Cyclophosphamide, Methotrexate, and Fluorouracil, With or Without Epirubicin Hydrochloride, in Treating Women Who Have Undergone Surgery for Breast Cancer (Group III Closed to New Patients as of 12/7/2009)
Primary Purpose
Breast Cancer
Status
Unknown status
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
cyclophosphamide
epirubicin hydrochloride
fluorouracil
methotrexate
laboratory biomarker analysis
adjuvant therapy
Sponsored by
About this trial
This is an interventional treatment trial for Breast Cancer focused on measuring stage I breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed breast cancer
- Underwent radical mastectomy, guadrantectomy, or tumorectomy with axillary node dissection within the past 4-6 weeks
- Biologically aggressive disease
At least 10 lymph nodes removed
Node-negative (> 1 cm, or > 2 cm if histology is favorable, esp. tubular carcinoma and/or prevalent intraductal component > 50%) tumors OR node-positive (1-3) tumors, meeting the following criteria:
- High thymidine-labeling index (> 3%)
- Poorly differentiated tumor (grade III)
- High S-phase fraction (> 10% by flow cytometry)
- High Ki67/MIB1 expression (< 20%)
- No bilateral breast cancer
- No T4a, inoperable T4b, T4c, or T4d disease
- Any estrogen receptor status (positive, negative, unknown)
- No distant metastases
PATIENT CHARACTERISTICS:
- Any menopause status
- WBC ≥ 3,500/mL
- ANC ≥ 1,500/mL
- Platelet count ≥ 120,000/mL
- AST and ALT ≤ 1.5 times upper limit of normal (ULN)
- Creatinine ≤ 1.5 mg/mL
- Bilirubin ≤ 1.5 times ULN
- Not pregnant
- Geographically accessible for follow-up
- No prior breast cancer and/or other cancer except for carcinoma in situ of the cervix or basal cell skin cancer treated with radical intent
- No significant alterations in cardiovascular function
- No serious psychiatric disorders
- No impaired renal or liver function
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
Sites / Locations
Outcomes
Primary Outcome Measures
Overall survival
Secondary Outcome Measures
Disease-free survival
Toxicity
Quality of life
Efficacy in subgroups of patients
Full Information
NCT ID
NCT01031030
First Posted
December 11, 2009
Last Updated
August 1, 2013
Sponsor
Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori
1. Study Identification
Unique Protocol Identification Number
NCT01031030
Brief Title
Cyclophosphamide, Methotrexate, and Fluorouracil, With or Without Epirubicin Hydrochloride, in Treating Women Who Have Undergone Surgery for Breast Cancer (Group III Closed to New Patients as of 12/7/2009)
Official Title
Adjuvant Treatment of Biologically Aggressive Breast Cancer (N-,N+1,3): Controlled Clinical Study
Study Type
Interventional
2. Study Status
Record Verification Date
December 2009
Overall Recruitment Status
Unknown status
Study Start Date
November 1997 (undefined)
Primary Completion Date
December 2010 (Anticipated)
Study Completion Date
undefined (undefined)
3. Sponsor/Collaborators
Name of the Sponsor
Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori
4. Oversight
5. Study Description
Brief Summary
RATIONALE: Drugs used in chemotherapy, such as cyclophosphamide, methotrexate, fluorouracil, and epirubicin hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether giving cyclophosphamide together with methotrexate and fluorouracil before, after, or without epirubicin hydrochloride is more effective in treating patients with breast cancer that can be removed by surgery.
PURPOSE: This randomized phase III trial is comparing three regimens of cyclophosphamide given together with methotrexate and fluorouracil, with or without epirubicin hydrochloride, to see how well it works in treating women who have undergone surgery for breast cancer. (Group III was closed to new patients as of 12/7/2009.)
Detailed Description
OBJECTIVES:
Primary
To determine the impact of adjuvant chemotherapy comprising epirubicin hydrochloride followed by cyclophosphamide, methotrexate, and fluorouracil versus cyclophosphamide, methotrexate, and fluorouracil followed by epirubicin hydrochloride versus cyclophosphamide, methotrexate, and fluorouracil on overall survival of patients with biologically aggressive, resectable, node-negative or node-positive breast cancer.
Secondary
To assess the disease-free survival and patterns of relapse in these patients.
To assess the tolerance to and toxicity of treatment in these patients.
To determine the quality of life of these patients.
To verify the effectiveness of these treatments in different subgroups of patients.
