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A Phase III, Randomized Clinical Trial of Standard Adjuvant Endocrine Therapy +/- Chemotherapy in Patients With 1-3 Positive Nodes, Hormone Receptor-Positive and HER2-Negative Breast Cancer With Recur

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Trial Conditions
  • Breast Cancer
  • Estrogen Receptor-positive Breast Cancer
  • Ductal Breast Carcinoma in Situ
  • Estrogen Receptor Positive
  • Estrogen Receptor and/or Progesterone Receptor Positive
  • HER2-negative Breast Cancer
  • Progesterone Receptor-positive Breast Cancer
  • HER2/Neu Negative
  • Progesterone Receptor Positive
  • Invasive Breast Carcinoma
  • Stage II Breast Cancer
  • Stage IIIA Breast Cancer
  • Multicentric Breast Carcinoma
  • Multifocal Breast Carcinoma
  • Stage IIIB Breast Cancer
  • Stage IIIC Breast Cancer
  • Synchronous Bilateral Breast Carcinoma
What is the purpose of this trial?

This randomized phase III clinical trial studies how well tamoxifen citrate, anastrozole, letrozole, or exemestane with or without chemotherapy work in treating patients with breast cancer that has spread from where it began in the breast to surrounding normal tissue (invasive). Estrogen can cause the growth of breast cancer cells. Hormone therapy, using tamoxifen citrate, may fight breast cancer by blocking the use of estrogen by the tumor cells. Aromatase inhibitors, such as anastrozole, letrozole, and exemestane, may fight breast cancer by lowering the amount of estrogen the body makes. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving tamoxifen citrate, anastrozole, letrozole, or exemestane is more effective with combination chemotherapy in treating patients with breast cancer.

Date & Status

Recruiting

Who can Participate?

Eligibility

Ages:
18 and older

Gender:
Female

Eligibility

Inclusion Criteria:

- Patients must have a histologically confirmed diagnosis of node positive (1-3 nodes)
invasive breast carcinoma with positive estrogen and/or progesterone receptor status,
and negative HER-2 status; estrogen and progesterone receptor positivity must be
assessed according to American Society of Clinical Oncology (ASCO)/College of
American Pathologists (CAP) guidelines as either estrogen receptor (ER) or
progesterone receptor (PR) >= 1% positive nuclear staining; HER-2 test result
negativity must be assessed as per ASCO/CAP 2013 guidelines using
immunohistochemistry (IHC), in situ hybridization (ISH) or both; HER-2 is negative if
a single test (or all tests) performed in a tumor specimen show: a) IHC negative (0
or 1+) or b) ISH negative using single probe or dual probe (average HER-2 copy number
< 4.0 signals per cell by single probe or HER-2/CEP ration < 2.0 with an average copy
number < 4.0 signals per cell by dual probe); if HER-2 IHC is 2+, evaluation for gene
amplification (ISH) must be performed and the ISH must be negative; ISH is not
required if IHC is 0 or 1+; HER-2 equivocal is not eligible

- Patients with multifocal, multicentric and synchronous bilateral breast cancers are
allowed

- Multifocal disease is defined as more than one invasive cancer < 2 cm from the
largest lesion within the same breast quadrant; (NOTE: the Oncotype DX testing
must be completed on the largest lesion)

- Multicentric disease is defined as more than one invasive cancer >= 2 cm from
the largest lesion within the same breast quadrant or more than one lesion in
different quadrants (NOTE: Oncotype DX testing should be completed on all tumors
and the determination for eligibility should be made on the highest recurrence
score)

- Synchronous bilateral disease is defined as invasive breast cancer with positive
lymph nodes (axillary or intramammary) in at least one breast, diagnosed within
30 days of each other; (NOTE: The Oncotype DX testing should be completed on
both tumors and the tumor with the highest recurrence score should be used)

- Patients will have undergone axillary staging by sentinel node biopsy or axillary
lymph nodes dissection (ALND); patients must have at least one, but no more than
three known positive lymph nodes (pN1a, pN1b or pN1c); patients with micrometastases
as the only nodal involvement (pN1mi) are not eligible; patients with positive
sentinel node are not required to undergo full axillary lymph node dissection; this
is at the discretion of the treating physician; axillary node evaluation is to be
performed per the standard of care at each institution

- Patients must not have inflammatory breast cancer and must not have metastatic
disease; patients with a prior diagnosis of contralateral ductal carcinoma in situ
(DCIS) are eligible if they underwent a mastectomy or lumpectomy with whole breast
radiation; prior partial breast irradiation, including brachytherapy, is not allowed;
patients with a prior diagnosis of ipsilateral DCIS or invasive breast cancer who
received radiation to that breast are not eligible

- Patients must have had either breast-conserving surgery with planned radiation
therapy or total mastectomy (with or without planned postmastectomy radiation);
patients must have clear margins from both invasive breast cancer and DCIS (as per
local institutional guidelines); lobular carcinoma in situ (LCIS) at the margins is
allowed

- Registration of patients who have not yet undergone Oncotype DX screening must occur
no later than 56 days after definitive surgery; (for all patients, Step 2
Registration must occur within 84 days after definitive surgery); if the Oncotype DX
Breast Cancer Assay has not been performed, patients must be willing to submit tissue
samples for testing to determine the Recurrence Score value; a representative block
or unstained sections from the representative block are sent directly to Genomic
Health for Oncotype DX Breast Cancer Assay which will be performed according to the
standard commercial process

