Estrogen Receptor Negative, Estrogen Receptor Positive, HER2/Neu Negative, HER2/Neu Positive, Progesterone Receptor Negative, Progesterone Receptor Positive, Recurrent Breast Carcinoma, Stage IIIC Breast Cancer AJCC v6, Stage IV Breast Cancer AJCC v6 and v7
Conditions
Brief summary
This randomized phase III trial studies the side effects and how well different chemotherapy regimens with or without bevacizumab work in treating patients with stage IIIC or stage IV breast cancer. Drugs used in chemotherapy, such as paclitaxel, paclitaxel albumin-stabilized nanoparticle formulation (nab-paclitaxel), and ixabepilone, 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. Bevacizumab may block tumor growth by targeting certain cells and slowing the growth of blood vessels to the tumor. It is not yet known which treatment regimen is more effective in treating patients with breast cancer.
Detailed description
PRIMARY OBJECTIVES: I. To compare the progression-free survival (PFS) in patients with metastatic breast cancer receiving nab-paclitaxel versus paclitaxel (control arm). II. To compare PFS in patients receiving ixabepilone versus paclitaxel. SECONDARY OBJECTIVES: I. To compare the objective response rate, duration of response, and time to treatment failure in patients receiving nab-paclitaxel versus paclitaxel, and to separately compare these endpoints in patients receiving ixabepilone versus paclitaxel. II. To compare the 12-month rate of progression in patients receiving nab-paclitaxel versus paclitaxel, and to separately compare this endpoint in patients receiving ixabepilone versus paclitaxel. III. To determine toxicities in patients receiving nab-paclitaxel as compared to paclitaxel, and in patients receiving ixabepilone as compared to paclitaxel. IV. To compare overall survival in patients receiving nab-paclitaxel versus paclitaxel, and to separately compare overall survival in patients receiving ixabepilone versus paclitaxel. V. To evaluate the relationships between secreted protein, acidic, cysteine-rich (SPARC) overexpression and changes in blood levels of caveolin-1 (Cav-1) to PFS and secondary endpoints of response during treatment with nab-paclitaxel as compared to paclitaxel, and with ixabepilone as compared to paclitaxel. VI. To evaluate the relationships between changes in blood levels of circulating tumor cells (CTCs) and circulating endothelial cells (CECs) to PFS and secondary endpoints of response during treatment with nab-paclitaxel as compared to paclitaxel, and with ixabepilone as compared to paclitaxel. VII. To evaluate the association of expression levels of the microtubule associated proteins tau and beta-tubulin isotype composition with PFS and secondary endpoints of response during treatment with nab-paclitaxel as compared to paclitaxel, and with ixabepilone as compared to paclitaxel. VIII. To investigate a potential cytochrome P450, family 2, subfamily C polypeptide 8, 2, 3 (CYP2C8\*2/\*3) by paclitaxel interaction with respect to progression-free survival (PFS). IX. To determine if CYP2C8\*2 and CPY2C8\*3 are associated with paclitaxel-induced peripheral neuropathy. X. To perform exploratory analysis of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4), cytochrome P450, family 3, subfamily A, polypeptide 5 (CYP3A5), ATP-binding cassette, sub-family B (MDR/TAP), member 1 (ABCB1) and ATP-binding cassette, sub-family C (CFTR/MRP), member 2 (ABCC2) polymorphisms with response and toxicity profiles. XI. To prospectively collect data on sociodemographics, non-cancer morbidities, and receipt of post-trial therapy to evaluate the role of potential disparities on survival from cancer. XII. To evaluate the relationship between physical activity behaviors at the time of enrollment in the protocol and progression-free and overall survival. XIII. To identify baseline factors that predict the risk of grade 3, 4, or 5 toxicity in patients receiving treatment with weekly paclitaxel, nab-paclitaxel, or ixabepilone combined with or without bevacizumab. XIV. To perform an exploratory analysis of whether other factors included in patient assessments (either individually or in combination) predict the risk of grade 3, 4, or 5 toxicity in patients receiving weekly paclitaxel, nab-paclitaxel, or ixabepilone combined with or without bevacizumab, with a specific focus on the relationship between pre-existing hypertension or neuropathy. XV. To compare the associations of baseline factors to grade 3, 4, or 5 toxicity in patients receiving weekly paclitaxel, nab-paclitaxel, or ixabepilone combined with or without bevacizumab. XVI. To explore whether longitudinal changes in factors are in association with the occurrence of grade 3, 4, or 5 toxicities in patients with weekly paclitaxel, nab-paclitaxel, or ixabepilone combined with or without bevacizumab. XVII. To explore the association between grade 2-4 neuropathy and longitudinal changes in