Selective Neoadjuvant Treatment According to Immunohistochemical Subtype for HER2 Negative Breast Cancer Patients
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Intervention: Epirubicin; Cyclophosphamide; Docetaxel; Exemestane; Goserelin; Carboplatin
Intervention MeSH terms: Cyclophosphamide; Carboplatin; Docetaxel; Epirubicin; Exemestane; Goserelin
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 189.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Her2neu negative breast cancer.; Neoadjuvant treatment.

Summary:

      This is an open-label study that includes two substudies of random distribution. First,a
      sample of the primary tumor will be obtained and will be analyzed by an immunohistochemical
      technique to determine several markers.Depending on the expression of these markers, the
      patients will be characterize as group 1 (Luminal A phenotype) or group 2 (Basal phenotype)
      and a random assignment will be performed to standard or experimental treatment.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Written informed consent.

          -  Breast cancer with histological diagnosis.

          -  Negative Human Epidermal Growth Factor Receptor 2 (HER2) tumours defined as
             immunohistochemistry (IHQ) 0,1+.

          -  No evidence of suspicion of metastatic disease.

          -  Age >= 18 years old.

          -  Performance status (Karnofsky index) >= 80 (ECOG 0,1).

          -  Adequate cardiac function by ECG in the previous 12 weeks.

          -  Hematology: neutrophils >= 1,5 x10^9/l; platelets >= 100 x10^9/l; hemoglobin >= 10
             g/dl.

          -  Adequate hepatic function: total bilirubin <= 1x Upper Normal Limit (UNL); Aspartate
             aminotransferase (AST) (SGOT) and Alanine aminotransferase (ALT) (SGPT) <= 2.5 x UNL;
             alkaline phosphatase <= 2.5 x UNL.

          -  Adequate renal function: creatinine <= 1 x UNL; creatinine clearance >= 60 ml/min.

          -  Patients able to comply with study treatment and follow-up.

          -  Negative pregnancy test in the previous 14 days.

        Exclusion Criteria:

          -  HER2 positive tumours (defined as IHQ 3+ or positive fluorescence in situ
             hybridization [FISH]).

          -  Prior systemic therapy for breast cancer (immunotherapy, hormonotherapy,
             chemotherapy).

          -  Prior treatment with anthracyclines or taxanes (paclitaxel, docetaxel) for any
             previous malignancy.

          -  Prior radiotherapy for breast cancer.

          -  Bilateral invasive breast cancer.

          -  Pregnant or lactating women.

          -  Previous grade >= 2 motor or sensorial neurotoxicity (National Cancer Institute Common
             Toxicity Criteria [NCICTC]).

          -  Other serious comorbidities: congestive heart failure or unstable angina; prior
             history of myocardial infarction in previous year; uncontrolled hypertension (HT);
             high risk arrhythmias; history of significant neurological or psychiatric disorders;
             uncontrolled active infection; active peptic ulcer; unstable diabetes mellitus;
             dyspnea at rest; or chronic therapy with oxygen.

          -  Previous or current history of neoplasms different from breast cancer, except for skin
             carcinoma, cervical in situ carcinoma, or any other tumor curatively treated and
             without recurrence in the last 10 years; ductal in situ carcinoma in the same breast;
             lobular in situ carcinoma.

          -  Chronic treatment with corticosteroids.

          -  Contraindications for administration of corticosteroids.

          -  Concomitant treatment with other therapy for cancer.

          -  Males.