Carboplatin and Paclitaxel followed by Doxorubicin and Cyclophosphamide in Treating Patients with Triple Negative Breast Cancer
This phase II trial studies how well carboplatin and paclitaxel followed by doxorubicin and cyclophosphamide work in treating patients with triple negative breast cancer. Drugs used in chemotherapy, such as carboplatin, paclitaxel, doxorubicin, and cyclophosphamide, 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.
Inclusion Criteria
- Subjects must have histologically or cytologically confirmed invasive breast cancer which meets the following criteria: * Estrogen receptor (ER) and progesterone receptor (PR)-negative as defined by local standard clinical immunohistochemistry (IHC) < 1% * HER2-negative using local standard testing; negative is defined as IHC 0 or 1+ (if 2+, must reflex to in-situ hybridization [ISH] method); if ISH method is used, ratio < 2 is considered negative * Clinical tumor size of at least 2.1 cm (T2) by palpation or imaging, regardless of the ipsilateral regional lymph node status, or any tumor size but with ipsilateral regional lymph nodes involved by the tumor (any T if ipsilateral regional node positive); subjects with inflammatory breast cancer are eligible; if bilateral breast cancer is present, the subject is eligible if the contralateral tumor is ductal breast carcinoma in situ (DCIS) only (without any invasive disease on biopsy) or another invasive breast cancer of any size that is also ER, PR and HER2 negative * Any radiographic abnormal ipsilateral regional lymph nodes or any clinically concerning ipsilateral regional lymph nodes with the exception of internal mammary nodes, should be sampled with a percutaneous biopsy, but no sentinel axillary lymph node mapping/biopsy is allowed before chemotherapy; if clinically node negative (cNO) pre-chemotherapy ipsilateral sentinel axillary lymph node mapping/biopsy is not allowed
- Candidate for neoadjuvant chemotherapy
- Eastern Cooperative Oncology Group (ECOG) performance status =< 1
- Left ventricular ejection fraction (LVEF) >= lower limit of normal (LLN) (per institutional normal) determined by echocardiogram or nuclear medicine scan, within 30 days of registration
- Hemoglobin > 9.5 g/dL
- Absolute neutrophil count >= institutional lower limit
- Platelets >= institutional lower limit
- Total bilirubin =< 1.25 x institutional upper limit
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) =< 2.5 times institutional upper limit
- Serum creatinine or creatinine clearance =< institutional upper limit or >= 60 mL/min creatinine clearance for patients with serum creatinine > institutional upper limit
- Non-pregnant; women of childbearing potential must have a negative pregnancy test (human chorionic gonadotropin [HCG] serum or urine) within 30 days prior to study registration and to be repeated if not done within 7 days of starting chemotherapy; it is not known what effects this treatment has on human pregnancy or development of the embryo or fetus; therefore, female subjects participating in this study should avoid becoming pregnant, and male subjects should avoid impregnating a female partner; non-sterilized female subjects of reproductive age and male subjects should use effective methods of contraception through defined periods during and after study treatment as specified below * Female subjects must meet one of the following: ** Natural postmenopausal before the screening visit defined as no menses at any time in the preceding 12 consecutive months, or ** Prior bilateral oophorectomy or bilateral tubal ligation, or ** If they are of childbearing potential, agree to practice two effective methods of contraception per discussion with the treating physicians from the time of signing of the informed consent form through three months after the last dose of study drug, or ** Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject; (periodic abstinence [e.g., calendar, ovulation, symptothermal, post ovulation methods] and withdrawal are not acceptable contraception methods) * Male subjects, even if surgically sterilized (i.e., status post vasectomy) must agree to one of the following: ** Practice effective barrier contraception during the entire study treatment period and through 90 days after the last study drug dose, or ** Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject; (periodic abstinence [e.g., calendar, ovulation, symptothermal, post ovulation methods] and withdrawal are not acceptable methods of contraception)
- Ability to understand a written informed consent document, and the willingness to sign it
Exclusion Criteria
- Prior chemotherapy or radiation therapy for invasive breast cancer within 6 months before registration
- Prior investigational drugs or interventions for invasive breast cancer treatment within 6 months before registration are not allowed; prior participation in window-of-opportunity trials without therapeutic intent is allowed if intervention is no more than 3 weeks in duration
- Stage IV metastatic breast cancer
- History of allergic reactions attributed to compounds of similar chemical composition to chemotherapy to be used in this study
- Breastfeeding women; cytotoxic chemotherapy is drug with the potential for teratogenic or abortifacient effects; due to unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with cytotoxic chemotherapy, breastfeeding should be discontinued
- Baseline peripheral neuropathy of severity > grade 1
- Other invasive cancer diagnosis within the past 5 years other than non-melanoma skin cancer
- Prior axillary lymph node dissection that preclude patient from surgical evaluation of axillary lymph node status
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT03301350.
PRIMARY OBJECTIVE:
I. To determine the pathologic response rate to low dose weekly carboplatin in combination with weekly paclitaxel regimen followed by dose dense doxorubicin/cyclophosphamide (AC) given in neoadjuvant setting for women with triple negative breast cancer (TNBC).
SECONDARY OBJECTIVES:
I. To evaluate the number of cycles, doses and delays of low dose weekly carboplatin/paclitaxel regimen administered.
II. To describe any treatment-related toxicity from the low dose weekly carboplatin/paclitaxel regimen.
III. To evaluate two-year invasive disease-free survival after treatment with this neoadjuvant regimen.
IV. To evaluate the two-year overall survival after treatment with this neoadjuvant regimen.
EXPLORATORY OBJECTIVE:
I. To store blood and tumor tissue for future studies to explore biomarkers of response to carboplatin and paclitaxel in TNBC.
OUTLINE:
Patients receive paclitaxel intravenously (IV) over 60 minutes and carboplatin IV over 60 minutes on days 1, 8, and 15. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Beginning cycle 5, patients receive doxorubicin IV over 3-5 minutes and cyclophosphamide IV over 30-60 minutes on day 1. Treatment repeats every 14 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days and then every 6 months for up to 2 years.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationUniversity of Wisconsin Carbone Cancer Center - University Hospital
Principal InvestigatorKari Braun Wisinski
- Primary IDUW16112
- Secondary IDsNCI-2017-01705, 2017-0547
- ClinicalTrials.gov IDNCT03301350