Does Adjuvant Zoledronic Acid Reduce Recurrence in Patients With High Risk Localized Breast Cancer?
Collecte de données
Maladies du sein+7
+ Néoplasmes du sein
+ Métastase de néoplasie
Étude thérapeutique
Résumé
Date de début de l'étude : 1 août 2003
Date à laquelle le premier participant a commencé l'étude.OBJECTIVES: Primary * Compare disease-free survival of women with stage II or III breast cancer at high risk of relapse treated with neoadjuvant or adjuvant chemotherapy and/or hormonal therapy with vs without zoledronate. Secondary * Compare time to bone metastases, as first recurrence, in patients treated with these regimens. * Compare time to bone metastases, per se, in patients treated with these regimens. * Compare time to distant metastases in patients treated with these regimens. * Compare overall survival in patients treated with these regimens. * Compare the reduction in skeletal-related events (fractures, spinal cord compression, radiotherapy to the bone, surgery to the bone, and hypercalcemia) before and after the development of bone metastases in patients treated with these regimens. * Determine the safety and toxicity of zoledronate in patients treated with these regimens. * Correlate prognostic factors, such as estrogen-receptor and progesterone-receptor status, TNM stage, tumor grade, HER2/neu status, and menopausal status with treatment outcome in patients treated with these regimens. * Determine more specific prognostic indicators for the development of bone metastases and factors that are able to predict specific benefit from bisphosphonate treatment using proteomics, tissue micro-array, and other modern techniques in these patients. OUTLINE: This is a randomized, open-label, parallel-group, multicenter study. Patients are stratified according to participating center. Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients receive neoadjuvant or adjuvant chemotherapy and/or hormonal therapy. Patients also receive concurrent zoledronate IV over 15 minutes every 3-4 weeks for 6 doses, every 3 months for 8 doses, and then every 6 months for 5 doses in the absence of disease progression or unacceptable toxicity. * Arm II: Patients receive neoadjuvant or adjuvant chemotherapy and/or hormonal therapy alone. After completion of study treatment, patients are followed annually for 5 years. PROJECTED ACCRUAL: A total of 3,300 patients (1,650 per treatment arm) will be accrued for this study within 3 years.
Protocole
Cette section fournit des détails sur le plan de l'étude, y compris la manière dont l'étude est conçue et ce qu'elle évalue.Traitement
Éligibilité
Les chercheurs recherchent des patients correspondant à une certaine description appelée critères d'éligibilité : état de santé général ou traitements antérieurs du patient.Femme
Le sexe biologique des participants éligibles à s'inscrire.À partir de 18 ans
Tranche d'âge des participants éligibles à participer.Volontaires sains non autorisés
Indique si les individus en bonne santé et ne présentant pas la condition étudiée peuvent participer.Conditions
Pathologie
Critères
DISEASE CHARACTERISTICS: * Diagnosis of primary breast cancer, meeting 1 of the following staging criteria: * Stage II * Stage III * T stage ≥ T1 * Receiving OR scheduled to receive chemotherapy and/or endocrine therapy * For patients receiving neoadjuvant therapy * Tumor \> 5 cm (T3), features of locally advanced disease (T4), OR biopsy-proven lymph node involvement (N1) * Scheduled to proceed to definitive surgery and/or radical radiotherapy with curative intent within 6 months of starting neoadjuvant therapy * No more than 30 days between initiation of neoadjuvant therapy and start of study drug * For patients receiving adjuvant therapy * Must have undergone complete primary tumor resection and treatment of axillary lymph nodes\* * Must have lymph node involvement * No prior neoadjuvant therapy\*\* * No more than 60 days since prior definitive surgery NOTE: \*Patients whose treatment plan includes further primary tumor resection and/or treatment of the axillary lymph nodes (e.g., clearance or radiotherapy) with curative intent after completion of chemotherapy are eligible provided the treatment is completed within 9 months of study entry NOTE: \*\*Preoperative endocrine therapy with a duration of \< 30 days is not considered prior neoadjuvant therapy * No evidence of recurrent or metastatic disease * No history of breast cancer, except ductal carcinoma in situ or lobular carcinoma in situ * Hormone receptor status: * Not specified PATIENT CHARACTERISTICS: Age * 18 and over Sex * Female Menopausal status * Premenopausal or postmenopausal Performance status * Karnofsky 80-100% OR * ECOG 0-1 Life expectancy * Not specified Hematopoietic * Not specified Hepatic * Not specified Renal * Creatinine ≤ 1.5 times upper limit of normal Other * Not pregnant or nursing * Fertile patients must use effective contraception * No active dental problems, including dental abscess or infection of the jaw bone (e.g., maxilla or mandible) * No prior or current diagnosis of osteonecrosis of the jaw * No other malignancy within the past 5 years (including prior contralateral breast cancer) except nonmelanoma skin cancer or curatively treated carcinoma in situ of the cervix * No history of disease with influence on bone metabolism, including any of the following: * Paget's disease of the bone * Primary hyperparathyroidism * Osteoporosis requiring treatment or likely to require treatment within the next 6 months * No other severe physical or psychological disease that would preclude study compliance * No known hypersensitivity to bisphosphonates PRIOR CONCURRENT THERAPY: Chemotherapy * See Disease Characteristics Endocrine therapy * See Disease Characteristics Radiotherapy * See Disease Characteristics Surgery * See Disease Characteristics * More than 4 weeks since prior and no concurrent dental or jaw surgery (e.g., extractions or implants) * Dental fillings, teeth scaling and polishing, or minor gingival surgery within the past 4 weeks are allowed Other * More than 1 year since prior bisphosphonates * More than 30 days since prior investigational drugs * No concurrent investigational drugs (i.e., not locally approved for any indication)
Plan de l'étude
Découvrez tous les traitements administrés dans cette étude, leur description détaillée et ce qu'ils impliquent.Objectifs de l'étude
Objectifs principaux
Objectifs secondaires