Phase III Randomized Study of Paclitaxel vs No Further Chemotherapy Following Doxorubicin/Cyclophosphamide for Resected Node-Positive Breast Cancer

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Alternate Title

Paclitaxel and Combination Chemotherapy in Treating Patients With Stage II or Stage III Breast Cancer

Basic Trial Information

PhaseTypeStatusAgeSponsorProtocol IDs
Phase IIITreatmentClosed18 to 78NCINSABP-B-28


I.  Compare disease-free survival and overall survival of patients with 
resected node-positive breast cancer treated with 4 courses of paclitaxel 
following 4 courses of doxorubicin/cyclophosphamide (AC) vs. 4 courses of AC 

Entry Criteria

Disease Characteristics:

Completely resected breast cancer
  Clinically confined to 1 breast and ipsilateral nodes (T1-3, N0-1, M0)
  Bone scan and/or x-rays negative for metastases in presence of bone pain
     X-ray, magnetic resonance imaging, or biopsy confirmation required for
     suspicious lesions

Total mastectomy/lumpectomy and axillary node dissection required
  Histologic confirmation of invasive adenocarcinoma
  At least 1 involved axillary lymph node

Additional criteria for lumpectomy:
  Primary tumor no greater than 5 cm on physical exam
  No invasive tumor or ductal carcinoma in situ in resection margins
     Re-excision permitted to obtain clear margins
     Total mastectomy required if clear margins unobtainable
  No diffuse tumors on mammogram unless surgically amenable to lumpectomy
  No ipsilateral mass following lumpectomy unless histologically benign
  No breast irradiation prior to randomization

None of the following:
  Contralateral breast cancer
     Biopsy required for:
        Suspicious mass in breast
        Suspicious palpable axillary node
        Palpable supraclavicular or infraclavicular node
  Infiltration of skin or underlying chest wall
     Tethering or dimpling of skin, or nipple inversion only, allowed
  Peau d'orange or skin edema of any magnitude

Hormone receptor status:
  Estrogen and progesterone receptor status required prior to randomization

Randomization within 63 days of initial cytologic or histologic diagnosis

Prior/Concurrent Therapy:

No prior therapy for breast cancer other than surgery
  Segmental resection of ipsilateral or contralateral lobular carcinoma in
  situ allowed

No prior anthracycline for any malignancy

No concurrent sex hormone therapy (e.g., birth control pills, ovarian hormone
replacement therapy)

Patient Characteristics:

  18 to 78

  Not specified

Menopausal status:
  Not specified

Performance status:
  Not specified

Life expectancy:
  At least 10 years

  (at time of randomization)
  WBC at least 4,000/mm3
  Platelet count at least 100,000/mm3

  (at time of randomization)
  Bilirubin normal
  AST or ALT normal

  (at time of randomization)
  Creatinine normal

  No contraindication to doxorubicin or paclitaxel therapy, including:
     Myocardial infarction
     Angina pectoris requiring medication
     History of documented congestive heart failure
     Arrhythmia requiring medication
     Severe conduction abnormality
     Valvular disease with documented cardiac function compromise
     Cardiomegaly on chest x-ray or ventricular hypertrophy on EKG unless left
        ventricular ejection fraction at least 45% on MUGA or echocardiogram
     Poorly controlled hypertension, i.e., diastolic above 100 mm Hg
  Concurrent medication that alters cardiac conduction (e.g., digitalis, beta-
  blockers, calcium channel blockers) allowed for hypertension or noncardiac

  No nonmalignant systemic disease that precludes treatment or follow-up
  No psychiatric or addictive disorder that precludes informed consent
  No second malignancy within 10 years except:
     Effectively treated nonmelanomatous skin cancer
     Surgically treated carcinoma in situ of the cervix
  No pregnant women

Chest x-ray within 3 months prior to randomization
Bilateral mammogram, bone scan, EKG, and gynecologic exam within 1 year prior
  to randomization

Expected Enrollment

This study will accrue 3050 patients over 21 months.


This is a randomized study.  Patients are stratified on the basis of number of 
positive nodes, tamoxifen assignment (based on age and hormone-receptor 
status), type of surgery, and participating institution.  Randomization must 
occur within 63 days of initial diagnosis, and treatment begins no sooner than 
2 weeks after the last surgery.

Patients in the first group receive doxorubicin and cyclophosphamide (AC) 
every 21 days for 4 courses.

Patients in the second group receive paclitaxel every 21 days for 4 courses 
following completion of AC as in the first group.

All patients over 50 years of age or with hormone-receptor-positive tumors 
receive oral daily tamoxifen for 5 years, beginning concurrently with 
chemotherapy.  Patients who underwent lumpectomy receive radiotherapy upon 
completion of their chemotherapy.

Granulocyte colony-stimulating factor is prohibited except to treat 
life-threatening infection, febrile neutropenia, or prolonged 
granulocytopenia.  Hormonal therapy other than tamoxifen is prohibited on 

Patients are followed every 6 months for 2.5 years, then yearly.

Published Results

Pusztai L, Jeong JH, Gong Y, et al.: Evaluation of microtubule-associated protein-Tau expression as a prognostic and predictive marker in the NSABP-B 28 randomized clinical trial. J Clin Oncol 27 (26): 4287-92, 2009.[PUBMED Abstract]

Yang SX, Costantino JP, Nguyen D, et al.: Correlation of levels of Akt phosphorylation at Ser473 with benefit from paclitaxel chemotherapy in NSABP B-28 patients with node-positive breast cancer. [Abstract] J Clin Oncol 27 (Suppl 15): A-537, 2009.

Mamounas EP, Bryant J, Lembersky B, et al.: Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28. J Clin Oncol 23 (16): 3686-96, 2005.[PUBMED Abstract]

Mamounas EP, Bryant J, Lembersky BC, et al.: Paclitaxel (T) following doxorubicin/cyclophosphamide (AC) as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28. [Abstract] Proceedings of the American Society of Clinical Oncology 22: A-12, 4, 2003.

Related Publications

Soran A, Nesbitt L, Mamounas EP, et al.: Centralized medical monitoring in phase III clinical trials: the National Surgical Adjuvant Breast and Bowel Project (NSABP) experience. Clin Trials 3 (5): 478-85, 2006.[PUBMED Abstract]

Campone M, Fumoleau P, Bourbouloux E, et al.: Taxanes in adjuvant breast cancer setting: which standard in Europe? Crit Rev Oncol Hematol 55 (3): 167-75, 2005.[PUBMED Abstract]

Piccart MJ, Lohrisch C, Duchateau L, et al.: Taxanes in the adjuvant treatment of breast cancer: why not yet? J Natl Cancer Inst Monogr (30): 88-95, 2001.[PUBMED Abstract]

Trial Contact Information

Trial Lead Organizations

National Surgical Adjuvant Breast and Bowel Project

Terry Mamounas, MD, MPH, FACS, Protocol chair
Ph: 330-363-6281

Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol.