Combination Chemotherapy With or Without Trastuzumab in Treating Women With Breast Cancer

Breast Neoplasms Clinical Trial

Official title:

Multicenter Phase III Randomized Trial Comparing Doxorubicin and Cyclophosphamide Followed By Docetaxel (AC-T) With Doxorubicin and Cyclophosphamide Followed By Docetaxel and Trastuzumab (Herceptin)(AC-TH) and With Docetaxel, Carboplatin and Trastuzumab (TCH) In The Adjuvant Treatment Of Node Positive and High Risk Node Negative Patients With Operable Breast Cancer Containing The HER2 Alteration

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00021255
• Other study ID #: TAX_GMA_302
• Secondary ID: BCIRG 006
• Status: Completed
• Phase: Phase 3
• First received: July 11, 2001
• Last updated: March 2, 2015
• Start date: April 2001
• Est. completion date: December 2014

Study information

• Verified date: March 2015
• Source: Sanofi
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

Primary objective:

• Compare disease-free survival in women with HER2-neu-expressing node-positive or high-risk node-negative operable breast cancer treated with adjuvant doxorubicin, cyclophosphamide, and docetaxel with or without trastuzumab (Herceptin) vs trastuzumab, docetaxel, and carboplatin.

Secondary objective:

• Compare overall survival of patients treated with these regimens.

• Compare the toxic effects (including cardiac) of these regimens in these patients.

• Compare quality of life of patients treated with these regimens.

• Compare pathologic and molecular markers for predicting efficacy of these regimens in these patients.

• For substudy: Compare peripheral levels of shed HER2-neu extracellular domain with fluorescence in situ hybridization in predicting outcome in patients treated with these regimens.

Other known NCT identifiers

• NCT00768092

Recruitment information / eligibility

• Status: Completed
• Enrollment: 3222
• Est. completion date: December 2014
• Est. primary completion date: December 2014
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 70 Years

Eligibility

Inclusion criteria:

• Histologically proven breast cancer with an interval between definitive surgery that includes axillary lymph node involvement assessment and registration of less than or equal to 60 days. A central pathology review may be performed post randomization for confirmation of diagnosis and molecular studies. The same block used for her2neu determination prior to randomization may be used for the central pathology review.

• Definitive surgical treatment must be either mastectomy with axillary lymph node involvement assessment, or breast conserving surgery with axillary lymph node involvement assessment for operable breast cancer (T1-3, Clinical N0-1, M0). Margins of resected specimen from definitive surgery must be histologically free of invasive adenocarcinoma and/or ductal carcinoma in situ (DCIS).

• Patients must be either lymph node positive or high risk node negative. Lymph node positive patients will be defined as patients having invasive adenocarcinoma with at least one axillary lymph node (pN1) showing evidence of tumor among a minimum of six resected lymph nodes. High risk lymph node negative patients will be defined as patients having invasive adenocarcinoma with either 0 (pNo) among a minimum of 6 resected lymph nodes or negative sentinel node biopsy (pNo) AND at least one of the following factors: tumor size > 2 cm, ER and/or PR status is negative, histologic and/or nuclear grade 2-3, or age < 35 years.

• Tumor must show the presence of the her2neu gene amplification by Fluorescence In-Situ Hybridization (FISH analysis) by a designated central laboratory.

• Estrogen and/or progesterone receptor analysis performed on the primary tumor prior to randomization. Results must be known at the time of randomization.

• Karnofsky Performance status index = 80%.

• Normal cardiac function must be confirmed by LVEF (MUGA scan) and ECG within 3 months prior to registration. The result of the MUGA must be equal to or above the lower limit of normal for the institution.

• Laboratory requirements: (within 14 days prior to registration)

a) Hematology: i) Neutrophils = 2.0 109/L ii) Platelets = 100 109/L iii) Hemoglobin = 10 g/Dl

b) Hepatic function: i) Total bilirubin = 1 UNL ii) ASAT (SGOT) and ALAT (SGPT) = 2.5 UNL iii) Alkaline phosphatase = 5 UNL iv) Patients with ASAT and/or ALAT > 1.5 x UNL associated with alkaline phosphatase > 2.5 x UNL are not eligible for the study.

c) Renal function: i) Creatinine = 175 µmol/L (2 mg/dL) ii) If limit reached, the calculated creatinine clearance should be = 60 mL/min.

• Complete staging work-up within 3 months prior to registration. All patients will have bilateral mammography, chest X-ray (PA and lateral) and/or CT and/or MRI, abdominal ultrasound and/or CT scan and/or MRI, and bone scan. In cases of positive bone scans, bone X-ray evaluation is mandatory to rule out the possibility of metastatic bone scan positivity. Other tests may be performed as clinically indicated.

• Negative pregnancy test (urine or serum) within 7 days prior to registration for all women of childbearing potential.

• An audiology assessment with normal results will be performed within 4 weeks of registration. This is only for those centers who have selected cisplatin as their platinum salt of choice for the BCIRG 006 study.

Exclusion criteria:

• Prior systemic anticancer therapy for breast cancer (immunotherapy, hormonotherapy, chemotherapy).

• Prior anthracycline therapy, taxoids (paclitaxel, docetaxel) or platinum salts for any malignancy.

• Prior radiation therapy for breast cancer.

• Bilateral invasive breast cancer.

• Pregnant, or lactating patients. Patients of childbearing potential must implement adequate non-hormonal contraceptive measures during study treatment (chemotherapy and tamoxifen therapy) and must have negative urine or serum pregnancy test within 7 days prior to registration.

• Any T4 or N2 or known N3 or M1 breast cancer.

• Pre-existing motor or sensory neurotoxicity of a severity = grade 2 by NCI criteria.

• Cardiac disease that would preclude the use of doxorubicin, docetaxel and Herceptin:

1. any documented myocardial infarction

2. angina pectoris that requires the use of antianginal medication

3. any history of documented congestive heart failure

4. Grade 3 or Grade 4 cardiac arrhythmia (NCI CTC, version 2.0)

5. clinically significant valvular heart disease

6. patients with cardiomegaly on chest x-ray or ventricular hypertrophy on ECG, unless they demonstrate by MUGA scan within the past 3 months that the LVEF is = the lower limit of normal for the radiology facility;

7. patients with poorly controlled hypertension i.e. diastolic greater than 100 mm/Hg. (Patients who are well controlled on medication are eligible for entry)

8. patients who currently receive medications (digitalis, beta-blockers, calcium channel-blockers, etc) that alter cardiac conduction, if these medications are administered for cardiac arrhythmia, angina or congestive heart failure. If these medications are administered for other reasons (ie hypertension), the patient will be eligible.

• Other serious illness or medical condition:

1. history of significant neurologic or psychiatric disorders including psychotic disorders, dementia or seizures that would prohibit the understanding and giving of informed consent

2. active uncontrolled infection

3. active peptic ulcer, unstable diabetes mellitus

4. impaired hearing (only for those patients treated at centers who have selected cisplatin as their platinum salt of choice)

• Past or current history of neoplasm other than breast carcinoma, except for:

1. curatively treated non-melanoma skin cancer

2. in situ carcinoma of the cervix

3. other cancer curatively treated and with no evidence of disease for at least 10 years

4. ipsilateral ductal carcinoma in-situ (DCIS) of the breast

5. lobular carcinoma in-situ (LCIS) of the breast

• Current therapy with any hormonal agent such as raloxifene, tamoxifen, or other selective estrogen receptor modulators (SERMs), either for osteoporosis or prevention. Patients must have discontinued these agents prior to randomization.

• Chronic treatment with corticosteroids unless initiated > 6 months prior to study entry and at low dose (= 20 mg methylprednisolone or equivalent).

• Concurrent treatment with ovarian hormonal replacement therapy. Prior treatment must be stopped prior to randomization.

• Definite contraindications for the use of corticosteroids.

• Concurrent treatment with other experimental drugs. Participation in another clinical trial with any investigational not marketed drug within 30 days prior to study entry.

• Concurrent treatment with any other anti-cancer therapy.

