This randomized phase II trial studies how well carboplatin and paclitaxel with or without panitumumab work in treating patients with invasive triple negative breast cancer. Drugs used in the chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping the them from dividing, or by stopping them from spreading. Monoclonal antibodies, such as panitumumab, may interfere with the ability of tumor cells to grow and spread. Giving carboplatin and paclitaxel with or without panitumumab before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.
PRIMARY OBJECTIVES: I. To determine the pathologic complete response (pCR) rate in patients with primary triple-receptor negative (estrogen receptor \[ER\]-negative, progesterone receptor \[PgR\]-negative, and human epidermal growth factor receptor 2 \[HER2\]-negative) inflammatory breast cancer (TN-IBC) by using a combination of panitumumab, carboplatin, and paclitaxel (PaCT) in comparison with carboplatin and paclitaxel (CT) followed by adriamycin and cyclophosphamide (AC) in a neoadjuvant setting. SECONDARY OBJECTIVES: I. To determine the disease-free survival (DFS) rates produced by either arm of trial combination treatment. II. To determine the overall survival (OS) rates produced by either arm of trial combination treatment. III. To determine the safety and tolerability of both arms of trial combination treatment. EXPLORATORY OBJECTIVES: I. To determine whether the pCR rate positively correlates with reduced nodal expression status. II. To determine whether the pCR rate inversely correlates with arginine methylation status of epidermal growth factor receptor (EGFR). III. To identify molecular biomarkers predictive of the pCR rate by analysis of multiplexed immunohistochemical (IHC) staining. IV. To identify molecular biomarkers predictive of the pCR rate by genomic and proteomic analysis. V. To determine whether the inhibition of the EGFR pathway downregulates the COX-2 pathway and mesenchymal marker. OUTLINE: Patients are randomized into 1 of 2 groups. GROUP A: Patients receive panitumumab intravenously (IV) over 1 hour on day 1 of cycle 0 and over 30 minutes on days 1, 8, and 15 of cycles 1-4. Patients also receive paclitaxel IV over 1-3 hours on days 1, 8, and 15 of cycles 1-4, and carboplatin IV over 30 minutes on day 1 of cycles 1-4. Treatment repeats every 21 days for up to 8 cycles in the absence of disease progression or unexpected toxicity. GROUP B: Patients receive paclitaxel, carboplatin, doxorubicin, and cyclophosphamide as in Group A. Treatment repeats every 21 days for up to 8 cycles in the absence of disease progression or unexpected toxicity. After completion of study treatment, patients are followed up at 1 month and then annually for at least 5 years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
42
M D Anderson Cancer Center
Houston, Texas, United States
Complete pathologic response
Will be estimated for each treatment arm with exact 95% confidence intervals. A Chi-square test or Fisher's exact test will be used to compare the differences in complete pathologic response rate between the two treatment arms. A logistic regression model will be used to assess the differences in complete pathologic response between the two treatment arms, adjusting for other covariates as appropriate. The analysis will be based on the modified intent-to-treat population.
Time frame: At the time of surgery, assessed up to 5 years
Disease free survival
The method of Kaplan-Meier method will be used to estimate the time-to-event outcomes.
Time frame: Up to 5 years
Overall survival
The method of Kaplan-Meier method will be used to estimate the time-to-event outcomes.
Time frame: Up to 5 years
Incidence of adverse events
Descriptive statistics will be used.
Time frame: Up to 5 years
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