Clinical trial NCT00274456: Phase II Trial Comparing ABI-007 (Abraxane®, Nab®-Paclitaxel) to Taxotere in First Line Therapy of Patients With Stage IV Breast Cancer
Official title: A Randomized Phase II Study of Weekly or Every 3 Weeks ABI-007 Versus Every 3 Weeks Taxotere as First Line Therapy of Stage IV (Metastatic) Breast Cancer
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Metastatic Breast Cancer
Keywords: Metastatic breast cancer, nab paclitaxel, docetaxel,
Lead sponsor: Celgene
Sponsor class: INDUSTRY
First posted: 2006-01-11
Enrollment: 302
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This was an open-label study conducted comparing the toxicity and antitumor activity of ABI-007 (Abraxane®, nab®-paclitaxel) to docetaxel (Taxotere).

Detailed description: This was an open-label, randomized study to compare the following regimens with respect to toxicity and antitumor activity:

* the maximum tolerated dose (MTD) of ABI-007 300 mg/m\^2 every 3 weeks;
* ABI-007 100 mg/m\^2 administered weekly for 3 weeks with a 1 week rest;
* ABI-007 150 mg/m\^2 administered weekly for 3 weeks with a 1 week rest;
* the standard dose and schedule of Taxotere (100 mg/m\^2 every 3 weeks).

Eligibility criteria: Inclusion Criteria:

Patients had to meet the following criteria to be eligible for the study:

1. Pathologically confirmed adenocarcinoma of the breast.
2. No prior chemotherapy for metastatic breast cancer.
3. Stage IV disease.
4. Measurable disease (must have been ≥ 2.0 cm, except for pulmonary lesions that were well documented on CT scan that were ≥ 1.0 cm).
5. At least 3 weeks since prior cytotoxic chemotherapy (patients should have recovered from all acute effects of such therapy.
6. At least 4 weeks since radiotherapy, with full recovery. The measurable disease was completely outside the radiation portal or there was radiologic or clinical exam proof of progressive disease within the radiation portal.
7. At least 4 weeks since major surgery, with full recovery.
8. Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
9. Age ≥18 years.
10. Patient had the following blood counts at Baseline:

    * Absolute neutrophil count (ANC) ≥1.5\*10\^9 cells/L
    * Platelets ≥100\*10\^9 cells/L
    * Hemoglobin (Hgb) ≥9 g/dL.
11. Patient had the following baseline blood chemistry levels:

    * Aspartate aminotransferase (AST \[SGOT\]), alanine aminotransferase (ALT \[SGPT\])≥2.5x upper limit of normal (ULN) range
    * Total bilirubin normal
    * Alkaline phosphatase ≥2.5x ULN (unless bone metastasis is present in the absence of liver metastasis)
    * Creatinine ≥1.5 mg/dL.
12. Peripheral neuropathy Grade 0 or 1 by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE).
13. If female of childbearing potential, pregnancy test was negative (within 72 hours of the first dose of study drug).
14. If fertile, the patient agreed to use an effective method to avoid pregnancy for the duration of the study.
15. Informed consent had been obtained.

Exclusion Criteria:

Patients who met any of the following criteria were excluded from the study:

1. Prior neo-adjuvant or adjuvant chemotherapy was allowed. No prior chemotherapy for metastatic disease was allowed. If a taxane was part of the adjuvant regimen, at least one year should have transpired since completion of taxane regimen.
2. Cumulative life-time dose of doxorubicin \>360 mg/m\^2. Doxorubicin was allowed as prior neo-adjuvant or adjuvant therapy but not for metastatic disease.
3. Concurrent immunotherapy or hormonal therapy for breast cancer.
4. Parenchymal brain metastases, unless documented to be clinically and radiographically stable for at least 6 months after treatment.
5. Serious intercurrent medical or psychiatric illness, including serious active infection.
6. History of class II-IV congestive heart failure.
7. History of other malignancy within the last 5 years which could affect the diagnosis or assessment of breast cancer.
8. Patients who had received an investigational drug within the previous 3 weeks.
9. Patient was enrolled in a different clinical study in which investigational procedures were performed or investigational therapies were administered. Also, a patient was not permitted enroll in such clinical trials while participating in this study.
10. Pregnant or nursing women
11. Patients with prior hypersensitivity to either Taxol or Taxotere.

Primary outcomes:
measure: Percentage of Participants Showing an Overall Response As Assessed by the Independent Radiology Reader and by the Investigator
timeFrame: Day 1 up to 95 weeks
Secondary outcomes:
measure: Percentage of Participants With Stable Disease for ≥ 16 Weeks, or Complete or Partial Overall Response
timeFrame: Day 1 up to 95 weeks
measure: Kaplan-Meier Estimates for Progression-free Survival (PFS)
timeFrame: Day 1 up to 95 weeks
measure: Kaplan-Meier Estimates for Duration of Response Based on Independent Radiology Assessment of Response and Progression
timeFrame: Day 1 - 95 weeks
measure: Kaplan-Meier Estimates for Duration of Response Based on Investigator Assessment of Response and Progression
timeFrame: Day 1 - 95 weeks
measure: Kaplan-Meier Estimate for Overall Survival (OS)
timeFrame: Day 1 to 221 weeks
measure: Participants With Treatment-Emergent, Treatment-Related Adverse Events
timeFrame: Day 1 up to 125 weeks
Other outcomes:
measure: Nadir of Myelosuppression (Over All Cycles) as Measured by Absolute Neutrophils (ANC), White Blood Cells (WBC) and Platelet Counts
timeFrame: Day 1 up to 125 weeks
measure: Nadir of Myelosuppression (Over All Cycles) as Measured by Hemoglobin (Hb) Counts
timeFrame: Day 1 up to 125 weeks
Locations:
city: Kiev
country: Ukraine
facility: Study Sites in Russia and the Ukraine
Study officials:
affiliation: Abraxis BioScience, LLC, a wholly owned subsidiary of Celgene Corporation
name: Jose Iglesias, MD
role: STUDY_CHAIR
References:
citation: O'Shaughnessy J, Gradishar WJ, Bhar P, Iglesias J. Nab-paclitaxel for first-line treatment of patients with metastatic breast cancer and poor prognostic factors: a retrospective analysis. Breast Cancer Res Treat. 2013 Apr;138(3):829-37. doi: 10.1007/s10549-013-2447-8. Epub 2013 Apr 6.
citation: Gradishar WJ, Krasnojon D, Cheporov S, Makhson AN, Manikhas GM, Clawson A, Bhar P. Significantly longer progression-free survival with nab-paclitaxel compared with docetaxel as first-line therapy for metastatic breast cancer. J Clin Oncol. 2009 Aug 1;27(22):3611-9. doi: 10.1200/JCO.2008.18.5397. Epub 2009 May 26.
citation: Gradishar WJ, Krasnojon D, Cheporov S, Makhson AN, Manikhas GM, Clawson A, Bhar P, McGuire JR, Iglesias J. Phase II trial of nab-paclitaxel compared with docetaxel as first-line chemotherapy in patients with metastatic breast cancer: final analysis of overall survival. Clin Breast Cancer. 2012 Oct;12(5):313-21. doi: 10.1016/j.clbc.2012.05.001. Epub 2012 Jun 23.