A Phase II Clinical Trial of Epirubicin Plus Cyclophosphamide Followed by Docetaxel Plus Trastuzumab and Bevacizumab Given as Neoadjuvant Therapy for HER2-Positive Locally Advanced Breast Cancer or Given as Adjuvant Therapy for HER2-Positive Pathologic Stage III Breast Cancer
NSABP FB-5 is a Phase II study for women with HER2-positive invasive breast cancer
evaluating a regimen of epirubicin plus cyclophosphamide followed by docetaxel plus
trastuzumab and bevacizumab in two patient cohorts:
- Cohort A: Women with unresected locally advanced breast cancer (clinical Stage IIIA,
IIIB, and IIIC)
- Cohort B: Women with resected pN2 or pN3 (pathologic Stage III) breast cancer.
The primary aims of the study are to determine the rate of cardiac events for all patients
and the pCR rate in the breast and axillary lymph nodes for Cohort A. Cardiac events will
be defined as NYHA Class III/IV congestive heart failure and cardiac death. For Cohort A,
secondary aims of the study include determining the rate of pCR in the breast and the cCR
rate following the neoadjuvant therapy. The secondary aims also include determining the
value of the regimen in improving 5-year RFS and 5-year OS and determining the non-cardiac
toxicities of the regimen in all patients.
Patients in Cohort A will receive neoadjuvant therapy consisting of epirubicin plus
cyclophosphamide (EC) every 21 days for 4 cycles plus bevacizumab given on Day 1 of Cycle 4
only, followed by docetaxel every 21 days for 4 cycles plus bevacizumab every 21 days for
the initial 3 cycles. Patients will also receive weekly trastuzumab beginning with the
first cycle of docetaxel and continuing until 1-7 days before surgery. Patients will then
have breast surgery (lumpectomy or mastectomy) with axillary staging. Approximately 4-6
weeks following surgery, bevacizumab and trastuzumab will resume and continue every 3 weeks
for 13 doses to complete one year of targeted therapy.
Patients in Cohort B will receive adjuvant therapy consisting of EC every 21 days for 4
cycles followed by docetaxel every 21 days for 4 cycles. Beginning with the first cycle of
docetaxel, patients will also receive bevacizumab every 21 days for 4 cycles and weekly
trastuzumab until 3 weeks after the last docetaxel dose. Beginning 3 weeks after the last
dose of docetaxel, both bevacizumab and trastuzumab will then be given every 3 weeks for 13
doses to complete 1 year of targeted therapy.
Cardiac monitoring will be conducted for both cohorts. For Cohort A, LVEF assessments will
be conducted at baseline, post-EC, 2-4 weeks following surgery (about 6 months from study
entry), and 9, 12, 15, and 18 months from study entry. For Cohort B, LVEF assessments will
be conducted at baseline, post-EC, and 6, 9, 12, 15, and 18 months from study entry. The
preferred method for LVEF assessment is 2-D echocardiogram; however, LVEF assessment by MUGA
scan is permitted.
Patient follow-up will continue for 5 years following study entry.
The FB-5 sample size is 105 patients.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Number of Patients With Pathological Complete Response (pCR) in the Breast and Nodes for Patients With HER2-positive LABC Following Neoadjuvant Treatment (Cohort A)
The determination of pCR is performed by the local pathologist following examination of tissue (breast and nodes)removed at the time of surgery. The outcome measure is the number of participants with no histologic evidence of invasive tumor cells in the surgical breast specimen, axillary nodes, or SNs identified after neoadjuvant chemotherapy.
Assessed at time of surgery on average at 8 months
No
Norman Wolmark, MD
Principal Investigator
NSABP Foundation, Inc.
United States: Food and Drug Administration
NSABP FB-5
NCT00464646
May 2007
May 2014
Name | Location |
---|---|
University of Iowa | Iowa City, Iowa 52242 |
Rush University Medical Center | Chicago, Illinois 60612-3824 |
Cancer Institute of New Jersey | New Brunswick, New Jersey 08901 |
University of Pittsburgh | Pittsburgh, Pennsylvania 15261 |
Albert Einstein Healthcare Network | Philadelphia, Pennsylvania 19141 |
Baptist Regional Cancer Institute | Jacksonville, Florida 32207 |
Kimmel Cancer Center at Jefferson | Philadelphia, Pennsylvania 19107 |
Kaiser Permanente-Vallejo | Vallejo, California 94589 |
Michigan State University - Breslin Cancer Center | East Lansing, Michigan 48824-1313 |
Mercy Hospital | Scranton, Pennsylvania 18501 |
Aultman Hospital | Canton, Ohio 44710 |
East Carolina University | Greenville, North Carolina 27858 |
NSABP Foundation, Inc. | Pittsburgh, Pennsylvania 15212 |
Clearview Cancer Institute- Huntsville | Huntsville, Alabama 35801 |
Kaiser Permanente-San Diego | San Diego, California 92120 |
CCOP, Colorado Cancer Research Program, Inc. | Denver, Colorado 80224 |
CCOP, Central Illinois | Springfield, Illinois 62526 |
CCOP, Northern Indiana Cancer Research Consortium | South Bend, Indiana 46601 |
NortonHealtcare Inc. | Louisville, Kentucky 40202 |
CCOP, Grand Rapids Clnical Oncology Program | Grand Rapids, Michigan 49503 |
CCOP, Michigan Cancer Research Consortium | Grosse Pointe Woods, Michigan 48236 |
CCOP, Kalamazoo, MI | Kalamazoo, Michigan 49007 |
CCOP, Metro-Minnesota | Minneapolis, Minnesota 55416 |
CCOP, Cancer Research for the Ozarks | Springfield, Missouri 65804 |
University Hospital and Medical Center - SUNY | Stonybrook, New York 11794 |
CCOP, Southeast Cancer Control Consortium | Charlotte, North Carolina 28203 |
Case Western Reserve/University Hospitals-Ireland Cancer Cntr. | Cleveland, Ohio 44106 |
CCOP, Dayton, OH | Dayton, Ohio 45429 |
CCOP, Columbia River Oncology | Portland, Oregon 97225 |
Allegheny General Hospital/Allegheny-Singer Research Institute | Pittsburgh, Pennsylvania 15212 |
CCOP, Upstate Carolina | Spartanburg, South Carolina 29303 |
Joe Arrington Cancer Research & Treatment Center | Lubbock, Texas 79410 |
CCOP, Scott and White Memorial Hospital | Temple, Texas 76508 |
MBCCOP, Virginia Commonwealth University | Richmond, Virginia 23298 |
CCOP, Marshfield Clinic | Marshfield, Wisconsin 54449 |