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Combination Chemotherapy With or Without Trastuzumab in Treating Women With Breast Cancer
This study is ongoing, but not recruiting participants.
Sponsors and Collaborators: North Central Cancer Treatment Group
National Cancer Institute (NCI)
Eastern Cooperative Oncology Group
Cancer and Leukemia Group B
Southwest Oncology Group
National Cancer Institute of Canada
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00005970
  Purpose

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. It is not yet known whether combination chemotherapy is more effective with or without trastuzumab in treating breast cancer.

PURPOSE: This randomized phase III trial is studying combination chemotherapy and trastuzumab to see how well they work compared to combination chemotherapy alone in treating women with breast cancer.


Condition Intervention Phase
Breast Cancer
Drug: cyclophosphamide
Drug: doxorubicin hydrochloride
Drug: paclitaxel
Drug: tamoxifen citrate
Drug: trastuzumab
Procedure: adjuvant therapy
Procedure: aromatase inhibition therapy
Phase III

Genetics Home Reference related topics: breast cancer
MedlinePlus related topics: Breast Cancer Cancer
Drug Information available for: Doxorubicin Doxorubicin hydrochloride Cyclophosphamide Paclitaxel Tamoxifen Tamoxifen citrate Citric acid Sodium Citrate Trastuzumab
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Active Control
Official Title: Phase III Trial of Doxorubicin and Cyclophosphamide (AC) Followed by Weekly Paclitaxel With or Without Trastuzumab as Adjuvant Treatment for Women With HER-2 Overexpressing Node Positive or High-Risk Node Negative Breast Cancer

Further study details as provided by National Cancer Institute (NCI):

Study Start Date: May 2000
  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed operable adenocarcinoma of the breast, meeting 1 of the following criteria:

    • Node-positive disease, meeting the following criteria:

      • One or more positive lymph nodes (T1-3, pN1-2, M0)
      • No cN2 disease
      • pN2 disease allowed
      • One positive lymph node by sentinel node biopsy or at least 6 axillary nodes must be examined on axillary node dissection with at least 1 positive lymph node
      • Metaplastic carcinoma allowed
    • High-risk node-negative disease, meeting the following criteria:

      • Node-negative as determined by 1 of the following:

        • Negative sentinel node biopsy
        • No positive lymph nodes found among at least 6 axillary nodes examined on axillary node dissection
      • Tumor must be greater than 2.0 cm if estrogen-receptor (ER)- and progesterone-receptor (PR)-positive disease is present OR greater than 1.0 cm if ER and PR negative NOTE: Lymph nodes positive by immunohistochemistry (IHC) only are not considered positive nodes
  • HER-2 positive

    • Fluorescent in situ hybridization (FISH) must show gene amplification OR
    • IHC assay must show a strong positive (3+) staining score
    • Ductal carcinoma in situ (DCIS) components must not be counted in determination of the degree of IHC staining or FISH amplification
  • No locally advanced (T4) tumors at diagnosis, including:

    • Tumors fixed to chest wall
    • Peau d'orange
    • Skin ulcerations/nodules
    • Clinical inflammatory changes (diffuse brawny cutaneous induration with an erysipeloid edge)
  • No bilateral invasive carcinoma or DCIS (metachronous or synchronous)

    • Unilateral invasive carcinoma and previous metachronous or synchronous DCIS of the contralateral breast treated with mastectomy allowed
  • No prior breast cancer except lobular carcinoma in situ (LCIS)
  • No more than 84 days since prior mastectomy or axillary or sentinel node dissection

    • No gross or microscopic disease at margins
  • No significant pericardial effusion
  • Hormone receptor status:

    • ER/PR status known

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Sex:

  • Female

Menopausal status:

  • Any status

Performance status:

  • Not specified

Life expectancy:

  • Not specified

Hematopoietic:

  • Absolute neutrophil count at least 1,500/mm^3
  • Platelet count at least 100,000/mm^3

Hepatic:

  • Bilirubin no greater than 1.5 times upper limit of normal (ULN)
  • AST no greater than 2 times ULN

Renal:

  • Not specified

Cardiovascular:

  • LVEF normal
  • No prior myocardial infarction or congestive heart failure
  • No prior arrhythmia or cardiovalvular disease that requires medications or is clinically significant
  • No uncontrolled hypertension (diastolic blood pressure [BP] greater than 100 mm Hg and systolic BP greater than 200 mm Hg)

Other:

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective barrier contraception during and for 2 months after study participation
  • No active unresolved infection
  • No known sensitivity to benzyl alcohol
  • No grade 2 or greater neuropathy
  • No other prior malignancy within the past 5 years except:

    • Effectively treated squamous cell or basal cell skin cancer
    • Carcinoma in situ of the cervix treated with surgery only
    • LCIS of the ipsilateral or contralateral breast treated with surgery and/or tamoxifen only

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • No prior biologic therapy or immunotherapy for breast cancer

Chemotherapy:

  • No prior chemotherapy for breast cancer
  • No prior anthracycline or taxane

Endocrine therapy:

