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Dose-adjusted Adjuvant FEC Compared to Standard FEC for Breast Cancer

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StatusCompleted
Sponsors
Henrik Lindman
Collaborators
Scandinavian Breast Group
Danish Breast Cancer Cooperative Group
Swedish Cancer Society
Swedish Cancer Foundation
Pharmacia Pharmaceutical Company
Swedish Breast Cancer Group

Keywords

Abstract

This is an open randomized phase III study. The primary objective of this study is to compare FEC adjuvant chemotherapy in operable breast cancer given either as fixed doses calculated according to the patients surface area or with doses adjusted according to leukopenia after course one in order to achieve hematological equitoxicity. The main aim of the study is to test whether chemotherapy dosage aimed at hematological equitoxicity will improve the effect of adjuvant chemotherapy.

Description

Group A, FECStandard(standard FEC) is given 7 courses of 5-fluorouracil-epirubicin (Farmorubicin)-cyclophosphamide with doses based on the patient's surface area. Leukocyte nadir values at day 10, 12 or 13 and 15 are measured. Dose-reductions of one step according to table 8.2.1 are performed in case of leukopenic fever or grade 4 leukopenia.

Group B FECTailored(Tailored FEC) receives course one at identical doses to group A. Leukocyte nadir values at day 10,12 or 13 and 15 are measured. Doses of subsequent courses are adjusted to achieve grade 3 leukopenia (leukocyte nadir 1.0 to 2.0) in patients experiencing only grade 0 to 2 leukopenia after course one.

Dose-reductions of one step according to table 8.2.1 are performed in case of leukopenic fever or grade 4 leukopenia .

Patients achieving only grade 0-2 leukopenia at the first course will be randomized into continued treatment at standard doses (Group A) or to doses tailored to achieve grade 3 leukopenia (Group B). The primary comparisons will be made between these two groups of patients.

Patients with grade 3-4 leukopenia after the first course not be randomized but followed according to the protocol and received treatment as group A, FECStandard.

Dates

Last Verified: 02/28/2019
First Submitted: 03/21/2019
Estimated Enrollment Submitted: 03/21/2019
First Posted: 03/24/2019
Last Update Submitted: 03/24/2019
Last Update Posted: 03/27/2019
Actual Study Start Date: 01/31/2001
Estimated Primary Completion Date: 07/31/2003
Estimated Study Completion Date: 06/30/2014

Condition or disease

Breast Cancer

Intervention/treatment

Drug: 5-FU, epirubicin and cyclophosphamide

Phase

Phase 3

Arm Groups

ArmIntervention/treatment
Active Comparator: Standard
Standard FEC (F600, E60, C600) every 3rd week.
Experimental: Tailored
Tailored FEC (F600, E75-90, C900-1200) every 3rd week.
Active Comparator: Registered
Non-randomized arm with patients with grade 3-4 leukopenia after first cycle and treated with standard FEC (F600, E60, C600) every 3rd week.

Eligibility Criteria

Ages Eligible for Study 18 Years To 18 Years
Sexes Eligible for StudyFemale
Accepts Healthy VolunteersYes
Criteria

Inclusion Criteria:

- Node positive or 2) High-risk node negative#

- no major cardiovascular morbidity

- female age 18-60

- ECOG/WHO performance status <1

- histologically proven invasive breast cancer

- written or oral witnessed informed consent according to the local Ethics Committee requirements

- start of adjuvant chemotherapy within 8 weeks after surgery

Exclusion Criteria:

- distant metastases (M1)

- locally advanced cancer

- nonradically operated (positive resection margins)

- pregnancy or lactation

- leukocyte count < 3.5 x109 /l

- platelets < 100 x109 /l

- other serious medical condition

- previous or concurrent malignancies at other sites, except basal cell carcinoma and carcinoma cervicis uteri in situ

Outcome

Primary Outcome Measures

1. Distant disease-free survival. [5-10 years]

Distant disease-free survival comparing standard and tailored arm.

Secondary Outcome Measures

1. Regio-locally relapsed disease [5-10 years]

Regiolocal disease-free survival

2. Overall survival [5-10 years]

Overall survival

3. Toxicity of treatment. [5-10 years]

Adverse events

4. Leukopenia and correlation to prognosis in distant disease-free survival. [5-10 years.]

Distant disease-free survival in patients groups based on nadir leukopenia after third cycle.

5. Effect of dose escalation of leukopenia and correlation to prognosis in distant disease-free survival. [5-10 years.]

Comparing distant disease-free survival difference between patients randomized to tailored and dose-escalated FEC with the Group of patients with standard FEC but with similar grade of leukopenia.

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