Breast Cancer
Conditions
Keywords
recurrent breast cancer, stage I breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer
Brief summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether chemotherapy is effective in treating women who have undergone surgery and radiation therapy for relapsed breast cancer. PURPOSE: Randomized phase III trial to determine the effectiveness of adjuvant chemotherapy in treating women who have undergone resection for local and/or regional relapsed breast cancer.
Detailed description
OBJECTIVES: Primary * Determine the efficacy of adjuvant chemotherapy, in terms of disease-free survival, in women with radically resected loco-regional relapsed breast cancer. Secondary * Determine the systemic disease-free and overall survival of patients treated with this regimen. * Determine the sites of recurrence, incidence of second (non-breast) malignancies, and causes of death without relapse of breast cancer in patients treated with this regimen. * Determine the quality of life of patients treated with this regimen (QOL portion closed 11/13/08). OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prior chemotherapy (yes vs no), estrogen receptor (ER) positive and/or progesterone receptor (PR) positive (yes vs no), and location of recurrence (breast vs mastectomy scar/chest wall vs regional lymph nodes). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive radiotherapy\* within 6 months after surgery. * Arm II: Within 10 weeks after surgery, patients receive at least 3 courses of an adjuvant chemotherapy regimen as determined by the investigator. Patients also receive radiotherapy\* within 6 months after surgery and after the completion of chemotherapy OR integrated with chemotherapy. NOTE: \*Patients with clear margins (R0) who received prior adjuvant radiotherapy are not required to receive further radiotherapy Patients with ER and/or PR positive tumors also receive standard hormonal therapy. Quality of life is assessed at baseline and at 9 and 12 months (QOL portion closed 11/13/08). Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 265 patients will be accrued for this study within 4 years.
Interventions
Given within 10 weeks after surgery.
Given within 6 months after surgery
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed invasive breast cancer * First local and/or regional (i.e., ipsilateral axillary or internal mammary lymph node region) recurrence after primary treatment with mastectomy or lumpectomy/quadrantectomy with clear surgical margins * Local failure is defined as a tumor recurrence in any soft tissue of the ipsilateral conserved breast or the chest wall, mastectomy scar, and/or skin * Regional failure is defined as a tumor recurrence in the ipsilateral axillary lymph nodes, extranodal soft tissue of the ipsilateral axilla, and/or ipsilateral internal mammary. Regional failure does not include supraclavicular lymph nodes or tumor in the opposite breast * No other prior recurrence in any site, including local * Surgical resection of the recurrence meeting 1 of the following criteria: * Uninvolved (clear) margins and planned radiotherapy with at least 40 Gy for patients who had no prior adjuvant radiotherapy * Mastectomy of the recurrence with uninvolved (clear) margins after lumpectomy/quadrantectomy alone for the primary * Adjuvant trastuzumab (Herceptin®) therapy or other HER-2 directed therapies are allowed for patients with HER-2 positive tumors and must be declared prior to randomization * No evidence of distant metastasis, including ipsilateral supraclavicular lymph nodes, by x-ray or CT scan of the chest, ultrasound or CT scan of the abdomen and pelvis, or bone scintigraphy only if alkaline phosphatase is \> 2 times normal or if medically indicated (e.g., bone pain) * No macroscopically incomplete surgery * No bilateral malignancy except carcinoma in situ * No suspicious mass in the opposite breast unless that mass has been proven by biopsy to be benign * No skeletal pain of unknown cause * No hot spots on bone scan for which metastases cannot be ruled out by x-ray, MRI, and/or CT scan * Hormone receptor status: * Determined in the recurrent tumor by immunohistochemistry and/or ligand-binding assay * Estrogen receptor positive or negative * Progesterone receptor positive or negative PATIENT CHARACTERISTICS: Age * Minimum 18 years Sex * Female Menopausal status * Not specified Performance status * Not specified Life expectancy * Not specified Hematopoietic * Not specified Hepatic * No elevated alkaline phosphatase Renal * Not specified Other * Fertile patients must use effective non-hormonal contraception * Medically suitable for chemotherapy of 3-6 months duration * No other primary malignant tumors except adequately treated carcinoma in situ of the cervix or nonmelanoma skin cancer * No non-malignant systemic disease that would preclude study treatment or prolong follow-up * No psychiatric or addictive disorder that would preclude giving informed consent * No history of noncompliance to medical regimens or potential for being unreliable PRIOR CONCURRENT THERAPY: Biologic therapy * Not specified Chemotherapy * See Disease Characteristics Endocrine therapy * Not specified Radiotherapy * See Disease Characteristics Surgery * See Disease Characteristics
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Disease-free Survival | 5 years after randomization |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | 5 years after randomization | — |
| Sites of First Failures | 5 years after randomization | Tumor recurrence in the breast, lymph nodes or other areas of the body including bone, lung, liver, central nervous system, bone marrow |
Countries
Australia, Belgium, Canada, Hungary, Netherlands, Peru, South Africa, Spain, Switzerland, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Arm I Observation (+/- Radiation). Patients receive radiotherapy\* within 6 months after surgery.
radiation therapy: Given within 6 months after surgery | 77 |
| Arm II Chemotherapy (+/- Radiation). Within 10 weeks after surgery, patients receive at least 3 courses of an adjuvant chemotherapy regimen as determined by the investigator. Patients may receive radiotherapy within 6 months after surgery and after the completion of chemotherapy OR integrated with chemotherapy.
