Breast Cancer Clinical Trial
Official title:
Assessing the REsponse Rate of Weekly Neo-adjuvanT pacliTAxel (Taxol) in Nigerian Women With Breast Cancer (ARETTA)
This is a two-stage phase II study with a single arm design. It will be conducted in women with breast cancer with stages IIA to IIIC (defined by AJCC 2009 classification) of all histological subtypes. All patients will receive 16 doses of paclitaxel; three breast ultrasound tests and tumor pathologic response evaluation will be used to assess the response to treatment.
Each patient will be assigned one of the following groups: 1) complete response, 2) partial
response, 3) stable disease, 4) progressive disease, 5) early death from malignant disease,
6) early death from toxicity, 7) early death because of other cause, or 8) unknown (not
assessable, insufficient data). Patients with a good response to 8 doses of paclitaxel
(complete response or partial response that are operable) will receive an additional 8
courses of paclitaxel chemotherapy before surgery and radiotherapy. The overall response for
these patients will be assessed by ultrasonography after a total of 16 weeks of Taxol
therapy. Patients with poor response (defined as stable disease or progressive disease or
partial response inoperable) as best response after eight weekly courses of paclitaxel will
receive 8 cycles of weekly PC. The overall response for these patients will also be assessed
by ultrasonography after 8 courses of PC therapy. Patients with poor response to 8 courses of
paclitaxel followed by 8 courses of PC based on ultrasound assessment will be regarded as
failing to respond to treatment. These patients will receive 4 cycles of 3-weekly FEC and
will be followed up. Patients in response groups 4-8 above will be considered as failing to
respond to treatment.
All conclusions will be based on all eligible patients. The schema for the study is presented
in Figures 4-1, 4-2 and 4-3. Patients with a global deterioration of health status requiring
discontinuation of treatment without objective evidence of disease progression at that time
will be classified as having "symptomatic deterioration". Every effort will be made to
document the objective progression even after discontinuation of treatment. All Premenopausal
patients will receive LHRH agonist for two years for contraception and fertility
preservation. Hormone-receptor positive patients will receive hormonal therapy with tamoxifen
or letrozole after surgery, radiotherapy and LHRH agonist according to the expression of
hormone receptors ER and PgR (see glossary and section 10.3) and according to the state of
primary menopause (see glossary) at the onset of the study. Patients with HER2-positive
disease (see glossary and section 10.3) will receive 5 threeweekly courses of trastuzumab
(Herceptin SC) with pertuzumab (Perjeta). After that pts will continue receiving trastuzumab
to complete total of 18 doses within 1 year of treatment.
The study is designed to estimate the RR of breast cancer patients to weekly paclitaxel
chemotherapy and to determine the RR to weekly PC combination chemotherapy in patients
resistant to or with poor response (including early progression) while on weekly single agent
paclitaxel.
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