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Ixabepilone and Cyclophophamide as Neoadjuvant Therapy in HER-2 Negative Breast Cancer
This study is currently recruiting participants.
Verified by Sarah Cannon Research Institute, May 2009
First Received: March 19, 2009   Last Updated: May 1, 2009   History of Changes
Sponsors and Collaborators: Sarah Cannon Research Institute
SCRI Oncology Research Consortium
Bristol-Myers Squibb
Information provided by: Sarah Cannon Research Institute
ClinicalTrials.gov Identifier: NCT00866905
  Purpose

We propose to evaluate ixabepilone in combination with cyclophosphamide for the neoadjuvant treatment of locally advanced breast cancer. In this regimen, ixabepilone is substituted for docetaxel, since preclinical and clinical studies suggest that ixabepilone is more active than either docetaxel or paclitaxel. The combination of ixabepilone and cyclophosphamide could further improve the efficacy of non-anthracycline neoadjuvant therapy.


Condition Intervention Phase
Breast Cancer
Drug: Ixabepilone
Drug: Cyclophosphamide
Phase II

Genetics Home Reference related topics: breast cancer
MedlinePlus related topics: Breast Cancer Cancer
Drug Information available for: Cyclophosphamide Ixabepilone
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Single Group Assignment, Efficacy Study
Official Title: Phase II Study of Ixabepilone and Cyclophosphamide as Neoadjuvant Therapy in HER2-Negative Breast Cancer

Further study details as provided by Sarah Cannon Research Institute:

Primary Outcome Measures:
  • To evaluate the pathologic complete response (pCR) rate following neoadjuvant treatment with six cycles of ixabepilone and cyclophophamide in HER2-negative locally advanced breast cancer [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • To characterize the safety and tolerability of the neoadjuvant combination of ixabepilone and cyclophosphamide [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]
  • To determine the disease-free survival (DFS) following neoadjuvant treatment with the combination of ixabepilone and cyclophosphamide [ Time Frame: 18 months ] [ Designated as safety issue: No ]
  • To determine the overall survival (OS) following neoadjuvant treatment with the combination of ixabepilone and cyclophosphamide [ Time Frame: 18 months ] [ Designated as safety issue: No ]
  • To evaluate the clinical response rate (clinical complete response [cCR] + clinical partial response [cPR]) to neoadjuvant treatment with the combination of ixabepilone and cyclophosphamide [ Time Frame: 18 months ] [ Designated as safety issue: No ]
  • To evaluate the Oncotype DX score in predicting the efficacy of neoadjuvant ixabepilone/cyclophosphamide [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 166
Study Start Date: April 2009
Estimated Study Completion Date: April 2011
Estimated Primary Completion Date: April 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental
Systemic Therapy followed by surgery and possible radiation therapy
Drug: Ixabepilone
40 mg/m2 IV infusion over 3 hours on day 1 of a 21 day cycle for 6 cycles
Drug: Cyclophosphamide
600 mg/m2 IV infusion per institutional guidelines on day 1 of a 21 day cycle for 6 cycles

Detailed Description:

In this study, patients with early stage, HER2-negative breast cancer will receive neoadjuvant treatment with ixabepilone and cyclophosphamide given every three weeks for a total of six cycles. Following surgery patients with hormone receptor-positive tumors will receive anti-estrogen treatment.

Patients may receive local regional radiation therapy after surgery per institutional guidelines at the investigator's discretion. Baseline tumor tissue and tumor tissue removed at the time of surgery will be tested by Oncotype DX assay to determine whether it is predictive of response to this neoadjuvant treatment regimen. This study will be one of the first investigations of the combination of ixabepilone and cyclophosphamide as neoadjuvant treatment for HER2-negative breast cancer. It will examine this treatment regimen for potential advantages gained from substitution of ixabepilone for a taxane and use of non-anthracycline agents.

  Eligibility

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

Inclusion Criteria:

  1. Female patients, age ≥18 years.
  2. Histologically confirmed invasive adenocarcinoma of the breast.
  3. Primary palpable disease confined to a breast and axilla on physical examination. For patients without clinically suspicious axillary adenopathy, the primary tumor must be larger than 2 cm in diameter by physical exam or imaging studies (clinical T2-T3, N0-N1, M0). For patients with clinically suspicious axillary adenopathy, the primary breast tumor can be any size (clinical T1-3, N1-2, M0). (T1N0M0 lesions are excluded.)
  4. Patients without clearly defined palpable breast mass or axillary lymph nodes but radiographically measurable tumor masses are acceptable. Accepted procedures for measuring breast disease are mammography, MRI, and breast ultrasound. This will need to be re-evaluated after 3 cycles and prior to surgery.
  5. Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2.
  6. No metastatic disease, as documented by complete staging workup

    • 6 weeks prior to initiation of study treatment.
  7. No previous treatment for breast cancer.
  8. HER2-negative tumor status. HER2-negative is defined as:

    • Immunohistochemical (IHC) 0, IHC 1+ OR
    • IHC 2+ or IHC 3+ must be confirmed as FISH (fluorescence in situ hybridization) negative (defined by ratio <2.2).
  9. Adequate hematologic function with:

    • Absolute neutophil count (ANC) >1500/μL.
    • Platelets ≥100,000/μL.
    • Hemoglobin ≥10 g/dL.
  10. Adequate hepatic function with:

