SWOG S0800 (NCI CDR0000636131): addition of bevacizumab to neoadjuvant nab-paclitaxel with dose-dense doxorubicin and cyclophosphamide improves pathologic complete response (pCR) rates in inflammatory or locally advanced breast cancer.

Abstract

SWOG S0800, a randomized open-label Phase II clinical trial, compared the combination of weekly nab-paclitaxel and bevacizumab followed by dose-dense doxorubicin and cyclophosphamide (AC) with nab-paclitaxel followed or preceded by AC as neoadjuvant treatment for HER2-negative locally advanced breast cancer (LABC) or inflammatory breast cancer (IBC). Patients were randomly allocated (2:1:1) to three neoadjuvant chemotherapy arms: (1) nab-paclitaxel with concurrent bevacizumab followed by AC; (2) nab-paclitaxel followed by AC; or (3) AC followed by nab-paclitaxel. The primary endpoint was pathologic complete response (pCR) with stratification by disease type (non-IBC LABC vs. IBC) and hormone receptor status (positive vs. negative). Overall survival (OS), event-free survival (EFS), and toxicity were secondary endpoints. Analyses were intent-to-treat comparing bevacizumab to the combined control arms. A total of 215 patients were accrued including 11 % with IBC and 32 % with triple-negative breast cancer (TNBC). The addition of bevacizumab significantly increased the pCR rate overall (36 vs. 21 %; p = 0.019) and in TNBC (59 vs. 29 %; p = 0.014), but not in hormone receptor-positive disease (24 vs. 18 %; p = 0.41). Sequence of administration of nab-paclitaxel and AC did not affect the pCR rate. While no significant differences in OS or EFS were seen, a trend favored the addition of bevacizumab for EFS (p = 0.06) in TNBC. Overall, Grade 3-4 adverse events did not differ substantially by treatment arm. The addition of bevacizumab to nab-paclitaxel prior to dose-dense AC neoadjuvant chemotherapy significantly improved the pCR rate compared to chemotherapy alone in patients with triple-negative LABC/IBC and was accompanied by a trend for improved EFS. This suggests reconsideration of the role of bevacizumab in high-risk triple-negative locally advanced breast cancer.

• Authors: Z A Nahleh, W E Barlow, D F Hayes, A F Schott, J R Gralow, W M Sikov, E A Perez, S Chennuru, H R Mirshahidi, S W Corso, D L Lew, L Pusztai, R B Livingston, G N Hortobagyi
• Journal: Breast cancer research and treatment (Breast Cancer Res Treat) Vol. 158 Issue 3 Pg. 485-95 (08 2016) ISSN: 1573-7217 [Electronic] Netherlands
• PMID: 27393622 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)

Chemical References

• 130-nm albumin-bound paclitaxel
• Albumins
• Bevacizumab
• Doxorubicin
• Cyclophosphamide
• Paclitaxel

Topics

• Adult
• Aged
• Albumins (administration & dosage, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Bevacizumab (administration & dosage, therapeutic use)
• Breast Neoplasms (drug therapy)
• Cyclophosphamide (administration & dosage, therapeutic use)
• Disease-Free Survival
• Doxorubicin (administration & dosage, therapeutic use)
• Drug Administration Schedule
• Female
• Humans
• Middle Aged
• Neoadjuvant Therapy
• Paclitaxel (administration & dosage, therapeutic use)
• Survival Analysis
• Treatment Outcome
• Young Adult