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Adjuvant Doxorubicin/Cyclophosphamide and Paclitaxel Plus Sorafenib Breast Cancer
This study is ongoing, but not recruiting participants.
First Received: October 15, 2007   Last Updated: January 11, 2008   History of Changes
Sponsors and Collaborators: Sarah Cannon Research Institute
SCRI Oncology Research Consortium
Bayer
Information provided by: Sarah Cannon Research Institute
ClinicalTrials.gov Identifier: NCT00544167
  Purpose

Sorafenib is being looked at in a number of solid tumor settings including breast cancer. This trial is designed as a pilot study to assess the safety and tolerability of a novel oral agent in combination with standard chemotherapy in the treatment of early stage node positive or otherwise high-risk breast cancer. If this should prove to be a tolerable regimen for patients, this would provide rationale for further studies in a larger randomized fashion.


Condition Intervention
Breast Cancer
Drug: Doxorubicin, Cyclophosphamide, Paclitaxel, Sorafenib

Genetics Home Reference related topics: breast cancer
MedlinePlus related topics: Breast Cancer Cancer
Drug Information available for: Cyclophosphamide Doxorubicin Doxorubicin hydrochloride Paclitaxel Myocet Sorafenib Sorafenib tosylate
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Single Group Assignment, Safety/Efficacy Study
Official Title: A Pilot Study of Adjuvant Doxorubicin and Cyclophosphamide Followed by Paclitaxel Plus Sorafenib in Women With Node Positive or High-Risk Early Stage Breast Cancer

Further study details as provided by Sarah Cannon Research Institute:

Primary Outcome Measures:
  • The primary objective is to assess the safety and tolerability of doxorubicin and cyclophosphamide followed by paclitaxel in combination with sorafenib in patients with early stage node positive or otherwise high-risk breast cancer.

Secondary Outcome Measures:
  • The secondary objective is to assess activity in the form of recurrence-free interval, distant recurrence-free interval, and overall survival in this pilot study.

Estimated Enrollment: 40
Study Start Date: May 2007
Estimated Study Completion Date: May 2009
Estimated Primary Completion Date: May 2008 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Doxorubicin, Cyclophosphamide, Paclitaxel, Sorafenib

    Doxorubicin 60 mg/m2 IV day1 q21 days x 4 cycles Cyclophosphamide 600 mg/m2 IV day 1 q21 days x 4 cycles Paclitaxel and Sorafenib will not start until after the doxorubicin/cyclophosphamide phase has completed.

    Paclitaxel may be administered on one of two schedules at physician discretion:

    175 mg/m2 IV day 1 q21 days x 4 cycles OR 80 mg/m2 IV weekly x 4 cycles (12 weeks total)

    Sorafenib 400 mg po BID to start concurrent with paclitaxel. Sorafenib will then be held during radiation therapy and resume once radiation is completed. Sorafenib will continue for a total of 12 months and in combination with adjuvant hormonal therapy (for those patients who are deemed candidates for such therapy) in the form of tamoxifen or an aromatase inhibitor. Cycle = 21 days

Detailed Description:

Primary Objectives The primary objective is to assess the safety and tolerability of doxorubicin / cyclophosphamide followed by paclitaxel in combination with sorafenib in patients with early stage node positive or otherwise high-risk breast cancer.

Secondary Objectives The secondary objectives are to assess activity in the form of recurrence-free-interval, distant recurrence-free interval,and overall survival in this pilot study of doxorubicin / cyclophosphamide followed by paclitaxel in combination with sorafenib in patients with early stage node positive or otherwise high-risk breast cancer.

  Eligibility

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

Inclusion Criteria:

  1. Patients must have histologically-confirmed breast cancer with an interval between definitive surgery that includes axillary lymph node involvement assessment and initiation of study treatment of less than or equal to 84 days. If the definitive surgery and the axillary lymph node dissection are performed on two different days, both days should be within the 84 day window.
  2. Definitive surgery - either mastectomy with axillary node involvement assessment, or breast conserving surgery with axillary node assessment.

