Panther: A Study Comparing Biweekly and Tailored EC-T Versus Three Weekly FEC-T in Breast Cancer Patients

Phase 3

Active, not recruiting

• Conditions: Breast Cancer
• Interventions: Drug: dtEC→dtT; Drug: FEC→T

• Registration Number: NCT00798070
• Lead Sponsor: Karolinska University Hospital

Brief Summary

This is an adjuvant, open, prospective, randomized study to compare:

A. Individually tailored and two weekly dosed epirubicin + cyclophosphamide followed by a three weeks break followed by biweekly and tailored docetaxel (dtEC→dtT) given every second week, to

B. Fixed dosed and three weekly epirubicin, cyclophosphamide and 5-fluorouracil, followed by fixed dosed and three weekly docetaxel (FEC→T).

Patients with primary node-positive or high risk lymph node negative breast cancer will be eligible for the study.

The primary objective of the phase 3 study is to compare breast cancer relapse-free survival (BCRFS) between the dtEC→dtT and FE100C→T. To detect a five-year BCRFS difference of 0.710 to 0.790 about 1000 patients per arm will be needed. They will be recruited during four years and followed another two years for breast cancer events.

Secondary objectives are to compare

1. Distant disease-free survival (DDFS)

2. Event-free survival and

3. Overall survival

4. Health-related quality of life and toxicity analyses according to CTC

5. Outcome in relation to tumour biological factors and polymorphism patterns

1. RFS in relation to the Sorlie classes using immunohistochemical markers and/or gene expression profiling comparing A vs B arm

2. RFS with receptor positive disease (analyzed in the local laboratories as described in the CRFs and also analyzed as continuous variables) in the comparison between the A- and B- arms.

3. RFS with high and low proliferation, respectively, (analyzed in the local laboratories as described in the CRFs and also analyzed as a continuous variable, or centrally analyzed), in the comparison between the A- and B-arms.

4. RFS in relation to HER-2/neu status (analyzed in the local laboratories as described in the CRFs) in the primary cancers in the comparison between the A- and B-arms and analyzed whether trastuzumab was given in sequence or concurrently.

5. RFS analyzed in relation to other molecular markers (e.g. gene expression profiling/ sequencing) in the primary cancers and SNPs signatures in normal DNA (related to toxicities for EC/FEC and docetaxel components, respectively, and given dose levels and outcome in relation to these factors and in relation QoL) to outcome per arm.

6. RFS analyzed in relation to tumour associated lymphocytes and Y-box binding protein in the comparison between the A- and B-arms.

Tumour tissue will be obtained and stored for studies of prognostication and therapy prediction.

Last patient randomized was September 2011.

Detailed Description

Are described under the heading "Outcome measures"

Study Timeline

• Study Start: 2007-02
• Study First Submitted: 2008-11-24
• Study First Submitted QC: 2008-11-24
• Study First Posted: 2008-11-25
• Primary Completion: 2016-04
• Status Verified: 2024-11
• Last Update Submitted: 2024-12-13
• Last Update Posted: 2024-12-18
• Study Completion: 2028-01

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: Female
• Target Recruitment: 2017

Inclusion Criteria

• Histological proven invasive primary breast cancer, with at least 5 (recommended 10) removed axillary lymph nodes OR negative sentinel node biopsy performed for the node negative cohort. Interval between definitive surgery that includes axillary lymph node dissection and registration must be less than 60 days. Paraffin block from the primary tumour must be retained (not mandatory for Austrian sites). Frozen tumour tissue is strongly recommended to be stored.
• Receptor negative or positive tumours with 1 or more positive axillary lymph nodes (more than 0.2 mm) OR axillary node negative breast cancers if the primary tumour is larger than 20 mm and receptor negative (Er and Pgr with no receptor content) and being Elston grade III. In Germany high risk node negative breast cancer patients are not eligible until labelling for docetaxel includes node-negative disease.
• A primary breast cancer patient being 35 years or younger considered suitable for adjuvant chemotherapy (may be receptor negative or positive, HER-2/neu negative or positive, with or without axillary lymph node metastases).
• Macroscopically and microscopically free margins after radical surgery (no cancer cells at borders of resection).
• No proven distant metastases (negative chest/pulmonary X-ray, bone scintigram (when clinical signs of skeletal metastases or elevated ALP) supplemented with normal conventional X-ray of hot spots, normal liver function test and haematological function tests; when abnormal values, CT or ultrasound of the liver, patient can be included if no metastases are demonstrated.
• Female age 18-65.
• Ambulant patients (ECOG 1 or less).
• No major cardiovascular morbidity NYHA I or II. (Appendix 3).
• Written informed consent according to the local ethics committee requirements.
• Patients of childbearing potential should have a negative pregnancy test within seven days of registration. (In Austria, pregnancy tests have to be repeated monthly during the treatment phase).

