Breast Cancer
Conditions
Keywords
Breast Cancer, neoadjuvant therapy, pCR rates
Brief summary
The present clinical trial will investigate the efficacy of a sequential interval-shortened and dose-intensified preoperative use of epirubicin, paclitaxel and CMF with preoperative sequential administration of epirubicin and cyclophosphamide followed by paclitaxel in breast cancer. In addition, the influence of darbepoetin alfa on the response rate and quality of life is to be investigated in both treatment arms.
Detailed description
Arm A: Sequential treatment in standard doses with Epirubicin (90 mg/m2)/cyclophosphamide (600 mg/m2) d1, q21d - 4× followed by paclitaxel (175 mg/m2) d1, q21d - 4×. Pegfilgratim should be used as secondary preventive after febrile neutropenia in the standard arm of the study, or in exceptional cases also after severe febrile neutropenia necessitating postponement of the treatment by more than one week ± Darbepoetin alfa 1 × 4.5 µg/kg of body weight every two weeks with the start of the first epirubicin dose (day 1) until 14 days after the last dose of paclitaxel Daily oral intake of 200 mg iron unless there complications occur with taking iron Arm B: sequential dose-intensified, interval-shortened treatment with Epirubicin (150 mg/m2) d1, q14d - 3× followed by paclitaxel (225 mg/m2) d1, q14d - 3×, followed by CMF (600/40/600 mg/m2) d1/d8, q28d - 3× Obligatory pegfilgratim 6 mg after epirubicin and/or paclitaxel: subcutaneous injection on day 2. After CMF pegfilgrastim should be used as a secondary preventive measure ± Darbepoetin alfa 1 × 4.5 µg/kg of body weight every two weeks with the start of the first dose of epirubicin (day 1) until 14 days after the last dose of CMF Daily oral dose of 200 mg iron unless complications occur in taking iron. Primary goal: Determining the relapse-free survival time and overall survival after dose-intensified sequential preoperative chemotherapy including anthracycline and taxan and/or after preoperative chemotherapy including anthracycline followed by taxan in a standard dose
Interventions
DRUGEpirubicin, paclitaxel, cyclophosphamide, Methotrexate, 5 FU, darbepoetin alfa
Epirubicin (90 mg/m2) d1, q21d - 4× / cyclophosphamide (600 mg/m2) d1, q21d - 4× followed by paclitaxel (175 mg/m2) d1, q21d - 4× +/- Darbepoetin alfa 1 × 4.5 μg/kg of body weight every two weeks with the start of the first epirubicin dose (day 1) to 14 days after the last dose of paclitaxel
DRUGEpirubicin, Cyclophosphamide, Paclitaxel, dabepoetin alfa
Epirubicin (150 mg/m2) d1, q14d - 3× followed by paclitaxel (225 mg/m2) d1, q14d - 3×, followed by CMF d1/d8, q28d - 3× Obligatory pegfilgratim 6 mg, subcutaneous injection on day 2 after epirubicin and/or paclitaxel and secondary prophylactic dose after CMF +/- Darbepoetin alfa 1 × 4.5 μg/kg of body weight every two weeks with the start of the first dose of epirubicin (day 1) until 14 days after the last dose of CMF
Sponsors
Pharmacia
Amgen
Bristol-Myers Squibb
GBG Forschungs GmbH
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed breast cancer: at least three fast biopsies. * Primary tumor ≥2 cm acc. to clinical measurement or manifestation of an inflammatory breast cancer. * No systemic metastasis, exclusion by chest x-ray, sonogram of the upper abdomen and skeletal scintiscan. * Age ≥18 years and ≤65 years. * ECOG \< 2/WHO 0-1 * Adequate organ function defined as SGOT and bilirubin ≤ 1.5× upper limit WBC ≥ 3000 /µL Neutrophils ≥ 1000 /µL Platelets ≥ 100,000 /µL Serum creatinine \< 2.0 mg/dL * Unremarkable heart echo * No florid hepatitis * Written consent to participate in the treatment optimization protocol
Exclusion criteria
* Multicentricity in various quadrants (contact the study office) * Known allergy to E. coli-produced medication * Known allergy to medication containing cremophor (e.g., cyclosporin A) * Patients receiving immunosuppressant therapy * Lack of consent after informing the patient * Lack of willingness to keep and disclose personal medical data as part of the study * Pregnancy, nursing * Secondary malignancy, excluding basalioma of the skin or carcinoma in situ of the cervix that has received curative therapy * Pre-existing treatment-resistant cardiac disease, coronary heart disease, arrhythmias, cardiac insufficiency * Patients with uncontrolled hypertension (diastolic \>95 mmHg) * A history of convulsions * Known hypersensitivity to darbepoetin alfa or any of its other ingredients or a known hypersensitivity to r-HuEPO
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Relapse-free survival time and overall survival | 2007 |
Outcome results
None listed