Letrozol vs Placebo en Mujeres Posmenopáusicas con Cáncer de Mama Primario Después del Tratamiento Adyuvante con Inhibidor de la Aromatasa
Este estudio tiene como objetivo comparar la efectividad de Letrozole frente a un placebo en la mejora de la supervivencia libre de enfermedad en mujeres posmenopáusicas que padecen cáncer de mama primario y que previamente han recibido terapia adyuvante con inhibidores de la aromatasa.
letrozole
+ placebo
Enfermedades de la Mama+2
+ Neoplasias
+ Neoplasias por Sitio
Estudio de Tratamiento
Resumen
Fecha de inicio: 24 de agosto de 1998
Fecha en la que se inscribió al primer participante.OBJECTIVES: Primary * Compare the disease-free survival and overall survival of postmenopausal women with primary breast cancer who have completed at least five years of adjuvant aromatase inhibitor as initial therapy or after tamoxifen treated with letrozole or placebo. Secondary * Compare the incidence of contralateral breast cancer in patients treated with these regimens. * Evaluate the long-term clinical and laboratory safety of letrozole, in terms of lipid profile, cardiovascular morbidity and mortality, incidence of bone fractures, change in bone density, and common toxic effects, in this patient population. * Compare the quality of life of patients treated with these regimens. Re-randomization Primary * Compare disease-free survival of patients who, after receiving at least 4.5 years of letrozole, are re-randomized to receive an additional 5 years of letrozole vs placebo. Secondary * Determine whether common genetic polymorphisms for genes encoding proteins involved in pharmacokinetic and/or pharmacodynamic pathways for letrozole contribute to individual variation in toxicity and efficacy of letrozole therapy. OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to receptor status (positive vs unknown), lymph node status (negative vs positive vs unknown), prior adjuvant chemotherapy (yes vs no), interval between last dose of aromatase inhibitor therapy and randomization (< 6 months vs 6 months-2 years), and duration of prior tamoxifen use (0 years vs < 2 years vs 2-4.5 years vs > 4.5 years). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive oral letrozole once daily. * Arm II: Patients receive oral placebo once daily. In both arms, treatment continues for 5 years in the absence of disease progression or unacceptable toxicity. Patients in arm II may then be offered oral letrozole once daily for up to 5 years. Quality of life is assessed at baseline, at 6 months, and then annually for 4.5 years. * Double-blind, re-randomization: Patients who complete ≥ 4.5 years of letrozole (arm I) and who did not experience recurrent disease or new primary breast cancer, including ductal carcinoma in situ, may participate in the double-blind, placebo-controlled, re-randomization portion of the study. Patients are stratified according to lymph node status at enrollment (negative vs positive vs unknown), prior adjuvant chemotherapy (yes vs no), and interval between last dose of letrozole and re-randomization (<6 months vs 6 months to 2 years). Common genetic single nucleotide polymorphisms for genes encoding proteins involved in pharmacokinetic and/or pharmacodynamic pathways for letrozole are analyzed in order to determine if these single nucleotide polymorphisms contribute to individual variation in toxicity and efficacy of letrozole therapy. Quality of life is assessed as during the first randomization. Patients are followed annually. PROJECTED ACCRUAL: A total of 4,700 patients will be accrued for this study.
