Clinical trial · Interventional
Paclitaxel, Nab-paclitaxel, or Ixabepilone With or Without Bevacizumab in Treating Patients With Stage IIIC or Stage IV Breast Cancer
A Randomized Phase III Trial of Weekly Paclitaxel Compared to Weekly Nanoparticle Albumin Bound Nab-paclitaxel or Ixabepilone With or Without Bevacizumab as First-Line Therapy for Locally Recurrent or Metastatic Breast Cancer
- Source
- ClinicalTrials.gov
- Retrieved
- Sep 8, 2026
- Layer
- normalized (units and labels harmonized; values unchanged)
- Run
- ING-CLINICALTRIALS-20260908-000001
Summary
Brief summary (as posted)
This randomized phase III trial studies the side effects and how well different chemotherapy regimens with or without bevacizumab work in treating patients with stage IIIC or stage IV breast cancer. Drugs used in chemotherapy, such as paclitaxel, paclitaxel albumin-stabilized nanoparticle formulation (nab-paclitaxel), and ixabepilone, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Bevacizumab may block tumor growth by targeting certain cells and slowing the growth of blood vessels to the tumor. It is not yet known which treatment regimen is more effective in treating patients with breast cancer.
Conditions
Conditions (9)
Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.
| Condition (as posted) | Mapped entity | Match | Confidence |
|---|---|---|---|
| Estrogen Receptor Negative | — | UNRESOLVED | — |
| Estrogen Receptor Positive | — | UNRESOLVED | — |
| HER2/Neu Negative | — | UNRESOLVED | — |
| HER2/Neu Positive | — | UNRESOLVED | — |
| Progesterone Receptor Negative | — | UNRESOLVED | — |
| Progesterone Receptor Positive | — | UNRESOLVED | — |
| Recurrent Breast Carcinoma | Breast Carcinoma | CURATED_BROADER | 0.78 |
| Stage IIIC Breast Cancer AJCC v6 | Malignant Breast Neoplasm | CURATED_BROADER | 0.78 |
Interventions
Interventions (6)
| Intervention | Type | Mapped drug | Match |
|---|---|---|---|
| Bevacizumab | Biological | Bevacizumab | ALIAS |
| Ixabepilone | Drug | — | UNRESOLVED |
| Laboratory Biomarker Analysis | Other | — | UNRESOLVED |
| Nab-paclitaxel | Drug | Nab-paclitaxel | ALIAS |
| Paclitaxel | Drug | Paclitaxel | ALIAS |
| Questionnaire Administration | Other | — | UNRESOLVED |
Design
Arms and outcomes
Arms (3)
- type
- ACTIVE_COMPARATOR
- label
- Arm A (Paclitaxel)
- description
- Patients receive 90 mg/m\^2 paclitaxel IV over 1 hour on days 1, 8, and 15. Patients may receive 10 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15.
- interventionNames
- Biological: Bevacizumab
- Other: Laboratory Biomarker Analysis
- Drug: Paclitaxel
- Other: Questionnaire Administration
- type
- EXPERIMENTAL
- label
- Arm B (Nab-paclitaxel)
- description
- Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15. Patients may also receive 10 mg/kg bevacizumab IV over 30-90 minutes on days 1 and 15.
