Cisplatin or Paclitaxel before Surgery in Treating Patients with Triple Negative Stage I-III Breast Cancer
This randomized phase II trial studies how well cisplatin or paclitaxel before surgery works in treating patients with triple negative stage I-III breast cancer. Drugs used in chemotherapy, such as cisplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or stopping them from spreading.
Inclusion Criteria
- Pathologic documentation of invasive breast cancer by biopsy (fine needle aspiration [FNA] alone is not adequate)
- American Joint Committee on Cancer (AJCC) clinical stage I with T1 > 1.5 cm, stage II or III invasive breast cancer; participants with multicentric or bilateral disease are eligible if at least one lesion meets stage eligibility criteria for the study and no tumor is HER2-positive; in this circumstance, the investigator must determine which will represent the target lesion to be assessed for response; this should remain consistent throughout the study; the target lesion should be selected on the basis of its size (lesion with the longest diameter) and suitability for accurate repetitive measurements
- Tumors must be HER2 negative defined as HER2 0 or 1+ by immunohistochemistry (IHC) assays and/or lack of gene amplification by fluorescence in situ hybridization (FISH) defined as a ratio < 2 on invasive tumor by local review
- Estrogen receptor (ER) and progesterone receptor (PgR) status by IHC must be known; tumor must be ER and PR negative (=< 5% staining) by local review
- Known BRCA1/2 status is not required for study entry; however patients known to have a germline deleterious BRCA1/2 mutation should be encouraged to consider a preoperative trial specifically designed for BRCA1/2 carriers, if available
- Breast imaging should include imaging of the ipsilateral axilla; for subjects with a clinically positive axilla by physical examination or clearly positive by imaging, axillary tissue acquisition is not required; for patients with a clinically negative axilla by examination and imaging, tissue acquisition is not required; for equivocal imaging findings, tissue acquisition (a needle aspiration, core biopsy) is required; sentinel lymph node (SLN) biopsy before neoadjuvant therapy is not allowed; * For a positive lymph node status by imaging and positive lymph node status by physical exam, a lymph node (LN) sampling not required but can be performed per physician discretion * For a positive lymph node status by imaging and negative lymph node status by physical exam, a LN sampling required * For a negative lymph node status by imaging and positive lymph node status by physical exam, a LN sampling required * For a negative lymph node status by imaging and negative lymph node status by physical exam, a LN sampling not required ** Participants with axillary adenopathy only are not eligible for this study
- Patients with a prior history of contra-lateral breast cancer are eligible if they have no evidence of recurrence of their initial primary breast cancer within the last 5 years
- Eastern Cooperative Oncology Group (ECOG) performance status =< 1
- Absolute neutrophil count (ANC) > 1,500/mm^3
- Platelet count > 100,000/mm^3
- Bilirubin < 1.5 x upper limit of normal (ULN), for patients with Gilbert syndrome, direct bilirubin will be measured instead of total bilirubin
- Alanine aminotransferase (ALT), aspartate aminotransferase (AST) =< 3.0 x ULN
- Alkaline phosphatase (ALK Phos) < 2.5 x ULN
- Creatinine < 1.5 mg/dl or creatinine clearance > 60 cc/min
- Hemoglobin > 9 mg/dl
- Use of an effective means of contraception is required in subjects of childbearing potential; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; women of child-bearing potential must agree to use adequate contraception (barrier method of birth control; abstinence) prior to study entry and for the duration of study participation
- Ability to understand and the willingness to sign a written informed consent document
- Individuals with a history of other malignancies are eligible if they have been disease-free for at least 5 years and are deemed by the investigator to be at low risk for recurrence of that malignancy and did not receive prior chemotherapy; individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, and basal cell or squamous cell carcinoma of the skin
- Patient must be willing to undergo mandatory research biopsy and blood draw; prior to biopsy procedures patients must be able to be off medications that could increase the risk of bleeding
Exclusion Criteria
- Prior non-taxane or platinum containing chemotherapy will be allowed if the prior exposure was at least 5 years ago and the exposure is thought not to potentially interact with the primary outcome of the trial or put the patient at undue risk, and should be reviewed with study principle investigator (PI) on a case by case basis
- Any prior treatment for the current breast cancer, including chemotherapy, hormonal therapy, radiation or experimental therapy
- Ipsilateral breast recurrence, unless prior treatment consisted of excision alone for ductal carcinoma in situ (DCIS) or breast conserving treatment and hormonal therapy for DCIS or invasive breast cancer
- Ongoing use of any other investigational or study agents
- Peripheral neuropathy of any etiology > grade 1 (National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] version 4.0)
- Significant hearing loss that would prevent cisplatin administration
- Renal dysfunction for which exposure to cisplatin would be unsafe or require cisplatin dose modification
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to study drugs (e.g. cisplatin, paclitaxel)
- Uncontrolled intercurrent illness including, but not limited to ongoing or active systemic infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, steroid dependent asthma, or psychiatric illness/social situations that would limit compliance with study requirements
- Any condition that would prohibit administration of corticosteroids
- Currently pregnant or breast-feeding; all females must have a negative serum or urine pregnancy test at the baseline visit (within 7 days of the first dose of study treatment); females of childbearing potential must agree to use a medically acceptable method of contraception (e.g., abstinence, an intrauterine device, a double-barrier method such as condom + spermicidal or condom + diaphragm with spermicidal, or have a vasectomized partner with confirmed azoospermia) throughout the entire study period and for 30 days after discontinuation of study treatment; the only subjects who will be exempt from this requirement are postmenopausal women (defined as women who have been amenorrheic for at least 12 consecutive months, in the appropriate age group, without other known or suspected primary cause) or subjects who have been sterilized surgically or who are otherwise proven sterile (i.e., bilateral tubal ligation with surgery at least 1 month before start of study treatment, hysterectomy, or bilateral oophorectomy with surgery at least 1 month before start of study treatment)
- Uncontrolled diabetes (if random blood sugar > 200 mg/dL, perform fasting blood sugar to ensure < 200 mg/dL)
- Known human immunodeficiency virus (HIV)-positive individuals on combination antiretroviral therapy are ineligible because these individuals are at increased risk of lethal infections when treated with marrow-suppressive therapy
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT01982448.
