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• Patients with operable histologically confirmed adenocarcinoma of the female breast who have completed primary surgical treatment and meet the following criteria:
• ER and/or progesterone receptor (PR)-positive: Estrogen and/or
progesterone receptor positive disease (as defined by local pathology
laboratory)
• Negative axillary nodes: As assessed by a sentinel lymph node
biopsy, an axillary dissection, or both, and as defined by the Sixth
Edition of the American Joint Committee on Cancer (AJCC) staging
criteria
• Tumor size 1.1-5.0 cm (or 5 mm-1.0 cm plus unfavorable histological
features):
• Unfavorable features defined as intermediate or poor nuclear
and/or histologic grade, or lymphovascular invasion
* NOTE: Definition of tumor size: The tumor size used for
determination of eligibility is the pathologic tumor size, which is
usually determined by the size of the tumor as measured by
inspection of the gross specimen; if the tumor size is measured
microscopically and the tumor includes ductal carcinoma in-situ,
the measurement should include only the invasive component of
the tumor
• The tumor must be human epidermal growth factor receptor 2
(Her2)/neu negative by either fluorescent in-situ hybridization (FISH)
or immunohistochemistry (e.g. 0 or 1+ by DAKO Herceptest)
• The patient and physician must be agreeable to initiate standard chemotherapy and hormonal therapy as adjuvant therapy
• A tissue specimen from the primary breast cancer has been located and is ready to be shipped to the appropriate laboratory after consent is obtained and within 3 days following pre-registration; NOTE: For determination of the Oncotype Recurrence Score, tissue must be shipped to Genomic Health; if the Oncotype DX Recurrence Score was previously performed by Genomic Health (prior to pre-registration), tissue must be submitted to the Eastern Cooperative Oncology Group (ECOG)-American College of Radiology Imaging Network (ACRIN) Central Biorepository and Pathology Facility upon randomization
• Leukocyte count >= 3500/mm^3
• Platelets >= 100,000/mm^3
• Serum creatinine =< 1.5 mg/dL
• Serum aspartate transaminase (AST) that is =< 3-fold the upper institutional limits of normal
• Patients must be disease-free of prior invasive malignancies for >= 5 years with the exception of curatively-treated basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix; patients with a previous ipsilateral or contralateral invasive breast cancer, or with bilateral synchronous cancers, are not eligible; patients with previous ipsilateral or contralateral ductal in situ carcinoma (DCIS) are not eligible
• Prior treatment
• Mandatory prior surgery criteria:
• Patient must pre-register within 84 days from the final surgical
procedure required to adequately treat the primary tumor (please
note that if margins are not clear and a resection has to be
conducted after pre-registration but before randomization, the
patient will be deemed to be within the 84 day window allowed
by protocol and therefore eligible)
• All tumors should be removed by either a mastectomy or local
excision plus an acceptable axillary procedure (i.e., sentinel
lymph node biopsy, axillary dissection, or both); there must be
adequate (at least 1 mm if margin width specified) tumor-free
margins of resection (for invasive and ductal carcinoma in-situ) in
order for the patients to be eligible; patients with lobular
carcinoma in-situ involving the resection margins are eligible
• Criteria re: other prior treatments:
• No prior chemotherapy for this malignancy
• No prior radiation therapy for this malignancy; this includes no
prior MammoSite Brachytherapy radiation therapy (RT)
• Hormonal therapy: Patients who develop breast cancer while
receiving a selective estrogen-receptor modulator (SERM; e.g.,
tamoxifen, toremifene, raloxifene) or an aromatase inhibitor (e.g.,
anastrazole, letrozole, exemestane) for breast cancer prevention
or a SERM for other indications (e.g., raloxifene for osteoporosis)
are not eligible; however, patients may have received up to 8
weeks of a SERM or aromatase inhibitor for this malignancy and
still be eligible for study entry
• Patients must have an anticipated life expectancy of at least 10 years
• Patients with the following medical conditions should not be enrolled on the study:
• Chronic obstructive pulmonary disease requiring treatment
• Chronic liver disease (e.g., cirrhosis, chronic active hepatitis)
• Previous history of a cerebrovascular accident
• History of congestive heart failure or other cardiac disease that would
represent a contraindication to the use of an anthracycline (e.g.,
doxorubicin or epirubicin)
• Chronic psychiatric condition or other condition that would impair
compliance with the treatment regimen
• Women must not be pregnant or breast-feeding; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to pre-registration to rule out pregnancy
• Women of childbearing potential must be strongly advised to utilize an
accepted and effective form of non-hormonal contraception (e.g.
intrauterine device, condoms, diaphragm, abstinence)
• Patients must not have previously had the Oncotype DX Assay performed, with the exception of patients who have had the assay performed and have a recurrence score of 11-25
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