be assessed to reflect their living quality.


Estimated Enrollment: 636
Study Start Date: June 2012
Estimated Study Completion Date: May 2020
Estimated Primary Completion Date: December 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 5-Fu/epirubicin/CTX following Docetaxel
Docetaxel for the first 3 cycles of chemotherapy followed by 3 cycles of FEC (Fluorouracil, epirubicin and cyclophosphamide) chemotherapy
Drug: 5-Fu/epirubicin/CTX following Docetaxel
Cycle 1-3: Docetaxel i.v. 75mg/m2 (One cycle = 21 days); Cycle 4-6: Fluorouracil i.v. 500 mg/m2, Epirubicin i.v. 75 mg/m2, Cyclophosphamide i.v. 500 mg/m2 (One cycle = 21 days)
Other Name: Fluorouracil: 5-Fu
Experimental: Docetaxel/capecitabine followed by XEC
Docetaxel/ capecitabine (TX) for the first 3 cycles of chemotherapy followed by 3 cycles of capecitabine/epirubicin/cyclophosphamide (XEC) chemotherapy
Drug: Docetaxel/capecitabine followed by XEC
Cycle 1-3: Docetaxel i.v. 75 mg/m2, Capecitabine, p.o., 1000 mg/m2,b.i.d (take Capecitabine for 2 weeks and withdraw for 1 week) (One cycle = 21 days); Cycle 4-6: Capecitabine, i.v. 1000 mg/m2, b.i.d (take for 2 weeks and withdraw for 1 week),Epirubicin, i.v. 75 mg/m2, Cyclophosphamide, i.v. 500 mg/m2 (One cycle = 21 days)
Other Name: Capecitabine: Xeloda

Detailed Description:

Post-operative adjuvant chemotherapy has been shown to improve overall survival, delay local relapse and reduce distant metastasis by multiple large-scale prospective clinical trial. In registry clinical trial for Capecitabine conducted by O Shaughnessy, it revealed that a combined chemotherapy of Capecitabine and Docetaxel achieved better outcomes compared with Docetaxel alone. And the significant effect of Capecitabine was also evidenced by CHAT trial in which Trastuzumab/Docetaxel/Capecitabine regimen was proved to perform greater than Trastuzumab/Docetaxel regimen. In addition to better outcomes, Capecitabine also showed good tolerance and safety profile. In 2009, Finnish Breast Cancer Group published their study results from FinXX clinical trial on Lancet Oncology, and in this trial, they compared the efficacy between sequential Docetaxel (3 cycles) followed by 3 cycles of Fluorouracil/Epirubicin/Cyclophosphamide (FEC) and sequential Docetaxel and Capecitabine (3 cycles) followed by 3 cycles of Capecitabine/Epirubicin/Cyclophosphamide (XEC) in lymph positive or high-risk lymph negative early-stage breast cancer patients. And their results showed a better outcome in TX-XEC regimen. 5-year follow-up analysis of this trial revealed that combined Capecitabine regimen can bring more significant clinical benefits to triple-negative breast cancer patients. Another clinical trial NO1062 released their preliminary results on comparison of AC-T and AC-XT regimens and it showed that combined Capecitabine regimen can significantly improve overall survival and this effect is more obvious in triple--negative breast cancer patients.