PRIMARY OBJECTIVES:
I. To compare the pathologic response to neoadjuvant platinum-based chemotherapy in triple-negative breast cancer (TNBC) with and without hormone receptor (HR)-deficiency, defined as a high hormone receptor deficiency (HRD) score or a BRCA mutation.
II. To compare the pathologic response to neoadjuvant taxane-based chemotherapy in TNBC with and without HR-deficiency, defined as a high HRD score or a BRCA mutation.
SECONDARY OBJECTIVES:
I. To evaluate whether the positive predictive value of HR-deficiency is greater for TNBC treated with cisplatin, as compared to TNBC treated with paclitaxel.
II. To determine the association of the HR-deficiency with pathologic complete response (pCR) to neoadjuvant platinum-based chemotherapy in TNBC.
III. To determine the association of the HR-deficiency with pCR to neoadjuvant taxane-based therapy in TNBC.
IV. To evaluate clinical and pathologic responses in TNBC treated with preoperative cisplatin and paclitaxel.
V. To evaluate the performance of the HRD-loss of heterozygosity (LOH) assay, the HRD-allelic imbalance extending to the telomere (TAI) assay, and the HRD-long segment transition (LST) assay, to predict pathologic response to cisplatin or taxane therapy in TNBC.
EXPLORATORY OBJECTIVES:
I. To explore the associations of gene expression signatures of taxane response and pathologic response to taxane chemotherapy.
II. To determine the associations of the BRCA1/(average [avg] BLM + FANCI) 3-gene messenger ribonucleic acid (mRNA) signature to pathologic response to neoadjuvant platinum-based chemotherapy or neoadjuvant taxane-based therapy in TNBC.
III. To determine the association of chromosome 15q26 copy number to pathologic response to neoadjuvant platinum-based chemotherapy in TNBC.
IV. To determine the associations of exome mutation number (Nmut) and proportion of mutational process D in exome mutation patterns to pathologic response to neoadjuvant platinum-based chemotherapy in TNBC.
V. To evaluate the relationship between chromosome 5 LOH, loss of Rad17, as well as PAM50 subtypes including basal and claudin low to pathologic response to neoadjuvant chemotherapy in TNBC.
VI. To explore the associations between molecularly defined TNBC subtypes to pathologic response to neoadjuvant chemotherapy in TNBC.
VII. To explore the proportion of triple negative cancers negative for germline BRCA1/2 mutations that test positive for an alternative genetic anomaly contained in the 25-gene hereditary cancer panel (HCP) profile.
VIII. To evaluate the association of intratumoral and stromal lymphocytes and pathologic response to taxane or cisplatin chemotherapy.
IX. To explore genomic alterations in circulating tumor deoxyribonucleic acid (DNA) before and after protocol treatment and compare them with the alterations observed in the archival tumor sample.
X. To explore relationships between predicters of pathologic response and clinical outcomes.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive cisplatin intravenously (IV) over 60 minutes on day 1.
ARM II: Patients receive paclitaxel IV over 60 minutes on days 1, 8, and 15. Patients with residual disease after 12 weeks of treatment may crossover to Arm I.
In both arms, treatment repeats every 3 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Within 42 days after administration of the last dose of chemotherapy, patients undergo definitive breast surgery.
After completion of study treatment, patients are followed up for 4 months.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationDana-Farber Harvard Cancer Center
Principal InvestigatorErica L. Mayer
- Primary ID13-383
- Secondary IDsNCI-2014-00955, 030, TBCRC 030, TBCRC: 030
- ClinicalTrials.gov IDNCT01982448