- interventionNames
- Biological: Bevacizumab
- Other: Laboratory Biomarker Analysis
- Drug: Nab-paclitaxel
- Other: Questionnaire Administration
Eligibility
Eligibility (as posted)
- Sex
- All
- Minimum age
- 18 Years
Show eligibility criteria text
Inclusion Criteria:
* Histologic confirmation of invasive cancer of the breast
* Stage IV disease or stage IIIC disease (using American Joint Committee on Cancer \[AJCC\] criteria, 6th edition) not amenable to local therapy
* Patients may not have a "currently active" second malignancy other than non-melanoma skin cancers; patients are not considered to have a "currently active" malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse
* Patients with human epidermal growth factor receptor 2 (HER2) negative disease are eligible; patients with HER2+ disease are eligible providing they have previously received trastuzumab or lapatinib; documentation of progression on HER2 directed therapy is not required; Her2/neu status must be known at the time of protocol registration
* Estrogen receptor (ER) and progesterone receptor (PgR) status must be known at the time of registration; ER and/or PgR \>= 1% cells will be considered positive
* Prior treatment may include adjuvant or neoadjuvant taxane, however, the interval between completion of adjuvant or neoadjuvant therapy and disease recurrence must be \>= 12 months
* No prior chemotherapy for metastatic breast cancer
* Any number of prior hormonal therapies are allowed; the last dose should have been administered at least 7 days prior to the initiation of protocol therapy
* Prior radiotherapy must be completed at least 2 weeks prior to study entry
* Treatment with bisphosphonates is allowed and recommended as per American Society of Clinical Oncology (ASCO) guidelines
* Prior trastuzumab or lapatinib required for patients with HER2 overexpressing tumors
* Prior treatment with bevacizumab is allowed
* Patients must not have had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study registration, and must have fully recovered from any such procedure
* The following are not considered to be major procedures: thoracentesis, paracentesis, port placement, laparoscopy, thoracoscopy, bronchoscopy, endoscopic ultrasonographic procedures, mediastinoscopy, skin biopsies, incisional biopsies and routine dental procedures
* Patients must not have anticipation of need for a major surgical procedure during the course of the study
* There are no restrictions on core biopsies, placement of a vascular access device or other minor procedures prior to registration
* Placement of a vascular access device after starting study therapy should be performed between day 15 and 28 of a treatment cycle (but not less than 48 hours before the next dose of bevacizumab) to allow for sufficient healing
* Patients must have measurable disease (target lesions): measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as \>= 2.0 cm with conventional techniques or as \>= 1 cm with spiral computed tomography (CT) scan
* Lesions that are considered non-measurable include the following:
* Bone lesions
* Leptomeningeal disease
* Ascites
* Pleural/pericardial effusion
* Inflammatory breast disease
* Lymphangitis cutis/pulmonitis
* Abdominal masses that are not confirmed and followed by imaging techniques
* Cystic lesions
* Patients with pre-existing peripheral neuropathy \>= grade 2 are not eligible for this study
* Patients must have an Eastern Cooperative Oncology Group (ECOG) (Zubrod) performance status of =\< 1 to be eligible for this trial
* Women must not be pregnant or breast feeding; premenopausal women must have a negative serum or urine beta-human chorionic gonadotropin (Hcg)
* Patients with a history of Common Terminology Criteria for Adverse Events (CTCAE) grade \>= 3 hypersensitivity to paclitaxel or Cremophor® EL are not eligible
* Patients with a history of abdominal fistula, or intra-abdominal abscess within 6 months prior to study registration are not eligible
* Patients with a history of gastrointestinal (GI) perforation within 12 months prior to registration are not eligible
