An open randomized phase III study to compare 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy in first line treatment, in combination with bevacizumab, and second line treatment of patients with HER2/neu negative, incurable, metastatic or unresectable locally advanced breast cancer.
The primary goal of this non-inferiority trial is to determine if the results obtained with a intermittent chemotherapy regimen (2 x 4 cycles of paclitaxel) are not inferior to the results of a continuous chemotherapy regimen (8 cycles of paclitaxel), both combined with bevacizumab in first line treatment of patients with HER2/neu negative, incurable, metastatic or unresectable locally advanced breast cancer.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
420
1. st line: * Paclitaxel and bevacizumab: 8 cycles, unless PD or unacceptable toxicity occurs earlier. * Bevacizumab until PD or unacceptable toxicity * At PD patients will go to the 2nd treatment line. 2. nd line: * Non-pegylated liposomal doxorubicin (Myocet®) (or capecitabine): 8 cycles, unless PD or unacceptable toxicity occurs earlier. * At PD patients will go to the 3rd treatment line. If possible, it is advised to cross-over from 2nd line non-pegylated liposomal doxorubicin to 3rd line capecitabine.
Arm B 1. st line * Paclitaxel and bevacizumab: 4 cycles, unless PD or unacceptable toxicity * Bevacizumab until PD or unacceptable toxicity * At PD \< 3 months after last paclitaxel start 2nd treatment line. * At PD ≥ 3 months after last paclitaxel, start another 4 cycles * Bevacizumab until the next PD or unacceptable toxicity * At the next PD start the 2nd treatment line. 2. nd line: * Myocet® or capecitabine: 4 cycles, unless PD or unacceptable toxicity * At PD \< 3 months start the 3rd treatment line. If possible, advised to cross-over from 2nd line Myocet® to 3rd line capecitabine. * At PD ≥ 3 months after last administration of Myocet® or capecitabine, start another 4 cycles of Myocet® or capecitabine * At the next PD start 3rd treatment line.
BOOG Study Center
Amsterdam, Netherlands
Progression free survival
PFS is defined as the time from start of treatment to the documented progression that requires the patient to switch to the next treatment line or to death due to any cause.
Time frame: 1 year
Progression free survival second line treatment
To compare the PFS of second line treatment of 8 continuous cycles of chemotherapy with liposomal doxorubicin (or capecitabine) with 8 cycles of intermittent (2 times 4 cycles) chemotherapy with liposomal doxorubicin (or capecitabine);
Time frame: 1 year
Objective overall response rate
To compare the objective Overall Response Rate (ORR) between 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy in first treatment line, combined with bevacizumab, and in second treatment line. ORR calculated as the proportion of patients with a best overall response of confirmed Complete Response (CR) and Partial Response (PR).
Time frame: 1 year
Duration of objective response
To compare the Duration of Objective Response (DOR) between 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy in first treatment line, combined with bevacizumab, and second treatment line; For the intermittent chemotherapy schedule the first DOR and, if applicable, second DOR in the same treatment line will be accumulated DOR calculated as the time from the date of first documented CR or PR to the first documented progression or death due to underlying cancer
Time frame: 1 year
Overall survival
To compare Overall Survival (OS) between 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy. OS calculated as the time from the date of randomization to the date of death due to any cause or the date of last contact
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Time frame: 1 year
Safety and tolerability. The total number of grade 3 and 4 adverse events will be analyzed.
To compare the Safety between 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy The total number of grade 3 and 4 adverse events will be analyzed as a measure of safety and tolerability
Time frame: 1 year
Quality of life measures
To compare the Quality of Life (QoL) between 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy. Changes in the RAND 36 quality of life scale will be measured
Time frame: 1 year
Pharmacoeconomics
To compare the Pharmacoeconomics between 8 continuous cycles of chemotherapy with 8 cycles of intermittent (2 times 4 cycles) chemotherapy. Direct medical costs will be calculated using a standard cost method.
Time frame: 1 year