COX Inhibition and Biomarkers During Neoadjuvant Chemoendocrine Therapy for ER+, HER2- Stage I-III Breast Cancer

Study Overview
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Brief Summary
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This study is designed to assess the safety and clinical activity of tamoxifen and the COX inhibitor, aspirin, given in combination with standard AC-T chemotherapy (doxorubicin, cyclophosphamide, and paclitaxel) for the treatment of high-risk estrogen receptor (ER)+, human epidermal growth factor receptor 2 (HER2)- breast cancer. If successful, the study could improve long-term outcomes for a subpopulation of women with aggressive stage I-III ER+/HER2- breast cancer.

Official Title
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COX Inhibition and Biomarkers of Response During Neoadjuvant Chemoendocrine Therapy for Estrogen Receptor Positive, Human Epidermal Growth Factor Receptor 2 Negative Stage I-III Breast Cancer

Conditions
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Breast Cancer, Estrogen Receptor-positive Breast Cancer

Intervention / Treatment
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* Drug: Aspirin
* Drug: Tamoxifen Pill
* Drug: Doxorubicin
* Drug: Cyclophosphamide
* Drug: Paclitaxel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Provision of signed and dated informed consent form Stated willingness to comply with all study procedures and availability for the duration of the study Male or female, aged 18 or older Newly diagnosed with ER+/HER2- stage I-III breast cancer according to American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines and the 8th edition of the American Joint Committee on Cancer (AJCC); ER positive is defined as ≥ 1% positive nuclear staining Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-2 Life expectancy ≥ 6 months Women of childbearing potential and men must agree to use adequate contraception (see section 5.4) prior to study entry and for at least 3 months following the last dose of tamoxifen If genomic profiling has been performed (OncotypeDx, Mammaprint or other), then the score must be in a medium- or high-risk range. Adequate Organ Function as described below. There are no requirements regarding recent transfusions Absolute Neutrophil Count ≥1000/mm3 Platelets ≥100,000/mm3 Hemoglobin ≥9 g/dL Serum Creatinine or Glomerular Filtration Rate (GFR) ≤ 1.5 x upper limit of normal (ULN) Bilirubin ≤ 1.5 x ULN (except in patients with Gilbert's disease, where bilirubin to 4x ULN or direct bilirubin ≤ ULN is allowed) Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤ 2.5 x ULN Alkaline phosphatase ≤ 2.5 x ULN Ability to take oral medication Exclusion Criteria: Receipt of any systemic treatment for the current diagnosis of breast cancer (breast biopsy, excisional biopsy, or other local therapy is acceptable as long as residual disease is present and is appropriate for systemic chemotherapy and additional curative intent resection) Current use of anticoagulant (e.g. warfarin (Coumadin), heparin, direct oral anticoagulants (DOAC)) within 72 hours of registration Pregnancy or lactation Currently in prison Requirement for supplemental oxygen therapy Current active cancer other than breast cancer History of severe bleeding that, in the treating investigator's opinion, would put the patient at increased risk with daily 325 mg aspirin use Known allergic reactions to aspirin, tamoxifen, doxorubicin, cyclophosphamide, or paclitaxel Participants classified according to the New York Heart Association classification as having Class II - IV heart disease (section 12.2) History of thrombosis or cerebrovascular accident

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

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
Intervention Model: Single Group Assignment
Interventional Model Description: All participants will receive aspirin and tamoxifen with standard AC-T chemotherapy
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tamoxifen and Aspirin with AC-T Chemotherapy<br>AC-T chemotherapy includes 4 cycles of doxorubicin and cyclophosphamide given every 2 or 3 weeks followed by either 12 weekly cycles of lower dose paclitaxel or 4 cycles of higher dose paclitaxel every 2 or 3 weeks. During this time, all participants would receive daily aspirin and daily tamoxifen. After the AC-T chemotherapy, participants will undergo standard of care surgery to remove any remaining tumor. | Drug: Aspirin<br>* 325 mg aspirin daily during AC-T chemotherapy<br>Drug: Tamoxifen Pill<br>* Tamoxifen (either 20 mg daily or 10 mg twice a day) during AC-T chemotherapy<br>Drug: Doxorubicin<br>* Doxorubicin (60 mg/m2) Given by IV with cyclophosphamide<br>* Other names: Adriamycin;Drug: Cyclophosphamide<br>* Cyclophosphamide (600 mg/m2) Given by IV with doxorubicin<br>* Other names: Cytoxan;Drug: Paclitaxel<br>* Paclitaxel 80 mg/m2 or 175 mg/m2 based on provider preference. Given by IV after completion of doxorubicin/cyclophosphamide therapy<br>* Other names: Taxol;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pathologic complete response (pCR) rate | Rate of participants that no longer have any tumor identified at the time of surgery after chemotherapy | At the time of surgery, following completion of AC-T chemotherapy, usually about 7.5 months | 
| Adverse events (AEs) | Frequency of adverse events occurring during and shortly after the study intervention | From time of informed consent through 30 days after completion of study intervention (for AEs) or 90 days after completion of study intervention (for Serious AEs) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ER+/HER2- Breast Cancer