Biomarker (p53 Gene) Analysis and Combination Chemotherapy Followed by Radiation Therapy and Surgery in Treating Women With Large Operable or Locally Advanced or Inflammatory Breast Cancer
RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Currently patients with breast cancer are treated with one of several very similar combinations of drugs. Analysis of biomarkers in tumor tissue may help doctors predict how well patients with breast cancer will respond to treatment and help doctors choose the best drug regimen to treat each patient.
PURPOSE: This randomized phase III trial is studying giving different regimens of chemotherapy and comparing how well they work in treating women with large operable or locally advanced or inflammatory breast cancer. This study is also looking at whether analyzing a specific biomarker (p53) in tumor tissue may help doctors predict how well patients will respond to treatment and help doctors choose the best drug to treat each patient.
Drug: epirubicin hydrochloride
Genetic: microarray analysis
Other: immunohistochemistry staining method
Other: laboratory biomarker analysis
Procedure: conventional surgery
Procedure: neoadjuvant therapy
Radiation: radiation therapy
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||First Prospective Intergroup Translational Research Trial Assessing the Potential Predictive Value of p53 Using a Functional Assay in Yeast in Patients With Locally Advanced/Inflammatory or Large Operable Breast Cancer Prospectively Randomised to a Taxane Versus a Non Taxane Regimen|
- Progression-free survival [ Time Frame: from randomization till first evidence of progression ] [ Designated as safety issue: No ]
- Distant metastasis-free survival [ Time Frame: randomization till first evidence recurrence ] [ Designated as safety issue: No ]
- Overall survival [ Time Frame: randomization till death ] [ Designated as safety issue: No ]
- Clinical and pathological responses [ Time Frame: after 3rd and 6d cycle of chemotherapy ] [ Designated as safety issue: No ]
- Clinical response according to RECIST criteria without pathologic response [ Time Frame: after 3rd and 6d cycle of chemotherapy ] [ Designated as safety issue: No ]
- Toxicity according to CTC v2.0 [ Time Frame: from randomization ] [ Designated as safety issue: Yes ]
- Agreement between p53 assessment by IHC method and functional test in yeast by analyzing the correlation between p52 and tumor status after 3 and 6 cycles of chemotherapy [ Time Frame: after 3 and 6 cycles of chemotherapy ] [ Designated as safety issue: No ]
- Tumor assessment using cDNA microarray technology [ Time Frame: end of treatment ] [ Designated as safety issue: No ]
|Study Start Date:||March 2001|
|Primary Completion Date:||November 2006 (Final data collection date for primary outcome measure)|
Active Comparator: non taxane based chemotherapy
either FEC 100 or Canadian CEF or Tailored FEC for 6 cycles
|Biological: filgrastim Drug: cyclophosphamide Drug: epirubicin hydrochloride Drug: fluorouracil Genetic: microarray analysis Other: immunohistochemistry staining method Other: laboratory biomarker analysis Procedure: biopsy Procedure: conventional surgery Procedure: neoadjuvant therapy Radiation: radiation therapy|
Experimental: taxane based chemotherapy
Docetaxel for 3 cycles followed by Epirubicin/Docetaxel for 3 cycles
|Drug: docetaxel Drug: epirubicin hydrochloride Genetic: microarray analysis Other: immunohistochemistry staining method Other: laboratory biomarker analysis Procedure: biopsy Procedure: conventional surgery Procedure: neoadjuvant therapy Radiation: radiation therapy|
Hide Detailed Description
- Compare neoadjuvant fluorouracil, epirubicin, and cyclophosphamide vs docetaxel and epirubicin followed by radiotherapy and surgery in women with locally advanced, inflammatory, or large operable breast cancer.
- Assess overall differences between the two arms.
- Assess interaction between p53 status and outcomes in each arm.
- Compare the progression-free survival of patients treated with these regimens.
- Compare the distant metastasis-free survival and survival of patients treated with these regimens.
- Compare the clinical and pathological responses to these regimens in these patients.
- Compare the toxicity of these regimens in these patients.
- Determine the p53 status in order to study the treatment effect in each of the p53 subgroups and test the interaction between treatment and p53 status.
- Assess the level of agreement between p53 assessment by IHC method and functional test in yeast.
- Evaluate the prognostic and predictive value of "high risk" p53 mutations.
- Perform a survival analysis according to gene clusters defined with the use of microarrays.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to stage of disease (large T2-3 vs locally advanced or inflammatory), p53 status (negative vs positive vs unknown), and participating center. Patients are randomized to 1 of 2 chemotherapy treatment arms.
Arm I (non-taxane arm): Patients receive 1 of 3 chemotherapy regimens comprising fluorouracil, epirubicin, and cyclophosphamide (FEC) (according to participating institution).
