Clinical Trial: Clinical Outcome of Chemotherapy in Surgical Patients With Infiltrating Ductal Carcinoma of Breast

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: A Phase I/II Multi-Center Study to Evaluate the Safety, Tolerability, and Efficacy of Chemotherapeutic Regiments in Surgical Patients With Infiltrating Ductal Carcinoma of Breast

Brief Summary: The overarching purpose of this study is to determine if the mainstay chemotherapeutic regimens represented by several genotoxic agents including but not limited to Cyclophosphamide, Doxorubicin, Epirubicin, Fluorouracil and Methotrexate (CDEFM), in the format of either a single agent or combinations are safe, tolerable, and effective in the treatment of patients with infiltrating ductal carcinoma of breast.

Detailed Summary:

Infiltrating ductal carcinoma (IDC) of breast, or sometimes called invasive ductal carcinoma of breast, is the most common type of breast malignancy. About 80% of all breast cancers are IDCs.

Once found, IDC usually has already broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, IDC can spread to the lymph nodes and possibly to other areas of the body with high frequency.

According to the statistics of American Cancer Society, more than 180,000 women in the United States are diagnosed with IDC each year. Although IDC can affect women at any age, it is more common as they grow older. Further, approximately two-thirds of women are 55 or older when they are diagnosed with such this symptom.

The treatments for invasive ductal carcinoma fall into two broad categories. First, local treatments for IDC, including surgery and radiation, which treat the primary tumor and surrounding areas such as the chest and lymph nodes. Second, systemic treatments for IDC, including chemotherapy, hormone therapy and targeted therapy, which are supposed to deliver cytotoxicity throughout the body to eliminate any cancer cells that have left the primary site and to help minimize the risk of recurrent disease.

PURPOSE: This randomized phase I/II trial is to determine the safety, tolerability and efficacy of single or concurrent administration of cyclophosphamide, doxorubicin, epirubicin, fluorouracil and methotrexate (CDEFM) to women undergoing surgery for infiltrating ductal carcinoma in situ breast cancer.

RATIONALE: This is a randomized, controlled, open-labeled and multicenter, pilot study. Patients are randomized to 1 of 2 treatment arms (arms A or B)
Sponsor: Shanghai Jiao Tong University School of Medicine

Current Primary Outcome: Incidence of treatment-emergent adverse events [ Time Frame: 6 months ]

The case of emergent events caused by treatment is measured by counting the blood cell number and detecting liver and kidney functions. Total blood cell number, alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and lactate dehydrogenase (LDH) > 20% above upper limit of normal, is considered as not safe.

Tolerability is measured by monitoring the first occurrence of grade 4 hematologic or grade 3-4 non hematologic toxicity as defined by the National Cancer Institute (NCI)-Common Toxicity Criteria (CTC) (NCI-CTC version 4; or CTCAE v4.0) and/or disruption of chemotherapy because of inacceptable toxicity.

Chemotherapeutic efficacy is measured by the remaining tumor size after computed tomography (CT) scanning and comparing it with the original primary tumor size 2-3 weeks after last cycle of chemotherapy. The ratio of post-treatment tumor size to pre-treatment tumor size < 50% is considered as effective. Otherwise not.



Original Primary Outcome: Same as current

Current Secondary Outcome: Circulating concentrations of tumor microenvironment-specific soluble factors [ Time Frame: 6 months ]

Influence of the cytotoxicity of chemotherapeutic regimens on the primary tumor microenvironment is systemically measured for each patient. The circulating amounts per volume of a group of literature-reported soluble factors including interleukin (IL)-6, IL-8, granulocyte macrophage colony stimulating factor (GM-CSF), Wnt family member 16B (WNT16B) and serine peptidase inhibitor Kazal type 1 (SPINK1) are measured in the peripheral blood 2-3 weeks post treatments to assess the influence of chemotherapies. Concentration of either IL-6 > 50 ng/ml, IL-8 > 80 ng/ml, GM-CSF > 20 ng/ml, WNT16B > 100 ng/ml or SPINK1 > 60 ng/ml, is considered that the primary tumor has an activated microenvironment. The measurement continues for two more times, including one performed at 2 months and the other performed as 6 months after completion of chemotherapeutic regimens.


Original Secondary Outcome: Same as current

Information By: Shanghai Jiao Tong University School of Medicine

Dates:
Date Received: August 25, 2016
Date Started: January 2013
Date Completion: December 2018
Last Updated: September 12, 2016
Last Verified: September 2016