To collect, retrospectively, information on the expression of tumor suppressor gene p53, oncogene c-erbB-2, and bcl-2 protein involved in apoptosis. (exploratory)
OUTLINE: This is a multicenter study. Patients are stratified according to center, lymph node status (N0 vs N1-3), and estrogen receptor status (negative vs positive). Patients are randomized to 1 of 3 treatment arms.
Arm I: Beginning 4-6 weeks following surgery, patients receive epirubicin hydrochloride IV on day 1. Treatment repeats every 3 weeks for 4 courses. Patients then receive cyclophosphamide IV, methotrexate IV, and fluorouracil IV on days 1-8. Treatment repeats every 4 weeks for 4 courses.
Arm II: Beginning 4-6 weeks following surgery, patients receive cyclophosphamide IV, methotrexate IV, and fluorouracil IV on days 1-8. Treatment repeats every 4 weeks for 4 courses. Patients then receive epirubicin hydrochloride IV on day 1. Treatment repeats every 3 weeks for 4 courses.
Arm III (closed to accrual as of 12/7/2009): Beginning 4-6 weeks following surgery, patients receive cyclophosphamide IV, methotrexate IV, and fluorouracil IV on days 1-8. Treatment repeats every 4 weeks for 6 courses.
Patients with estrogen receptor-positive disease receive tamoxifen daily for 5 years after completing chemotherapy.
After completion of study therapy, patients are followed every 3 months for 1 year, every 6 months for 4 years, and then annually for 5 years.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
stage I breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Masking
None (Open Label)
Allocation
Randomized
Enrollment
800 (Anticipated)
8. Arms, Groups, and Interventions
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Intervention Type
Drug
Intervention Name(s)
epirubicin hydrochloride
Intervention Type
Drug
Intervention Name(s)
fluorouracil
Intervention Type
Drug
Intervention Name(s)
methotrexate
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Type
Procedure
Intervention Name(s)
adjuvant therapy
Primary Outcome Measure Information:
Title
Overall survival
Secondary Outcome Measure Information:
Title
Disease-free survival
Title
Toxicity
Title
Quality of life
Title
Efficacy in subgroups of patients
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed breast cancer
Underwent radical mastectomy, guadrantectomy, or tumorectomy with axillary node dissection within the past 4-6 weeks
Biologically aggressive disease
At least 10 lymph nodes removed
Node-negative (> 1 cm, or > 2 cm if histology is favorable, esp. tubular carcinoma and/or prevalent intraductal component > 50%) tumors OR node-positive (1-3) tumors, meeting the following criteria:
High thymidine-labeling index (> 3%)
Poorly differentiated tumor (grade III)
High S-phase fraction (> 10% by flow cytometry)
High Ki67/MIB1 expression (< 20%)
No bilateral breast cancer
No T4a, inoperable T4b, T4c, or T4d disease
Any estrogen receptor status (positive, negative, unknown)
No distant metastases
PATIENT CHARACTERISTICS:
Any menopause status
WBC ≥ 3,500/mL
ANC ≥ 1,500/mL
Platelet count ≥ 120,000/mL
AST and ALT ≤ 1.5 times upper limit of normal (ULN)
Creatinine ≤ 1.5 mg/mL
Bilirubin ≤ 1.5 times ULN
Not pregnant
Geographically accessible for follow-up
No prior breast cancer and/or other cancer except for carcinoma in situ of the cervix or basal cell skin cancer treated with radical intent
No significant alterations in cardiovascular function
No serious psychiatric disorders
No impaired renal or liver function
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dino Amadori, MD
Organizational Affiliation
Morgagni-Pierantoni Ospedale
Official's Role
Principal Investigator
12. IPD Sharing Statement
Citations:
PubMed Identifier
26206258
Citation
Farolfi A, Scarpi E, Rocca A, Mangia A, Biglia N, Gianni L, Tienghi A, Valerio MR, Gasparini G, Amaducci L, Faedi M, Baldini E, Rubagotti A, Maltoni R, Paradiso A, Amadori D. Time to initiation of adjuvant chemotherapy in patients with rapidly proliferating early breast cancer. Eur J Cancer. 2015 Sep;51(14):1874-81. doi: 10.1016/j.ejca.2015.07.003. Epub 2015 Jul 20.
Results Reference
derived
Learn more about this trial
Cyclophosphamide, Methotrexate, and Fluorouracil, With or Without Epirubicin Hydrochloride, in Treating Women Who Have Undergone Surgery for Breast Cancer (Group III Closed to New Patients as of 12/7/2009)
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