  • Prior tamoxifen or any other hormonal therapy for breast cancer allowed if administered for no more than 4 weeks
  • Prior tamoxifen or raloxifene for chemoprevention (e.g., Breast Cancer Prevention Trial) or for other indications (e.g., prior LCIS) allowed
  • No concurrent tamoxifen or raloxifene
  • No concurrent hormonal therapy (e.g., birth control pills or hormone replacement therapy)

Radiotherapy:

  • No prior radiotherapy for breast cancer

Surgery:

  • See Disease Characteristics

Other:

  • No concurrent digitalis or beta-blockers for congestive heart failure
  • No concurrent medications for cardiac arrhythmias or angina pectoris
  • No concurrent cardioprotective drugs
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00005970

  Show 210 Study Locations
Sponsors and Collaborators
North Central Cancer Treatment Group
Eastern Cooperative Oncology Group
Cancer and Leukemia Group B
Southwest Oncology Group
National Cancer Institute of Canada
Investigators
Study Chair: Edith A. Perez, MD Mayo Clinic
Study Chair: Nancy E. Davidson, MD Sidney Kimmel Comprehensive Cancer Center
Study Chair: Peter A. Kaufman, MD Norris Cotton Cancer Center
Study Chair: Silvana Martino, DO John Wayne Cancer Institute at Saint John's Health Center
Study Chair: Karen A. Gelmon, MD British Columbia Cancer Agency
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Publications of Results:
Moreno-Aspitia A, Dueck AC, Lingle WL, et al.: Serum HER2 (sHER2) levels in early-stage HER2 neu (+) breast cancer (HER2+BC): results from the NCCTG adjuvant Intergroup trial N9831. [Abstract] J Clin Oncol 26 (Suppl 15): A-529, 2008.
Perez EA, Reinholz MM, Dueck AC, et al.: c-MYC amplification and correlation with patient outcome in early stage HER2+ breast cancer from the NCCTG adjuvant intergroup trial N9831. [Abstract] 31st Annual San Antonio Breast Cancer Symposium, December 10-14, 2008, San Antonio, Texas. A-56, 2008.
Perez EA, Suman VJ, Davidson NE, Sledge GW, Kaufman PA, Hudis CA, Martino S, Gralow JR, Dakhil SR, Ingle JN, Winer EP, Gelmon KA, Gersh BJ, Jaffe AS, Rodeheffer RJ. Cardiac Safety Analysis of Doxorubicin and Cyclophosphamide Followed by Paclitaxel With or Without Trastuzumab in the North Central Cancer Treatment Group N9831 Adjuvant Breast Cancer Trial. J Clin Oncol. 2008 Feb 4; [Epub ahead of print]
Kutteh LA, Hobday T, Jaffe A, et al.: A correlative study of cardiac biomarkers and left ventricular ejection fraction (LVEF) from N9831, a phase III randomized trial of chemotherapy and trastuzumab as adjuvant therapy for HER2-positive breast cancer. [Abstract] J Clin Oncol 25 (Suppl 18): A-579, 2007.
Reinholz MM, Jenkins RB, Hillman D, et al.: The clinical significance of polysomy 17 in the HER2+ N9831 intergroup adjuvant trastuzumab trial. [Abstract] Breast Cancer Res Treat 106 (1): A-36, S11, 2007.
Halyard MY, Pisansky TM, Solin LJ, et al.: Adjuvant radiotherapy (RT) and trastuzumab in stage I-IIA breast cancer: toxicity data from North Central Cancer Treatment Group phase III trial N9831. [Abstract] J Clin Oncol 24 (Suppl 18): A-523, 2006.
Perez EA, Suman VJ, Davidson NE, Martino S, Kaufman PA, Lingle WL, Flynn PJ, Ingle JN, Visscher D, Jenkins RB. HER2 testing by local, central, and reference laboratories in specimens from the North Central Cancer Treatment Group N9831 intergroup adjuvant trial. J Clin Oncol. 2006 Jul 1;24(19):3032-8.
Miller DV, Jenkins RB, Lingle WL, et al.: Focal HER2/neu amplified clones partially account for discordance between immunohistochemistry and fluorescence in-situ hybridization results: data from NCCTG N9831 intergroup adjuvant trial. [Abstract] J Clin Oncol 22 (Suppl 14): A-568, 19s, 2004.
Perez EA, Suman VJ, Davidson NE, et al.: HER2 testing by local, central, and reference laboratories in the NCCTG N9831 intergroup adjuvant trial. [Abstract] J Clin Oncol 22 (Suppl 14): A-567, 19s, 2004.
Perez EA, Suman VJ, Davidson NE, Kaufman PA, Martino S, Dakhil SR, Ingle JN, Rodeheffer RJ, Gersh BJ, Jaffe AS. Effect of doxorubicin plus cyclophosphamide on left ventricular ejection fraction in patients with breast cancer in the North Central Cancer Treatment Group N9831 Intergroup Adjuvant Trial. J Clin Oncol. 2004 Sep 15;22(18):3700-4.
Perez EA, Suman VJ, Davidson NE, et al.: Effect of doxorubicin plus cyclophosphamide (AC) on left ventricular ejection fraction (LVEF) in the NCCTG N9831 intergroup adjuvant trial. [Abstract] Proceedings of the American Society of Clinical Oncology 22: A-75, 19, 2003.
Roche PC, Suman VJ, Jenkins RB, Davidson NE, Martino S, Kaufman PA, Addo FK, Murphy B, Ingle JN, Perez EA. Concordance between local and central laboratory HER2 testing in the breast intergroup trial N9831. J Natl Cancer Inst. 2002 Jun 5;94(11):855-7.