Protocolo
Esta sección proporciona detalles del plan del estudio, incluyendo cómo está diseñado y qué se está evaluando.Se reclutarán 5187 pacientes
Número total de participantes que el ensayo clínico espera reclutar.Estudio de Tratamiento
Elegibilidad
Los investigadores buscan pacientes que cumplan ciertos criterios, conocidos como criterios de elegibilidad: estado general de salud o tratamientos previos.Mujer
Sexo biológico de los participantes elegibles para inscribirse.Hasta 120 Años
Rango de edades de los participantes que pueden unirse al estudio.Voluntarios sanos no permitidos
Indica si personas sanas, sin la condición que se estudia, pueden participar.Condiciones
Patología
Criterios
DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed primary invasive breast carcinoma resected at time of original diagnosis * No ductal carcinoma in situ * Axillary lymph node negative, positive, or unknown * No evidence of metastases * No localized or distant breast cancer recurrence * Not registered on protocol NCCTG-893052, any other IBCSG protocol, or protocol SWOG-S9623 * Hormone receptor status: * Estrogen or progesterone receptor positive as defined by tumor receptor content at least 10 fmol/mg protein or receptor positive by ERICA or PgRICA * Unknown status allowed if effort to determine status has been made by immunocytochemistry * No contralateral breast cancer PATIENT CHARACTERISTICS: Age: * Postmenopausal Sex: * Female Menopausal status: * Postmenopausal defined by one of the following: * Age 50 or over at start of adjuvant tamoxifen * Under age 50 and considered postmenopausal by treating physician at start of adjuvant tamoxifen * Under age 50 at start of adjuvant tamoxifen and had bilateral oophorectomy (surgical or radiation) * Under age 50 and premenopausal at start of adjuvant tamoxifen, but became amenorrheic during tamoxifen and remained amenorrheic for at least 1 year * Considered postmenopausal by physician with LH/FSH levels under the treatment center's postmenopausal limits Performance status: * ECOG 0-2 Life expectancy: * At least 5 years Hematopoietic: * WBC ≥ 3,000/mm\^3 OR * Granulocyte count ≥ 1,500/mm\^3 * Platelet count ≥ 100,000/mm\^3 Hepatic: * AST and/or ALT \< 2 times upper limit of normal (ULN) (unless imaging examinations have ruled out metastatic disease) * Alkaline phosphatase \< 2 times ULN (unless imaging examinations have ruled out metastatic disease) Renal: * Not specified Other: * No concurrent medical or psychiatric condition that would preclude study participation * No other malignancy within the past 5 years except adequately treated superficial squamous cell or basal cell skin cancer or carcinoma in situ of the cervix * Able to swallow study drug * Adequate oral intake PRIOR CONCURRENT THERAPY: Biologic therapy: * Not specified Chemotherapy: * Prior adjuvant chemotherapy allowed * No concurrent chemotherapy Endocrine therapy: * Completed at least 4.5 but no more than 6 years of adjuvant tamoxifen after resection * Completed at least 4.5-6 years of adjuvant aromatase inhibitor as initial therapy or after tamoxifen * No more than 3 months since prior adjuvant tamoxifen * No concurrent hormone replacement therapy (e.g., megestrol) * No concurrent selective estrogen-receptor modulators (e.g., raloxifene or idoxifene) * Concurrent intermittent vaginal estrogens (e.g., Estring) allowed if other local measures for intractable vaginal atrophy are insufficient * No other concurrent aromatase inhibitors * No more than 2 years since prior aromatase inhibitor therapy (re-randomization) Radiotherapy: * Prior radiotherapy allowed Surgery: * See Disease Characteristics Other: * At least 1 month since prior investigational drugs * Prior treatment on a clinical trial for breast cancer allowed if permission has been obtained from the sponsors of the original study for their patient to participate on MA.17/JMA.17/BIG-97-01 * No prior placebo on core protocol * No concurrent anticancer therapy * Concurrent thyroid medication, calcium, vitamin D, and bisphosphonates allowed
Plan de Estudio
Conoce todos los tratamientos administrados en este estudio, su descripción detallada y en qué consisten.2 grupos de intervención están designados en este estudio
50% de probabilidad de ser asignado al grupo placebo
Grupos de Tratamiento
Grupo I
ExperimentalGrupo II
PlaceboObjetivos del Estudio
Objetivos Primarios
Centros del Estudio
Estos son los hospitales, clínicas o centros de investigación donde se lleva a cabo el estudio. Puedes encontrar la ubicación más cercana a ti y su estado de reclutamiento.Este estudio tiene 57 ubicaciones
BCCA - Cancer Centre for the Southern Interior
Kelowna, CanadaNRGH - Nanaimo Cancer Clinic
Nanaimo, CanadaPenticton Regional Hospital
Penticton, Canada