Adjuvant Albumin-bound Paclitaxel Versus Taxanes in Breast Cancer: a Real-world Study

Study Overview
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Brief Summary
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This is a prospective, multi-center, real-world study designed to evaluate the efficacy and safety of albumin-bound paclitaxel versus paclitaxel or docetaxel in adjuvant treatment of breast cancer.

Official Title
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Adjuvant AC Followed by Albumin-bound Paclitaxel Versus AC Followed by Taxanes in Breast Cancer: a Prospective, Multi-center, Real-world Study

Conditions
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Breast Cancer

Intervention / Treatment
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* Drug: doxorubicin
* Drug: epirubicin
* Drug: pirarubicin
* Drug: cyclophosphamide
* Drug: albumin-bound paclitaxel
* Drug: paclitaxel
* Drug: docetaxel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female patients aged from 18 to 70 years old; Histologically confirmed as invasive breast cancer; Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; Participants achieved complete tumor resection by radical mastectomy, modified radical mastectomy or breast-conserving surgery with negative margins; AC-T adjuvant chemotherapy is planned after breast cancer surgery; Participants with HER-2 negative breast cancer at high risk of recurrence who meet any of the following conditions: 1) HR positive, and ≥4 positive lymph nodes or 1-3 positive lymph nodes with other risk of recurrence [such as high Ki67 expression (≥20%), T > 2 cm, age < 35 years, lymphovascular invasion, grade 3 histology]; 2) HR negative with positive lymph node or T > 2 cm; LVEF ≥ 50%; Participants had good compliance with the planned treatment and follow-up, understood the study procedures of this study, and signed informed consent form. Exclusion Criteria: In the past and present, participants with severe cardiac disease or discomfort , including but not limited: 1) High-risk uncontrolled arrhythmia, atrial tachycardia (heart rate > 100/min in resting state), significant ventricular arrhythmia (ventricular arrhythmia) or higher atrioventricular block (second-degree type 2 [Mobitz 2] atrioventricular block or third-degree atrioventricular block); 2) Angina pectoris requiring anti-angina medication; 3) Clinically significant valvular heart disease; 4) ECG showing transmural myocardial infarction; 5) Uncontrolled hypertension (eg systolic blood pressure > 180mm Hg or diastolic blood pressure > 100mmHg); 6) Myocardial infarction; 7) Congestive heart failure; Participants who have received prior any systematic treatment for breast cancer; Participants with bilateral invasive breast cancer; Breast cancer with distant metastasis; Grade 2 or higher Sensory or motor neurotoxicity was present as assessed by CTCAE V5.0; Participants have the following serious illnesses or medical conditions, including but not limited: 1) History of serious neurological or psychiatric disorders, including psychosis, dementia, or epilepsy, that prevent understanding and informed consent; 2) Active uncontrolled infection; 3) Active peptic ulcer, unstable diabetes; Previous or current existence of other malignant tumors other than breast cancer; Severe liver and kidney dysfunction; The presence of any myelodysplastic and other hematopoietic disorders; Participants who are known to be allergic to the active or other components of the study treatment; Participants who are pregnant, breastfeeding, or refuse to use adequate contraception prior to study entry and for the duration of study participation; Participants who were judged by the investigator to be unsuitable for this study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: AC followed by albumin-bound paclitaxel<br>A (doxorubicin, epirubicin or pirarubicin) and C (cyclophosphamide) for 4 cycles followed by albumin-bound paclitaxel for 4 cycles. | Drug: doxorubicin<br>* doxorubicin 50 60mg/m2, i.v., d1, q3w or q2w.<br>Drug: epirubicin<br>* epirubicin 80 100mg/m2, i.v., d1, q3w or q2w.<br>Drug: pirarubicin<br>* pirarubicin 40 50mg/m2, i.v., d1, q3w or q2w.<br>Drug: cyclophosphamide<br>* cyclophosphamide 600mg/m2, i.v., d1, q3w or q2w.<br>Drug: albumin-bound paclitaxel<br>* albumin-bound paclitaxel 260mg/m2, i.v., d1, q3w; 260mg/m2, i.v., d1, q2w; or 125mg/m2, i.v., d1, qw.<br>|
| Active Comparator: AC followed by taxanes<br>A (doxorubicin, epirubicin or pirarubicin) and C (cyclophosphamide) for 4 cycles followed by paclitaxel or docetaxel for 4 cycles. | Drug: doxorubicin<br>* doxorubicin 50 60mg/m2, i.v., d1, q3w or q2w.<br>Drug: epirubicin<br>* epirubicin 80 100mg/m2, i.v., d1, q3w or q2w.<br>Drug: pirarubicin<br>* pirarubicin 40 50mg/m2, i.v., d1, q3w or q2w.<br>Drug: cyclophosphamide<br>* cyclophosphamide 600mg/m2, i.v., d1, q3w or q2w.<br>Drug: paclitaxel<br>* paclitaxel 175mg/m2, i.v., d1, q3w; 175mg/m2, i.v., d1, q2w; or 80mg/m2, i.v., d1, qw.<br>Drug: docetaxel<br>* docetaxel 80 100mg/m2, i.v., d1, q3w.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 5-year invasive disease-free survival (IDFS) rate | Invasive disease free survival was defined as the time from enrollment until the date of first occurrence of one of the following events: invasive ipsilateral breast tumor recurrence, local/regional invasive recurrence, distant recurrence (including first metastasis), invasive contralateral breast cancer, second primary invasive cancer (nonbreast, not including squamous or basal cell skin cancers, or new in situ carcinomas of any site), or death from any cause. 5-year IDFS rate is thepercentage of participants with IDFS from enrollment through 5 years. | up to 60 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| IDFS | Invasive disease free survival was defined as the time from enrollment until the date of first occurrence of one of the following events: invasive ipsilateral breast tumor recurrence, local/regional invasive recurrence, distant recurrence (including first metastasis), invasive contralateral breast cancer, second primary invasive cancer (nonbreast, not including squamous or basal cell skin cancers, or new in situ carcinomas of any site), or death from any cause. | up to 60 months | 
| overall survival (OS) | OS was defined as the time from enrollment assignment to death as a result of any cause. | up to 60 months | 
| 3-year invasive disease-free survival (IDFS) rate | 3-year IDFS rate is the percentage of participants with IDFS from enrollment through 3 years. | up to 36 months | 
| Incidence and severity of adverse events | Adverse events as assessed by NCI-CTCAE V5.0 | up to 60 months |