* Patients with a history of significant bleeding episodes (e.g., hemoptysis, upper or lower GI bleeding) within 6 months prior to registration are not eligible
* Patients must not have a history of clinically significant cardiovascular disease that includes the following:
* Uncontrolled hypertension defined as systolic blood pressure \> 150 and/or diastolic blood pressure \> 90 mmHg on antihypertensive medications or any prior history of hypertensive crisis or hypertensive encephalopathy
* History of myocardial infarction or unstable angina within past 6 months
* New York Heart Association (NYHA) congestive heart failure grade 2 or greater
* Symptomatic peripheral vascular disease
* Significant vascular disease (e.g., aortic aneurysm, aortic dissection) or arterial thrombotic events
* Patients on full dose anticoagulants must be on a stable dose of warfarin, or be on a stable dose of low molecular weight (LMW) heparin; patients receiving anti-platelet or on daily prophylactic dose aspirin are eligible, as are patients receiving stable doses of anticoagulation for atrial fibrillation
* Patients may not have a history of stroke or transient ischemic attack within 6 months prior to study registration
* Patients with a history of seizures must be well controlled with standard medication
* Patients must not have progressing or untreated central nervous system (CNS) metastases or leptomeningeal disease; patients with a history of resected brain metastases with stable magnetic resonance imaging (MRI) scans for 3 months including within 4 weeks of study start are eligible; patients with a history of gamma knife radiosurgery or whole brain radiation with stable MRI scans for 3 months including within 4 weeks of study start are eligible
* No serious, non-healing wound, ulcer or bone fracture
* Life expectancy of \>= 12 weeks
* Granulocytes \>= 1,500/ul
* Platelet count \>= 100,000/ul
* Creatinine =\< 2.0 mg/dL
* Bilirubin \< 1.5 mg/dL (unless due to Gilbert's syndrome)
* Transaminases (aspartate aminotransferase \[AST\], alanine aminotransferase \[ALT\]) =\< 2.5 x upper limit of normal (ULN)
* Serum or urine beta-Hcg negative in premenopausal women of child-bearing potential
* Urine protein =\< 1+ protein\* or urine protein: creatinine ratio (UPC) \< 1
* Patients discovered to have \>= 2+ proteinuria at baseline must undergo a 24-hour urine collection that must demonstrate \< 1 g of protein/24 hr or UPC ratio =\< 1 to allow participation in the studyReferences
Publications (4)
- DERIVEDStover DG, Salgado R, Savenkov O, Ballman K, Mayer EL, Magbanua MJM, Loi S, Vater M, Glover K, Watson M, Wen Y, Symmans WF, Perou C, Carey LA, Partridge AH, Rugo HS. Association between tumor-infiltrating lymphocytes and survival in patients with metastatic breast cancer receiving first-line chemotherapy: analysis of CALGB 40502. NPJ Breast Cancer. 2024 Aug 21;10(1):75. doi: 10.1038/s41523-024-00683-x. PMID 39169033
- DERIVEDQuintanilha JCF, Wang J, Sibley AB, Jiang C, Etheridge AS, Shen F, Jiang G, Mulkey F, Patel JN, Hertz DL, Dees EC, McLeod HL, Bertagnolli M, Rugo H, Kindler HL, Kelly WK, Ratain MJ, Kroetz DL, Owzar K, Schneider BP, Lin D, Innocenti F. Bevacizumab-induced hypertension and proteinuria: a genome-wide study of more than 1000 patients. Br J Cancer. 2022 Feb;126(2):265-274. doi: 10.1038/s41416-021-01557-w. Epub 2021 Oct 6. PMID 34616010
- DERIVEDMehrotra S, Sharma MR, Gray E, Wu K, Barry WT, Hudis C, Winer EP, Lyss AP, Toppmeyer DL, Moreno-Aspitia A, Lad TE, Valasco M, Overmoyer B, Rugo H, Ratain MJ, Gobburu JV. Kinetic-Pharmacodynamic Model of Chemotherapy-Induced Peripheral Neuropathy in Patients with Metastatic Breast Cancer Treated with Paclitaxel, Nab-Paclitaxel, or Ixabepilone: CALGB 40502 (Alliance). AAPS J. 2017 Sep;19(5):1411-1423. doi: 10.1208/s12248-017-0101-9. Epub 2017 Jun 15. PMID 28620884
- DERIVEDRugo HS, Barry WT, Moreno-Aspitia A, Lyss AP, Cirrincione C, Leung E, Mayer EL, Naughton M, Toppmeyer D, Carey LA, Perez EA, Hudis C, Winer EP. 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). J Clin Oncol. 2015 Jul 20;33(21):2361-9. doi: 10.1200/JCO.2014.59.5298. Epub 2015 Jun 8. PMID 26056183