    • Serum bilirubin ≤ the institutional upper limit of normal (ULN).
    • Aspartate aminotransferase (AST) ≤2.5 x institutional ULN.
    • Alanine aminotransferase (ALT) ≤2.5 x institutional ULN.
  11. Adequate renal function with serum creatinine ≤1.5 x ULN.
  12. Estrogen and progesterone receptor status in the primary tumor known or pending at the time of study registration.
  13. Knowledge of the investigational nature of the study and ability to provide consent for study participation.
  14. For patients who had, or will have sentinel lymph node and/or axillary dissection prior to initiation of study treatment, completion at least 4 weeks prior to starting study treatment and well-healed wound
  15. Bilateral, synchronous breast cancer is allowed if one primary tumor meets the inclusion criteria.
  16. Sufficient archived breast tumor specimen available at baseline for the Oncotype DX assay. -

Exclusion Criteria:

  1. Inflammatory breast cancer.
  2. Peripheral neuropathy (motor or sensory) ≥ grade 1 by the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v 3.0).
  3. Prior radiation that included ≥30% of major bone marrowcontaining areas (pelvis, lumbar, spine).
  4. Chronic use of cytochrome P450 (CYP) 3A4 inhibitors and use of the following strong CYP3A4 inhibitors: ketoconazole, itraconazole, clarithromycin, atazanavir, nefazodone, saquinavir, telithromycin, ritonavir, amprenavir, indinavir, nelfinavir, delavirdine, and voriconazole. Use of these agents should be discontinued at least 72 hours prior to initiation of study treatment.
  5. Chemotherapy within 5 years of starting study treatment except for low doses of agents used for anti-inflammatory indications such as rheumatoid arthritis, psoriasis, and connective tissue disorders. Although such doses and schedules cannot result in myelosuppression, patients must discontinue this therapy while they are receiving study treatment.
  6. Known or suspected hypersensitivity to Cremophor®EL (polyoxyethylated castor oil) or a drug formulated in Cremophor®EL such as paclitaxel, or any other agent given in the course of this study.
  7. Pregnancy or breast-feeding. A negative serum pregnancy test within 7 days prior to first study treatment (Day 1, Cycle 1) for all women of childbearing potential is required. Patients of childbearing potential must agree to use a birth control method that is approved by their study physician while receiving study treatment and for 3 weeks after their last dose of study treatment. Patients must agree to not breast-feed while receiving study treatment.
  8. Concurrent treatment with an ovarian hormonal replacement therapy or with hormonal agents such as raloxifene, tamoxifen or other selective estrogen receptor modulator (SERM). Patients must have discontinued use of such agents prior to beginning study treatment.
  9. History of malignancy treated with curative intent within the previous 5 years with the exception of skin cancer, cervical carcinoma in situ, or follicular thyroid cancer. Patients with previous invasive cancers (including breast cancer) are eligible if the treatment was completed more than 5 years prior to initiating current study treatment, and there is no evidence of recurrent disease.
  10. Uncontrolled intercurrent illness including (but not limited to) ongoing or active infection.
  11. Chronic treatment with corticosteroid unless treatment was begun >6 months prior to study treatment and is at a low dose (≤20 mg methylprednisolone or equivalent).
  12. Use of any investigational agent within 30 days of administration of the first dose of study drug.
  13. Requirement for radiation therapy concurrent with neoadjuvant study chemotherapy.
  14. Concurrent treatment with any anti-cancer therapy other than those agents used in this study.
  15. Inability or unwillingness to comply with study procedures including follow-up visits.
  16. Mental condition or psychiatric disorder that would prevent patient comprehension of the nature, scope, and possible consequences of the study or that would limit compliance with study requirements.
  17. Any other disease(s), metabolic dysfunction, or findings from a physical examination or clinical laboratory test result that would cause reasonable suspicion of a disease or condition that contraindicates the use of study drugs, that may affect the interpretation of the results, or that renders the patient at high risk from treatment complications -
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00866905

Contacts
Contact: Denise A Yardley, M.D. 615-329-7274 dyardley@tnonc.com
Contact: Trials Info 615-329-7274 trialsinfo@scresearch.net

Locations
United States, Indiana
Providence Medical Group Recruiting
Terre Haute, Indiana, United States, 47802
United States, Maryland
Center for Cancer and Blood Disorders Recruiting
Bethesda, Maryland, United States, 20817
United States, Missouri
St. Louis Cancer Care Recruiting
Chesterfield, Missouri, United States, 63017
United States, Tennessee
Tennessee Oncology Recruiting
Nashville, Tennessee, United States, 37203
Contact: Trials Information     615-329-7274     trialsinfo@scresearch.net    
United States, Texas
South Texas Oncology and Hematology Recruiting
San Antonio, Texas, United States, 78258
Sponsors and Collaborators
Sarah Cannon Research Institute
SCRI Oncology Research Consortium
Bristol-Myers Squibb
Investigators
Study Chair: Denise A Yardley, M.D. SCRI Oncology Research Consortium
  More Information

No publications provided

Responsible Party: SCRI Oncology Research Consortium ( Denise A. Yardley )
Study ID Numbers: SCRI BRE 133
Study First Received: March 19, 2009
Last Updated: May 1, 2009
ClinicalTrials.gov Identifier: NCT00866905     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by Sarah Cannon Research Institute:
Breast Cancer
Ixabepilone
Ixempra
Cyclophosphamide
Cytoxan
Neoadjuvant Therapy

Study placed in the following topic categories:
Immunologic Factors
Skin Diseases
Epothilones
Tubulin Modulators
Breast Neoplasms
Antimitotic Agents
Antineoplastic Agents, Alkylating
Cyclophosphamide
Antirheumatic Agents
Alkylating Agents
Immunosuppressive Agents
Breast Diseases

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Skin Diseases
Immunologic Factors
Antineoplastic Agents
Epothilones
Mitosis Modulators
Physiological Effects of Drugs
Breast Neoplasms
Antimitotic Agents
Cyclophosphamide
Immunosuppressive Agents
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Tubulin Modulators
Myeloablative Agonists
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Alkylating Agents
Breast Diseases

ClinicalTrials.gov processed this record on May 07, 2009