the following functional status measures: a) Older Americans Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire (MFAQ) (Instrumental Activities of Daily Living \[IADL\]); b) Medical Outcomes Study (MOS) Physical Functioning; c) Karnofsky Performance Status Rated Healthcare Professional; d) Timed "Up and Go"; e) OARS Physical Health Section. OUTLINE: Patients are randomized to 1 of 3 treatment arms. ARM A (WEEKLY PACLITAXEL): Patients receive paclitaxel intravenously (IV) over 1 hour on days 1, 8, and 15. Patients may also receive bevacizumab IV over 30-90 minutes on days 1 and 15. ARM B (WEEKLY NAB-PACLITAXEL): Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15. Patients may also receive bevacizumab as in Arm A. ARM C (WEEKLY IXABEPILONE): Patients receive ixabepilone IV over 60 minutes on days 1, 8, and 15. Patients may also receive bevacizumab as in Arm A. (closed to accrual as of 7/18/11) In all arms, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study therapy, patients are followed every 6 months for 2 years and then annually for up to 3 years.
Interventions
BIOLOGICALBevacizumab
Given IV
DRUGIxabepilone
Given IV
OTHERLaboratory Biomarker Analysis
Correlative studies
DRUGNab-paclitaxel
Given IV
DRUGPaclitaxel
Given IV
OTHERQuestionnaire Administration
Ancillary studies
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologic confirmation of invasive cancer of the breast * Stage IV disease or stage IIIC disease (using American Joint Committee on Cancer \[AJCC\] criteria, 6th edition) not amenable to local therapy * Patients may not have a "currently active" second malignancy other than non-melanoma skin cancers; patients are not considered to have a "currently active" malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse * Patients with human epidermal growth factor receptor 2 (HER2) negative disease are eligible; patients with HER2+ disease are eligible providing they have previously received trastuzumab or lapatinib; documentation of progression on HER2 directed therapy is not required; Her2/neu status must be known at the time of protocol registration * Estrogen receptor (ER) and progesterone receptor (PgR) status must be known at the time of registration; ER and/or PgR \>= 1% cells will be considered positive * Prior treatment may include adjuvant or neoadjuvant taxane, however, the interval between completion of adjuvant or neoadjuvant therapy and disease recurrence must be \>= 12 months * No prior chemotherapy for metastatic breast cancer * Any number of prior hormonal therapies are allowed; the last dose should have been administered at least 7 days prior to the initiation of protocol therapy * Prior radiotherapy must be completed at least 2 weeks prior to study entry * Treatment with bisphosphonates is allowed and recommended as per American Society of Clinical Oncology (ASCO) guidelines * Prior trastuzumab or lapatinib required for patients with HER2 overexpressing tumors * Prior treatment with bevacizumab is allowed * Patients must not have had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study registration, and must have fully recovered from any such procedure * The following are not considered to be major procedures: thoracentesis, paracentesis, port placement, laparoscopy, thoracoscopy, bronchoscopy, endoscopic ultrasonographic procedures, mediastinoscopy, skin biopsies, incisional biopsies and routine dental procedures * Patients must not have anticipation of need for a major surgical procedure during the course of the study * There are no restrictions on core biopsies, placement of a vascular access device or other minor procedures prior to registration * Placement of a vascular access device after starting study therapy should be performed between day 15 and 28 of a treatment cycle (but not less than 48 hours before the next dose of bevacizumab) to allow for sufficient healing * Patients must have measurable disease (target lesions): measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as \>= 2.0 cm with conventional techniques or as \>= 1 cm with spiral computed tomography (CT) scan * Lesions that are considered non-measurable include the following: * Bone lesions * Leptomeningeal disease * Ascites * Pleural/pericardial effusion * Inflammatory breast disease * Lymphangitis cutis/pulmonitis * Abdominal masses that are not confirmed and followed by imaging techniques * Cystic lesions * Patients with pre-existing peripheral neuropathy \>= grade 2 are not eligible for this study * Patients must have an Eastern Cooperative Oncology Group (ECOG) (Zubrod) performance status of =\< 1 to be eligible for this trial * Women must not be pregnant or breast feeding; premenopausal women must have a negative serum or urine beta-human chorionic gonadotropin (Hcg) * Patients with a history of Common Terminology Criteria for Adverse Events (CTCAE) grade \>= 3 hypersensitivity to paclitaxel or Cremophor® EL are