Breast Cancer
Conditions
Keywords
sequential administration chemiotherapy, early breast cancer, breast cancer, aromatase inhibitor, adjuvant, post menopausal
Brief summary
Breast cancer is the most common form of cancer among women. For patients candidated for adjuvant chemotherapy and endocrine therapy the optimal timing for their has not been clearly defined yet.
Detailed description
Breast cancer is the most common form of cancer among women in North America, Europe and Latin America. Because nearly 80% of breast cancers are endocrine-responsive tumors, the majority of patients candidates for adjuvant chemotherapy (CT) are also candidates for endocrine therapy (ET). The optimal timing (i.e. concomitant vs sequential administration) for the integration of these two treatments has not been clearly defined yet. In patients with hormone receptor positive early stage breast cancer who are candidates to adjuvant chemotherapy and endocrine therapy, the optimal timing for the integration of these two treatment modalities has not been clearly defined yet.
Interventions
DRUGAnastrozole or Letrozole or Exemestane
Adjuvant chemotherapy → Anastrozole or Letrozole or Exemestane once a day for 5 years (sequential arm)
Sponsors
IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
Clinical Research Technology S.r.l.
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
* Women with histological diagnosis of invasive breast cancer completely removed by surgery, any T, any N. * Postmenopausal status defined by at least one of the following conditions: 1. Aged ≥ 60 2. Aged 45-59 and satisfying one or more of the following criteria: * amenorrhea for ≥12 months and intact uterus; * amenorrhea for \<12 months and follicle-stimulating hormone (FSH) within the postmenopausal range, including: * pts with hysterectomy * pts who have received hormone replacement therapy (HRT) * pts with chemotherapy-induced amenorrhea 3. bilateral oophorectomy at any age \>18 years. * Primary tumor positive for Estrogen Receptors (ER) and/or Progesteron receptors (PgR) (≥1% tumor cells positive by immunohistochemistry or ≥ 10 fmol/mg cytosol protein by ligand binding assay). * Patients who are prescribed 5 years of endocrine therapy with an aromatase inhibitors (AI) * Indication for adjuvant chemotherapy- Patients with HER-2 positive tumors are eligible provided that they are prescribed trastuzumab according to registered schedule. * Signed informed consent.
Exclusion criteria
* HRT currently assumed or during the month before randomization * Recurrent or metastatic disease * HER-2 positive tumors if treatment with trastuzumab is considered not appropriate/feasible * Concurrent illness that contraindicate adjuvant endocrine treatment and/or chemotherapy * Patients who have received Tamoxifen as part of any breast cancer prevention trial * Previous history of invasive breast cancer or other invasive malignancy within the previous 10 years, other than squamous or basal cell carcinoma of the skin or carcinoma in situ of the cervix, adequately cone biopsied * Concomitant severe disease which would place the patient at unusual risk * Concurrent treatment with experimental drugs * Patients treated with systemic investigational drugs within the past 30 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disease- free Survival (DFS) | up to 15 years | the primary outcome indicator will be the so called DFS, defined as time elapsing between the date of randomization and the date of one of the following events, whichever occurs first, assessed up to 15 years: * Local Recurrence of disease * Regional recurrence of disease * Distant recurrence of disease * Contralateral invasive or intraductal breast cancer * Second primary malignancy other than breast * Death for any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | time between the date of randomization up to the date of death for any cause, assessed up to 15 years. | — |
| Translational Study: genomic analysis | up to 15 years | Expression of genes associated with ER and Ki67 expression will be analyzed by Real Time polymerase chain reaction (PCR) on RNA extracted from formalin-fixed paraffin embedded (FFPE) sections of tumors classified as intermediate risk by clinical and pathological variables (stage I-II, G2, hormone receptors positive) and will be correlated with disease free survival. |
| Translational Study: epigenetic analysis | up to 15 years | miRNA expression analysis by real time PCR and DNA methylation analysis by pyrosequencing will be assessed on FFPE sections of tumors classified as intermediate risk by clinical and pathological variables (stage I-II, G2, hormone receptors positive) |
| Translational Study: proteomic analysis | up to 15 years | The different proteomic profiles identified in FFPE sections of hormone receptors positive G2 tumors will be correlated with DFS |
Countries
Italy
Contacts
PRINCIPAL_INVESTIGATORLucia Del Mastro, MD
IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
Outcome results
None listed