Randomized Phase III Trial of Paclitaxel Once Per Week Compared With Nanoparticle Albumin-Bound Nab-Paclitaxel Once Per Week or Ixabepilone With Bevacizumab As First-Line Chemotherapy for Locally Recurrent or Metastatic Breast Cancer: CALGB 40502/NCCTG N063H (Alliance) - PubMed (original) (raw)

Clinical Trial

. 2015 Jul 20;33(21):2361-9.

doi: 10.1200/JCO.2014.59.5298. Epub 2015 Jun 8.

William T Barry 2, Alvaro Moreno-Aspitia 2, Alan P Lyss 2, Constance Cirrincione 2, Eleanor Leung 2, Erica L Mayer 2, Michael Naughton 2, Deborah Toppmeyer 2, Lisa A Carey 2, Edith A Perez 2, Clifford Hudis 2, Eric P Winer 2

Affiliations

Clinical Trial

Randomized Phase III Trial of Paclitaxel Once Per Week Compared With Nanoparticle Albumin-Bound Nab-Paclitaxel Once Per Week or Ixabepilone With Bevacizumab As First-Line Chemotherapy for Locally Recurrent or Metastatic Breast Cancer: CALGB 40502/NCCTG N063H (Alliance)

Hope S Rugo et al. J Clin Oncol. 2015.

Abstract

Purpose: We compared nab-paclitaxel or ixabepilone once per week to paclitaxel with bevacizumab as first-line therapy for patients with advanced breast cancer (BC) to evaluate progression-free survival (PFS) for nab-paclitaxel or ixabepilone versus paclitaxel.

Patients and methods: Eligible patients were age ≥ 18 years with chemotherapy-naive advanced BC. Patients were randomly assigned to bevacizumab with paclitaxel 90 mg/m(2) (arm A), nab-paclitaxel 150 mg/m(2) (arm B), or ixabepilone 16 mg/m(2) (arm C), once per week for 3 of 4 weeks. Planned enrollment was 900 patients, which would give 88% power to detect a hazard ratio of 0.73.

Results: In all, 799 patients were enrolled, and 783 received treatment (97% received bevacizumab). Arm C was closed for futility at the first interim analysis (n = 241), and arm A (n = 267) and arm B (n = 275) were closed for futility at the second interim analysis. Median PFS for paclitaxel was 11 months, ixabepilone was inferior to paclitaxel (PFS, 7.4 months; hazard ratio, 1.59; 95% CI, 1.31 to 1.93; P < .001), and nab-paclitaxel was not superior to paclitaxel (PFS, 9.3 months; hazard ratio, 1.20; 95% CI, 1.00 to 1.45; P = .054). Results were concordant with overall survival; time to treatment failure was significantly shorter in both experimental arms v paclitaxel. Hematologic and nonhematologic toxicity, including peripheral neuropathy, was increased with nab-paclitaxel, with more frequent and earlier dose reductions.

Conclusion: In patients with chemotherapy-naive advanced BC, ixabepilone once per week was inferior to paclitaxel, and nab-paclitaxel was not superior with a trend toward inferiority. Toxicity was increased in the experimental arms, particularly for nab-paclitaxel. Paclitaxel once per week remains the preferred palliative chemotherapy in this setting.

Trial registration: ClinicalTrials.gov NCT00785291.

© 2015 by American Society of Clinical Oncology.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.

Fig 1.

CONSORT diagram for the intent-to-treat analysis of data from the Cancer and Leukemia Group B (CALGB) 40502 (Paclitaxel, Nab-Paclitaxel, or Ixabepilone With or Without Bevacizumab in Treating Patients With Stage IIIC or Stage IV Breast Cancer) trial.

Fig 2.

Fig 2.

Kaplan-Meier plots of ixabepilone or nab-paclitaxel compared with paclitaxel, respectively, for (A, B) progression-free survival (PFS), and (C, D) overall survival by treatment arm.

Fig 3.

Fig 3.

Kaplan-Meier plots of progression-free survival (PFS) for the exploratory analyses in patient subgroups of ixabepilone or nab-paclitaxel compared with paclitaxel, respectively, defined by (A, B) triple-negative disease and (C, D) hormone receptor–positive disease

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