not eligible * Patients with a history of abdominal fistula, or intra-abdominal abscess within 6 months prior to study registration are not eligible * Patients with a history of gastrointestinal (GI) perforation within 12 months prior to registration are not eligible * Patients with a history of significant bleeding episodes (e.g., hemoptysis, upper or lower GI bleeding) within 6 months prior to registration are not eligible * Patients must not have a history of clinically significant cardiovascular disease that includes the following: * Uncontrolled hypertension defined as systolic blood pressure \> 150 and/or diastolic blood pressure \> 90 mmHg on antihypertensive medications or any prior history of hypertensive crisis or hypertensive encephalopathy * History of myocardial infarction or unstable angina within past 6 months * New York Heart Association (NYHA) congestive heart failure grade 2 or greater * Symptomatic peripheral vascular disease * Significant vascular disease (e.g., aortic aneurysm, aortic dissection) or arterial thrombotic events * Patients on full dose anticoagulants must be on a stable dose of warfarin, or be on a stable dose of low molecular weight (LMW) heparin; patients receiving anti-platelet or on daily prophylactic dose aspirin are eligible, as are patients receiving stable doses of anticoagulation for atrial fibrillation * Patients may not have a history of stroke or transient ischemic attack within 6 months prior to study registration * Patients with a history of seizures must be well controlled with standard medication * Patients must not have progressing or untreated central nervous system (CNS) metastases or leptomeningeal disease; patients with a history of resected brain metastases with stable magnetic resonance imaging (MRI) scans for 3 months including within 4 weeks of study start are eligible; patients with a history of gamma knife radiosurgery or whole brain radiation with stable MRI scans for 3 months including within 4 weeks of study start are eligible * No serious, non-healing wound, ulcer or bone fracture * Life expectancy of \>= 12 weeks * Granulocytes \>= 1,500/ul * Platelet count \>= 100,000/ul * Creatinine =\< 2.0 mg/dL * Bilirubin \< 1.5 mg/dL (unless due to Gilbert's syndrome) * Transaminases (aspartate aminotransferase \[AST\], alanine aminotransferase \[ALT\]) =\< 2.5 x upper limit of normal (ULN) * Serum or urine beta-Hcg negative in premenopausal women of child-bearing potential * Urine protein =\< 1+ protein\* or urine protein: creatinine ratio (UPC) \< 1 * Patients discovered to have \>= 2+ proteinuria at baseline must undergo a 24-hour urine collection that must demonstrate \< 1 g of protein/24 hr or UPC ratio =\< 1 to allow participation in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival | Time from randomization to progression or death due to any cause, whichever occurs first (up to 5 years) | Progression-free survival (PFS) is defined as the interval from registration until first disease progression, regardless of site, or death resulting from any cause, which ever occurred first. Distribution was estimated using the Kaplan Meier product-limit method. Progression is defined as a 20% increase in the sum of longest diameter of target lesions (per Response Evaluation Criteria in Solid Tumors \[RECIST\] criteria). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Objective Tumor Response Rate | Up to 5 years | Response was defined by the Response Evaluation Criteria in Solid Tumors (RECIST). A responding participant had either a Complete Response (disappearance of all target lesions) or Partial Response (30% decrease in sum of longest diameter of target lesions). |
| Time to Treatment Failure | Time from randomization until progression, death, or yearly termination of protocol therapy (up to 5 years) | Time from registration until treatment failure, defined as early termination of protocol therapy for any reason, first disease progression or death without progression. Surviving participants who were failure free were censored as date last known alive and failure free. Distribution was estimated using the Kaplan Meier product-limit method. |
| 12 Month Progression Free Survival | 12 months | Percentage of participants who were alive and progression free at 12 months. The 12 month progression free survival, with 95% confidence interval, was estimated using the Kaplan Meier method. |
| Overall Survival | Time from randomization to death or last follow-up (up to 5 years) | Overall survival was measured as the interval from study entry until death, from any cause, or last contact. Distribution was estimated using the Kaplan Meier product-limit method. |
Countries
Puerto Rico, United States
Contacts
PRINCIPAL_INVESTIGATORHope S Rugo
Alliance for Clinical Trials in Oncology
Participant flow
Recruitment details
Between October 2008 - November 2011, a total of 799 participants were recruited.
