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Validate Gene Expression and Proteomic Signatures Predictive of Treatment for Response for Breast Cancer Patient

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ClinicalTrials.gov Identifier: NCT00669773
Recruitment Status : Unknown
Verified December 2013 by Haematology-Oncology, National University Hospital, Singapore.
Recruitment status was:  Active, not recruiting
First Posted : April 30, 2008
Last Update Posted : December 10, 2013
Information provided by (Responsible Party):
Haematology-Oncology, National University Hospital, Singapore

Brief Summary:

Primary Objectives

  1. Validate our previously generated tumor gene expression and proteomic profiles in this independent sample to determine the predictive power to distinguish good from poor clinical and pathological responders to adriamycin or docetaxel.
  2. Validate our previously generated plasma proteomic profiles in this independent sample to determine the predictive power to distinguish good from poor clinical and pathological responders to adriamycin and docetaxel.

Secondary objectives

  1. To correlate adriamycin and docetaxel pharmacokinetics with

    1. Genetic polymorphisms of drug metabolizing enzymes and transporters, including MDR-1, Cyp3A, GSTs, and the nuclear receptors.
    2. Drug toxicity and tumor response.
    3. Peripheral mononuclear cell gene expression profiles
  2. To study ondansetron pharmacokinetics and correlate that with genetic polymorphisms.

Condition or disease Intervention/treatment Phase
Breast Cancer Drug: Adriamycin Drug: Docetaxel Phase 2

Detailed Description:
Many chemotherapeutic agents are active in breast cancer, although response rate to any individual drug is only 30-50%. The choice of chemotherapy is empirical, and development of a chemosensitivity assay is desirable, to reduce costs, unnecessary toxicity, and loss of window of opportunity to cure. Single molecular markers to predict sensitivity are not highly accurate, as chemotherapy resistance mechanisms likely involve complex pathways. High-throughput technologies such as gene expression microarray and Proteinchip array allow simultaneous analysis of thousands of genes, and hundreds of proteins, and may be more informative. We previously conducted a study on patients with measurable primary breast tumor who received primary chemotherapy with an alternating regimen of adriamycin and docetaxel, and generated tumor genomic and tumor and plasma proteomic signatures that predicted for clinical and pathological response using high throughput discovery platforms. This protocol aims to recruit 20 patients as an independent test set to validate the genomic and proteomic signatures generated previously. Half the patients will be randomized to receive 4 cycles of pre-operative adriamycin (Arm A) allowing validation of the adriamycin-specific signatures, while the other half will be randomized to receive 4 cycles of pre-operative docetaxel (Arm B) allowing validation of the docetaxel-specific signatures. Subjects will then undergo resection of the primary breast tumor, followed by 4 cycles of adjuvant therapy with the alternative drug (docetaxel in Arm A, adriamycin in Arm B). Serial tumor and plasma samples will be obtained for genomic and proteomic analysis. The previously generated genomic and proteomic signatures will be applied to this independent dataset to categorize patients into good and poor responders, and the prediction correlated with actual treatment responses. Secondary goals include the correlation of patient genotype with drug pharmacokinetics, and the correlation of chemotherapy-induced peripheral blood mononuclear cell gene expression changes with treatment response and toxicities

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 49 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 2 Randomized Study of Adriamycin & Docetaxel in the First-line Treatment of Locally Advanced or Metastatic Breast Cancer Patients With Measurable Primary Breast Tumor to Validate Gene Expression & Proteomic Signatures Predictive of Treatment Response
Study Start Date : February 2007
Estimated Primary Completion Date : February 2014
Estimated Study Completion Date : February 2014

Resource links provided by the National Library of Medicine

Drug Information available for: Docetaxel
U.S. FDA Resources

Arm Intervention/treatment
Experimental: Adriamycin
Arm A: 4 cycles of adriamycin at 75mg/m2 3 weekly followed by surgery followed by 4 cycles of docetaxel at 75mg/m2 3 weekly
Drug: Adriamycin
Arm A: 4 cycles of adriamycin at 75mg/m2 3 weekly followed by surgery followed by 4 cycles of docetaxel at 75mg/m2 3 weekly
Experimental: Docetaxel Drug: Docetaxel
Arm B: 4 cycles of docetaxel at 75mg/m2 3 weekly followed by surgery followed by 4 cycles of adriamycin at 75mg/m2 3 weekly.

