Chemotherapy With or Without Bevacizumab in Treating Women With Stage I, Stage II, or Stage IIIA Breast Cancer That Can Be Removed By Surgery



Status:Active, not recruiting
Conditions:Breast Cancer, Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:18 - 120
Updated:4/21/2016
Start Date:November 2006
End Date:March 2016

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A Randomized Phase III Trial of Neoadjuvant Therapy in Patients With Palpable and Operable Breast Cancer Evaluating the Effect on Pathologic Complete Response (pCR) of Adding Capecitabine or Gemcitabine to Docetaxel When Administered Before AC With or Without Bevacizumab and Correlative Science Studies Attempting to Identify Predictors of High Likelihood for pCR With Each of the Regimens

RATIONALE: Drugs used in chemotherapy work in different ways to stop the growth of tumor
cells, either by killing the cells or by stopping them from dividing. Giving more than one
drug (combination chemotherapy) may kill more tumor cells. Monoclonal antibodies, such as
bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells
to grow and spread. Others find tumor cells and help kill them or carry tumor-killing
substances to them. Bevacizumab may also stop the growth of breast cancer by blocking blood
flow to the tumor. Giving chemotherapy and bevacizumab before surgery may make the tumor
smaller and reduce the amount of normal tissue that needs to be removed. Giving bevacizumab
after surgery may kill any tumor cells that remain after surgery. It is not yet known which
chemotherapy regimen is more effective with or without bevacizumab in treating breast
cancer.

PURPOSE: This randomized phase III trial is studying six different chemotherapy regimens to
compare how well they work with or without bevacizumab in treating women with stage I, stage
II, or stage IIIA breast cancer that can be removed by surgery.

OBJECTIVES:

Primary

- Compare the efficacy of docetaxel followed by doxorubicin hydrocloride and
cyclophosphamide (AC) vs docetaxel and capecitabine followed by AC vs docetaxel and
gemcitabine hydrochloride followed by AC, with or without bevacizumab, in terms of an
increase in the rate of pathologic complete response (pCR) in the breast, in women with
palpable or operable breast cancer.

Secondary

- Compare docetaxel/capecitabine with AC vs docetaxel/gemcitabine hydrochloride with AC
vs docetaxel with AC, with or without bevacizumab, in terms of the rate of pCR in the
breast and all post-therapy lymph nodes evaluated histologically (pCR breast and
nodes).

- Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based
regimens (docetaxel with AC, docetaxel and capecitabine with AC, and docetaxel and
gemcitabine hydrochloride with AC) will increase the rate of pCR of the breast and
nodes compared to the same docetaxel/anthracycline-based regimens without bevacizumab
in these patients.

- Determine whether the addition of capecitabine or gemcitabine hydrochloride to
docetaxel, with or without bevacizumab, will increase the rate of clinical overall
response (cOR) compared to docetaxel alone with or without bevacizumab in these
patients.

- Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based
regimens will increase the rate of cOR compared to the same
docetaxel/anthracycline-based regimens without bevacizumab in these patients.

- Determine whether the addition of capecitabine or gemcitabine hydrochloride to
docetaxel, with or without bevacizumab, will increase the rate of clinical complete
response (cCR) compared to docetaxel alone with or without bevacizumab in these
patients.

- Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based
regimens (docetaxel with AC, docetaxel/capecitabine with AC, and docetaxel/gemcitabine
hydrochloride with AC) will increase the rate of cCR compared to the same
docetaxel/anthracycline-based regimens without bevacizumab in these patients.

- Identify gene expression profiles that can predict pCR in patients treated with the
different sequential docetaxel/anthracycline-based regimens with or without
bevacizumab.

- Identify gene expression profiles that can predict cOR in patients treated with
docetaxel alone, docetaxel/capecitabine, or docetaxel/gemcitabine hydrochloride with or
without bevacizumab.

- Determine the accuracy of an in vitro chemoresponse assay (ChemoFx®) as a predictor of
pCR in patients treated with the different sequential docetaxel/anthracycline-based
regimens without bevacizumab.

- Determine the accuracy of ChemoFx® as a predictor of cOR in patients treated with
docetaxel alone, docetaxel/capecitabine, or docetaxel/gemcitabine hydrochloride without
bevacizumab in these patients.