Other Publications:
Jahanzeb M. Adjuvant trastuzumab therapy for HER2-positive breast cancer. Clin Breast Cancer. 2008 Aug;8(4):324-33.
Partridge AH, Wolff AC, Marcom PK, Kaufman PA, Zhang L, Gelman R, Moore C, Lake D, Fleming GF, Rugo HS, Atkins J, Sampson E, Collyar D, Winer EP. The impact of sharing results of a randomized breast cancer clinical trial with study participants. Breast Cancer Res Treat. 2008 Jun 10; [Epub ahead of print]
Reinholz MM, Dueck AC, Lingle WL, et al.: The concordance between NCCTG's and NSABP's C-myc FISH assays. [Abstract] J Clin Oncol 26 (Suppl 15): A-22110, 2008.
Garrison LP Jr, Lubeck D, Lalla D, Paton V, Dueck A, Perez EA. Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2-positive breast cancer. Cancer. 2007 Jun 25; [Epub ahead of print]
Kurian AW, Thompson RN, Gaw AF, Arai S, Ortiz R, Garber AM. A cost-effectiveness analysis of adjuvant trastuzumab regimens in early HER2/neu-positive breast cancer. J Clin Oncol. 2007 Feb 20;25(6):634-41.
Liberato NL, Marchetti M, Barosi G. Cost effectiveness of adjuvant trastuzumab in human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2007 Feb 20;25(6):625-33.
Perez E, Romond E, Suman V, et al.: Updated results of the combined analysis of NCCTG N9831 and NSABP B-31 adjuvant chemotherapy with/without trastuzumab in patiens with HER2-positive breast cancer. [Abstract] J Clin Oncol 25 (Suppl 18): 512, 6s, 2007.
Telli ML, Hunt SA, Carlson RW, Guardino AE. Trastuzumab-related cardiotoxicity: calling into question the concept of reversibility. J Clin Oncol. 2007 Aug 10;25(23):3525-33.
Baselga J, Perez EA, Pienkowski T, Bell R. Adjuvant trastuzumab: a milestone in the treatment of HER-2-positive early breast cancer. Oncologist. 2006;11 Suppl 1:4-12. Review.
Garrison LP, Perez EA, Dueck A, et al.: Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2+ breast cancer. [Abstract] J Clin Oncol 24 (Suppl 18): A-6023, 306s, 2006.
Gupta AK, Mekan SF, Eckman MH: Trastuzumab for all? A decision analysis examining tradeoffs between efficacy and cardiac toxicity of adjuvant therapy in HER2 positive breast cancer. [Abstract] J Clin Oncol 24 (Suppl 18): A-6022, 306s, 2006.
Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, Tan-Chiu E, Martino S, Paik S, Kaufman PA, Swain SM, Pisansky TM, Fehrenbacher L, Kutteh LA, Vogel VG, Visscher DW, Yothers G, Jenkins RB, Brown AM, Dakhil SR, Mamounas EP, Lingle WL, Klein PM, Ingle JN, Wolmark N. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1673-84.
Perez EA, Rodeheffer R. Clinical cardiac tolerability of trastuzumab. J Clin Oncol. 2004 Jan 15;22(2):322-9. Review.

Study ID Numbers: CDR0000067953, NCCTG-N9831, CALGB-49909, ECOG-N9831, SWOG-N9831, GUMC-00224, CAN-NCIC-MA28
Study First Received: July 5, 2000
Last Updated: January 7, 2009
ClinicalTrials.gov Identifier: NCT00005970  
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
stage I breast cancer
stage II breast cancer
stage IIIA breast cancer

Study placed in the following topic categories:
Skin Diseases
Paclitaxel
Citric Acid
Trastuzumab
Breast Neoplasms
Cyclophosphamide
Tamoxifen
Doxorubicin
Breast Diseases

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Hormone Antagonists
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Bone Density Conservation Agents
Antibiotics, Antineoplastic
Selective Estrogen Receptor Modulators
Estrogen Receptor Modulators
Neoplasms by Site
Therapeutic Uses
Alkylating Agents
Estrogen Antagonists
Antineoplastic Agents, Hormonal
Mitosis Modulators
Antimitotic Agents
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Tubulin Modulators
Myeloablative Agonists
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Antineoplastic Agents, Phytogenic

ClinicalTrials.gov processed this record on January 30, 2009