- If the Oncotype DX Recurrence Score is already known and is 25 or less, the
patient must be registered to Step 2 immediately following Step 1 registration;
if the Oncotype DX Recurrence Score is already known and is greater than 25, the
patient is ineligible

- Patients must have a complete history and physical examination within 28 days prior
to registration

- Patients must have a performance status of 0-2 by Zubrod criteria

- Patients must be able to receive taxane and/or anthracycline based chemotherapy

- Patients must not have begun chemotherapy or endocrine therapy for their breast
cancer prior to registration

- Patients must not require concurrent chronic treatment with systemic steroids
(inhaled steroids are allowed) or other immunosuppressive agents

- Patients must not have received an aromatase inhibitor (AI) or a selective estrogen
receptor modulator (SERM) such as tamoxifen or raloxifene within 5 years prior to
registration

- Patients must not be pregnant or nursing; women of reproductive potential must have
agreed to use an effective contraceptive method; a woman is considered to be of
"reproductive potential" if she has had menses at any time in the preceding 12
consecutive months; in addition to routine contraceptive methods, "effective
contraception" also includes heterosexual celibacy and surgery intended to prevent
pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy,
bilateral oophorectomy or bilateral tubal ligation; however, if at any point a
previously celibate patient chooses to become heterosexually active during the time
period for use of contraceptive measures outlined in the protocol, he/she is
responsible for beginning contraceptive measures

- No other prior malignancy is allowed except for adequately treated basal cell (or
squamous cell) skin cancer, in situ cervical cancer, or other cancer for which the
patient has been disease-free for 5 years

- The Quality of Life and Economic Substudy is permanently closed to accrual effective
12/1/12; patients who consented to QOL prior to 12/1/12 should continue to complete
QOL forms per their expectation report; patients who are able to complete a
questionnaire in English must be offered the opportunity to participate in the
Quality of Life and Economic Substudy; (The Quality of Life and Economic Substudy is
available to U.S. INSTITUTIONS ONLY); patients who are not able to complete a
questionnaire in English are registered to S1007 without participating in the Quality
of Life and Economic Substudy

- Patients who consent to participate in the Quality of Life and Economic Substudy
and who do not yet know the results of their Oncotype DX screening must agree to
complete the S1007 Health-Related Quality of Life Questionnaire: Enrollment
between 14 days prior to and 7 days after Step 1 Registration

- Patients who consent to participate in the Quality of Life and Economic Substudy
and who do already know their Oncotype DX Recurrence Score (and it is 25 or
less) will proceed to Step 2 Registration without completing the S1007
Health-Related Quality of Life Questionnaire Enrollment Form (but will complete
the S1007 Health-Related Quality of Life Questionnaire: Randomized Study Form)

- Patients or their legally authorized representative must be informed of the
investigational nature of this study and must sign and give written informed consent
in accordance with institutional and federal guidelines; for Step 1 registration of
patients who have not yet submitted specimens for the Oncotype DX Breast Cancer
Assay, the appropriate consent form is the Step 1 Consent Form; for both Step 1 and
Step 2 registration of patients whose Recurrence Score is already known and is 25 or
less, the appropriate consent form is the Step 2 Consent Form

- As a part of the Oncology Patient Enrollment Network (OPEN) registration process the
treating institution's identity is provided in order to ensure that the current
(within 365 days) date of institutional review board approval for this study has been
entered in the system

- STEP 2 REGISTRATION

- Recurrence score (RS) by Oncotype DX must be =< 25

- Step 2 Registration must take place within 84 days after definitive surgery; patients
must not have begun chemotherapy or endocrine therapy for their breast cancer prior
to randomization

- Patients randomized to either arm may also co-enroll in phase III trials that compare
local therapies, or compare systemic therapies (such as chemotherapy, if randomized
to Arm I of S1007)

- The Quality of Life and Economic Substudy is permanently closed to accrual effective
12/1/12; patients at U.S. INSTITUTIONS who consent to participate in the Quality of
Life and Economic Substudy must agree to complete the S1007 Health-Related Quality of
Life Questionnaire: Randomized Study Form after Recurrence Score results and
randomized treatment status are known but before treatment has been initiated

- Patients or their legally authorized representative must be informed of the
investigational nature of this study and must sign and give written informed consent
in accordance with institutional and federal guidelines; for all patients the
appropriate consent form for this registration is the Step 2 Consent

Gender: Female
Steward Physician(s)
  • Kevin Kalinsky
Facilities
  • Saint Anne's Hospital - Recruiting
Trial Interventions
Drug
  • Anastrozole
  • Exemestane
  • Letrozole
  • Systemic Chemotherapy
  • Tamoxifen Citrate
Other
  • Laboratory Biomarker Analysis
  • Quality-of-Life Assessment
For more information about this trial, contact

Dorcas Chi

Phone: 617-789-3000

Han-Ting Lin

Phone: 978-687-0151

Peter R. Ward

Phone: (508) 674-5600


Physician Researcher

Investigator Name:

  • Kevin Kalinsky

Other Information

Sponsor: National Cancer Institute (NCI)
Phase: Phase 3
Trial ID: NCT01272037
Volunteers:  Not Accepting Healthy Volunteers

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