HOBOE: A Phase 3 Study of Adjuvant Triptorelin and Tamoxifen, Letrozole, or Letrozole and Zoledronic Acid in Premenopausal Patients With Breast Cancer.

Conditions

Breast Cancer

Keywords

early breast cancer, adjuvant therapy, premenopause, premenopausal, menopausal status, postmenopause, bone mineral density, hormone sensitive, aromatase inhibitors, letrozole, disease-free survival

Brief summary

The HOBOE study was amended in November 2009, and, after reaching enrollment of the first 500 patients, the study began recruiting premenopausal patients only. The primary objective of the extended study is to compare disease free survival in premenopausal patients with early breast cancer. Patients receive triptorelin and are randomized in a 1:1:1 fashion to receive tamoxifen or letrozole, or letrozole + zoledronic acid. The purpose of the HOBOE study, Version 1, was to compare the adjuvant hormonal therapy treatments of Tamoxifen, Letrozole and Letrozole + Zoledronate for their effects on bone loss in breast cancer patients. Postmenopausal and premenopausal patients were eligible, the latter also receiving monthly triptorelin. Upon reaching the enrollment of the first 500 patients in March 2010, the study began recruiting premenopausal patients only.

Müller V, Hörner M, Thill M, Banys-Paluchowski M, Schmatloch S, Fasching PA, Harbeck N, Langanke D, Uhrig S, Häberle L, Fischer D, Hein A, Fehm TN, Goossens C, Terhaag J, Heilenkötter U, Dall P, Rudlowski C, Wuerstlein R, Aydogdu M, Keyver-Paik MD, Hammerle C, Deuerling N, Stickeler E, Aktas B, Belleville E, Thoma M, Ditsch N, Baila Y, Roos C, Mann C, Iuliano C, Brucker SY, Schneeweiss A, Hartkopf AD.

2025-03-221 citations

10.1016/j.breast.2025.104458

Ten-year update of HOBOE phase III trial comparing triptorelin plus either tamoxifen or letrozole or zoledronic acid + letrozole in premenopausal hormone receptor-positive early breast cancer patients.

Gravina A, Gargiulo P, De Laurentiis M, Arenare L, De Placido S, Orditura M, Cinieri S, Riccardi F, Ribecco AS, Putzu C, Del Mastro L, Rossi E, Ciardiello F, Di Rella F, Nuzzo F, Pacilio C, Caputo R, Cianniello D, Forestieri V, Giuliano M, Arpino G, Orlando L, Mocerino C, Schettino C, Piccirillo MC, Gallo C, Perrone F.

2025-01-03

10.1016/j.esmoop.2024.104085

Adjuvant zoledronic acid and letrozole plus ovarian function suppression in premenopausal breast cancer: HOBOE phase 3 randomised trial.

Perrone F, De Laurentiis M, De Placido S, Orditura M, Cinieri S, Riccardi F, Ribecco AS, Putzu C, Del Mastro L, Rossi E, Tinessa V, Mosconi AM, Nuzzo F, Di Rella F, Gravina A, Iodice G, Landi G, Pacilio C, Forestieri V, Lauria R, Fabbri A, Ibrahim T, De Maio E, Barni S, Gori S, Simeon V, Arenare L, Daniele G, Piccirillo MC, Normanno N, de Matteis A, Gallo C.

2019-06-0150 citations

10.1016/j.ejca.2019.05.004

Interventions

DRUGtamoxifen

20 mg daily for 5 years

DRUGtriptorelin

Premenopausal patients will receive triptorelin 3.75 mg IM at the beginning of therapy and every 4 weeks for 5 years or up to age 55

DRUGletrozole

2.5 mg daily for 5 years

DRUGzoledronic acid

4 mg every 6 months

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

FEMALE

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* Histological diagnosis of breast cancer * Surgical resection of breast cancer (breast conserving surgery or mastectomy) * No evidence of disease * Indication for adjuvant hormonal therapy (ER and/or PgR positive with IHC exam in at least 1% of primary tumor cells, according to St. Gallen criteria) * Patient age at least 18 years * Written informed consent . Premenopausal status defined as LMP within 12 months of randomization (FSH, LH will not be considered as determinants of menopausal status due the chemotherapy induced reversible ovarian suppression) Please note that patients who have received neoadjuvant or adjuvant chemotherapy and/or locoregional radiation therapy may be included in the study

Exclusion criteria

* Performance status (ECOG)\>2. * Previous or concomitant malignancy (with the exception of adequately treated nonmalignant skin cancer and carcinoma in situ of the uterine cervix * Metastatic breast cancer * Creatinine \> 1.25 times the value of upper normal limit * Pregnant or lactating females * Clinical or radiologic evidence of bone fractures * Treatment with systemic cortisone therapy within 12 months prior to randomization * Treatment with drugs that could alter bone metabolism (calcitonin, mithramycin, gallium nitrate) within 2 weeks prior to randomization * Previous treatment with tamoxifen or aromatase inhibitors * AST and/or ALT \> 3 times the value of upper normal limit with clinical and laboratory findings that indicate a grade of hepatic insufficiency that could potentially increase the risk of assuming letrozole * Any concomitant conditions that would, in the Investigator's opinion, contraindicate the use of any of the drugs used in this study * Inability to provide informed consent * Inability to comply with followup * Patient undergoing invasive dental work at time of baseline evaluation or foreseen during the course of adjuvant therapy

Design outcomes

Primary

Measure	Time frame
disease free survival in premenopausal patients	observation period is 10 years from initiation of treatment
bone mineral density	12 months from initiation of therapy

Secondary

Measure	Time frame
overall survival	observation period is 10 years from initiation of treatment
toxicity of letrozole + triptorelin and letrozole + zoledronic acid + triptorelin in premenopausal patients	monthly
Bone mineral density measured	yearly after first year of therapy
disease free survival in postmenopausal patients	observation period is 10 years from initiation of treatment

Countries

Italy

Outcome results

None listed