This is a multicenter, international, double-blind randomized Phase III study to evaluate the pathological complete response (pCR) according to Chevalier classification between Fulvestrant® and the combination of Fulvestrant® plus Palbociclib as neoadjuvant therapy of hormone-sensitive patients with operable luminal breast cancer. Eligible patients will be assessed upfront using the OncotypeDX® molecular test (Recurrence Score \<31).
This is a multicenter, international, double-blind, randomized study. Eligible patients based on inclusion/exclusion criteria will be assessed using OncotypeDX molecular test. Patients with low/intermediate risk (Recurrence Score \<31) will be treated with the induction neoadjuvant Fulvestrant (500 mg (milligram) intra muscular(i.m) at Day 1, 14 and 28 and then every 4 weeks), plus Goserelin (3.6 mg subcutaneous (s.c) every 4 weeks, only for pre and peri-menopausal patients) for 4 months, followed by clinical and radiological assessment of the disease response. Patients with objective response or stabilization will be randomized and treated for 4 additional months with: * Fulvestrant 500 mg i.m every 4 weeks (+ Goserelin 3.6 mg s.c every 4 weeks, only for pre and peri-menopausal patients) and Placebo or * Combination Fulvestrant 500 mg i.m every 4 weeks (+ Goserelin 3.6 mg s.c every 4 weeks, only for pre and peri-menopausal patients) and Palbociclib 125 mg per os daily, 3 weeks on and 1 week off. Patients with documented progressive disease will be considered at the discretion of the investigator for surgery or neoadjuvant chemotherapy. The preferred chemotherapy protocol will be FEC 100 -Taxotere (5fluorouracil 500mg/m2, Epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2 (FEC) q3 weeks for 3 cycles followed by Docetaxel 100 mg/m2 (T) q 3 weeks for 3 cycles) for a total of 6 cycles with clinical and radiological assessment after each 3 cycles of chemotherapy (CT). Chemotherapy candidates will as well undergo surgery. The expected interval between the cycles will be 21 days, unless the patient has not recovered from toxicity. Specific dose adjustments will be set out in the protocol. Breast and nodal surgery will be performed at completion of therapy (8 months of hormonal therapy for responding patients and 6 additional cycles of CT for non-responders). The type of surgery will be left at the discretion of the investigators. Radiation therapy and adjuvant systemic treatment and endocrine therapy will be as well left at the discretion of the investigators. Patients will be followed every 6 months during 5 years post surgery.
Study Type
INTERVENTIONAL
All patients in all arms will receive Fulvestrant 500mg
Dose reduction to 100 mg and 75 mg
Only for pre or peri menopausal patient
Center Pierre et Marie Curie
Algiers, Algeria
Cancer Center - Blida
Blida, Algeria
CHU - Oran
Oran, Algeria
pCR according to Le Chevalier's classification
pathological complete response will be assessed according to Le Chevalier's classification between two arms
Time frame: up to 5 years after the end of treatment period
pCR according to Sataloff's classification
pathological complete response will be assessed according to Sataloff's classification between two arms
Time frame: up to 5 years after the end of treatment period
radiological response
radiological response according to the WHO criteria (US/Mammography/MRI)
Time frame: up to 5 years after the end of treatment period
Rate of breast conservative surgery
Rate of breast conservative surgery will be assessed and compared between two arms
Time frame: up to 5 years after the end of treatment period
Safety /Tolerability of the combination Fulvestrant + Palbociclib
Safety and tolerability will be assessed in terms of adverse events (AEs), laboratory data and vital signs. Treatment-related adverse events will be assessed by using CTCAE v4.1 classification
Time frame: up to 5 years after the end of treatment period
DFS and OS
Evaluation and comparison of Disease Free Survival (DFS) and Overall Survival (OS) between two arms
Time frame: up to 5 years after the end of treatment period
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Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
354
Placebo
University of Alexandria
Alexandria, Egypt
National Cancer Institut (NCI)
Cairo, Egypt
King Hussein Cancer Center (KHCC) - Amman
Amman, Jordan
Hotel Dieu de France
Beirut, Lebanon
Hopital Cheikh Khalifa Ibn Zaid
Casablanca, Morocco
Department of Oncology - Institut National d'Oncologie
Rabat, Morocco
King Abdul Aziz Medical City-National Guard Health Affairs (NGHA)
Riyadh, Saudi Arabia
...and 4 more locations