Primary Outcome Measures :
  1. Clinical and pathological response rate [ Time Frame: 12 weeks ]
    Clinical and pathological response rate to four cycles of pre-operative chemotherapy.

Secondary Outcome Measures :
  1. Baseline and serial changes in tumor & plasma genomic and proteomic changes [ Time Frame: at different time-points (see description below) ]

    Core biopsy of breast tumor before treatment, after one cycle of pre-operative chemotherapy, and after the fourth cycle of pre-operative chemotherapy or study withdrawal for a total of 3 core biopsies.

    Plasma samples for proteomics before treatment, during pre-operative chemotherapy and before surgery, before first cycle of post-operative chemotherapy, within 4 weeks after completion of 4 cycles of post-operative chemotherapy, and four monthly thereafter.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Patients may be included in the study only if they meet all of the following criteria:

  • Female, age 18 years or above.
  • Histologic or cytologic diagnosis of breast carcinoma.
  • T2-4 breast cancer with measurable primary breast tumor, defined as palpable tumor with both diameters 2.0cm or greater as measured by caliper.
  • Patients must not have received prior chemotherapy or hormonal therapy for the treatment of breast cancer.
  • Karnofsky performance status of 70 or higher.
  • Estimated life expectancy of at least 12 weeks.
  • Adequate organ function including the following:

    • Bone marrow:

      • Absolute neutrophil (segmented and bands) count (ANC)>= 1.5 x 10 9/L
      • Platelets >= 100 x 10 9/L
    • Hepatic:

      • Bilirubin <= 1.5 x upper limit of normal (ULN),
      • ALT or AST <= 2.5x ULN, (or <= 5 X with liver metastases)
    • Renal:

      • creatinine <= 1.5x ULN
  • Left ventricular ejection fraction >= 50%
  • Signed informed consent from patient or legal representative.
  • Patients with reproductive potential must use an approved contraceptive method if appropriate (eg, intrauterine device, birth control pills, or barrier device) during and for three months after the study. Females with childbearing potential must have a negative serum pregnancy test within 7 days prior to study enrollment.

Exclusion Criteria:

Patients will be excluded from the study for any of the following reasons:

  • Prior treatment for locally advanced or metastatic breast cancer.
  • Treatment within the last 30 days with any investigational drug.
  • Concurrent administration of any other tumor therapy, including cytotoxic chemotherapy, hormonal therapy, and immunotherapy.
  • Active infection that in the opinion of the investigator would compromise the patient's ability to tolerate therapy.
  • Pregnancy.
  • Breast feeding.
  • Serious concomitant disorders that would compromise the safety of the patient or compromise the patient's ability to complete the study, at the discretion of the investigator.
  • Poorly controlled diabetes mellitus.
  • Second primary malignancy that is clinically detectable at the time of consideration for study enrollment.
  • Symptomatic brain metastasis.
  • History of significant neurological or mental disorder, including seizures or dementia.
  • Peripheral neuropathy of CTC grade 2 or above (NCI CTC version 3).
  • History of hypersensitivity to drugs formulated in Tween 80, the vehicle used for commercial docetaxel formulations.

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): NCT00669773

National University Hospital
Singapore, Singapore
Sponsors and Collaborators
National University Hospital, Singapore
Principal Investigator: Soo Chin LEE, MBBS, MRCP National University Hospital, Singapore

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Haematology-Oncology, Dr. Lee Soo Chin, National University Hospital, Singapore
ClinicalTrials.gov Identifier: NCT00669773     History of Changes
Other Study ID Numbers: BR08/34/06
HSA No: CTC0700019 ( Other Identifier: Health Sciences Authority )
2006/00411 ( Other Identifier: NHG Domain Specific Review Boards )
First Posted: April 30, 2008    Key Record Dates
Last Update Posted: December 10, 2013
Last Verified: December 2013

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
Liposomal doxorubicin
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antibiotics, Antineoplastic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors