comparison of biological therapies following combination chemotherapy and bone marrow or peripheral stem cell transplantation in women with stage ii or stage iii breast cancer

Conditions: Breast Cancer

Summary: rationale: drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. combining chemotherapy with peripheral stem cell transplantation or bone marrow transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. biological therapy may interfere with the growth of the cancer cells. it is not yet known which post-transplant biological therapy regimen is more effective for breast cancer. purpose: randomized phase iii trial to compare the effectiveness of cyclosporine and interferon gamma to that of interleukin-2 following combination chemotherapy and bone marrow or peripheral stem cell transplantation in women who have stage ii or stage iii breast cancer.

objectives: * determine the response, disease-free survival (dfs), and overall survival of women with high-risk stage ii or iii breast cancer treated with high-dose cyclophosphamide, thiotepa, and carboplatin with autologous marrow and/or peripheral blood stem cell transplantation. * determine the safety of immunomodulation consisting of cyclosporine and interferon gamma versus low-dose interleukin-2 in this patient population. * determine parameters associated with immune activation and autologous graft-versus-host disease. * determine which immunomodulation regimen is more efficacious with respect to dsf. outline: this is a randomized study. patients are stratified according to stage (ii vs iii), age, lymph node status, and inflammatory histology. patients are randomized to one of two immunomodulation arms. autologous harvest of at least 1 million cd34+ cells /kg or 400 million mononuclear cells/kg must be achieved. all patients receive cyclophosphamide iv continuously and thiotepa iv continuously over 96 hours on days -6 through -3 and carboplatin iv over 5 hours daily on days -6 through -3. patients undergo autologous bone marrow and/or peripheral blood stem cell transfusion on day 0. * arm i: patients receive cyclosporine iv over 4 hours twice a day, beginning on day 0 and continuing until discharge from the hospital, and interferon gamma subcutaneously (sc) every 2 days on days 7-28. * arm ii: patients receive interleukin-2 sc daily for 28 days following recovery of blood counts. treatment continues in the absence of disease progression or unacceptable toxicity. patients are followed every 3 months for 1 year and then annually for 5 years. projected accrual: a total of 70 patients (30 with stage ii disease and 40 with stage iii disease) will be accrued over 2 years.

Eligibility criteria:
disease characteristics: * histologically confirmed breast cancer * stage ii with at least 10 lymph nodes involved with malignancy or * stage iii (any t3b-t4, n2 or n3, m0) * ineligible for other high priority national or institutional study * no metastasis to brain (confirmed by ct or mri) * hormone receptor status: * not specified patient characteristics: age: * 18 to physiologic 65 sex: * female menopausal status: * not specified performance status: * ecog 0-1 life expectancy: * not specified hematopoietic: * not specified hepatic: * bilirubin less than 2 times normal renal: * creatinine less than 1.5 times normal cardiovascular: * lvef at least 45% other: * hiv negative * not pregnant or nursing prior concurrent therapy: biologic therapy: * not specified chemotherapy: * at least 3 cycles of prior chemotherapy required * stage ii patients must have completed 4-6 courses of doxorubicin and/or taxol-based adjuvant chemotherapy * stage iii patients must have achieved complete or partial response to 4-6 courses of doxorubicin and/or taxol-based induction chemotherapy * no other concurrent chemotherapy endocrine therapy: * not specified radiotherapy: * not specified surgery: * not specified

Keywords: stage ii breast cancer stage iiia breast cancer stage iiib breast cancer