Neoadjuvant Study of Two Platinum Regimens in Triple Negative Breast Cancer (NeoSTOP)
Primary Purpose
Triple-negative Breast Cancer
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Paclitaxel
Carboplatin
Doxorubicin
Cyclophosphamide
Docetaxel
Sponsored by
About this trial
This is an interventional treatment trial for Triple-negative Breast Cancer focused on measuring TNBC, breast cancer, neoadjuvant, carboplatin, docetaxel, paclitaxel, doxorubicin, cyclophosphamide
Eligibility Criteria
Inclusion Criteria:
- Patients with newly diagnosed stage I (T>1cm), II or III triple negative breast cancer who have not had definitive breast surgery or received systemic chemotherapy
- The invasive tumor must be hormone receptor-poor, defined as both estrogen receptor and progesterone receptor staining present in ≤ 10% of invasive cancer cells by Immunohistochemistry.
- HER- 2 negativity will be based on the current ASCO-CAP guidelines for HER testing
- No prior chemotherapy, endocrine therapy or radiation therapy with therapeutic intent for this cancer
- Female subjects age 18 - 70 years
- ECOG Performance Status of 0-1
Adequate organ and marrow function as defined below:
- Leukocytes ≥ 3,000/uL
- Absolute neutrophil count ≥ 1500/uL
- Platelets ≥ 100,000/uL
- Total bilirubin ≤ 1.5mg/dL
- AST(SGOT)/ALT(SPGT) ≤ 2 x institutional upper limit of normal
- Creatinine ≤ 1.5mg/dl and/or Creatinine Clearance ≥ 60mL/min
- Serum albumin ≥ 3.0 g/dL
- Women of child-bearing potential must agree to use adequate contraception
- Pretreatment lab values must be performed within 14 days of treatment initiation, and other baseline studies performed within 30 days prior to registration
- Subjects should have LVEF ≥ 50% by echocardiogram or MUGA scan performed within 4 weeks prior to treatment initiation
- Subjects should have breast and axillary imaging with breast MRI or breast and axillary ultrasound within 4 weeks prior to treatment initiation
- Subjects with clinically/radiologically abnormal axillary lymph nodes should have pathological confirmation of disease with image guided biopsy/fine needle aspiration.
- Subjects must be already enrolled in P.R.O.G.E.C.T observational registry
- Staging to rule out metastatic disease is recommended for subjects with clinical stage III disease
- Subjects with bilateral disease are eligible if they meet other eligibility criteria.
- Neuropathy: No baseline neuropathy grade > 2
Exclusion Criteria:
- Current or anticipated use of other investigational agents
- Subject has received chemotherapy, radiotherapy or surgery for the treatment of breast cancer
- Subject with metastatic disease
- History of allergic reactions to compounds of similar chemical or biologic composition to carboplatin, docetaxel, doxorubicin, cyclophosphamide, paclitaxel, or other agents used in the study
- Subjects with inflammatory breast cancer
- Uncontrolled intercurrent illness including, but not limited to ongoing or active infection or psychiatric illness/social situations that would limit compliance with study requirements
- Subject is pregnant or nursing
- Subjects with concomitant or previous malignancies within the last 5 years. Exceptions include: adequately treated basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, and ductal carcinoma in situ (DCIS).
- Ejection Fraction <50% on ECHO or MUGA
- Cardiac function: Subjects with congestive heart failure, myocardial infarction, unstable angina pectoris, an arterial thrombotic event, stroke or transient ischemia attack within the past 12 months, uncontrolled hypertension (Systolic BP>160 or Diastolic BP>90), uncontrolled or symptomatic arrhythmia, or grade ≥ 2 peripheral vascular disease
Sites / Locations
- University of Kansas Cancer Center - CRC
- Hays Medical Center
- University of Kansas Cancer Center - Overland Park
- Salina Regional Health Center
- University of Kansas Cancer Center - Westwood
- Truman Medical Center
- University of Kansas Cancer Center - South
- University of Kansas Cancer Center - North
- University of Kansas Cancer Center - Lee's Summit
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Active Comparator
Arm Label
Carboplatin + Paclitaxel then Doxorubicin + Cyclophosphamide
Carboplatin + Docetaxel
Arm Description
Paclitaxel (80mg/m2) given IV every week x12 weeks and Carboplatin (AUC 6) given IV every 21 days x 4 cycles, followed by Doxorubicin (60mg/m2) given IV and Cyclophosphamide (600mg/m2) given IV every 14 days X 4 cycles
Carboplatin (AUC 6) given IV and Docetaxel (75mg/m2) given IV every 21 days x 6 cycles
Outcomes
Primary Outcome Measures
Number of Participants With Pathological Complete Response
To evaluate the pathological complete response rates with neoadjuvant chemotherapy regimens of carboplatin plus paclitaxel x 4 cycles followed by doxorubicin plus cyclophosphamide X 4 cycles and carboplatin plus docetaxel X 6 cycles in subjects with stage I-III triple-negative breast cancer. Pathological complete response is defined as no evidence of disease in the breast and axilla at the time of pathology review except for DCIS.
