• Pathologic complete response and near pathologic complete response [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• Define the rate of pathologic complete response and near pathologic complete response in the affected breast after the preoperative administration of oxidized glutathione (NOV-002) in combination with doxorubicin hydrochloride and cyclophosphamide followed by docetaxel in women with stage IIB or IIIC breast cancer.

Secondary

• Define the safety profiles of preoperative administration of NOV-002 in combination with doxorubicin hydrochloride and cyclophosphamide followed by docetaxel.
• Correlate serum protein glutathionylation with clinical and pathologic responses.

OUTLINE: This is a multicenter study.

Patients receive oxidized glutathione (NOV-002) IV twice on day -1 of course 1 and once on day 1 of courses 2-8. Patients receive NOV-002 subcutaneously once daily on days 2-21 of courses 1-8. Patients also receive chemotherapy comprising doxorubicin hydrochloride IV and cyclophosphamide IV on day 1 of courses 1-4 followed by docetaxel IV on day 1 of courses 5-8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.

Patients undergo definitive surgery 3-6 weeks after completion of neoadjuvant therapy.

Blood samples are obtained at baseline and periodically during study to measure serum and plasma protein glutathionlylation. Additional blood samples are collected from some patients for immunological correlative studies.

After completion of study therapy, patients are followed at 30 days.

DISEASE CHARACTERISTICS:

• Histologically confirmed infiltrating (i.e., invasive) breast cancer

  • Newly diagnosed disease

  • Clinical stage IIB or IIIC (T2-4, N0 or N1, M0) or (any T, N1-3, M0) disease, as defined by 1 of the following criteria:

    • Primary tumor ≥ 2 cm (T2-4)
    • Pathologically-proven axillary nodal involvement (N1-3)
  • No evidence of metastatic disease except to the ipsilateral axillary lymph nodes
• Disease confirmed by core needle biopsy
• Inflammatory breast cancer (T4) allowed

• Clinically palpable disease that is measurable by RECIST AND meets 1 of the following staging criteria:

  • Primary tumor ≥ 2 cm (T2-4)

    • Bilateral synchronic breast cancers allowed, provided 1 of the primary tumors is selected as the target tumor
  • Pathologically-proven axillary nodal involvement (N1-3)
• HER-2/neu negative by FISH or 0-2 positive staining by IHC

• Hormone-receptor status:

  • Estrogen or progesterone receptor-negative or -positive

PATIENT CHARACTERISTICS:

• Female
• Menopausal status not specified
• ECOG performance status 0-1
• Life expectancy > 6 months
• ANC ≥ 1,500/mm³
• Platelet count ≥ 1,000/mm³
• Bilirubin ≤ 1.5 times upper limit of normal (ULN)
• AST or ALT ≤ 2.5 times ULN
• INR ≤ 1.5
• Creatinine ≤ 2 mg/dL or 177 mmol/L OR calculated creatinine clearance ≥ 50 mL/min
• Cardiac ejection fraction ≥ 50% by baseline MUGA or ECHO
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No other malignancy within the past 5 years except curatively treated basal cell carcinoma of the skin or cervical intraepithelial neoplasia

• No prior or concurrent clinically significant (i.e., active) cardiac disease, including any of the following:

  • New York Heart Association grade II-IV congestive heart failure
  • Symptomatic coronary artery disease
  • Unstable angina
  • Cardiac arrhythmia not well-controlled with medication
  • Myocardial infarction within the past 6 months
• No severe or poorly controlled systemic disease (e.g., hypertension; clinically significant cardiovascular, pulmonary, or metabolic disease, disorders of wound-healing, ulcer, or bone fracture)
• No known HIV, HBV, or HCV infection
• No known hypersensitivity to any of the components of oxidized glutathione (NOV-002) or to any of the other study drugs
• Patient or caregiver must be able to administer daily subcutaneous injections

PRIOR CONCURRENT THERAPY:

• No prior primary systemic or local treatment for breast cancer, including surgery, radiotherapy, chemotherapy, hormonal therapy, or biological therapy
• No prior anthracycline- or taxane-based therapy for any other indication
• More than 4 weeks since prior and no other concurrent investigational treatment
• No other concurrent investigational agent
• No other concurrent cytotoxic chemotherapy or hormonal agent
• No other concurrent antineoplastic therapy including, but not limited to, immunotherapy, monoclonal antibody therapy, or targeted agents

• No concurrent localized or partial breast radiotherapy

  • No other concurrent radiotherapy during the period of study drug administration
• No concurrent growth factors for primary prophylaxis during the first course of treatment