Protocol Number: 01-C-0173
Patients 18 years of age or older with stage IIIB or stage IV inflammatory breast cancer who have not been treated with chemotherapy or radiation therapy may be eligible for this study. Candidates will undergo a medical history and physical examination, blood and urine tests, electrocardiogram and chest X-ray. A mammogram of both breasts, computed tomography (CT) of the head, chest, abdomen and pelvis, and a bone scan will be done to determine the extent of disease. Those enrolled will undergo the following procedures at various intervals before, during and/or after completing chemotherapy: - Tumor and skin biopsies - A small piece of tumor tissue and a small piece of skin are removed under local anesthesia for microscopic study. The tumor tissue will be used to study the effects of bevacizumab on blood vessels and the biology of inflammatory breast cancer. - Dynamic MRI - Magnetic resonance imaging of the breast will be used to examine changes in the blood vessels and breast cancer following bevacizumab treatment. Dynamic MRI involves injecting a contrast liquid into a vein before scanning. A standard MRI scan will also be done before the dynamic MRI. - Blood tests will be done to 1) study clot formation and breakdown, 2) measure levels of VEGF and VCAM-1, a substance produced by cells lining blood vessel walls, and 3) check blood counts and liver and kidney function. - MUGA or echocardiogram - MUGA is a nuclear medicine scan that checks the heart's pumping ability. An echocardiogram (ultrasound scan of the heart) can also be used to evaluate heart function. - Blood pressure monitoring - Urine tests Patients will have a central venous line (plastic tube) placed into a major vein in the chest before beginning treatment. The line remains in the body during the entire treatment period and is used to give chemotherapy and other medications such as antibiotics, if needed, and to withdraw blood samples. The line is usually placed under local anesthesia in the radiology department or the operating room. All treatment will be given on a single day every 3 weeks. This constitutes one treatment cycle. Cycle 1 will be bevacizumab alone; cycles 2 through 7 will be bevacizumab with doxorubicin and docetaxel. During each cycle, patients will also receive ten injections under the skin of G-CSF, a drug that raises the number of infection-fighting white blood cells, which are often decreased as a side effect of chemotherapy. After cycle 7, patients may require surgery or radiation or radiation alone. After radiation treatment, bevacizumab will be re-started, given alone every 3 weeks for an additional eight cycles. Patients whose tumors are positive for estrogen or progesterone receptors will be advised to take the drug tamoxifen for 5 years to decrease the chances of disease recurrence. This would begin with cycle 8.
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