- Determine the impact of preoperative bevacizumab and sequential chemotherapy regimens
and postoperative bevacizumab therapy on cardiac function in these patients.

- Determine the impact of bevacizumab on surgical complications in these patients.

- Determine the toxicity of the preoperative regimens and the toxicity of postoperative
bevacizumab in these patients.

- Compare the docetaxel/anthracycline-based regimens with vs without bevacizumab, in
terms of an increase in disease-free survival, of these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor
size (2-4 cm vs > 4 cm), nodal status (negative vs positive), hormone receptor status
(estrogen receptor [ER]-positive and/or progesterone-receptor [PgR]-positive vs ER- and
PgR-negative), and age (< 50 years vs ≥ 50 years). Patients are randomized to 1 of 6
treatment arms.

Core needle biopsies are performed at baseline. Tumor tissue samples are also collected
during definitive surgery. Samples are examined for gene expression and polymorphism by
reverse transcriptase-polymerase chain reaction analysis and chemoresponse assay (ChemoFx®).

After completion of study therapy, patients are followed periodically for 10 years.

PROJECTED ACCRUAL: A total of 1,200 patients will be accrued for this study.

Inclusion Criteria:

- The patient must have consented to participate and must have signed and dated an
appropriate Institutional Review Board (IRB)-approved consent form that conforms to
federal and institutional guidelines for the study treatment and submission of
pre-entry core biopsy material for correlative studies.

- Patients must be female.

- Patients must be 18 years of age or older.

- Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of
0 or 1.

- The diagnosis of invasive adenocarcinoma of the breast must have been made by core
needle biopsy.

- The primary breast tumor must be palpable and measure greater than or equal to 2.0 cm
on physical exam.

- All patients must have their left ventricular ejection fraction (LVEF) assessed by
multigated acquisition (MUGA) scan or echocardiogram within 3 months prior to study
entry. The LVEF must be greater than or equal to the lower limit of normal (LLN) for
the cardiac imaging facility performing the study. Note: If the cardiac imaging
facility cannot provide a LLN, use 50% as the LLN value.

- Note: Since the pre-entry LVEF serves as the baseline for comparing subsequent LVEF
assessments to determine if bevacizumab therapy can be continued, it is critical that
this baseline study be an accurate assessment of the patient's LVEF. If the baseline
LVEF is greater than 75%, the investigator should have the study reviewed for
accuracy prior to study entry. Following study entry, the LVEF determination may be
reviewed up until the time of the post-chemotherapy (preoperative) evaluation. Please
note that if a more accurate value is obtained from the review of the baseline MUGA
or echocardiogram, the correct value must be submitted to the NSABP before the
post-chemotherapy (preoperative) MUGA or echocardiogram is performed or it cannot be
used for managing postoperative bevacizumab.

- All patients must have an EKG within 3 months prior to study entry.

- At the time of randomization:

- Absolute neutrophil count (ANC) must be greater than or equal to 1200/mm3.

- Platelet count must be greater than or equal to 100,000/mm3.

- Hemoglobin must be greater than or equal to 10 g/dL.

- There must be evidence of adequate hepatic function by these criteria:

- Total bilirubin must be less than or equal to the ULN for the lab unless the
patient has a grade 1 bilirubin elevation (greater than ULN to 1.5 x ULN)
resulting from Gilbert's disease or similar syndrome due to slow conjugation of
bilirubin; and

- Alkaline phosphatase must be less than or equal 2.5 x ULN for the lab; and

- Aspartate Aminotransferase (AST) must be less than or equal to 1.5 x ULN for the
lab.

- Alkaline phosphatase and AST may not both be greater than the ULN. For example,
if the alkaline phosphatase is greater than the ULN but less than or equal 2.5 x
ULN, then the AST must be less than or equal the ULN. If the AST is greater than
the ULN but less than or equal 1.5 x ULN, then the alkaline phosphatase must be
less than or equal ULN.

- Patients with either skeletal pain or alkaline phosphatase that is greater than ULN
but less than or equal 2.5 x ULN are eligible for inclusion in the study if bone
scans do not demonstrate metastatic disease. Suspicious findings on bone scan must be
confirmed as benign by x-ray, MRI, or biopsy.

