'ADVANCE' (A Pilot Trial) ADjuVANt Chemotherapy in the Elderly: Developing and Evaluating Lower-Toxicity Chemotherapy Options for Older Patients With Breast Cancer
Overview
- Phase
- Phase 1
- Intervention
- Paclitaxel
- Conditions
- Breast Cancer
- Sponsor
- Dana-Farber Cancer Institute
- Enrollment
- 41
- Locations
- 5
- Primary Endpoint
- Toxicity and receipt of planned therapy (feasibility)
- Status
- Active, not recruiting
- Last Updated
- 8 months ago
Overview
Brief Summary
This study is being conducted to carefully study how chemotherapy is tolerated in group of patients age 70.
Detailed Description
This clinical trial is dedicated to patients age 70 and older and is focused on understanding how the investigators can improve upon breast cancer outcomes for older women, a group of patients who often do worse than younger patients and who are not well represented in clinical trials to date. Through this clinical trial, the investigators aim to better understand the side effects, experiences, and changes in physical function that may occur with chemotherapy. The investigators are also very interested in the genomics (or gene-changes) and biological changes that may occur in breast cancers in older women that may be different from the changes we see in younger patients. Even though the chemotherapy agents being used in this study are used frequently when treating breast cancer, The investigators have limited information on how these agents are tolerated in older patients. This research study is called a Feasibility Study, because the investigators will be closely monitoring how easily it is to administer chemotherapy to a relatively small group of participants (up to 40) and to what degree side effects occur. The investigators will administer commercially available chemotherapy agents used in breast cancer in the specific setting of the treating older patients with early-stage breast cancer and with some mild modification of how these agents are given and in what combination. For participants with triple negative breast cancer, paclitaxel and carboplatin will be administered in standard, weekly doses. Both agents are FDA-approved for use in early breast cancer. However, carboplatin and paclitaxel are not typically used as a 'stand-alone' treatment for breast cancer, meaning they are often used together along with other chemotherapy agent(s) over a longer period. For participants with hormone receptor-positive breast cancer, paclitaxel and cyclophosphamide will be administered, which are both FDA-approved agents to treat breast cancer as part of a longer regimen to treat early breast cancer. In this clinical trial the investigators are modifying the way the chemotherapy is delivered so that it may be more tolerable than the longer treatment course. This clinical trial does not limit the use of other chemotherapy or other treatments being recommended for breast cancer, but any other recommended treatments would be given after the participants receive their paclitaxel and carboplatin on the clinical trial.
Investigators
Rachel Freedman, MD, MPH
Principal Investigator
Dana-Farber Cancer Institute
Eligibility Criteria
Inclusion Criteria
- •Participants must have histologically or cytologically confirmed breast cancer that is human epidermal growth factor receptor 2 negative (HER2-negative) per the most recent 2018 ASCO CAP guidelines94
- •Estrogen Receptor and Progesterone immunohistochemistry (IHC) status must be known; any status is eligible, but this will define in which cohort a patient will enroll:
- •Additional eligibility for cohort 1: Triple negative disease- defined as IHC staining of \<10% for ER and PR per local pathology review
- •Additional eligibility for cohort 2: Hormone receptor-positive disease defined as IHC for ER or PR \>/= 10% per local pathology review
- •Men and women are eligible
- •Age 70 and older at the time of protocol registration
- •Non-metastatic, invasive breast cancer (scans are not required to document non-metastatic disease- any staging work-up is up to the treating provider's discretion)
- •Recommended to have either neoadjuvant chemotherapy or adjuvant chemotherapy per their treating provider.
- •Any surgery, nodal assessment, radiation, hormonal therapy is left up to the treating provider but should not occur concurrently with study therapy. If any additional chemotherapy is planned by a treating provider, this must occur AFTER all study-related chemotherapy is completed.
- •Any patient receiving pre-operative hormonal therapy and who is then recommended for adjuvant chemotherapy is eligible, though hormonal therapy should be held during study treatment administration
Exclusion Criteria
- •Participants who have already received chemotherapy for the current cancer. Prior diagnoses of breast cancers are allowed, provided that the treating provider feels that the current cancer represents a new primary breast cancer and not recurrent disease.
- •Participants who are receiving any other investigational or anti-cancer agents. Any additional radiation, hormonal therapy or chemotherapy planned should be administered once the study treatments have completed.
- •History of allergic reactions attributed to compounds of similar chemical or biologic composition to cyclophosphamide, carboplatin, and paclitaxel.
- •Prior chemotherapy receipt is allowed in the setting of treatment of other/prior cancers, but no prior carboplatin (cohort 1), cyclophosphamide (cohort 2), or paclitaxel (both cohorts) receipt in the last 2 years is allowed (given toxicity and possible efficacy concerns
Arms & Interventions
Carboplatin + Paclitaxel
* Paclitaxel will be administered intravenously 3 times per cycle * Carboplatin will be administered intravenously 3 times per cycle
Intervention: Paclitaxel
Carboplatin + Paclitaxel
* Paclitaxel will be administered intravenously 3 times per cycle * Carboplatin will be administered intravenously 3 times per cycle
Intervention: Carboplatin
Cyclophosphamide + Paclitaxel
* Paclitaxel will be administered intravenously 3 times per cycle * Cyclophosphamide will be administered once per cycle
Intervention: Paclitaxel
Cyclophosphamide + Paclitaxel
* Paclitaxel will be administered intravenously 3 times per cycle * Cyclophosphamide will be administered once per cycle
Intervention: Cyclophosphamide
Outcomes
Primary Outcomes
Toxicity and receipt of planned therapy (feasibility)
Time Frame: 3 months
Examine the number of treatments received divided by the denominator of 12 treatments
Secondary Outcomes
- NCI PRO-CTCAE(2 Years)
- Invasive disease-free survival(2 years)
- Overall survival(2 years)
- Consequences of toxicity or disease events(2 years)
- Adverse events(2 years)