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Efficacy and Tolerance Study of Bevacizumab in Her2- Inflammatory Breast Cancer Patients (Beverly1)

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ClinicalTrials.gov Identifier: NCT00820547
Recruitment Status : Completed
First Posted : January 12, 2009
Last Update Posted : October 22, 2019
Sponsor:
Information provided by (Responsible Party):
UNICANCER

Brief Summary:

RATIONALE: Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving bevacizumab and combination chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving bevacizumab and radiation therapy after surgery may kill any tumor cells that remain after surgery.

PURPOSE: This phase II trial is studying giving bevacizumab together with chemotherapy before surgery and bevacizumab and radiation therapy after surgery to see how well it works in treating patients with inflammatory breast cancer.


Condition or disease Intervention/treatment Phase
Breast Cancer Biological: bevacizumab Drug: cyclophosphamide Drug: docetaxel Drug: epirubicin hydrochloride Drug: fluorouracil Phase 2

Detailed Description:

OBJECTIVES:

Primary

  • Evaluate the complete histological response rate in patients with inflammatory HER2-negative breast cancer treated with bevacizumab and concurrent chemotherapy followed by bevacizumab and concurrent hormonal therapy after surgery and radiotherapy.

Secondary

  • Evaluate the progression-fee and overall survival of these patients at 3 and 5 years.
  • Evaluate the tolerance of bevacizumab in these patients.
  • Assess circulating metastatic disease before, during, and after treatment.
  • Assess circulating endothelial cells before, during, and after treatment.
  • Assess predictive factors of response by genomic and proteomic studies on frozen tumor samples and fluid samples (i.e., serum and plasma).

OUTLINE: This is a multicenter study.

  • Neoadjuvant induction therapy:

    • Courses 1-4: Patients receive bevacizumab IV over 30-90 minutes, fluorouracil IV, epirubicin hydrochloride IV over 10 minutes, and cyclophosphamide IV over 5 minutes on day 1.
    • Courses 5-8: Patients receive bevacizumab IV over 30-90 minutes and docetaxel IV over 1 hour on day 1.

Treatment repeats every 21 days for 8 courses in the absence of disease progression or unacceptable toxicity.

  • Surgery: Patients undergo surgery 4-6 weeks after completion of bevacizumab.
  • Adjuvant therapy: Beginning 2-4 weeks after surgery, patients undergo radiotherapy for 6 weeks. Patients also receive bevacizumab IV over 30-90 minutes beginning 2-4 weeks after surgery, during the radiotherapy period. Treatment with bevacizumab repeats every 3 weeks for 30 weeks in the absence of disease progression or unacceptable toxicity. Patients who are estrogen receptor- or progesterone receptor-positive (≥ 10% by IHC) receive the following concurrent hormonal therapy beginning in week 7:

    • Premenopausal patients: Patients receive tamoxifen citrate for 5 years.
    • Postmenopausal patients: Patients receive aromatase-inhibitor therapy (or tamoxifen citrate if unable to tolerate anti-aromatase therapy) for 5 years.
    • Perimenopausal patients: Patients receive tamoxifen citrate for 2-3 years and aromatase-inhibitor therapy for 2-3 years OR tamoxifen citrate for 5 years followed by aromatase-inhibitor therapy for 2-3 years (if follicle-stimulating hormone > 30 IU/L and/or estradiol < 30 ng/L).

After completion of study treatment, patients are followed for at least 3 years.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 100 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Study Evaluating the Efficacy and Tolerance of Bevacizumab (Avastin) in HER2- Inflammatory Breast Cancer
Actual Study Start Date : January 2009
Actual Primary Completion Date : April 2015
Actual Study Completion Date : September 2019


Arm Intervention/treatment
Experimental: (FEC / Docetaxel) + Bevacizumab
Neoadjuvant treatment: 4 cycles FEC + Bevacizumab followed by 4 cycles Docetaxel + Bevacizumab Adjuvant: Bevacizumab for 1 year
Biological: bevacizumab
During neoadjuvant phase: 15 mg/kg, d1 q3w, 8 cycles During adjuvant phase:15 mg/kg, d1 q3w, 10 cycles

Drug: cyclophosphamide
Neoadjuvant: 500 mg/m2 d1 q3w, 4 cycles

Drug: docetaxel
Neoadjuvant: 100 mg/m2 q3w, 4 cycles

Drug: epirubicin hydrochloride
Neoadjuvant: 100 mg/m2, d1 q3w, 4 cycles

Drug: fluorouracil
Neoadjuvant: 500 mg/m2, d1 q3w, 4 cycles




Primary Outcome Measures :
  1. Complete histologic response rate [ Time Frame: Post surgery ]

