Breast Cancer
Conditions
Keywords
metronomic capecitabine, aromatase inhibitor, first line treatment, metastatic breast cancer
Brief summary
The study is designed to compare the clinical benefit following treatment with aromatase inhibitor in combination with metronomic capecitabine versus aromatase inhibitor alone in women with hormone receptor-positive, Her2-negative advanced breast cancer who have not received prior systemic anti-cancer therapies for their advanced/metastatic disease.
Detailed description
Initial endocrine therapy (ET) is a common choice for hormone receptor positive (HR+), HER2 negative (HER2-) metastatic breast cancer (MBC) patients for its good tolerability, low toxicity and durable response. The median time to progression (TTP) of initial ET in HR+, HER2- metastatic patients is about 9 months with aromatase inhibitors (AIs). However, all metastatic patients receiving ET will develop resistance to the conventional endocrine treatments ultimately. So some novel agents, like palbociclib and everolimus, are approved to be effective in improving the efficacy of standard ET. But the fact we have to face is either palbociclib or everolimus is focusing on a single checkpoint of pathway that responsible for resistance of ET. In clinical, there are some patients without an activation of resistance-related pathways have poor response to endocrine therapy. And the mechanisms of resistance to endocrine therapy is complicated and not fully understood. So far, these novel agents have not completely solved the clinical problems of secondary drug-resistance. Maybe a broad spectrum anti-cancer therapy with low toxicity and good tolerability is more practical and promising in the near future. Metronomic chemotherapy is administration of low-dose chemotherapy to induce disease control in metastatic cancer patients, which has low-incidence of adverse effects. More and more evidences showed activity of metronomic therapy in breast cancer. Metronomic therapy with or without endocrine therapy in both metastatic and neoadjuvant setting showed considerable efficacy. Although the concept of combination of chemotherapy and endocrine therapy simultaneously was large abandoned because of previous using tamoxifen and intravenous chemotherapy showing no additional benefit, with better understanding of the biology of endocrine therapy and metronomic chemotherapy, it's worth to evaluate whether endocrine therapy plus low-dose metronomic chemotherapy brings a better clinical benefit rate without sacrificing the quality of patients' life. In this phase III study, we investigate the efficacy and safety of low-dose capecitabine plus AI to treat metastatic HR+, HER2- postmenopausal breast cancer patients.
Interventions
DRUGCapecitabine
Capecitabine, 500mg, orally three times daily (continuously)
DRUGAromatase Inhibitor
Aromatase Inhibitor (Anastrozole, 1mg, orally once daily or Letrozole, 2.5mg, orally once daily or Exemestane , 25mg, orally once daily)
Sponsors
Sun Yat-sen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Adult women with locoregionally recurrent or metastatic disease not amenable to curative therapy * Confirmed diagnosis of ER positive/Her2-negative breast cancer * No prior systemic anti-cancer therapy for locoregionally recurrent or metastatic disease * Any menopausal status, but premenopausal or perimenopausal patients are required to receive LHRHa treatment * Measurable disease defined by RECIST version 1.1, or bone-only disease * Eastern Cooperative Oncology Group (ECOG) 0-2, and life expectancy ≥ 3 months * Adequate organ and marrow function * Resolution of all toxic effects of prior therapy or surgical procedures
Exclusion criteria
* Patients who have progressed within 2 years of adjuvant endocrine therapy * Patients who have not received prior endocrine therapy and are eligible to receive fulvestrant as initial therapy * Patients with advanced, symptomatic, visceral spread that are at risk of life threatening complication in the short term * Known uncontrolled or symptomatic central nervous system metastases * Diagnosis of any other malignancy within 3 years prior to randomization (except adequately treated basal or squamous cell skin cancer or cervical carcinoma in situ) * Serious uncontrolled intercurrent infections or intercurrent medical or psychiatric illness
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progress-free survival | Baseline up to approximately 20 months | Time from randomization to the first documentation of objective tumor progression or to death due to any cause without documented progression. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Baseline until death (up to approximately 48 months) | Time from randomization to date of death due to any cause. |
Countries
China
Contacts
PRINCIPAL_INVESTIGATORShusen Wang, MD
Sun Yat-sen University
Outcome results
None listed