- FEC 100: Patients receive fluorouracil IV over 15 minutes, epirubicin IV over 1 hour, and cyclophosphamide IV over 1 hour on day 1. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
- Canadian FEC: Patients receive oral cyclophosphamide on days 1-14 and epirubicin IV and fluorouracil IV on days 1 and 8. If oral medications are not tolerated, patients may switch to cyclophosphamide IV on days 1 and 8. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
- Tailored FEC: Patients receive fluorouracil IV over 15 minutes, epirubicin IV over 1 hour, and cyclophosphamide IV over 1-2 hours on day 1. Patients also receive filgrastim (G-CSF) subcutaneously on days 2-15 or until blood counts recover. Treatment repeats every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
- Arm II (taxane arm): Patients receive docetaxel IV over 1 hour on days 1, 22, and 43 followed by epirubicin IV over 15 minutes and docetaxel IV over 1 hour on days 64, 85, and 106 in the absence of disease progression or unacceptable toxicity.
Following chemotherapy, patients may undergo loco-regional therapy comprising radiotherapy with or without breast conservation surgery or mastectomy. Patients with estrogen- and/or progesterone-receptor-positive disease also receive tamoxifen or an aromatase inhibitor for 5 years.
Two tumor samples (incisional or tricut biopsies) are taken before chemotherapy. Samples are analyzed by IHC, a functional test in yeast, and microarray analysis.
Patients are followed every 3 months for 1 year, every 4 months for 1.5 years, and then every 6 months thereafter.
PROJECTED ACCRUAL: A total of 1,850 patients will be accrued for this study within 5.5 years.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00017095
Hide Study Locations
|Institut Jules Bordet|
|Brussels, Belgium, 1000|
|CHU Liege - Domaine Universitaire du Sart Tilman|
|Liege, Belgium, B-4000|
|Algemeen Ziekenhuis Sint-Augustinus|
|Wilrijk, Belgium, 2610|
|Centre Paul Papin|
|Angers, France, 49036|
|Bordeaux, France, 33076|
|Centre de Lutte Contre le Cancer Georges-Francois Leclerc|
|Dijon, France, 21079|
|Centre Hospitalier Departemental|
|La Roche Sur Yon, France, F-85025|
|Centre Regional de Lutte Contre le Cancer - Centre Val d'Aurelle|
|Montpellier, France, 34298|
|Centre Regional Rene Gauducheau|
|Nantes-Saint Herblain, France, 44805|
|Centre Henri Becquerel|
|Rouen, France, 76038|
|Centre Rene Huguenin|
|Saint Cloud, France, 92211|
|Centre Paul Strauss|
|Strasbourg, France, 67085|
|Centre Alexis Vautrin|
|Vandoeuvre-les-Nancy, France, 54511|
|Onze Lieve Vrouwe Gasthuis|
|Amsterdam, Netherlands, 1091 HA|
|Leiden University Medical Center|
|Leiden, Netherlands, 2300 CA|
|Daniel Den Hoed Cancer Center at Erasmus Medical Center|
|Rotterdam, Netherlands, 3008 AE|
|Medical University of Gdansk|
|Gdansk, Poland, 80-211|
|Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology|
|Warsaw, Poland, 02-781|
|Hospitais da Universidade de Coimbra (HUC)|
|Coimbra, Portugal, 3049|
|Instituto Portugues de Oncologia de Francisco Gentil - Centro Regional de Oncologia de Lisboa, S.A.|
|Lisbon, Portugal, 1099-023 Codex|
|Institute of Oncology - Ljubljana|
|Ljubljana, Slovenia, Sl-1000|
|Sahlgrenska University Hospital at Gothenburg University|
|Gothenburg (Goteborg), Sweden, S-413 45|
|Lund University Hospital|
|Lund, Sweden, S-22185|
|Malmo University Hospital|
|Malmo, Sweden, S-20502|
|Sahlgrenska University Hospital - Molndal at Gothenburg University|
|Molndal, Sweden, S-43180|
|Orebro University Hospital|
|Orebro, Sweden, 70185|
|Karolinska University Hospital - Huddinge|
|Stockholm, Sweden, S-171 76|
|Uppsala University Hospital|
|Uppsala, Sweden, S-75185|
|Aarau, Switzerland, 5001|
|Swiss Institute for Applied Cancer Research|
|Bern, Switzerland, CH-3008|
|Bern, Switzerland, CH-3010|
|Hopital Cantonal Universitaire de Geneve|
|Geneva, Switzerland, CH-1211|
|Centre Hospitalier Universitaire Vaudois|
|Lausanne, Switzerland, CH-1011|
|Zurich, Switzerland, CH-8091|
|Northern Centre for Cancer Treatment at Newcastle General Hospital|
|Newcastle Upon Tyne, England, United Kingdom, NE4 6BE|
|Royal South Hants Hospital|
|Southampton, England, United Kingdom, SO14 0YG|
|Ninewells Hospital and Medical School|
|Dundee, Scotland, United Kingdom, DD1 9SY|
|Edinburgh Cancer Centre at Western General Hospital|
|Edinburgh, Scotland, United Kingdom, EH4 2XU|
|Scottish Cancer Therapy Network|
|Edinburgh, Scotland, United Kingdom, EH5 3SQ|
|Study Chair:||Herve Bonnefoi||Institut Bergonie, Bordeaux|