Doxorubicin Hydrochloride and Cyclophosphamide Followed by Paclitaxel With or Without Carboplatin in Treating Patients With Triple-Negative Breast Cancer

STATUS

Recruiting
End date

Nov 16, 2023
participants needed

782
sponsor

NRG Oncology

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Updated on 17 May 2022

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ct scan

platelet count

paclitaxel

renal function

cancer

cyclophosphamide

absolute neutrophil count

ejection fraction

metastatic disease

estrogen

carcinoma

breast cancer

MRI

gilbert's syndrome

doxorubicin

probe

metastasis

neutrophil count

carboplatin

immunohistochemistry

tumor cells

epidermal growth factor receptor

primary tumor

carcinoma in situ

biomarker analysis

positron emission tomography

human epidermal growth factor

adenocarcinoma

erbb2

estrogen receptor

breast adenocarcinoma

breast conserving surgery

pet/ct scan

triple-negative breast cancer

mastectomy

lumpectomy

adenocarcinoma of the breast

ductal carcinoma in situ

axillary lymph node dissection

lobular carcinoma in situ

sentinel node

ductal carcinoma

isolation procedure

Summary

This randomized phase III trial studies how well doxorubicin hydrochloride and cyclophosphamide followed by paclitaxel with or without carboplatin work in treating patients with triple-negative breast cancer. Drugs used in chemotherapy, such as doxorubicin hydrochloride, cyclophosphamide, paclitaxel, and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether doxorubicin hydrochloride and cyclophosphamide is more effective when followed by paclitaxel alone or paclitaxel and carboplatin in treating triple-negative breast cancer.

Description

PRIMARY OBJECTIVES:

I. To determine whether the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin (doxorubicin hydrochloride)/cyclophosphamide followed by paclitaxel will improve the invasive disease-free survival (IDFS) compared to doxorubicin/cyclophosphamide followed by paclitaxel when administered to patients with operable node-positive or high-risk node-negative triple-negative breast cancer.

SECONDARY OBJECTIVES:

I. To determine whether the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin/cyclophosphamide followed by paclitaxel will improve the overall survival (OS) compared to doxorubicin/cyclophosphamide followed by paclitaxel when administered to patients with operable node-positive or high-risk node-negative triple-negative breast cancer.

II. To determine whether the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin/cyclophosphamide followed by paclitaxel will improve the breast cancer-free survival (BCFS) compared to doxorubicin/cyclophosphamide followed by paclitaxel when administered to patients with operable node-positive or high-risk node-negative triple-negative breast cancer.

III. To determine whether the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin/cyclophosphamide followed by paclitaxel will improve the recurrence-free interval (RFI) compared to doxorubicin/cyclophosphamide followed by paclitaxel when administered to patients with operable node-positive or high-risk node-negative triple-negative breast cancer.

IV. To determine whether the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin/cyclophosphamide followed by paclitaxel will improve the distant recurrence-free interval (DRFI) compared to doxorubicin/cyclophosphamide followed by paclitaxel when administered to patients with operable node-positive or high-risk node-negative triple-negative breast cancer.

V. To determine the toxicity of doxorubicin/cyclophosphamide followed by paclitaxel administered concurrently with carboplatin compared to the toxicity of doxorubicin/cyclophosphamide followed by paclitaxel alone.

VI. To determine if germline breast cancer (BRCA) status is associated with benefit in IDFS or OS from the addition of carboplatin to an adjuvant chemotherapy regimen of doxorubicin/cyclophosphamide followed by paclitaxel in patients with operable node-positive or high-risk node-negative triple-negative breast cancer.

VII. To determine if the addition of carboplatin will improve the RFI among the homologous recombination (HR) deficient patients as determined by the homologous recombination deficiency (HRD) score.

VIII. To determine whether the efficacy of carboplatin on RFI in HR-deficient patients differs from that in patients who are not HR-deficient.

IX. To collect tissue and blood samples at several occasions for future biomarkers development in predicting risk of breast cancer recurrence in patients with operable node-positive or high-risk node-negative triple-negative breast cancer treated with doxorubicin/cyclophosphamide followed by paclitaxel with or without carboplatin and predicting benefit from the addition of carboplatin among these patients.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I (DOXORUBICIN HYDROCHLORIDE [A] CYCLOPHOSPHAMIDE [C]-->WEEKLY PACLITAXEL [WP]): Patients receive doxorubicin hydrochloride intravenously (IV) over 15 minutes and cyclophosphamide IV over 30 minutes on day 1. Treatment repeats every 2 weeks for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive paclitaxel IV over 60 minutes on day 1. Treatment repeats weekly for 12 courses in the absence of disease progression or unacceptable toxicity.