Participants by arm
| Arm | Count |
|---|---|
| Arm A (Paclitaxel) Patients receive 90 mg/m\^2 paclitaxel IV over 1 hour on days 1, 8, and 15. Patients may receive 10 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15. Treatment continues until progression. | 283 |
| Arm B (Nab-paclitaxel) Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15. Patients may also receive 10 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15. Treatment continues until progression. | 271 |
| Arm C (Ixabepilone) Patients receive ixabepilone IV over 60 minutes on days 1, 8, and 15. Patients may also receive 10 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15. Treatment continues until progression. (closed to accrual as of 7/18/11) | 245 |
| Total | 799 |
Baseline characteristics
| Characteristic | Arm B (Nab-paclitaxel) | Arm A (Paclitaxel) | Arm C (Ixabepilone) | Total |
|---|---|---|---|---|
| Age, Customized 20-29 | 2 participants | 2 participants | 1 participants | 5 participants |
| Age, Customized 30-39 | 18 participants | 15 participants | 17 participants | 50 participants |
| Age, Customized 40-49 | 56 participants | 52 participants | 55 participants | 163 participants |
| Age, Customized 50-59 | 89 participants | 109 participants | 86 participants | 284 participants |
| Age, Customized 60-69 | 74 participants | 74 participants | 68 participants | 216 participants |
| Age, Customized 70-79 | 28 participants | 24 participants | 15 participants | 67 participants |
| Age, Customized 80+ | 4 participants | 7 participants | 3 participants | 14 participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 15 Participants | 19 Participants | 13 Participants | 47 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 239 Participants | 252 Participants | 221 Participants | 712 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 17 Participants | 12 Participants | 11 Participants | 40 Participants |
| Hormone Receptor Status ER/PgR Negative | 76 participants | 82 participants | 67 participants | 225 participants |
| Hormone Receptor Status ER/PgR Positive | 195 participants | 201 participants | 178 participants | 574 participants |
| Physician's Decision to use Bevacizumab Bevacizumab not planned | 4 participants | 8 participants | 8 participants | 20 participants |
| Physician's Decision to use Bevacizumab Bevacizumab planned | 44 participants | 51 participants | 15 participants | 110 participants |
| Physician's Decision to use Bevacizumab Bevacizumab required | 223 participants | 224 participants | 222 participants | 669 participants |
| Prior Adjuvant Taxane No | 151 participants | 158 participants | 138 participants | 447 participants |
| Prior Adjuvant Taxane Yes | 120 participants | 125 participants | 107 participants | 352 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 2 Participants | 2 Participants | 5 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 45 Participants | 42 Participants | 26 Participants | 113 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 3 Participants | 1 Participants | 4 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 10 Participants | 15 Participants | 8 Participants | 33 Participants |
| Race (NIH/OMB) White | 214 Participants | 220 Participants | 206 Participants | 640 Participants |
| Region of Enrollment United States | 271 participants | 283 participants | 245 participants | 799 participants |
| Sex: Female, Male Female | 268 Participants | 277 Participants | 243 Participants | 788 Participants |
| Sex: Female, Male Male | 3 Participants | 6 Participants | 2 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| other Total, other adverse events | 263 / 272 | 248 / 264 | 230 / 238 |
| serious Total, serious adverse events | 65 / 272 | 80 / 264 | 59 / 238 |
Outcome results
Primary
Progression Free Survival
Progression-free survival (PFS) is defined as the interval from registration until first disease progression, regardless of site, or death resulting from any cause, which ever occurred first. Distribution was estimated using the Kaplan Meier product-limit method. Progression is defined as a 20% increase in the sum of longest diameter of target lesions (per Response Evaluation Criteria in Solid Tumors \[RECIST\] criteria).