- Patients with AST or alkaline phosphatase greater than ULN are eligible for inclusion
in the study if liver imaging does not demonstrate metastatic disease and adequate
bone marrow and liver function results as described above are met.

- The following criteria for evidence of adequate renal function must be met:

- Serum creatinine less than or equal ULN for the lab.

- Calculated creatinine clearance must be greater than 50 mL/min.

- Urine protein/urine creatinine (UPC) ratio must be less than 1.0.

- Patient must be able to swallow oral medications.

Exclusion criteria:

- Tumor determined to be strongly human epidermal growth factor receptor 2
(HER2)-positive by immunohistochemistry (3+) or by fluorescent in situ hybridization
(positive for gene amplification).

- Excisional or incisional biopsy for this primary breast tumor.

- Surgical axillary staging procedure prior to study entry. Exceptions: 1) Fine Needle
Aspiration (FNA) or core biopsy of an axillary node is permitted for any patient, and
2) although not recommended, a pre-neoadjuvant therapy sentinel lymph node biopsy for
patients with clinically negative axillary nodes is permitted.

- Tumors clinically staged as T4.

- Ipsilateral cN2b or cN3 disease. (Patients with cN1 or cN2a disease are eligible.)

- Definitive clinical or radiologic evidence of metastatic disease.

- Synchronous bilateral breast cancer (invasive or DCIS).

- Treatment including radiation therapy, chemotherapy, biotherapy, and/or hormonal
therapy for the currently diagnosed breast cancer prior to study entry.

- Any sex hormonal therapy, e.g., birth control pills, ovarian hormonal replacement
therapy, etc. (These patients are eligible if this therapy is discontinued prior to
randomization.)

- Therapy with any hormonal agent such as raloxifene, tamoxifen, or other selective
estrogen receptor modulator (SERM), either for osteoporosis or breast cancer
prevention. (Patients are eligible only if these medications are discontinued prior
to randomization.)

- Prior history of breast cancer, including DCIS. (Patients with a history of lobular
carcinoma in situ [LCIS] are eligible.)

- Prior therapy with anthracyclines, taxanes, capecitabine, 5-FU, gemcitabine, or
bevacizumab for any malignancy.

- Other malignancies unless the patient is considered to be disease-free for 5 or more
years prior to randomization and is deemed by her physician to be at low risk for
recurrence. Patients with the following cancers are eligible if diagnosed and treated
within the past 5 years: carcinoma in situ of the cervix, carcinoma in situ of the
colon, melanoma in situ, and basal cell and squamous cell carcinoma of the skin.

- Cardiac disease that would preclude the use of anthracyclines. This includes:

- angina pectoris that requires the use of anti-anginal medication;

- history of documented congestive heart failure;

- serious cardiac arrhythmia requiring medication;

- severe conduction abnormality;

- valvular disease with documented cardiac function compromise; and

- uncontrolled hypertension defined as BP greater than 150/90 on antihypertensive
therapy. (Patients with hypertension that is well controlled on medication are
eligible.)

- History of myocardial infarction documented by elevated cardiac enzymes or persistent
regional wall abnormalities on assessment of LV function.

- History of transient ischemic attack (TIA) or cerebrovascular accident (CVA).

- History of other arterial thrombotic event within 12 months before study entry.

- Symptomatic peripheral vascular disease.

- Any significant non-traumatic bleeding within 6 months before study entry.

- Serious or non-healing wound, skin ulcers, or incompletely healed bone fracture.

- Gastroduodenal ulcer(s) determined by endoscopy to be active.

- Invasive procedures defined as follows:

- Major surgical procedure, open biopsy, or significant traumatic injury within 28
days prior to planned start of study therapy. (Note: Placement of a vascular
access device is not considered a major surgical procedure.)

- Anticipation of need for major surgical procedures (other than the required
breast surgery) during the course of the study.

- Known bleeding diathesis or coagulopathy. (Patients on warfarin with an in-range
international normalized ration [INR] [usually between 2 and 3] are eligible.)

- Sensory/motor neuropathy greater than or equal grade 2, as defined by the NCI's
Common Terminology Criteria for Adverse Events Version 3.0 (CTCAE v3.0).

- Other non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that
would preclude treatment with any of the treatment regimens or would prevent required
follow-up.

