Breast Cancer Clinical Trial
Official title:
A Randomized Phase III Trial of Sequential Chemotherapy Using Doxorubicin, Paclitaxel, and Cyclophosphamide or Concurrent Doxorubicin and Cyclophosphamide Followed by Paclitaxel at 14 or 21 Day Intervals in Women With Node Positive Stage II/IIIA Breast Cancer
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so
they stop growing or die. Giving drugs at different times or combining more than one drug may
kill more tumor cells. It is not yet known which chemotherapy regimen is more effective for
breast cancer.
PURPOSE: Randomized phase III trial to compare the effectiveness of chemotherapy consisting
of either doxorubicin, cyclophosphamide, or paclitaxel given at different times with that of
combination chemotherapy consisting of doxorubicin plus cyclophosphamide followed by
paclitaxel in treating women with stage II or stage IIIA breast cancer.
OBJECTIVES: I. Compare the sequential chemotherapy with doxorubicin, paclitaxel and
cyclophosphamide to combined doxorubicin and cyclophosphamide followed by paclitaxel for
disease free and overall survival in women with node positive stage II or IIIA breast cancer.
II. Determine whether increasing the dose density of adjuvant chemotherapy will improve
disease free and overall survival. III. Compare the toxicity in patients treated with these
regimens.
OUTLINE: This is a randomized study. Patients are randomized into one of four arms
(sequential chemotherapy every 2 weeks vs every 3 weeks vs concurrent chemotherapy followed
by paclitaxel every 2 weeks vs every 3 weeks). All tumor should be removed by either a
modified radical mastectomy or a segmental mastectomy plus axillary node dissection. Adjuvant
chemotherapy is started within 84 days following the last surgical procedure. Arm I: Patients
receive sequential chemotherapy every 3 weeks. Doxorubicin IV is administered once every 3
weeks for 4 doses. Paclitaxel IV is then administered over 3 hours once every 3 weeks for 4
doses. Cyclophosphamide IV is administered once every 3 weeks for 4 doses following
paclitaxel. Arm II: Patients receive sequential chemotherapy every 2 weeks. Doxorubicin IV is
administered once every 2 weeks for 4 doses. Paclitaxel IV is then administered over 3 hours
once every 2 weeks for 4 doses. Cyclophosphamide IV is administered once every 2 weeks for 4
doses following paclitaxel. Filgrastim (G-CSF) is administered by subcutaneous injection on
days 3-10 after each dose of doxorubicin, paclitaxel, and cyclophosphamide. Arm III: Patients
receive combination chemotherapy every 3 weeks. Combination doxorubicin IV and
cyclophosphamide IV is administered once every 3 weeks for 4 doses. Paclitaxel IV is
administered over 3 hours once every 3 weeks for 4 doses following combination chemotherapy.
Arm IV: Patients receive combination chemotherapy every 2 weeks. Combination doxorubicin IV
and cyclophosphamide IV is administered once every 2 weeks for 4 doses. Paclitaxel IV is
administered over 3 hours once every 2 weeks for 4 doses following combination chemotherapy.
G-CSF is administered by subcutaneous injection on days 3-10 after each dose of
doxorubicin/cyclophophamide and after each dose of paclitaxel. After completion of all
chemotherapy, patients receive tamoxifen orally for 5 years. Patients undergo radiotherapy
4-6 weeks after the completion of chemotherapy. Patients are followed every 6 months for 5
years, then annually until death.
PROJECTED ACCRUAL: A total of 2,000 patients will be accrued for this study within 22 months.
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