Secondary Outcome Measures
Number of Participants With Minimal Residual Disease
To evaluate minimal residual disease rates (residual cancer burden 0+1) with two neoadjuvant chemotherapy regimens in subjects with stage I-III triple-negative breast cancer.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02413320
Brief Title
Neoadjuvant Study of Two Platinum Regimens in Triple Negative Breast Cancer
Acronym
NeoSTOP
Official Title
Randomized Open Label Phase II Trial of Neoadjuvant Carboplatin Plus Docetaxel or Carboplatin Plus Paclitaxel Followed by Doxorubicin Plus Cyclophosphamide in Stage I-III Triple-negative Breast Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
July 2015 (undefined)
Primary Completion Date
February 1, 2019 (Actual)
Study Completion Date
February 1, 2020 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Priyanka Sharma
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Evaluate if the two carboplatin containing chemotherapy regimens will reduce the growth of breast cancer cells in women with Stage I, II, or III triple negative breast cancer.
Detailed Description
Sporadic and germline BRCA mutation associated triple-negative breast cancer share several pathological and molecular similarities which have led to the exploration of DNA damaging agents like platinum compounds in patients with triple-negative breast cancer. Recent studies demonstrate that addition of neoadjuvant carboplatin to doxorubicin/cyclophosphamide/taxane-based chemotherapy improves pathological complete response in patients with stage I-III triple-negative breast cancer but also increase toxicity.
A recent study reported encouraging pathological complete response rates with a non-anthracycline carboplatin plus docetaxel neoadjuvant chemotherapy regimen in a cohort of 49 triple negative breast cancer patients. This chemotherapy regimen of carboplatin plus docetaxel yielded an overall pathological complete response rate of 65% in unselected triple-negative breast cancer with pathological complete response rates of 61% in sporadic and 77% in germline BRCA-associated triple-negative breast cancer. The chemotherapy regimen of carboplatin/docetaxel is well tolerated and should be studied further and compared with regimens that add carboplatin to the standard anthracycline/taxane containing regimens.
This is the basis for the proposed randomized neoadjuvant phase II study to further estimate and compare pathological complete response rates of carboplatin plus docetaxel x 6 cycles to carboplatin plus paclitaxel x 4 cycles followed by doxorubicin plus cyclophosphamide x 4 cycles in stage I-III triple negative-breast cancer.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Triple-negative Breast Cancer
Keywords
TNBC, breast cancer, neoadjuvant, carboplatin, docetaxel, paclitaxel, doxorubicin, cyclophosphamide
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
101 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Carboplatin + Paclitaxel then Doxorubicin + Cyclophosphamide
Arm Type
Active Comparator
Arm Description
Paclitaxel (80mg/m2) given IV every week x12 weeks and Carboplatin (AUC 6) given IV every 21 days x 4 cycles, followed by Doxorubicin (60mg/m2) given IV and Cyclophosphamide (600mg/m2) given IV every 14 days X 4 cycles
Arm Title
Carboplatin + Docetaxel
Arm Type
Active Comparator
Arm Description
Carboplatin (AUC 6) given IV and Docetaxel (75mg/m2) given IV every 21 days x 6 cycles
Intervention Type
Drug
Intervention Name(s)
Paclitaxel
Other Intervention Name(s)
taxol
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Other Intervention Name(s)
paraplatin
Intervention Type
Drug
Intervention Name(s)
Doxorubicin
Other Intervention Name(s)
adriamycin
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
cytoxin, procytox
Intervention Type
Drug
Intervention Name(s)
Docetaxel
Other Intervention Name(s)
taxotere
Primary Outcome Measure Information:
Title
Number of Participants With Pathological Complete Response
Description
To evaluate the pathological complete response rates with neoadjuvant chemotherapy regimens of carboplatin plus paclitaxel x 4 cycles followed by doxorubicin plus cyclophosphamide X 4 cycles and carboplatin plus docetaxel X 6 cycles in subjects with stage I-III triple-negative breast cancer. Pathological complete response is defined as no evidence of disease in the breast and axilla at the time of pathology review except for DCIS.
Time Frame
20 weeks
Secondary Outcome Measure Information:
Title
Number of Participants With Minimal Residual Disease
Description
To evaluate minimal residual disease rates (residual cancer burden 0+1) with two neoadjuvant chemotherapy regimens in subjects with stage I-III triple-negative breast cancer.
Time Frame
20 weeks
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients with newly diagnosed stage I (T>1cm), II or III triple negative breast cancer who have not had definitive breast surgery or received systemic chemotherapy
The invasive tumor must be hormone receptor-poor, defined as both estrogen receptor and progesterone receptor staining present in ≤ 10% of invasive cancer cells by Immunohistochemistry.