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Breast Neoplasms

Intervention

Drug:
• doxorubicine, cyclophosphamide, docetaxel
doxorubicine IV, cyclophosphamide IV, docetaxel IV
• doxorubicine, cyclophosphamide, trastuzumab, docetaxel
doxorubicine IV, cyclophosphamide IV, trastuzumab IV, docetaxel IV
• trastuzumab, docetaxel, carboplatin
trastuzumab IV, docetaxel IV, carboplatin IV

Locations

Country	Name	City	State
Argentina	Sanofi-Aventis Administrative Office	Buenos Aires
Australia	Sanofi-Aventis Administrative Office	Macquarie Park
Austria	Sanofi-Aventis Administrative Office	Vienna
Belgium	Sanofi-Aventis Administrative Office	Diegem
Bosnia and Herzegovina	Sanofi-Aventis Administrative Office	Sarajevo
Brazil	Sanofi-Aventis Administrative Office	Sao Paulo
Bulgaria	Sanofi-Aventis Administrative Office	Vazrjdane Region
Canada	Sanofi-Aventis Administrative Office	Québec
Colombia	Sanofi-Aventis Administrative Office	Bogota
Croatia	Sanofi-Aventis Administrative Office	Zagreb
Czech Republic	Sanofi-Aventis Administrative Office	Praha
Egypt	Sanofi-Aventis Administrative Office	Cairo
Estonia	Sanofi-Aventis Administrative Office	Tallin
France	Sanofi-Aventis Administrative Office	Paris
Germany	Sanofi-Aventis Administrative Office	Frankfurt
Greece	Sanofi-Aventis Administrative Office	Kallithea
Hong Kong	Sanofi-Aventis Administrative Office	Hong Kong
Hungary	Sanofi-Aventis Administrative Office	Budapest
India	Sanofi-Aventis Administrative Office	Mumbai
Ireland	Sanofi-Aventis Administrative Office	Dublin
Israel	Sanofi-Aventis Administrative Office	Natanya
Italy	Sanofi-Aventis Administrative Office	Milan
Korea, Republic of	Sanofi-Aventis Administrative Office	Seoul
Lebanon	Sanofi-Aventis Administrative Office	Beirut
Mexico	Sanofi-Aventis Administrative Office	Col. Coyoacan
Poland	Sanofi-Aventis Administrative Office	Warsaw
Romania	Sanofi-Aventis Administrative Office	Bucuresti
Russian Federation	Sanofi-Aventis Administrative Office	Moscow
Slovakia	Sanofi-Aventis Administrative Office	Bratislava
Slovenia	Sanofi-Aventis Administrative Office	Ljubljana
South Africa	Sanofi-Aventis Administrative Office	Gauteng
Spain	Sanofi-Aventis Administrative Office	Barcelona
Sweden	Sanofi-Aventis Administrative Office	Bromma
Switzerland	Sanofi-Aventis Administrative Office	Genève
Taiwan	Sanofi-Aventis Administrative Office	Taipei
Tunisia	Sanofi-Aventis Administrative Office	Megrine
Turkey	Sanofi-Aventis Administrative Office	Istanbul
United Kingdom	Sanofi-Aventis Administrative Office	Guildford Surrey
United States	Sanofi-Aventis Administrative Office	Bridgewater	New Jersey
Uruguay	Sanofi-Aventis Administrative Office	Montevideo
Venezuela	Sanofi-Aventis Administrative Office	Caracas

Sponsors (2)

Lead Sponsor	Collaborator
Sanofi	Cancer International Research Group

Countries where clinical trial is conducted

United States,  Uruguay,  Venezuela,  Argentina,  Australia,  Austria,  Belgium,  Bosnia and Herzegovina,  Brazil,  Bulgaria,  Canada,  Colombia,  Croatia,  Czech Republic,  Egypt,  Estonia,  France,  Germany,  Greece,  Hong Kong,  Hungary,  India,  Ireland,  Israel,  Italy,  Korea, Republic of,  Lebanon,  Mexico,  Poland,  Romania,  Russian Federation,  Slovakia,  Slovenia,  South Africa,  Spain,  Sweden,  Switzerland,  Taiwan,  Tunisia,  Turkey,  United Kingdom, 

References & Publications (1)

Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, Mackey J, Glaspy J, Chan A, Pawlicki M, Pinter T, Valero V, Liu MC, Sauter G, von Minckwitz G, Visco F, Bee V, Buyse M, Bendahmane B, Tabah-Fisch I, Lindsay MA, Riva A, Crown J; Breast Cancer International Research Group. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011 Oct 6;365(14):1273-83. doi: 10.1056/NEJMoa0910383. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Disease free survival		calculated from the date of randomization up to the first date of local, regional, or distant relapse, second primary cancer (with the exception of curatively treated non-melanoma skin cancer or in situ carcinoma of the cervix)	No
Secondary	Overall survival		measured from the date of randomization up to the date of death of any cause.	No