Breast cancer Cancer Breast
Conditions
Interventions
Patients are randomised to receive either (neo)adjuvant chemotherapy and/or endocrine therapy alone, or (neo)adjuvant chemotherapy and/or hormonal therapy plus zoledronic acid.
The AZ
Sponsors
The University of Sheffield (UK)
Eligibility
Sex/Gender
Female
Inclusion criteria
Inclusion criteria: Patients with stage II or III primary breast cancer 1. Female patients with Stage II/III primary breast cancer, with T stage =T1 2. Patients should be receiving/scheduled to receive chemotherapy and/or endocrine therapy 3. Patients receiving neo-adjuvant therapy a. Must have tumour size of >5 cm (T3), features of locally advanced disease (T4) or biopsy-proven lymph node involvement b. Should be scheduled to proceed to definitive surgery$ and/or radical radiotherapy with curative intent within 6 months of starting neoadjuvant therapy c. Time between commencement of neoadjuvant treatment and planned start date of study drug should be =30 days 4. Patients receiving adjuvant therapy a. Must have undergone complete primary tumour resection and treatment of the axillary lymph nodes*, without any prior neoadjuvant therapy# b. Must have evidence of lymph node involvement c. Time between definitive surgery and planned start date of study drug should be =60 days 5. Performance status: Karnofsky Index =80% or Eastern Cooperative Oncology Group (ECOG) 0 and 1 6. Women of childbearing potential must be using a reliable and appropriate method of contraception 7. Age =18 years 8. Patient must have given written informed consent prior to any study-specific procedures $Final definitive surgery is considered to include re-operation for inadequate margins or another bona fide oncological indication *Patients whose treatment plan is to proceed to further primary tumour resection and/or treatment of the axillary lymph nodes (e.g. clearance or radiotherapy) with curative intent after completion of chemotherapy would be eligible but this must be completed within 9 months of randomisation #Pre-operative endocrine therapy of less than 30 days would not be classed as prior neoadjuvant therapy
Exclusion criteria
Exclusion criteria: 1. Metastatic or recurrent breast cancer or a history of breast cancer (aside from ductal carcinoma in situ [DCIS] or lobular carcinoma in situ [LCIS]) prior to the currently diagnosed case 2. History of prior cancers within the preceding 5 years (including previous contralateral breast cancer), aside from non-melanomatous skin cancer or carcinoma in situ of the uterine cervix treated with curative intent 3. History of diseases with influence on bone metabolism, such as Paget?s disease of bone, primary hyperparathyroidism or osteoporosis requiring treatment at the time of study entry or considered likely to become necessary within the subsequent 6 months 4. Severe physical or psychological concomitant diseases that might impair compliance with the provisions of the study protocol 5. Prior treatment with bisphosphonates within the past year 6. Serum creatinine >1.5 x Upper Limit of Normal 7. Known hypersensitivity to bisphosphonates 8. Current active dental problems including dental abscess or infection of the jawbone (maxilla or mandible), or a current or prior diagnosis of osteonecrosis of the jaw (ONJ) 9. Recent (within 4 weeks of study entry) or planned dental or jaw surgery (e.g. extractions, implants). Recent dental fillings, teeth scaling and polishing or minor gingival surgery do not exclude the patient. 10. Pregnancy or breast-feeding 11. Use of other investigational drugs in the 30 days prior to study entry. (Patients may be receiving treatments within a clinical trial providing the treatment under test has a licensed indication within your country).
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| To determine whether zoledronic acid with chemotherapy and/or endocrine therapy is superior to chemotherapy and/or endocrine therapy alone in improving disease-free survival | — |
Secondary
| Measure | Time frame |
|---|---|
| To determine whether zoledronic acid with chemotherapy and/or endocrine therapy is superior to chemotherapy and/or endocrine therapy alone in terms of: 1. Invasive disease-free survival (Added 05/05/2011) 2. Time to bone metastases as first recurrence 3. Time to bone metastases per se 4. Time to distant metastases 5. Overall survival 6. Reducing skeletal-related events* prior to development of bone metastases 7. Reducing skeletal-related events* following development of bone metastases Additional secondary objectives are: 1. To assess the safety and toxicity of zoledronic acid in this clinical setting 2. To evaluate the influence of prognostic factors, such as estrogen receptor (ER)/progesterone receptor (PR) status, tumour, node, metastasis (TNM) stage, tumour grade, human epidermal growth factor receptor 2 (HER2/neu) (if available) and menopausal status on treatment outcome 3. To use proteomics, tissue micro-array and other modern techniques to identify more specific prognostic indicators for the development of bone metastases and factors that are able to predict specific benefit from bisphosphonate treatment (to be investigated via sub-studies) * Defined as: fractures, spinal cord compression, radiation therapy to bone, surgery to bone and hypercalcaemia | — |
Countries
Australia, England, Ireland, Portugal, Spain, Taiwan, Thailand, United Kingdom
Outcome results
None listed