    Margins of resected specimen must be free of invasive disease and/or ductal carcinoma in situ (DCIS). The finding of lobular carcinoma in-situ will not be scored as a positive margin.

  3. Stage I, II, IIIA, and IIIC (T1-3, N3a only). Patients must be either lymph node positive or high-risk node negative. Node positivity is defined as having invasive adenocarcinoma in at least one axillary node (pN1) or intramammary nodes. At least 6 axillary or intramammary nodes must have been histologically examined. Malignant involvement must be detectable by routine pathologic examination with hematoxylin and eosin staining. Patients with immunohistologic staining as the only evidence of nodal involvement are considered node-negative. High-risk node negative disease is defined as invasive adenocarcinoma not involved in a lymph node determined by Sentinel Node Biospy AND at least one of the following: Tumor size > 2 cm; Estrogen receptor negative; Progesterone receptor negative; Histological and/or nuclear grade 2-3; or Age <35 years.
  4. Age > 18 years.
  5. ECOG performance status 0 or 1.
  6. Normal cardiac function must be confirmed by left ventricular ejection fraction (LVEF) by Echocardiography or MUGA scan and electrocardiogram (ECG) within 35 days prior to initiation of study treatment. The LVEF must be equal to or above the lower limit of institutional normal.
  7. Patients must have adequate bone marrow function with ANC > 1500, platelets > 100,000 and hemoglobin >10.0 gm/dl.
  8. Patients must have normal liver function (bilirubin within institutional normal limits (wnl) and transaminases < 2.5 times the upper limits of normal. If the transaminases are normal, alkaline phosphatase may be up to 5 x upper limit of normal.
  9. Serum creatinine <= 2mg/dl (If greater than 1.5, the creatinine clearance, calculated according to the Cockroft-Gault formula, must be <= 60ml/min).
  10. Patients must be able to understand the nature of this study and give written informed consent.
  11. Complete staging work-up within 5 weeks prior to initiation of study treatment with the exception of baseline mammography, which must be done within 120 days prior to initiation of study treatment. All patients must have mammography and/or ultrasound, CT scans of the chest, abdomen/pelvis and either a PET scan or Bone Scan.
  12. INR < 1.5 or a PT/PTT within normal limits. Patients receiving anti-coagulation treatment with an agent such as warfarin or heparin may be allowed to participate. For patients on warfarin, the INR should be measured prior to initiation of sorafenib and monitored.

Exclusion Criteria:

  1. Prior systemic anticancer therapy for breast cancer (immunotherapy, chemotherapy, hormonal therapy).
  2. Patients with HER2 positive breast cancer as determined by FISH or IHC3+ standing are ineligible for this trial.
  3. Prior anthracycline or taxane therapy.
  4. Prior radiation therapy for breast cancer.
  5. Bilateral invasive disease.
  6. Any T4 or known M1 breast cancer.
  7. Pre-existing motor or sensory neurotoxicity of a severity ≥ 2 by NCI CTCAE v 3.0 criteria.
  8. Cardiac disease that includes: myocardial infarction; angina, congestive heart failure, arrhythmia; valvular heart disease; cardiomegaly on chest imaging or ventricular hypertrophy on ECG - unless the LVEF is within normal range for the institution; patients with poorly controlled hypertension (defined as systolic blood pressure > 150 and /or diastolic blood pressure > 100 mmHg on antihypertensive medications); patients who receive medications for angina, arrhythmias, or congestive heart failure.
  9. Current therapy with raloxifene, tamoxifen or other selective estrogen receptor modulator, either for prevention or osteoporosis.
  10. Concurrent treatment with ovarian hormonal replacement therapy.
  11. Male patients.
  12. History of prior malignancy within 5 years with the exception of skin cancer or cervical carcinoma in situ.
  13. Women who are pregnant (positive pregnancy test) or breast feeding. Subjects of childbearing potential must use effective birth control measures during treatment.
  14. Treatment with a non-approved or investigational drug within 30 days before day 1 of trial treatment.
  15. Patients with active infection requiring parenteral antibiotics.
  16. Inability to comply with study and/or follow-up procedures.
  17. Patients with neurological symptoms must undergo a CT scan/MRI of the brain to exclude brain metastasis.
  18. Known human immunodeficiency virus infection or chronic Hepatitis B or C.
  19. Thrombotic or embolic events such as a stroke and transient ischemic attack within the past 6 months.
  20. Pulmonary hemorrhage/bleeding event ≥ NCI CTCAE v3.0 Grade 2 within 4 weeks of first dose of study drug.
  21. Any other hemorrhage/bleeding event ≥ NCI CTCAE v3.0 Grade 3 within 4 weeks of first dose of study drug.
  22. Serious non-healing wound, ulcer, or bone fracture.
  23. Major surgery, open biopsy or significant traumatic injury within 4 weeks of first dose of study drug.
  24. Use of St. John's Wort or rifampin (rifampicin).
  25. Known or suspected allergy/hypersensitivity to any agent given in the course of this trial.
  26. Any condition that impairs patient's ability to swallow whole pills.
  27. Any malabsorption problem.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00544167

