Ixabepilone and Cyclophosphamide as Neoadjuvant Therapy in HER-2 Negative Breast Cancer

Breast Cancer Clinical Trial

Official title:

Phase II Study of Ixabepilone and Cyclophosphamide as Neoadjuvant Therapy in HER2-Negative Breast Cancer

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00866905
• Other study ID #: SCRI BRE 133
• Status: Completed
• Phase: Phase 2
• Start date: April 2009
• Est. completion date: October 2014

Study information

• Verified date: November 2021
• Source: SCRI Development Innovations, LLC
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

We propose to evaluate ixabepilone in combination with cyclophosphamide for the neoadjuvant treatment of locally advanced breast cancer. In this regimen, ixabepilone is substituted for docetaxel, since preclinical and clinical

studies suggest that ixabepilone is more active than either docetaxel or paclitaxel. The combination of ixabepilone and cyclophosphamide could further improve the efficacy of non-anthracycline neoadjuvant therapy.

Description:

In this study, patients with early stage, HER2-negative breast cancer will receive neoadjuvant treatment with ixabepilone and cyclophosphamide given every three weeks for a total of six cycles. Following surgery patients with hormone receptor-positive tumors will receive anti-estrogen treatment. Patients may receive local regional radiation therapy after surgery per institutional guidelines at the investigator's discretion. Baseline tumor tissue and tumor tissue removed at the time of surgery will be tested by Oncotype Detailed Description (DX) assay to determine whether it is predictive of response to this neoadjuvant treatment regimen. This study will be one of the first investigations of the combination of ixabepilone and cyclophosphamide as neoadjuvant treatment for HER2-negative breast cancer. It will examine this treatment regimen for potential advantages gained from substitution of ixabepilone for a taxane and use of non-anthracycline agents.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 168
• Est. completion date: October 2014
• Est. primary completion date: July 2014
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Female patients, age =18 years.

2. Histologically confirmed invasive adenocarcinoma of the breast.

3. Primary palpable disease confined to a breast and axilla on

physical examination. For patients without clinically suspicious

axillary adenopathy, the primary tumor must be larger than 2 cm

in diameter by physical exam or imaging studies (clinical T2-T3,

N0-N1, M0). For patients with clinically suspicious axillary

adenopathy, the primary breast tumor can be any size (clinical

T1-3, N1-2, M0). (T1N0M0 lesions are excluded.)

4. Patients without clearly defined palpable breast mass or axillary

lymph nodes but radiographically measurable tumor masses are

acceptable. Accepted procedures for measuring breast disease

are mammography, MRI, and breast ultrasound. This will need to

be re-evaluated after 3 cycles and prior to surgery.

5. Eastern Cooperative Oncology Group performance status (ECOG

PS) 0-2.

6. No metastatic disease, as documented by complete staging workup

• 6 weeks prior to initiation of study treatment.

7. No previous treatment for breast cancer.

8. HER2-negative tumor status. HER2-negative is defined as:

• Immunohistochemical (IHC) 0, IHC 1+ OR

• IHC 2+ or IHC 3+ must be confirmed as FISH (fluorescence in situ

hybridization) negative (defined by ratio <2.2).

9. Adequate hematologic function with:

• Absolute neutrophil count (ANC) >1500/µL.

• Platelets =100,000/µL.

• Hemoglobin =10 g/dL.

10. Adequate hepatic function with:

• Serum bilirubin = the institutional upper limit of normal (ULN).

• Aspartate aminotransferase (AST) =2.5 x institutional ULN.

• Alanine aminotransferase (ALT) =2.5 x institutional ULN.

11. Adequate renal function with serum creatinine =1.5 x ULN.

12. Estrogen and progesterone receptor status in the primary tumor

known or pending at the time of study registration.

13. Knowledge of the investigational nature of the study and ability to

provide consent for study participation.

14. For patients who had, or will have sentinel lymph node and/or

axillary dissection prior to initiation of study treatment, completion

at least 4 weeks prior to starting study treatment and well-healed

wound

15. Bilateral, synchronous breast cancer is allowed if one primary

tumor meets the inclusion criteria.

16. Sufficient archived breast tumor specimen available at baseline

for the Oncotype DX assay.

-

Exclusion Criteria:

1. Inflammatory breast cancer.

2. Peripheral neuropathy (motor or sensory) = grade 1 by the

Common Terminology Criteria for Adverse Events version 3.0

(CTCAE v 3.0).

3. Prior radiation that included =30% of major bone marrow containing

areas (pelvis, lumbar, spine).

4. Chronic use of cytochrome P450 (CYP) 3A4 inhibitors and use of

the following strong CYP3A4 inhibitors: ketoconazole,

itraconazole, clarithromycin, atazanavir, nefazodone, saquinavir,

telithromycin, ritonavir, amprenavir, indinavir, nelfinavir,

delavirdine, and voriconazole. Use of these agents should be

discontinued at least 72 hours prior to initiation of study treatment.

5. Chemotherapy within 5 years of starting study treatment except

for low doses of agents used for anti-inflammatory indications

such as rheumatoid arthritis, psoriasis, and connective tissue

disorders. Although such doses and schedules cannot result in

myelosuppression, patients must discontinue this therapy while

they are receiving study treatment.