ARM II (AC-->WP + CARBOPLATIN): Patients receive doxorubicin hydrochloride and cyclophosphamide as in Arm I. Patients then receive paclitaxel IV over 60 minutes on days 1, 8, and 15 and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 3 weeks for 4 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 6 months for 5 years and then every 12 months for 5 years.

Details

Condition	Breast Adenocarcinoma, Estrogen Receptor Negative, HER2/Neu Negative, Progesterone Receptor Negative, Stage IB Breast Cancer, Stage IIA Breast Cancer, Stage IIB Breast Cancer, Stage IIIA Breast Cancer, Stage IIIC Breast Cancer, Triple-Negative Breast Carcinoma
Treatment	cyclophosphamide, laboratory biomarker analysis, doxorubicin hydrochloride, carboplatin, Paclitaxel
Clinical Study Identifier	NCT02488967
Sponsor	NRG Oncology
Last Modified on	17 May 2022

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Eligibility		Yes	No	Not Sure
Inclusion Criteria
	The patient must have signed and dated an institutional review board (IRB)-approved consent form that conforms to federal and institutional guidelines
	Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
	The tumor must be unilateral invasive adenocarcinoma of the breast on histologic examination
	All of the following staging criteria (according to the 7th edition of the American Joint Committee on Cancer [AJCC] Cancer Staging Manual) must be met
	By pathologic evaluation, primary tumor must be pT1-3
	By pathologic evaluation, ipsilateral nodes must be pN0, pN1 (pN1mi, pN1a, pN1b, pN1c), pN2a, pN2b, pN3a, or pN3b
	If pN0, tumor must be > 3.0 cm
	The tumor must have been determined to be human epidermal growth factor receptor 2
	(HER2)-negative as follows
	Immunohistochemistry (IHC) 0-1+; or
	IHC 2+ and in situ hybridization (ISH) non-amplified with a ratio of HER2 to centromere enumerator probe 17 (CEP17) < 2.0, and if reported, average HER2 gene copy number < 4 signals/cells; or
	ISH non-amplified with a ratio of HER2 to CEP17 < 2.0, and if reported, average HER2 gene copy number < 4 signals/cells
	The tumor must have been determined to be estrogen receptor (ER)-and progesterone
	The patient must have undergone either a mastectomy (total, skin-sparing, or nipple-sparing) or lumpectomy
	For patients who undergo lumpectomy, the margins of the resected specimen must be histologically free of invasive tumor and ductal carcinoma in situ (DCIS) as determined by the local pathologist; if pathologic examination demonstrates tumor at the line of resection, additional excisions may be performed to obtain clear margins; if tumor is still present at the resected margin after re-excision(s), the patient must undergo mastectomy to be eligible; (patients with margins positive for lobular carcinoma in situ [LCIS] are eligible without additional resection)
	receptor (PgR)-negative assessed by current American Society of Clinical
	For patients who undergo mastectomy, the margins must be free of residual gross tumor; (patients with microscopic positive margins are eligible as long as post-mastectomy radiation therapy [RT] of the chest wall will be administered)
	Oncology (ASCO)/College of American Pathologists (CAP) guidelines; patients
	with < 1% ER and PgR staining by IHC are considered negative
	The patient must have completed one of the procedures for evaluation of pathologic nodal status listed below
	Sentinel lymphadenectomy alone
	If pathologic nodal staging based on sentinel lymphadenectomy is pN0 or pN1b
	If pathologic nodal staging based on sentinel lymphadenectomy is pN1mi or pN1a and the patient has undergone breast conserving surgery (with planned breast radiotherapy), the primary tumor must be T1 or T2 by pathologic evaluation and the nodal involvement must be limited to 1 or 2 positive nodes
	Axillary lymphadenectomy with or without SN isolation procedure
	Absolute neutrophil count (ANC) must be >= 1200/mm^3
	Platelet count must be >= 100,000/mm^3
	Sentinel lymphadenectomy followed by removal of additional non-sentinel lymph
	Hemoglobin must be >= 10 g/dL
	nodes if the sentinel node (SN) is positive; or
	Total bilirubin must be =< upper limit of normal (ULN) for the laboratory (lab) unless the patient has a bilirubin elevation > ULN to 1.5 x ULN due to Gilbert's disease or similar syndrome involving slow conjugation of bilirubin
	The interval between the last surgery for breast cancer (including re-excision of
	Alkaline phosphatase must be =< 2.5 x ULN for the lab
	margins) and randomization must be no more than 60 days
	Aspartate aminotransferase (AST) must be =< 1.5 x ULN for the lab
	Note: If alanine aminotransferase (ALT) is performed instead of AST (per institution's standard practice), the ALT value must be =< 1.5 x ULN; if both were performed, the AST must be =< 1.5 x ULN
	Patients with alkaline phosphatase that is > ULN but =< 2.5 x ULN or unexplained bone pain are eligible for inclusion in the study if a bone scan, PET-CT scan, or PET scan performed within 90 days prior to randomization does not demonstrate metastatic disease
	Adequate renal function determined within 6 weeks prior to randomization defined as the most recent serum creatinine =< ULN or measured or calculated creatinine clearance > 60 mL/min
