The aim of this project is to evaluate tailored primary systemic therapy with sequential nab paclitaxel and epirubicin and cyclophosphamide in early breast cancer. This study will be an open label phase II clinical trial. The hypothesis is that tailored neoadjuvant chemotherapy with sequential nab paclitaxel and epirubicin and cyclophosphamide is feasible and achieves high response rates. It is proposed that 60 patients will be enrolled in this study including 40 patients which are likely to have chemotherapy sensitive tumors and 20 patients who have ER positive tumors and are more likely to respond to hormonal treatment as an exploratory cohort. The target population is women with early breast cancer who are eligible for primary systemic therapy. The overall response rate in the breast will be measured. Secondary endpoints will include response rates in axillary lymph nodes, safety and tolerability and the rate of breast conservation. Participants will have a blood test to determine a specific genotype status that may help in predicting sensitivity to chemotherapy. This genotype test result is exploratory and will not influence selection of therapy for participants. Patients will also be given the option of having he their tumour tissues used in laboratory studies involving isolating cancer initiating cells from the tumor to subsequently generate breast cancer models in the laboratory and using aptamers (chemical antibodies) to target tumours.
Description: Pathological complete response defined as breast only, ypT0/ ypTis regardless of nodal statusMeasure: Pathological complete response in the breast Time: 24 weeks (time window + 4 weeks)
Description: Pathologic assessmentMeasure: Pathologic Response rate in breast and axillary lymph nodes Time: 24 weeks (time window + 4 weeks)
Description: Pathologic assessmentMeasure: Rate of pathologic complete response and near complete response in the breast combined Time: 24 weeks (time window + 4 weeks)
Description: Safety will be measured using NCI Common Toxicity Criteria for Adverse Effects version 4.0Measure: Safety and tolerability Time: During treatment (24 weeks)
Single Group Assignment
There is one SNP
A homozygous common missense variant (NQO1*2, rs1800566(T), NM_000903.2:c.558C4T) that disables NQO1 strongly has been shown to predicts poor survival among two independent series of women with breast cancer, an effect particularly evident after anthracycline based adjuvant chemotherapy with epirubicin.