6. Known or suspected hypersensitivity to Cremophor®EL

(polyoxyethylated castor oil) or a drug formulated in

Cremophor®EL such as paclitaxel, or any other agent given in the

course of this study.

7. Pregnancy or breast-feeding. A negative serum pregnancy test

within 7 days prior to first study treatment (Day 1, Cycle 1) for all

women of childbearing potential is required. Patients of

childbearing potential must agree to use a birth control method

that is approved by their study physician while receiving study

treatment and for 3 weeks after their last dose of study treatment.

Patients must agree to not breast-feed while receiving study

treatment.

8. Concurrent treatment with an ovarian hormonal replacement

therapy or with hormonal agents such as raloxifene, tamoxifen or

other selective estrogen receptor modulator (SERM). Patients

must have discontinued use of such agents prior to beginning

study treatment.

9. History of malignancy treated with curative intent within the

previous 5 years with the exception of skin cancer, cervical

carcinoma in situ, or follicular thyroid cancer. Patients with

previous invasive cancers (including breast cancer) are eligible if

the treatment was completed more than 5 years prior to initiating

current study treatment, and there is no evidence of recurrent

disease.

10. Uncontrolled intercurrent illness including (but not limited to)

ongoing or active infection.

11. Chronic treatment with corticosteroid unless treatment was begun

>6 months prior to study treatment and is at a low dose (=20 mg

methylprednisolone or equivalent).

12. Use of any investigational agent within 30 days of administration

of the first dose of study drug.

13. Requirement for radiation therapy concurrent with neoadjuvant

study chemotherapy.

14. Concurrent treatment with any anti-cancer therapy other than

those agents used in this study.

15. Inability or unwillingness to comply with study procedures

including follow-up visits.

16. Mental condition or psychiatric disorder that would prevent patient

comprehension of the nature, scope, and possible consequences

of the study or that would limit compliance with study

requirements.

17. Any other disease(s), metabolic dysfunction, or findings from a

physical examination or clinical laboratory test result that would

cause reasonable suspicion of a disease or condition that

contraindicates the use of study drugs, that may affect the

interpretation of the results, or that renders the patient at high risk

from treatment complications

-

Related Conditions & MeSH terms

• Breast Cancer
• Breast Neoplasms

Intervention

Drug:
• Ixabepilone
40 mg/m2 IV infusion over 3 hours on day 1 of a 21 day cycle for 6 cycles
• Cyclophosphamide
600 mg/m2 IV infusion per institutional guidelines on day 1 of a 21 day cycle for 6 cycles

Locations

Country	Name	City	State
United States	Medical Oncology Associates of Augusta	Augusta	Georgia
United States	Aventura Medical Center	Aventura	Florida
United States	Center for Cancer and Blood Disorders	Bethesda	Maryland
United States	National Capital Clinical Research Consortium	Bethesda	Maryland
United States	Chattanooga Oncology Hematology Associates	Chattanooga	Tennessee
United States	St. Louis Cancer Care	Chesterfield	Missouri
United States	Oncology Hematology Care	Cincinnati	Ohio
United States	Family Cancer Center	Collierville	Tennessee
United States	South Carolina Oncology Associates, PA	Columbia	South Carolina
United States	Florida Cancer Specialists	Fort Myers	Florida
United States	Northeast Georgia Medical Center	Gainesville	Georgia
United States	Watson Clinic Center for Cancer Care and Research	Lakeland	Florida
United States	Cancer Centers of Southwest Oklahoma	Lawton	Oklahoma
United States	Hematology Oncology Associates of Northern NJ	Morristown	New Jersey
United States	Tennessee Oncology	Nashville	Tennessee
United States	Methodist Cancer Center	Omaha	Nebraska
United States	Mercy Hospital	Portland	Maine
United States	Virginia Cancer Institute	Richmond	Virginia
United States	South Texas Oncology and Hematology	San Antonio	Texas
United States	Providence Medical Group	Terre Haute	Indiana

Sponsors (2)

Lead Sponsor	Collaborator
SCRI Development Innovations, LLC	Bristol-Myers Squibb

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Pathologic Complete Response Rate (pCR)	Pathologic complete response (pCR) rate will be determined by the pathologic evaluation of breast and lymph node samples collected at the time of surgery. pCR is defined as no residual disease in breast or lymph nodes in resected tissue samples.	6 months
Secondary	Absence of Grade-4 Non-hematologic Toxicity Excluding, Alopecia, Nausea, Vomiting and Bone Pain	Non hematologic treatment-related grade 4 toxicities measured according to CTCAE 3.0	3 months
Secondary	Overall Survival	Overall survival (OS) determined as the time between day 1 cycle 1 to the date of death from any cause. The percentage of patients who were alive at 3 years, estimated by Kaplan Meier method as the probability of being event free at 3 years is reported here.	36 months
Secondary	Disease Free Survival	Defined as the time between Day 1 Cycle 1, and date of first documented recurrence, initiation of additional chemotherapy, or death.	36 Months