Secondary Outcome Measures :
  1. Progression-free survival [ Time Frame: 3 and 5 years ]
  2. Overall survival [ Time Frame: 3 and 5 years ]
  3. Toxicity as assessed by CTCAE v3.0 [ Time Frame: 3 and 5 years ]
  4. Predictive factors of response to bevacizumab [ Time Frame: 3 and 5 years ]
  5. Circulating peripheral cells (circulating endothelial and tumor cells): correlation of initial rate and association with histological response after surgery [ Time Frame: Post-surgery ]
  6. Genomic and proteomic analyses and correlation with histologic response [ Time Frame: Post surgery ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed inflammatory breast cancer, meeting 1 of the following staging criteria:

    • T4d, any N (AJCC stage IIIB or IIIC)
    • Gustave-Roussy Institute (IGR) classification Poussee evolutirie (PEV; measures tumor growth over time) 2

      • PEV 2: tumor with underlying breast tissue, especially skin, that is affected by subacute inflammation and edema involving < ½ of breast surface
    • IGR classification PEV 3

      • PEV 3: acute or subacute inflammation and edema involving > ½ of breast surface
    • Biopsy-confirmed presence of tumor embolism in surface lymph nodes
  • HER2-negative (HER2 0 or 1+, or HER2 2+ by IHC if FISH-negative allowed)
  • No metastatic disease
  • No non-inflammatory breast cancer with edema, ulceration, or satellite skin nodules
  • No bilateral breast cancer
  • Hormone receptor status known

PATIENT CHARACTERISTICS:

  • Any menopausal status allowed
  • WHO performance status 0-2
  • Life expectancy ≥3 months
  • LVEF normal by ECHO
  • ANC >1.5 x 10^9/L
  • Platelet count >100 x 10^9/L
  • INR ≤1.5 (except for patients on prophylactic anticoagulants)
  • aPTT ≤1.5 times upper limit of normal (ULN)
  • Total bilirubin normal
  • SGOT and SGPT ≤1.25 times ULN
  • Alkaline phosphatase ≤2.5 times ULN
  • Creatinine clearance ≥60 mL/min
  • Proteinuria <2+ or 24-hour urine protein ≤1 g
  • No unhealed wound, stomach ulcer, or bone fracture
  • No history of thrombotic or hemorrhagic disorders
  • No significant cardiovascular disease including the following:

    • Cerebrovascular accident within the past 6 months
    • Unstable angina
    • Cardiac failure
    • Myocardial infarction
    • Arrhythmia requiring treatment
  • No uncontrolled hypertension (i.e., systolic BP >150 mm Hg and/or diastolic BP >100 mm Hg)
  • No other active infection or serious illness that would preclude patient from receiving study treatment
  • No hypersensitivity to any active products or excipients of study drugs
  • Not pregnant or nursing
  • Fertile patients must use effective contraception during and for 6 months after completion of study treatment
  • No social or psychologic reasons that would prevent study compliance or follow-up
  • No patients who are incarcerated or on probation

PRIOR CONCURRENT THERAPY:

  • No prior chemotherapy, radiotherapy, or hormonal therapy for this disease
  • More than 4 weeks since prior surgery (diagnostic biopsy or installation of implant allowed)
  • More than 10 days since prior chronic non-inflammatory steroids (e.g., acetylsalicylic acid >325 mg/day) or platelet anticoagulation treatment (e.g., dipyridamole, ticlopidine, clodiprogel, cilostazol)
  • More than 10 days since prior oral or parenteral anticoagulant or thrombolytic drugs (preventative thrombolytic drugs allowed)
  • No concurrent participation in another experimental clinical trial

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00820547


Locations
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Sponsors and Collaborators
UNICANCER
Investigators
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Principal Investigator: Patrice Viens, MD Institut Paoli-Calmettes
Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: UNICANCER
ClinicalTrials.gov Identifier: NCT00820547    
Other Study ID Numbers: PACS09 UC-0140/0802
UNICANCER-PACS-09-0802 ( Other Identifier: Internal Id Number )
2008-001807-53 ( EudraCT Number )
First Posted: January 12, 2009    Key Record Dates
Last Update Posted: October 22, 2019
Last Verified: October 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Unicancer will share de-identified individual data that underlie the results reported under the following conditions: the data shared will be limit to that required for independent mandated verification of the published results, the applicant will need authorization from Unicancer for personal access, and data will only be transferred after signing of a data access agreement. A decision concerning the sharing of other study documents, including protocol and statistical analysis plan will be examined upon request.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: Unicancer will consider access to study data upon written detailed request sent to Unicancer, from 6 months until 5 years after publication of summary data.
Keywords provided by UNICANCER:
inflammatory breast cancer
stage IIIA breast cancer
stage IIIB breast cancer
stage IIIC breast cancer
male breast cancer
HER2-negative breast cancer
Additional relevant MeSH terms:
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Breast Neoplasms
Inflammatory Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Cyclophosphamide
Bevacizumab
Docetaxel
Fluorouracil
Epirubicin
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antineoplastic Agents, Immunological
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Antimetabolites
Antimetabolites, Antineoplastic