Locations
United States, Florida
Florida Hospital Cancer Institute
Orlando, Florida, United States, 32804
Integrated Community Oncology Network
Jacksonville, Florida, United States, 32256
United States, Kentucky
Consultants in Blood Disorders and Cancer
Louisville, Kentucky, United States, 40207
United States, Michigan
Grand Rapids Clinical Oncology Program
Grand Rapids, Michigan, United States, 49503
United States, Nebraska
Methodist Cancer Center
Omaha, Nebraska, United States, 68114
United States, Tennessee
Chattanooga Oncology Hematology Associates
Chattanooga, Tennessee, United States, 37404
Tennessee Oncology, PLLC
Nashville, Tennessee, United States, 37023
United States, Virginia
Peninsula Cancer Institute
Newport News, Virginia, United States, 23601
Sponsors and Collaborators
Sarah Cannon Research Institute
SCRI Oncology Research Consortium
Bayer
Investigators
Study Chair: Denise Yardley, M.D. SCRI Oncology Research Consortium
  More Information

No publications provided

Responsible Party: SCRI Oncology Research Consortium ( Denise A. Yardley, M.D. )
Study ID Numbers: SCRI BRE 112
Study First Received: October 15, 2007
Last Updated: January 11, 2008
ClinicalTrials.gov Identifier: NCT00544167     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by Sarah Cannon Research Institute:
Breast Cancer
Early Stage
High Risk
Node Positive
Doxorubicin
Cyclophosphamide
Paclitaxel
Sorafenib

Study placed in the following topic categories:
Skin Diseases
Immunologic Factors
Adjuvants, Immunologic
Breast Neoplasms
Antimitotic Agents
Cyclophosphamide
Protein Kinase Inhibitors
Tamoxifen
Immunosuppressive Agents
Doxorubicin
Anti-Bacterial Agents
Paclitaxel
Tubulin Modulators
Antineoplastic Agents, Alkylating
Aromatase Inhibitors
Antirheumatic Agents
Antineoplastic Agents, Phytogenic
Alkylating Agents
Sorafenib
Breast Diseases

Additional relevant MeSH terms:
Immunologic Factors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Physiological Effects of Drugs
Cyclophosphamide
Antibiotics, Antineoplastic
Protein Kinase Inhibitors
Neoplasms by Site
Therapeutic Uses
Alkylating Agents
Breast Diseases
Skin Diseases
Mitosis Modulators
Breast Neoplasms
Enzyme Inhibitors
Antimitotic Agents
Immunosuppressive Agents
Pharmacologic Actions
Doxorubicin
Neoplasms
Paclitaxel
Tubulin Modulators
Myeloablative Agonists
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Sorafenib
Antineoplastic Agents, Phytogenic

ClinicalTrials.gov processed this record on May 06, 2009