Exclusion Criteria

• Previous neo-adjuvant treatment.
• Non-radical surgery (histopathological positive margins).
• Proven distant metastases.
• Pregnancy or lactation.
• Other serious medical condition.
• Previous or concurrent malignancies at other sites, except basal cell carcinoma and/or squamous cell carcinoma in situ of the skin or cervix. Patients with previous breast cancer (invasive and/or ductal carcinoma in situ) in the other breast without loco-regional (large lung volumes) radiotherapy, without objective findings for relapse, with > 5 years since diagnosis can be included.
• Abnormal laboratory values precluding the possibility to safely deliver the used cytotoxic agents in the study.
• Hypersensitivity to drugs formulated in polysorbate 80.
• Peripheral neuropathy grade ≥2.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A: dtEC→dtT	dtEC→dtT	Individually tailored and two weekly dosed epirubicin + cyclophosphamide followed by a three weeks break followed by biweekly and tailored docetaxel (dtEC→dtT) given every second week
Arm B: FEC→T	FEC→T	Fixed dosed and three weekly epirubicin, cyclophosphamide and 5-fluorouracil, followed by fixed dosed and three weekly docetaxel

Primary Outcome Measures

Name	Time	Method
Breast cancer relapse-free survival	2 years	Breast cancer recurrence free survival is defined as time from randomization to the first of the events; local-, regional- or distant breast cancer recurrence or death due to breast cancer or last date of follow-up if no event has occurred. This was defined already in the phase 2 protocol (1 Sept 2004).

Secondary Outcome Measures

Name	Time	Method
Event-free survival	2 years	Event-free survival is defined as time from randomization to the first of the events breast cancer recurrence (any type), contra-lateral breast cancer, other malignancy or any cause of death.
Distant disease-free survival	2 years	Distant disease free survival is defined as time from randomization to the first of distant metastases or death due to breast cancer.
BCRFS in arm A in relation to given dose levels	2 years	Breast cancer relapse free survival
Health-related quality of life and toxicity analyses according to CTC	2 years
Overall survival	2 years	Overall survival is defined as time from randomization to any death.
Outcome in relation to tumour biological factors and polymorphism patterns	2 years	Comparing arm A vs B regarding: 1. RFS in relation to the Sorlie classes using immunohistochemical markers and/or gene expression profiling comparing A vs B arm; 2. RFS with receptor positive disease in the comparison between the A- and B arms; 3. RFS with high and low proliferation, respectively, in the comparison between the A- and B-arms.; 4. RFS in relation to HER-2/neu status in the primary cancers in the comparison between the A- and B-arms and analyzed whether trastuzumab was given in sequence or concurrently; 5. RFS analyzed in relation to other molecular markers in the primary cancers and SNPs signatures in normal DNA to outcome per arm; 6. RFS analyzed in relation to tumour associated lymphocytes and Y-box binding protein in the comparison between the A- and B-arms.; Description of a to e are more detailed in the protocol, shortened here due to space limitation.

Trial Locations

Locations (71)

MUG - Med. Univ.-Klinik Graz; 🇦🇹 Graz, Austria

MUI - Univ. Klinik f. Frauenheilkunde, Innsbruck; 🇦🇹 Innsbruck, Austria

LKH Leoben; 🇦🇹 Leoben, Austria

AKH Linz; 🇦🇹 Linz, Austria

KH BHS Linz; 🇦🇹 Linz, Austria

LKH Rankweil; 🇦🇹 Rankweil, Austria

LKH Salzburg / PMU; 🇦🇹 Salzburg, Austria

KH BHB St. Veit/Glan; 🇦🇹 St. Veit/Glan, Austria

Klinikum Wels - Grieskirchen GmbH; 🇦🇹 Wels, Austria

Brustzentrum Hanusch-KH; 🇦🇹 Wien, Austria

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