- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00072020
Chemotherapy and/or Hormone Therapy With or Without Zoledronate in Treating Women With Stage II or Stage III Breast Cancer
Does Adjuvant Zoledronic Acid Reduce Recurrence in Patients With High Risk Localized Breast Cancer?
RATIONALE: Zoledronate may delay or prevent the formation of bone metastases. It is not yet known whether chemotherapy and/or hormone therapy are more effective with or without zoledronate in preventing cancer recurrence and bone metastases in women with breast cancer.
PURPOSE: This randomized phase III trial is studying giving chemotherapy and/or hormone therapy together with zoledronate to see how well they work compared to chemotherapy and/or hormone therapy alone in preventing cancer recurrence and bone metastases in women with stage II or stage III breast cancer.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
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.
Study Type
Phase
- Phase 3
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
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)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Masking: None (Open Label)
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
---|
Disease-free survival as assessed annually for 10 years
|
Secondary Outcome Measures
Outcome Measure |
---|
Time to bone metastases as first recurrence assessed annually for 10 years
|
Time to bone metastases per se as assessed annually for 10 years
|
Time to distant metastases as assessed annually for 10 years
|
Overall survival as assessed by final analysis at 10 years
|
Skeletal-related events prior to development of bone metastases as assessed annually for 10 years
|
Skeletal-related events following development of bone metastases as assessed annually for 10 years
|
Safety and toxicity of zoledronic acid as assessed annually for 10 years
|
Evaluation of the influence of prognostic factors (e.g., estrogen receptor or progesterone receptor [ER/PR] status, TNM stage, tumor grade, HER2/neu, and menopausal status) on treatment outcome
|
Analysis of tumor-specific mutations, proteomics and gene expression changes in tumor cells
|
Collaborators and Investigators
Sponsor
Investigators
- Robert E. Coleman, MD, FRCP, Cancer Research Centre at Weston Park Hospital
- Victoria Hiley, University of Leeds
Publications and helpful links
General Publications
- Marshall H, Gregory W, Bell R, et al.: Adjuvant therapy with zoledronic acid (AZURE-BIG 01/04): The influence of menopausal status and age on treatment effects. [Abstract] J Clin Oncol 30 (Suppl 15): A-502, 2012.
- Coleman RE, Marshall H, Cameron D, Dodwell D, Burkinshaw R, Keane M, Gil M, Houston SJ, Grieve RJ, Barrett-Lee PJ, Ritchie D, Pugh J, Gaunt C, Rea U, Peterson J, Davies C, Hiley V, Gregory W, Bell R; AZURE Investigators. Breast-cancer adjuvant therapy with zoledronic acid. N Engl J Med. 2011 Oct 13;365(15):1396-405. doi: 10.1056/NEJMoa1105195. Epub 2011 Sep 25.
- Coleman R, Woodward E, Brown J, Cameron D, Bell R, Dodwell D, Keane M, Gil M, Davies C, Burkinshaw R, Houston SJ, Grieve RJ, Barrett-Lee PJ, Thorpe H. Safety of zoledronic acid and incidence of osteonecrosis of the jaw (ONJ) during adjuvant therapy in a randomised phase III trial (AZURE: BIG 01-04) for women with stage II/III breast cancer. Breast Cancer Res Treat. 2011 Jun;127(2):429-38. doi: 10.1007/s10549-011-1429-y. Epub 2011 Mar 11.
- Coleman RE, Winter MC, Cameron D, Bell R, Dodwell D, Keane MM, Gil M, Ritchie D, Passos-Coelho JL, Wheatley D, Burkinshaw R, Marshall SJ, Thorpe H; AZURE (BIG01/04) Investigators. The effects of adding zoledronic acid to neoadjuvant chemotherapy on tumour response: exploratory evidence for direct anti-tumour activity in breast cancer. Br J Cancer. 2010 Mar 30;102(7):1099-105. doi: 10.1038/sj.bjc.6605604. Epub 2010 Mar 16.
- Coleman R, Thorpe H, Cameron D, et al.: Zoledronic acid is well tolerated and can be safely administered with adjuvant chemotherapy first safety data from the AZURE trial (BIG01/04). [Abstract] Breast Cancer Res Treat 100 (Suppl 1): A-2080, S107, 2006.
- Coleman R, Cameron D, Dodwell D, Bell R, Wilson C, Rathbone E, Keane M, Gil M, Burkinshaw R, Grieve R, Barrett-Lee P, Ritchie D, Liversedge V, Hinsley S, Marshall H; AZURE investigators. Adjuvant zoledronic acid in patients with early breast cancer: final efficacy analysis of the AZURE (BIG 01/04) randomised open-label phase 3 trial. Lancet Oncol. 2014 Aug;15(9):997-1006. doi: 10.1016/S1470-2045(14)70302-X. Epub 2014 Jul 15.
Study record dates
Study Major Dates
Study Start
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- SHEFF-AZURE
- CDR0000335111 (Registry Identifier: PDQ (Physician Data Query))
- EU-20315
- ISRCTN79831382
- BIG-1-04
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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