Based on the results of FinXX and NO1062, it's of great value to optimize combined Capecitabine regimen and clarify involved questions, such as whether the efficacy of Capecitabine is related to its treatment course or not, whether Capecitabine should be combined into current standardized chemotherapy or a sequential therapy. Also, there are still no clear conclusions on the best post-operative adjuvant chemotherapy for triple--negative breast cancer patients. Especially in Chinese population, the efficacy and safety of Capecitabine in adjuvant chemotherapy has not been well established. So it's necessary to explore reasonable dosage, safety profile and efficacy of combined Capecitabine therapy. Based on this purpose, this study is hoped to compare efficacy and safety of sequential Docetaxel followed by Fluorouracil/Epirubicin/Cyclophosphamide (FEC) and sequential Docetaxel and Capecitabine followed by Capecitabine/Epirubicin/Cyclophosphamide (XEC) as post-operative adjuvant chemotherapy in the treatment of triple-negative breast cancer in Chinese population.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Female aged 18 - 70 years old;
  • Histological confirmed with unilateral invasive carcinoma (all pathological types are applicable);
  • Newly diagnosed conditions allowing direct surgery without any absolute contraindication for surgery;
  • No mass or microscopic tumor residue after surgery resection;
  • Initiate adjuvant chemotherapy within 30 days after surgery;
  • Axillary lymph node positive (including the sentinel lymph node positive and lymph node positive after axillary dissection), for example, axillary lymph node negative requires that primary tumor size must be greater than 1cm;
  • Definite reports on ER/PR/Her2 receptor showing all ER/PR/Her2 negative (specific definitions: immunohistochemical detection of ER <10% tumor cells is defined as ER negative, PR <10% positive tumor cells is defined as PR-negative, Her2 is 0~1+ or 2+ but determined negative via FISH or CISH detected (no amplification) is defined as Her2 negative);
  • No relevant clinical or imaging evidence of metastasis showing in the preoperative examination (M0);
  • Without peripheral neuropathy;
  • ECOG performance score is 0 or 1;
  • Postoperative recovery was good and an interval of at least one week since the surgery is necessary;
  • White blood cell count> 4 × 10^9/l, neutrophil count> 2 × 10^9/l, platelet count> 100 × 10^9/l and hemoglobin 9g/dl);
  • ASAT and ALAT <1.5 folds of the upper limit of normal values, alkaline phosphatase <2.5 folds of the upper limit of normal values, total bilirubin <1.5 folds of the upper limit of normal values;
  • Serum creatinine <1.5 folds of the upper limit of normal value;
  • Women at childbearing age should take contraception measures during treatment;
  • Cardiac function: echocardiographic examination showed LEVF> 50%;
  • Informed consent form signed. -

Exclusion Criteria:

  • Bilateral breast cancer or carcinoma in situ (DCIS / LCIS);
  • Metastasis at any location;
  • Any tumor > T4a (UICC1987) (accompanied by skin involvement, lump adhesion and fixation, inflammatory breast cancer);
  • Any of ER, PR or Her-2 is positive;
  • Contralateral breast clinically or radiologically suspected to be malignant but not confirmed which needs a biopsy;
  • Previous neoadjuvant therapy, including chemotherapy, radiotherapy and hormone therapy;
  • Previously suffering from malignant tumors (except for basal cell carcinoma and cervical carcinoma in situ), including contralateral breast cancer;
  • Already enrolled into other clinical trials;
  • Severe systemic disease and/or uncontrollable infection, unable to be enrolled in this study
  • LEVF <50% (echocardiography);
  • Suffering from severe cardiovascular and cerebrovascular diseases within six months before the randomization (such as: unstable angina, chronic heart failure, uncontrollable high blood pressure > 150/90mmHg, myocardial infarction or brain vascular accident);
  • Known allergic to taxane and anthracycline agents;
  • Women at childbearing age refuse to take contraception measures during the treatment and 8 weeks after completion of treatment;
  • Pregnant and breast-feeding women;
  • Pregnancy test showed positive results before drug administration after enrolling in to the study;
  • With mental illness and cognitive impairment, unable to understand trial protocol and side effects and complete trial protocol and follow-ups (systematic evaluation is required before recruiting into this study);
  • Without personal freedom and independent civil capacity.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01642771

Contacts
Contact: JUNJIE LI, M.D. 021-64175590 ext 8808 lijunjie_ronaldo@hotmail.com

  Show 37 Study Locations
Sponsors and Collaborators
China Breast Cancer Clinical Study Group
Investigators
Principal Investigator: Zhimin Shao, M.D. China Breast Cancer Clinical Study Group
  More Information

Publications:

Responsible Party: Zhimin Shao, MD, Dr., China Breast Cancer Clinical Study Group
ClinicalTrials.gov Identifier: NCT01642771     History of Changes
Other Study ID Numbers: EBC protocol 1.1
Study First Received: July 4, 2012
Last Updated: June 25, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by China Breast Cancer Clinical Study Group:
Triple-negative Breast Cancer
Post-operative adjuvant Chemotherapy
Docetaxel
Capecitabine
Epirubicin
Cyclophosphamide
Fluorouracil

Additional relevant MeSH terms:
Triple Negative Breast Neoplasms
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Docetaxel
Capecitabine
Cyclophosphamide
Epirubicin
Fluorouracil
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Myeloablative Agonists
Antibiotics, Antineoplastic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Antimetabolites, Antineoplastic

ClinicalTrials.gov processed this record on October 19, 2014