Postoperative Use of Zoledronic Acid in Breast Cancer Patients After Neoadjuvant Chemotherapy

Phase 3

Completed

• Conditions: Breast Cancer
• Interventions: Drug: Zoledronic acid

• Registration Number: NCT00512993
• Lead Sponsor: German Breast Group

Brief Summary

The purpose of this study is to determine the event-free survival (EFS) after zoledronic acid for 5 years versus no postoperative treatment in patients with "chemo-insensitive" breast cancer (ypT1-4 and/or ypN1-3) after preoperative anthracycline/taxane containing chemotherapy

Detailed Description

The study is restricted to patients having had primary systemic chemotherapy for stage II and III breast cancer. Participation in a preoperative chemotherapy trial investigating anthracycline and taxane based regimen is allowed, but not mandatory for all patients. Patients must have significant remaining tumor tissue in the breast and/or axillary lymph node. This implies resistance to further chemotherapy and a clinically relevant risk for relapse. Bisphosphonates have a distinct mechanism of action and have demonstrated efficacy in the treatment of breast cancer with metastasis to the bone as well as adjuvant treatment after surgery of primary breast cancer. The 3rd generation bisphosphonate zoledronic acid has a favorable toxicity profile and can be conveniently given to patients over a long term period.

Study Timeline

• Study Start: 2004-12
• Study First Submitted: 2007-08-03
• Study First Submitted QC: 2007-08-07
• Study First Posted: 2007-08-08
• Primary Completion: 2013-11
• Study Completion: 2013-11
• Status Verified: 2015-03
• Last Update Submitted: 2015-03-04
• Last Update Posted: 2015-03-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 654

Inclusion Criteria

• Written informed consent must be obtained and documented according to the local regulatory requirements prior to beginning specific protocol procedures;
• Complete baseline documentation sent to GBG;
• Prior preoperative chemotherapy for at least 4 cycles, of which at least two must contain a taxane and an anthracycline;
• Completely resected unilateral or bilateral primary carcinoma of the breast with histologically detectable tumor residuals (ypT1-4) and/or histology confirmed involvement of axillary nodes (ypN1-3). Sentinel node biopsy is allowed, but complete axillary clearance is mandatory in node positive cases;
• A maximum interval of 3 years from date of axillary surgery to entering this trial;
• Age 18 years or older;
• Karnofsky index >= 70%;
• Life expectancy of at least 10 years, disregarding the diagnosis of cancer;
• No clinical evidence of local recurrence or distant metastases. Complete staging work-up: All patients must have breast ultrasound, chest X-ray, ultrasound or CT scan of the liver within 3 months prior to registration, as well as (bilateral) mammography or breast MRI and bone scan within 8 months prior to registration. In case of a positive bone scan, bone X-ray is mandatory. Other tests may be performed as clinically indicated;
• Adequate renal and hepatic function (serum creatinine, bilirubin, and transaminases within 1.5 × upper normal range);
• Patients must be available and compliant for treatment and follow-up. Patients registered on this trial must be treated and followed up at the participating center.

Exclusion Criteria

• Known hypersensitivity reaction to the investigational compound;
• Prior postoperative chemotherapy;
• Prior treatment with bisphosphonates since breast cancer surgery;
• Pregnant or lactating patients. Patients of childbearing potential must have a negative pregnancy test (urine or serum) within 14 days prior to registration and must implement adequate non-hormonal contraceptive measures (barrier methods, intra uterine contraceptive devices, sterilization) during study treatment;
• History of diseases with influence on bone metabolism, such as Paget's disease of bone and primary hyperparathyroidism or osteoporosis requiring treatment at the time of study entry or considered likely to become necessary within the six months
• Other serious illness or medical condition that may interfere with the understanding and giving of informed consent and the conduct of the study
• Prior or concomitant secondary malignancy (except non-melanomatous skin cancer or carcinoma in situ of the uterine cervix)
• Concurrent treatment with other experimental drugs or any other anti-cancer therapy;
• Abnormal renal function as evidenced by a calculated creatinine clearance < 30 ml/minute;
• Serum calcium concentration < 8.0 mg/dl (2.00 mmol/L) or > 12.0 mg/dl (3.00 mmol/L)
• Concurrent treatment with sex hormones. Prior treatment must be stopped before study entry;
• Current active dental problems including infection of the teeth or jawbone (maxilla or mandibular); dental or fixture trauma, or a current or prior diagnosis of osteonecrosis of the jaw, of exposed bone in the mouth, or of slow healing after dental procedures.
• Recent (within 6 weeks) or planned dental or jaw surgery (e.g.. extraction, implants)
• Male patients.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment	Zoledronic acid	Patients receive zoledronic acid (4mg) for 5 years. Additionally patients receive standard endocrine, radiologic and trastuzumab treatment, respectively

Primary Outcome Measures

Name	Time	Method
The event-free survival (EFS) after zoledronic acid for 5 years versus no postoperative treatment in patients with "chemo-insensitive" breast cancer (ypT1-4 and/or ypN1-3) after preoperative anthracycline/taxane containing chemotherapy.	5 years

Secondary Outcome Measures

Name	Time	Method
The bone-metastasis free-survival in both arms.	5 years
The overall survival in both treatment arms.	5 years
The toxicity of and compliance to zoledronic acid.	5 years
The prognostic impact of chemotherapy induced amenorrhea in premenopausal patients.	5 years
The EFS with respect to the interval between surgery and randomization.	5 years
The predictive value of primary breast tumor response on the effect of postoperative treatment.	5 years

Trial Locations

Locations (92)

A. ö. Krankenhaus der Barmherzigen Brüder, Interne Abteilung; 🇦🇹 St. Veit a. d. Glan, Carinthia, Austria

Landeskrankenhaus Wolfsberg, Chirurgische Abteilung; 🇦🇹 Wolfsberg, Carinthia, Austria

Medizinische Universität Wien; 🇦🇹 Wien, Lower Austria, Austria

LKH-Univ. Klinikum Graz, Onkologie; 🇦🇹 Graz, Styria, Austria

Universitäts Klinikum Innsbruck; 🇦🇹 Innsbruck, Tirol, Austria

Allgemeines Krankenhaus der Stadt Linz, Innere Medizin 3/Zentrum f. Häm. u. Med. Onkologie; 🇦🇹 Linz, Upper Austria, Austria

Landeskrankenhaus Steyr, 2. Med. Abt. Onkologie; 🇦🇹 Steyr, Upper Austria, Austria

Klinikum Wels-Grieskirchen GmbH, Abt. f. Innere Medizin IV; 🇦🇹 Wels, Upper Austria, Austria

Landeskrankenhaus Feldkirch; 🇦🇹 Rankweil, Vorarlberg, Austria

LKH Salzburg, Uni.klinik f. Innere Med. III/Onkol. Amb.; 🇦🇹 Salzburg, Austria

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