Fulvestrant and/or Anastrozole in Treating Postmenopausal Patients With Stage II-III Breast Cancer Undergoing Surgery
Diagnosis: Breast: Early Stage Disease
NCT ID: NCT01953588
(View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 14-143
This randomized phase III trial has several primary objectives. One primary objective is to compare the efficacy of 3 different endocrine therapies, the estrogen receptor down regulator fulvestrant and the aromatase inhibitor anastrozole, either alone or in combination, in reducing cancer growth before surgery (neoadjuvant) in postmenopausal women with clinical stage II-III estrogen receptor positive and HER2 negative breast cancer. Another primary objective is to evaluate whether patients who achieved a modified PEPI (Preoperative Endocrine Prognostic Index) score of 0, defined by tumor size <5 cm, N0, Ki67<2.7% (by central testing), at surgery post 6 months of neoadjuvant endocrine therapy predict excellent long term outcome, for whom chemotherapy is unnecessary.
Dana-Farber Cancer Institute, Brigham and Women's Hospital
Daniel Morganstern, MD,
Dana-Farber Cancer Institute:
Breast Cancer Nursing Team, 617-632-3478
1. Female ≥18 years of age
2. Eastern Cooperative Oncology Group (ECOG) performance status 0-2
3. Postmenopausal, verified by:
- post bilateral surgical oophorectomy or
- no spontaneous menses ≥ 1 year or
- no menses for < 1 year with follicle-stimulating hormone (FSH) and estradiol
levels in postmenopausal range, according to institutional standards
4. Pathologic confirmation of invasive breast cancer diagnosed by core needle biopsy
5. Clinical T2-T4c, any N, M0 invasive breast cancer, by AJCC 7th edition clinical
staging, with the goal being surgery to complete excision of the tumor in the breast
and the lymph node. The extent of disease is a solitary lesion where the lesion is:
- its size can be measured bidimensional by tape, ruler or caliper technique and
- its largest tumor diameter is at least 2.0 cm (that is considered measurable
by the WHO criteria)
- Patients with contralateral ductal carcinoma in situ and/or invasive breast
cancer are not eligible.
- Patients with multifocal/multi-lesional breast cancer are not eligible if more
than one lesion is invasive breast cancer in the same breast.
6. Invasive breast cancer is estrogen receptor positive with an Allred score of 6, 7 or
8 by local institution standard protocol.
7. Invasive breast cancer is Human Epidermal Growth Factor Receptor 2 (HER2) negative
defined as 0 or 1+ by immunohistochemistry (IHC) or with a fluorescence in situ
hybridization (FISH) ratio (HER2 gene copy/chromosome 17) < 2 if IHC 2+ by local
institution standard protocol.
8. Documentation of mammogram and ultrasound (including ductal carcinoma in situ (DCIS)
and invasive cancer) of the diseased breast performed within 42 days prior to
registration. Mammogram for the unaffected contralateral breast is required within 12
months prior to registration.
9. Laboratory values ≤ 14 days prior to registration:
1. Absolute Neutrophil Count (ANC) > 1000/mm3
2. Platelet Count > 100,000/mm3
3. Total Bilirubin < 1.5 x upper limits of normal (ULN)
4. Creatinine < 1.5 x ULN
5. Serum alanine transaminase (ALT) < 2.5 x ULN
10. Tissue acquisition: Patient must agree to provide the required research biopsies at
baseline, week 4 and at surgery for biomarker and correlative studies.
1. Premenopausal status
2. Inflammatory breast cancer defined as clinically significant erythema of the breast
and/or documented dermal lymphatic invasion (not direct skin invasion by tumor or
peau d' orange without erythema).
3. An excisional biopsy of this breast cancer.
4. Hormone replacement therapy of any type, megestrol acetate, or raloxifene within one
week prior to registration.
5. Tumor estrogen receptor (ER) Allred score between 0-5 or HER2 positive by IHC (3+) or
amplified by FISH > 2.0.
6. Surgical axillary staging procedure prior to study entry. Note: Fine needle
aspiration (FNA) or core needle biopsy of axillary node is permitted.
7. Clinical or radiographic evidence of metastatic disease. Metastatic workup is not
required, but is recommended for patients with clinical stage III disease. Note:
Isolated ipsilateral supraclavicular node involvement is permitted.
8. Breast implants are contraindicated only if the implant precludes the required
research biopsies. Patients who have previously had implants removed within 6 weeks
prior to registration are eligible.
9. Treatment for this cancer including surgery, radiation therapy, chemotherapy,
biotherapy, hormonal therapy or investigational agent prior to study entry.
10. History of invasive breast cancer or contralateral DCIS.