Neoadjuvant Chemotherapy Using Doxorubicin and Paclitaxel in Treating Women With Large Breast Cancer

NCT ID: NCT00096291

Last Updated: 2017-04-10

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 62 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2000-02-29

Brief Summary

RATIONALE: Drugs used in chemotherapy, such as doxorubicin and paclitaxel, work in different ways to stop tumor cells from dividing so they stop growing or die. Giving chemotherapy before and after surgery may shrink the tumor so it can be removed and may kill any tumor cells remaining after surgery.

PURPOSE: This randomized phase II trial is comparing two different regimens of doxorubicin and paclitaxel to see how well they work in treating women who are undergoing surgery for breast cancer.

Detailed Description

OBJECTIVES:

Primary

• Determine whether tumors in women with palpable invasive breast cancer with wild type p53 are more sensitive to doxorubicin than to paclitaxel when given as sequential single-agent neoadjuvant chemotherapy.
• Determine whether tumors with inactivated p53 are more sensitive to paclitaxel than to doxorubicin when given as sequential single-agent neoadjuvant chemotherapy in these patients.

Secondary

• Correlate other biological markers (physiological and molecular) with tumor response in patients treated with these regimens.
• Determine changes in these biological markers during and after neoadjuvant chemotherapy in these patients.
• Compare breast MRI, in terms of assessing tumor response, with physical exam, mammogram, and ultrasound in patients treated with these regimens.
• Determine whether there are MRI indicators (e.g., tumor morphology or lesion enhancement) that are predictive of response in patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor size (> 5 cm vs ≤ 3-5 cm) and presence of palpable regional lymph nodes (yes vs no). Patients are randomized to 1 of 2 treatment arms.

All patients undergo biopsy, bilateral mammogram, MRI, ultrasound, blood marker, molecular (gene microarrays and functional p53 status), and physiologic studies before initiation of neoadjuvant chemotherapy. Some of these studies are repeated after completion of treatment with the first chemotherapeutic agent and after completion of treatment with the second chemotherapeutic agent as outlined below.

• Arm I: Patients receive doxorubicin IV on days 1, 15, 29, and 43. Patients with no residual tumor (indicated by clinical evaluation and radiologic studies) after completion of doxorubicin undergo definitive surgery. After surgery, patients receive paclitaxel IV over 1 hour on days 1, 8, 15, 22, 29, 36, 43, 50, and 57.

Patients with residual tumor > 2 cm after completion of doxorubicin undergo 8-12 core needle biopsies. Patients with residual tumor < 2 cm after completion of doxorubicin undergo 4-6 core needle biopsies. After core needle biopsies, patients receive paclitaxel as above.

• Arm II: Patients receive paclitaxel IV over 1 hour on days 1, 8, 15, 22, 29, 36, 43, 50, and 57. Patients with no residual tumor (indicated by clinical evaluation and radiologic studies) after completion of paclitaxel undergo definitive surgery. After surgery, patients receive doxorubicin IV on days 1, 15, 29, and 43.

Patients with residual tumor > 2 cm after completion of paclitaxel undergo 8-12 core needle biopsies. Patients with residual tumor < 2 cm after completion of paclitaxel undergo 4-6 core needle biopsies. After core needle biopsies, patients receive doxorubicin as above.

In both arms, treatment continues in the absence of disease progression or unacceptable toxicity.

Samples from core needle biopsies are analyzed by microarray analysis for gene expression profiles.

Patients are followed every 6 months for 5 years.

PROJECTED ACCRUAL: A total of 100 patients (50 per treatment arm) will be accrued for this study within 4-5 years.