	Left ventricular ejection fraction (LVEF) assessment must be performed within 90 days prior to randomization; (LVEF assessment performed by 2-dimensional [D] echocardiogram is preferred; however, multi gated acquisition [MUGA] scan may be substituted based on institutional preferences;) the LVEF must be >= 50% regardless of the cardiac imaging facility's lower limit of normal
	Patients with AST or alkaline phosphatase > ULN are eligible for inclusion in the
	study if liver imaging (computed tomography [CT], magnetic resonance imaging
	[MRI], positron emission tomography [PET]-CT, or PET scan) performed within 90
	days prior to randomization does not demonstrate metastatic disease and the
	requirements above are met
Exclusion Criteria
	T4 tumors including inflammatory breast cancer
	Definitive clinical or radiologic evidence of metastatic disease; required imaging studies must have been performed within 90 days prior to randomization
	Synchronous or previous contralateral invasive breast cancer; (patients with synchronous and/or previous contralateral DCIS or LCIS are eligible)
	Any previous history of ipsilateral invasive breast cancer or ipsilateral DCIS; (patients with synchronous or previous ipsilateral LCIS are eligible)
	History of non-breast malignancies (except for in situ cancers treated only by local excision and basal cell and squamous cell carcinomas of the skin) within 5 years prior to randomization
	Previous therapy with anthracyclines or taxanes for any malignancy
	Chemotherapy administered for the currently diagnosed breast cancer prior to randomization
	Any continued use of sex hormonal therapy, e.g., birth control pills, ovarian hormone replacement therapy; patients are eligible if these medications are discontinued prior to randomization
	Cardiac disease (history of and/or active disease) that would preclude the use of the drugs included in the treatment regimens; this includes but is not confined to
	Active cardiac disease
	Angina pectoris that requires the current use of anti-anginal medication
	Ventricular arrhythmias except for benign premature ventricular contractions
	Supraventricular and nodal arrhythmias requiring a pacemaker or not controlled with medication
	Conduction abnormality requiring a pacemaker
	Valvular disease with documented compromise in cardiac function; or
	Symptomatic pericarditis
	History of cardiac disease
	Myocardial infarction documented by elevated cardiac enzymes or persistent regional wall abnormalities on assessment of left ventricle (LV) function
	History of documented congestive heart failure (CHF); or
	Documented cardiomyopathy
	Active hepatitis B or hepatitis C with abnormal liver function tests
	Patients known to be human immunodeficiency virus (HIV) positive with a baseline cluster of differentiation (CD)4 count of < 250 cells/mm^3 or have a history of acquired immune deficiency syndrome (AIDS) indicator conditions
	Intrinsic lung disease resulting in dyspnea
	History of hospitalization in past 12 months for diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
	Active infection or chronic infection requiring chronic suppressive antibiotics
	Nervous system disorder (paresthesia, peripheral motor neuropathy, or peripheral sensory neuropathy) >= grade 2, per the Common Terminology Criteria for Adverse Events (CTCAE) version (v)4.0
	Conditions that would prohibit administration of corticosteroids
	Chronic daily treatment with corticosteroids with a dose of >= 10 mg/day methylprednisolone equivalent (excluding inhaled steroids)
	Other non-malignant systemic disease that would preclude the patient from receiving study treatment or would prevent required follow-up
	Uncontrolled hypertension defined as sustained systolic blood pressure (BP) > 150 mmHg
	Psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements
	or diastolic BP > 90 mmHg; (patients with initial BP elevations are eligible
	Pregnancy or lactation at the time of study entry; (note: pregnancy testing according to institutional standards for women of childbearing potential must be performed within 2 weeks prior to randomization)
	if initiation or adjustment of BP medication lowers pressure to meet entry
	Use of any investigational product within 4 weeks prior to randomization
	criteria)
	Known hypersensitivity to any of the study drugs or excipients, e.g., polysorbate 80 and Cremophor® EL

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absolute neutrophil count

epidermal growth factor receptor

primary tumor

carcinoma in situ

biomarker analysis

positron emission tomography

human epidermal growth factor

adenocarcinoma

erbb2

estrogen receptor

breast adenocarcinoma

breast conserving surgery

pet/ct scan

triple-negative breast cancer

mastectomy

lumpectomy

adenocarcinoma of the breast

ductal carcinoma in situ

axillary lymph node dissection

lobular carcinoma in situ

sentinel node

ductal carcinoma

isolation procedure

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Doxorubicin Hydrochloride and Cyclophosphamide Followed by Paclitaxel With or Without Carboplatin in Treating Patients With Triple-Negative Breast Cancer