Time frame: Time from randomization to progression or death due to any cause, whichever occurs first (up to 5 years)
Population: Participants who never began protocol treatment were excluded.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A (Paclitaxel) | Progression Free Survival | 10.97 months |
| Arm B (Nab-paclitaxel) | Progression Free Survival | 9.3 months |
| Arm C (Ixabepilone) | Progression Free Survival | 7.36 months |
Comparison: Stratified log-rank tests are used for the two primary comparisons of PFS within an experimental arm relative to PFS within the control arm. The family-wise error rate will be controlled at a one-sided 0.025 level. This is achieved in a 3-arm trial with a common control group by conducting the marginal log-rank tests with a one-sided α = 0.0135. Sample size calculations are based on having high power to detect a hazard ratio of 1.36, in the control arm as compared to the experimental arms.p-value: 0.05495% CI: [1, 1.45]Log Rank
Comparison: Stratified log-rank tests are used for the two primary comparisons of PFS within an experimental arm relative to PFS within the control arm. The family-wise error rate will be controlled at a one-sided 0.025 level. This is achieved in a 3-arm trial with a common control group by conducting the marginal log-rank tests with a one-sided α = 0.0135. Sample size calculations are based on having high power to detect a hazard ratio of 1.36, in the control arm as compared to the experimental arms.p-value: <0.000195% CI: [1.28, 1.87]Log Rank
Secondary
12 Month Progression Free Survival
Percentage of participants who were alive and progression free at 12 months. The 12 month progression free survival, with 95% confidence interval, was estimated using the Kaplan Meier method.
Time frame: 12 months
Population: Participants who never began protocol treatment were excluded.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A (Paclitaxel) | 12 Month Progression Free Survival | 45 percentage of participants |
| Arm B (Nab-paclitaxel) | 12 Month Progression Free Survival | 36 percentage of participants |
| Arm C (Ixabepilone) | 12 Month Progression Free Survival | 28 percentage of participants |
Secondary
Objective Tumor Response Rate
Response was defined by the Response Evaluation Criteria in Solid Tumors (RECIST). A responding participant had either a Complete Response (disappearance of all target lesions) or Partial Response (30% decrease in sum of longest diameter of target lesions).
Time frame: Up to 5 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A (Paclitaxel) | Objective Tumor Response Rate | 38.2 percentage of participants |
| Arm B (Nab-paclitaxel) | Objective Tumor Response Rate | 34.1 percentage of participants |
| Arm C (Ixabepilone) | Objective Tumor Response Rate | 25.6 percentage of participants |
Secondary
Overall Survival
Overall survival was measured as the interval from study entry until death, from any cause, or last contact. Distribution was estimated using the Kaplan Meier product-limit method.
Time frame: Time from randomization to death or last follow-up (up to 5 years)
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A (Paclitaxel) | Overall Survival | 26.55 months |
| Arm B (Nab-paclitaxel) | Overall Survival | 23.52 months |
| Arm C (Ixabepilone) | Overall Survival | 23.53 months |
p-value: 0.295% CI: [0.92, 1.47]Log Rank
p-value: 0.03895% CI: [1.01, 1.61]Log Rank
Secondary
Time to Treatment Failure
Time from registration until treatment failure, defined as early termination of protocol therapy for any reason, first disease progression or death without progression. Surviving participants who were failure free were censored as date last known alive and failure free. Distribution was estimated using the Kaplan Meier product-limit method.
Time frame: Time from randomization until progression, death, or yearly termination of protocol therapy (up to 5 years)
Population: Participants who never began protocol treatment were excluded.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Arm A (Paclitaxel) | Time to Treatment Failure | 6.6 months |
| Arm B (Nab-paclitaxel) | Time to Treatment Failure | 5.19 months |
| Arm C (Ixabepilone) | Time to Treatment Failure | 4.93 months |