Conditions

Breast Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: NONE

Study Groups

Sequence Doxorubicin followed by Paclitaxel

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel versus Paclitaxel followed by Doxorubicin

Group Type: ACTIVE_COMPARATOR

Doxorubicin followed by Paclitaxel

Intervention Type: OTHER

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel Paclitaxel followed by Doxorubicin

Paclitaxel followed by Doxorubicin

Intervention Type: OTHER

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel versus Paclitaxel followed by Doxorubicin

Sequence of neoadjuvant CT: Paclitaxel followed by Doxorubicin

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel versus Paclitaxel followed by Doxorubicin

Group Type: OTHER

Paclitaxel followed by Doxorubicin

Intervention Type: OTHER

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel versus Paclitaxel followed by Doxorubicin

Interventions

Doxorubicin followed by Paclitaxel

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel Paclitaxel followed by Doxorubicin

Intervention Type: OTHER

Paclitaxel followed by Doxorubicin

Patients will be randomized into 2 groups based on sequence of neoadjuvant chemotherapy:

Doxorubicin followed by Paclitaxel versus Paclitaxel followed by Doxorubicin

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

DISEASE CHARACTERISTICS:

• Diagnosis of invasive breast cancer

• Tumor ≥ 3 cm and palpable

• Multiple masses are allowed provided at least 1 mass is ≥ 3 cm
• Clinically positive axillary or supraclavicular lymph nodes allowed
• Fine needle aspiration or core needle biopsy positive for invasive breast cancer AND/OR fine needle aspiration of lymph nodes positive
• HER2/neu-positive OR negative
• No inflammatory breast cancer
• No distant metastases
• Hormone receptor status:

• Estrogen receptor (ER)-positive OR ER-negative

PATIENT CHARACTERISTICS:

Age

• 18 and over

Sex

• Female

Menopausal status

• Premenopausal or postmenopausal

Performance status

• Karnofsky 60-100%

Life expectancy

• Not specified

Hematopoietic

• Granulocyte count ≥ 1,000/mm^3
• Platelet count ≥ 100,000/mm^3

Hepatic

• Bilirubin ≤ 2 times upper limit of normal (ULN)
• SGOT ≤ 2 times ULN

Renal

• Not specified

Cardiovascular

• LVEF ≥ 50%
• No congestive heart failure
• No serious conduction system abnormality
• No other significant cardiovascular disease

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Patients with other prior or concurrent malignancies allowed provided they have received no prior chemotherapy AND they are likely to have been cured from a prior malignancy
• No severe medical or psychiatric condition that would preclude study compliance
• No known HIV positivity

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• No prior chemotherapy

Endocrine therapy

• No prior hormonal therapy for breast cancer

Radiotherapy

• No prior radiotherapy for this malignancy

Surgery

• Not specified

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 120 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

Massachusetts General Hospital

OTHER

Sponsor Role: lead

Responsible Party

Alphonse Taghian, MD, PhD

Principle Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Alphonse G. Taghian, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dana-Farber Cancer Institute

Locations

Massachusetts General Hospital Cancer Center

Boston, Massachusetts, United States

Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute

Boston, Massachusetts, United States

Countries

United States

References

Taghian AG, Abi-Raad R, Assaad SI, Casty A, Ancukiewicz M, Yeh E, Molokhia P, Attia K, Sullivan T, Kuter I, Boucher Y, Powell SN. Paclitaxel decreases the interstitial fluid pressure and improves oxygenation in breast cancers in patients treated with neoadjuvant chemotherapy: clinical implications. J Clin Oncol. 2005 Mar 20;23(9):1951-61. doi: 10.1200/JCO.2005.08.119.

Reference Type: RESULT

PMID: 15774788 (View on PubMed)

Yeh E, Slanetz P, Kopans DB, Rafferty E, Georgian-Smith D, Moy L, Halpern E, Moore R, Kuter I, Taghian A. Prospective comparison of mammography, sonography, and MRI in patients undergoing neoadjuvant chemotherapy for palpable breast cancer. AJR Am J Roentgenol. 2005 Mar;184(3):868-77. doi: 10.2214/ajr.184.3.01840868.

Reference Type: RESULT

PMID: 15728611 (View on PubMed)

Other Identifiers

P50CA089393

Identifier Type: NIH

Identifier Source: secondary_id

View Link

P30CA006516

Identifier Type: NIH

Identifier Source: secondary_id

View Link

DFCI-99278

Identifier Type: -

Identifier Source: secondary_id

CDR0000382123

Identifier Type: -

Identifier Source: org_study_id