Adjuvant phase III trial to compare intense dose-dense adjuvant treatment with EnPC to dose dense, tailored therapy with dtEC-dtD for patients with high-risk early breast cancer (GAIN-2).

Authors

null

Volker Moebus

Klinikum Frankfurt Hoechst, Frankfurt, Germany

Volker Moebus , Helmut Forstbauer , Grischa Wachsmann , Andreas Schneeweiss , Angelika Ober , Ekkehard von Abel , Petra Krabisch , Heinz-Gert Hoeffkes , Karin Kast , Bernd Christensen , Michael Niedermeier , Mustafa Deryal , Christoph Uleer , Yvonne Fauster , Thomas Goehler , Sibylle Loibl , Valentina Nekljudova , Gunter Von Minckwitz

Organizations

Klinikum Frankfurt Hoechst, Frankfurt, Germany, GOSPL Troisdorf, Troisdorf, Germany, Klinikum Sindelfingen-Böblingen, Sindelfingen-Böblingen, Germany, University Hospital Heidelberg, Heidelberg, Germany, St. Vincent Hospital Limburg, Limburg, Germany, Klinikum Schwäbisch-Gmünd, Schwäbisch-Gmünd, Germany, Klinikum Chemnitz, Chemnitz, Germany, Klinikum Fulda, Fulda, Germany, Department of Gynecology and Obstetrics, University Hospital Dresden, Dresden, Germany, Ruppiner Kliniken, Neuruppin, Germany, Onkologische Gemeinschaftspraxis, Memmingen, Germany, Caritasklinik St. Theresia Saarbrücken, Saarbrücken, Germany, Gynecology Practice, Hildesheim, Germany, Kreiskrankenhaus Freudenstadt, Freudenstadt, Germany, Onkozentrum Dresden, Dresden, Germany, German Breast Group, Neu-Isenburg, Germany

Research Funding

Other

Background: Intense dose-dense (idd) chemotherapy (CT) significantly improves overall survival in breast cancer patients. Two preceding trials explored iddETC vs a dd combination of EC-TX (GAIN) and dtEC-dtD vs conventional dosed FEC-D (Panther). Nab-paclitaxel (nP) provides a better toxicity profile and higher efficacy compared to solvent based taxanes and might be preferred in an idd regimen. Methods: This is a multicenter, prospective, randomized, open-label phase III trial comparing iddEnPC or dtEC-dtD as adjuvant CT. Pts with uni- or bilateral primary high risk node-positive (N+) breast cancer (BC) and centrally confirmed ER/PR/HER2 and Ki-67 status can be included. Luminal A pts are only recruited with N+ ≥4. Randomization to iddEnPC or dtEC-dtD will be stratified by biological subtype defined by hormone receptor, HER2 and Ki-67. The iddEnPC arm will receive epirubicin (150mg/m2) q2w x3 followed by nP (260-330mg/m2, dose to be determined in run-in phase) q2w x3, followed by cyclophosphamide (2g/m2) q2w x3. The dtEC-dtD arm will receive EC (38-120/450-1200 mg/m2) q2w x4 followed after 1 wk rest by docetaxel (60-100mg/m2) q2w x4. GAIN-2 will compare toxicity and efficacy of an idd regimen (EnPC) vs a dd regimen with modification of single doses depending on individual hematological and non-hematological toxicities. Primary objective is invasive disease-free survival (IDFS). Secondary objectives are survival by other definitions, compliance, safety, side effects of taxanes and subgroup analyses (by 0-3, 4-9 or 10+ involved nodes and Ki-67). Efficacy analyses are planned 60 mths after end of accrual, safety interim analyses after 200 and 900 pts have completed CT. It was assumed that dtEC-dtD will achieve a 5-yr IDFS of 75% and ddEnPC will improve IDFS to 79% (HR 0.819) with a power of 80% (α=0.05, ß= 0.2).GAIN-2 is registered under NCT01690702 Results: 75pts were recruited since 1stOct 2012. Recruitment (in total 2886 pts) is planned for 36 mths in 80-100 sites in Germany. Run-in safety data to be presented. Conclusion: GAIN-2 will compare the efficacy of adjuvant iddEnPC and dtEC-dtD in pts with early N+ BC. Clinical trial information: NCT01690702.

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Abstract Details

Meeting

2013 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Breast Cancer - Triple-Negative/Cytotoxics/Local Therapy

Track

Breast Cancer

Sub Track

Cytotoxic Chemotherapy

Clinical Trial Registration Number

NCT01690702

Citation

J Clin Oncol 31, 2013 (suppl; abstr TPS1137)

DOI

10.1200/jco.2013.31.15_suppl.tps1137

Abstract #

TPS1137

Poster Bd #

33D

Abstract Disclosures