- Conditions that would prohibit administration of corticosteroids.

- History of severe hypersensitivity reaction to drugs formulated with polysorbate 80.

- Administration of any investigational agents within 30 days before study entry.

- Pregnancy or lactation at the time of proposed randomization.
We found this trial at
433
sites
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Kapiolani Medical Center for Women and Children Hawai‘i Pacific Health is an integrated health care...
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1200 S Cedar Crest Blvd
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2600 6th Street Southwest
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86 Jonathan Lucas Street
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Hollings Cancer Center at Medical University of South Carolina Located at the Medical University of...
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1025 Morehead Medical Dr # 600
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200 Hawthorne Lane
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115 Business loop 70 w
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100 North Academy Ave
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1 Hurley Plaza
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Hurley Medical Center From its founding in 1908, Hurley Medical Center has devoted itself to...
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1600 South Andrews Avenue
Fort Lauderdale, Florida 33316
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4725 North Federal Highway
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11143 Parkview Plaza Dr # 100
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33 Villa Road, Suite 400
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Grosse Pointe Woods, Michigan 48236
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85 Retreat Ave # 2
Hartford, Connecticut 06102
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701 Ilalo Street Suite 600
Honolulu, Hawaii 96813
808-586-3010
Cancer Research Center of Hawaii The University of Hawaii Cancer Center is the only National...
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2001 86th Street West
Indianapolis, Indiana 46260
(317) 338-2345
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200 Hawkins Drive
Iowa City, Iowa 52242
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1240 S Old Dixie Hwy
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524 South Park Street
Kalamazoo, Michigan 49007
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200 North Park Street
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1900 South Avenue
La Crosse, Wisconsin 54601
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Gundersen Lutheran Center for Cancer and Blood Gundersen Health System is where caring meets excellence...
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902 Savannah Road
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800 Rose St
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11234 Anderson Street
Loma Linda, California 92354
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4300 Alton Road
Miami Beach, Florida 33140
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2501 N Orange Ave # 235
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4800 Friendship Avenue
Pittsburgh, Pennsylvania 15224
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401 College Street
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4502 Medical Drive
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1717 S J St
Tacoma, Washington 98405
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42 E Laurel Rd # 2545
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825 N Emporia Ave
Wichita, Kansas 67214
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1 Medical Center Blvd
Winston-Salem, North Carolina 27103
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777 Kimole Ln
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517-265-0900
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98-1079 Moanalua Rd
Aiea, Hawaii 96701
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161 North Forge Street
Akron, Ohio 44304
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Akron, Ohio 44307
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American Fork, Utah 84003
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Ames, Iowa 50010
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Anderson, South Carolina 29621
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Ann Arbor, Michigan 48106
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5301 McAuley Drive
Ann Arbor, Michigan 48197
734-712-4673
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364 White Oak St
Asheboro, North Carolina 27203
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Asheville, North Carolina 28816
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Auburn, Washington 98002
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700 Potomac St
Aurora, Colorado 80012
(303) 363-7200
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900 Caton Ave.
Baltimore, Maryland 21229
410-368-6000
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6701 North Charles Street
Baltimore, Maryland 21204
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Barberton, Ohio 44203
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Baton Rouge, Louisiana 70809
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4950 Essen Ln
Baton Rouge, Louisiana 70809
(225) 767-0847
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8111 South Emerson Avenue
Beech Grove, Indiana 46237
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130 Fisher Road
Berlin, Vermont 05602
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Bethlehem, Pennsylvania 18015
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2900 12th Ave N Ste 160W
Billings, Montana 59101
(406) 238-6290
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1101 N 27th St # 201
Billings, Montana 59101
(406) 237-3585
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Billings, Montana 59101
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Billings, Montana 59107
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2200 E Washington St,
Bloomington, Illinois 61701
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931 Highland Blvd
Bozeman, Montana 59715
(406) 585-5070