HER- 2 negativity will be based on the current ASCO-CAP guidelines for HER testing
No prior chemotherapy, endocrine therapy or radiation therapy with therapeutic intent for this cancer
Female subjects age 18 - 70 years
ECOG Performance Status of 0-1
Adequate organ and marrow function as defined below:
Leukocytes ≥ 3,000/uL
Absolute neutrophil count ≥ 1500/uL
Platelets ≥ 100,000/uL
Total bilirubin ≤ 1.5mg/dL
AST(SGOT)/ALT(SPGT) ≤ 2 x institutional upper limit of normal
Creatinine ≤ 1.5mg/dl and/or Creatinine Clearance ≥ 60mL/min
Serum albumin ≥ 3.0 g/dL
Women of child-bearing potential must agree to use adequate contraception
Pretreatment lab values must be performed within 14 days of treatment initiation, and other baseline studies performed within 30 days prior to registration
Subjects should have LVEF ≥ 50% by echocardiogram or MUGA scan performed within 4 weeks prior to treatment initiation
Subjects should have breast and axillary imaging with breast MRI or breast and axillary ultrasound within 4 weeks prior to treatment initiation
Subjects with clinically/radiologically abnormal axillary lymph nodes should have pathological confirmation of disease with image guided biopsy/fine needle aspiration.
Subjects must be already enrolled in P.R.O.G.E.C.T observational registry
Staging to rule out metastatic disease is recommended for subjects with clinical stage III disease
Subjects with bilateral disease are eligible if they meet other eligibility criteria.
Neuropathy: No baseline neuropathy grade > 2
Exclusion Criteria:
Current or anticipated use of other investigational agents
Subject has received chemotherapy, radiotherapy or surgery for the treatment of breast cancer
Subject with metastatic disease
History of allergic reactions to compounds of similar chemical or biologic composition to carboplatin, docetaxel, doxorubicin, cyclophosphamide, paclitaxel, or other agents used in the study
Subjects with inflammatory breast cancer
Uncontrolled intercurrent illness including, but not limited to ongoing or active infection or psychiatric illness/social situations that would limit compliance with study requirements
Subject is pregnant or nursing
Subjects with concomitant or previous malignancies within the last 5 years. Exceptions include: adequately treated basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, and ductal carcinoma in situ (DCIS).
Ejection Fraction <50% on ECHO or MUGA
Cardiac function: Subjects with congestive heart failure, myocardial infarction, unstable angina pectoris, an arterial thrombotic event, stroke or transient ischemia attack within the past 12 months, uncontrolled hypertension (Systolic BP>160 or Diastolic BP>90), uncontrolled or symptomatic arrhythmia, or grade ≥ 2 peripheral vascular disease
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Priyanka Sharma, MD
Organizational Affiliation
University of Kansas Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Kansas Cancer Center - CRC
City
Fairway
State/Province
Kansas
ZIP/Postal Code
66205
Country
United States
Facility Name
Hays Medical Center
City
Hays
State/Province
Kansas
ZIP/Postal Code
67601
Country
United States
Facility Name
University of Kansas Cancer Center - Overland Park
City
Overland Park
State/Province
Kansas
ZIP/Postal Code
66210
Country
United States
Facility Name
Salina Regional Health Center
City
Salina
State/Province
Kansas
ZIP/Postal Code
67401
Country
United States
Facility Name
University of Kansas Cancer Center - Westwood
City
Westwood
State/Province
Kansas
ZIP/Postal Code
66205
Country
United States
Facility Name
Truman Medical Center
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64108
Country
United States
Facility Name
University of Kansas Cancer Center - South
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64131
Country
United States
Facility Name
University of Kansas Cancer Center - North
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64154
Country
United States
Facility Name
University of Kansas Cancer Center - Lee's Summit
City
Lee's Summit
State/Province
Missouri
ZIP/Postal Code
64064
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
33208340
Citation
Sharma P, Kimler BF, O'Dea A, Nye L, Wang YY, Yoder R, Staley JM, Prochaska L, Wagner J, Amin AL, Larson K, Balanoff C, Elia M, Crane G, Madhusudhana S, Hoffmann M, Sheehan M, Rodriguez R, Finke K, Shah R, Satelli D, Shrestha A, Beck L, McKittrick R, Pluenneke R, Raja V, Beeki V, Corum L, Heldstab J, LaFaver S, Prager M, Phadnis M, Mudaranthakam DP, Jensen RA, Godwin AK, Salgado R, Mehta K, Khan Q. Randomized Phase II Trial of Anthracycline-free and Anthracycline-containing Neoadjuvant Carboplatin Chemotherapy Regimens in Stage I-III Triple-negative Breast Cancer (NeoSTOP). Clin Cancer Res. 2021 Feb 15;27(4):975-982. doi: 10.1158/1078-0432.CCR-20-3646. Epub 2020 Nov 18.
Results Reference
result
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Neoadjuvant Study of Two Platinum Regimens in Triple Negative Breast Cancer
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