chemotherapy: Given within 10 weeks after surgery. | 85 |
| Total | 162 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 21 | 9 |
| Overall Study | Lack of Efficacy | 34 | 24 |
Baseline characteristics
| Characteristic | Arm I | Total | Arm II |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 17 Participants | 31 Participants | 14 Participants |
| Age, Categorical Between 18 and 65 years | 60 Participants | 131 Participants | 71 Participants |
| Estrogen receptor (ER) status of primary tumor negative | 20 participants | 47 participants | 27 participants |
| Estrogen receptor (ER) status of primary tumor positive | 47 participants | 96 participants | 49 participants |
| Estrogen receptor (ER) status of primary tumor unknown | 10 participants | 19 participants | 9 participants |
| Estrogen receptor (ER) status of the isolated local or regional recurrence Negative | 29 participants | 58 participants | 29 participants |
| Estrogen receptor (ER) status of the isolated local or regional recurrence Positive | 48 participants | 104 participants | 56 participants |
| Location of isolated loco-regional recurrence (ILRR) Breast | 41 participants | 88 participants | 47 participants |
| Location of isolated loco-regional recurrence (ILRR) Mx scar/chest wall | 26 participants | 53 participants | 27 participants |
| Location of isolated loco-regional recurrence (ILRR) Regional lymph nodes | 10 participants | 21 participants | 11 participants |
| Menopausal Status at isolated loco-regional recurrence (ILRR) post | 63 participants | 128 participants | 65 participants |
| Menopausal Status at isolated loco-regional recurrence (ILRR) pre | 14 participants | 34 participants | 20 participants |
| Prior chemotherapy No | 25 participants | 61 participants | 36 participants |
| Prior chemotherapy Yes | 52 participants | 101 participants | 49 participants |
| Progesterone receptor (PgR) status of the isolated local or regional recurrence negative | 40 participants | 79 participants | 39 participants |
| Progesterone receptor (PgR) status of the isolated local or regional recurrence not available | 2 participants | 4 participants | 2 participants |
| Progesterone receptor (PgR) status of the isolated local or regional recurrence positive | 35 participants | 79 participants | 44 participants |
| Region of Enrollment Australia | 1 participants | 2 participants | 1 participants |
| Region of Enrollment Canada | 15 participants | 31 participants | 16 participants |
| Region of Enrollment Hungary | 17 participants | 33 participants | 16 participants |
| Region of Enrollment Netherlands | 6 participants | 12 participants | 6 participants |
| Region of Enrollment Peru | 1 participants | 1 participants | 0 participants |
| Region of Enrollment South Africa | 3 participants | 5 participants | 2 participants |
| Region of Enrollment Spain | 9 participants | 20 participants | 11 participants |
| Region of Enrollment Switzerland | 6 participants | 16 participants | 10 participants |
| Region of Enrollment United States | 19 participants | 42 participants | 23 participants |
| Sex: Female, Male Female | 77 Participants | 162 Participants | 85 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
| Surgery for primary tumor Breast conserving | 46 participants | 98 participants | 52 participants |
| Surgery for primary tumor Mastectomy | 31 participants | 64 participants | 33 participants |
| Time from primary surgery to isolated loco-regional recurrence (ILRR) surgery | 6.2 years | 5.5 years | 5.0 years |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 77 | 0 / 85 |
| serious Total, serious adverse events | 0 / 77 | 12 / 85 |
Outcome results
Disease-free Survival
Time frame: 5 years after randomization
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm I | Disease-free Survival | 57 percentage of participants |
| Arm II | Disease-free Survival | 69 percentage of participants |
Overall Survival
Time frame: 5 years after randomization
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm I | Overall Survival | 76 percentage of participants |
| Arm II | Overall Survival | 88 percentage of participants |
Sites of First Failures
Tumor recurrence in the breast, lymph nodes or other areas of the body including bone, lung, liver, central nervous system, bone marrow
Time frame: 5 years after randomization
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm I | Sites of First Failures | Secon (non-breast) Malignancy | 0 participants |
| Arm I | Sites of First Failures | Failures | 34 participants |
| Arm I | Sites of First Failures | Contralateral Breast | 1 participants |
| Arm I | Sites of First Failures | Distant | 22 participants |
| Arm I | Sites of First Failures | Death without prior Cancer Event | 0 participants |
| Arm I | Sites of First Failures | Soft Tissue | 2 participants |
| Arm I | Sites of First Failures | Local or Regional | 9 participants |
| Arm I | Sites of First Failures | Bone | 5 participants |
| Arm I | Sites of First Failures | Death, cause unknown | 2 participants |
| Arm I | Sites of First Failures | Viscera | 15 participants |
| Arm I | Sites of First Failures | Deaths | 21 participants |
| Arm II | Sites of First Failures | Viscera | 7 participants |
| Arm II | Sites of First Failures | Deaths | 9 participants |
| Arm II | Sites of First Failures | Local or Regional | 6 participants |
| Arm II | Sites of First Failures | Contralateral Breast | 1 participants |
| Arm II | Sites of First Failures | Secon (non-breast) Malignancy | 1 participants |
| Arm II | Sites of First Failures | Death without prior Cancer Event | 1 participants |
| Arm II | Sites of First Failures | Death, cause unknown | 0 participants |
| Arm II | Sites of First Failures | Failures | 24 participants |
| Arm II | Sites of First Failures | Distant | 15 participants |
| Arm II | Sites of First Failures | Soft Tissue | 0 participants |
| Arm II | Sites of First Failures | Bone | 8 participants |