Bozeman Deaconess Cancer Center Bozeman Deaconess Cancer Center provides the latest cancer technologies and treatment...
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Bozeman, MT
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Bronx, NY
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130 S Bryn Mawr Ave
Bryn Mawr, Pennsylvania 19010
(484) 337-3000
Bryn Mawr Hospital Bryn Mawr Hospital, a nationally recognized community teaching hospital, is conveniently located...
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Bryn Mawr, PA
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Burlington, NC
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Burlington, VT
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201 E Nicollet Blvd
Burnsville, Minnesota 55337
(952) 892-2000
Fairview Ridges Hospital Fairview Ridges Hospital is a 150-bed, Level III Trauma Care facility, offering...
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Burnsville, MN
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400 S Clark St
Butte, Montana 59701
(406) 723-2616
St. James Healthcare Cancer Care The St. James Cancer Center is an integrated cancer treatment...
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Butte, MT
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210 W Walnut St
Canton, Illinois 61520
(309) 647-5240
Graham Hospital At Graham Hospital, we have a proud and rich history of serving the...
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Canton, IL
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210 W Walnut St
Canton, Illinois 61520
309-647-5240
Illinois CancerCare - Canton Illinois CancerCare is one of the largest private oncology and hematology...
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Canton, IL
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211 Saint Francis Drive
Cape Girardeau, Missouri 63703
573-331-3000
Saint Francis Medical Center Saint Francis Medical Center is a 282-bed facility serving more than...
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Cape Girardeau, MO
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160 S Adams St
Carthage, Illinois 62321
(217) 357-6877
Illinois CancerCare - Carthage Illinois CancerCare, P.C. is a comprehensive practice treating patients withcancer andblood...
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Carthage, IL
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1454 North County Road 2050
Carthage, Illinois 62321
(217) 357-8500
Memorial Hospital Memorial Hospital is a vital force in establishing and maintaining the well-being of...
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Carthage, IL
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Castro Valley, California 94546
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Castro Valley, CA
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20055 Lake Chabot Rd #130
Castro Valley, California 94546
(510) 888-0657
Valley Medical Oncology Consultants - Castro Valley Valley Medical Oncology Consultants (VMOC) has been helping...
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Castro Valley, CA
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20126 Stanton Ave
Castro Valley, California 94546
(510) 581-0556
East Bay Radiation Oncology Center East Bay Radiation Oncology Center offers superior medical and technical...
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Castro Valley, CA
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1303 North Main Street
Cedar City, Utah 84721
(435) 868-5680
Sandra L. Maxwell Cancer Center The Huntsman-Intermountain Cancer Center at Valley View Medical Center in...
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Cedar City, UT
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914 S Scheuber Rd
Centralia, Washington 98531
(360) 736-2803
Providence Centralia Hospital We are a 127-bed, not for profit hospital providing emergency, diagnostic, cancer,...
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Centralia, WA
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505 S Plummer Ave
Chanute, Kansas 66720
(620) 431-7580
Cancer Center of Kansas, PA - Chanute Dr. H.E. Hynes founded Cancer Center of Kansas,...
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Chanute, KS
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Charleston, South Carolina 29401
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Charleston, SC
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3110 MacCorkle Ave. S.E.
Charleston, West Virginia 25304
304-347-1206
West Virginia University Health Sciences Center - Charleston The West Virginia University Robert C. Byrd...
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Charleston, WV
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1653 W. Congress Parkway
Chicago, Illinois 60612
(312) 942-5000
Rush University Medical Center Rush University Medical Center encompasses a 664-bed hospital serving adults and...
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Chicago, IL
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1969 W Ogden Ave
Chicago, Illinois 60612
(312) 864-6000
John H. Stroger, Jr. Hospital of Cook County The Level 1 Trauma Center is one...
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Chicago, IL
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Chicago, Illinois 60608
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Chicago, IL
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12961 27th Ave
Chippewa Falls, Wisconsin 54729
715-738-3700
Marshfield Clinic - Chippewa Center The 15,000 square foot Lake Hallie Center provides urgent care...
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Chippewa Falls, WI
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11100 Euclid Avenue
Cleveland, Ohio 44106
216.844.8797
Case Comprehensive Cancer Center The Case Comprehensive Cancer Center (Case CCC) based at Case Western...
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Cleveland, OH
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Clyde, OH
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Coeur d'Alene, Idaho 83814
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Coeur d'Alene, ID
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2222 N. Nevada Avenue
Colorado Springs, Colorado 80907
(719) 776-5000
Penrose Cancer Center at Penrose Hospital Through a full range of clinical trials, genetic counseling,...
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Colorado Springs, CO
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