Breast Adenocarcinoma, Radiation Dermatitis, Radiation Toxicity
Conditions
Keywords
Non-metastatic breast cancer, Post operative adjuvant radiotherapy, Radiotherapy cutaneous toxicity
Brief summary
Phase III, prospective, interventional, multicentric, comparative, randomized, open study with 2 parallel arms, evaluating the efficacy of Cicaderma ointment vs standard management of each site in preventing the onset of grade \> 2 radiodermatitis according to the National Cancer Institute - Common Terminology Criteria for Adverse Events-Version (NCI-CTCAE-V5)
Detailed description
Breast cancer is the most common cancer in women. It accounts for more than 1/3 of new cancer cases and is the 1st cause of death for women. Management usually includes tumorectomy or mastectomy precede or not by a chemotherapy, then adjuvant irradiation that can be supplemented with adjuvant chemotherapy and / or hormone therapy. Radiotherapy uses ionizing radiation (photons, electrons ...) to destroy cancer cells and consists in precisely directing these radiations on the area to be treated while preserving as much as possible healthy tissues and surrounding organs. Radiation-induced dermatitis is a skin lesion that occurs after exposure to ionizing radiation and is commonly seen in patients. Acute radiodermatitis occurs in the days or weeks following the start of irradiation with different degrees of severity (dry or exsudative radiodermatitis, acute radionecrosis) They are responsible for an alteration of patients' quality of life (pain, sensitivity to UV radiation, discomfort sensations ...), which may lead to a temporary or even permanent therapeutic interruption and reduce the probability of tumor control. The management of these dermatitis is very heterogeneous, no study having demonstrated the superiority of a preventive or curative treatment. Trolamine (Biafine®) is to date the only topic with a Marketing Authorization (MA) for the treatment of radiation-induced secondary erythema. A study conducted on 254 patients at the Léon Bérard Center from 1999 to 2001 demonstrated that the preventive use of a calendula-based topical was associated with a statistically significant reduction of grade 2 radiodermitis compared to trolamine in patients presenting an early breast cancer treated with post-operative irradiation. However, this calendula ointment, which does not have the MA in the indicated indication, was in practice more difficult to apply than trolamine. Currently, skin hygiene measures to be applied are systematically explained to patients before carrying out post-operative radiotherapy (cotton clothing, neutral soap, etc.). Some centers such as Center Léon Bérard recommend the systematic use of a topic after each session, while others recommend hygiene measures or implement other options (essential oils ...). However, the effectiveness of these current practices on the prevention of radiodermatitis has not yet been demonstrated. It is a phase III, prospective, interventional, multicentric, comparative, randomized, open study with 2 parallel arms Patients will be randomized (1 :1) in Arm A (hygiene measures + preventive treatment with Cicaderma ointment) or Arm B (preventive treatment according to the site recommendations (at least the hygiene measures) with a stratification (site, body mass index ≤25 vs \>25 and RT hypofractionning).
Interventions
DRUGcicaderma + simple hygiene rules
Cicaderma ointment (2 applications / day: after the radiotherapy session) and in the evening) + simple hygiene rules
OTHERSimple hygiene rules and a maximum of one topical treatment
Simple hygiene rules according to the site recommandations including eventually a maximum of one topical treatment
Sponsors
Centre Leon Berard
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized, multicentric Phase III study evaluating the Cicaderma ointment efficacy versus standard practice of each site in the prevention of radiodermatitis in patients presenting a non metastatic breast cancer
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Patient requiring a post-operative radiotherapy (post mastectomy or tumorectomy) for a mammary adenocarcinoma or an unilateral in situ breast cancer histologically documented, early stage of disease (non metastatic) * Patient with no residual tumor (R0 or R1) * Patient informed and having given her signed consent * Patient affiliated to a social security regimen
Exclusion criteria
* Unsolved cutaneous toxicities of any previous treatment * Hormonotherapy started prior to radiotherapy * Concomitant use of other topical treatments than the study treatments on the irradiated area * Patient treated by concomitant chemotherapy and/or targeted therapy * Known hypersensibility to at least one component of the topicals used or Cicadema ointment * Patient for whom follow-up does not seem possible even in the short term * Pregnant or breastfeeding woman * Participation in another clinical trial that may interfere with the evaluation of the primary endpoint * Patient Under tutorship or curatorship or deprived of liberty
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comparison of the Cicaderma ointment efficacy versus the standard management of each site in preventing the onset of grade >= 2 radiodermatitis (NCI-CTCAE-V5) | Up to 30+/-4 days after the end of radiotherapy interruption | Number of patients presenting \>= 2 radiodermatitis according to the National Cancer Institute - Common Terminology Criteria for Adverse Events-Version (NCI-CTCAE-V5) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patients' satisfaction | 30+/-4 days after the end of radiotherapy interruption | Patients' satisfaction evaluated using the Patient's evaluation of the preventive management of radiodermatits - Likert scale in 5 points (from very unsatisfied to very satisfied) |
| Patients' quality of life: DLQI questionnaire | Up to 30+/-4 days after the end of radiotherapy interruption | Patients' quality of life evaluated using the Dermatology Life Quality Index (DLQI) questionnaire (validated questionnaire composed of 10 items leading to a global score) |
| Patients' pain in the irradiated area: numeric scale | Up to 30+/-4 days after the end of radiotherapy interruption | Patients' pain evaluated using a numeric scale from 0 (no pain) to 10 (unbearable pain) |
| Rate of temporary or permanent RT interruption related to the onset of grade 3 radiodermatitis | Through radiotherapy completion, an average of 5 weeks | Temporary or permanent radiotherapy interruption related to the onset of grade 3 radiodermatitis observed during patients' treatment period |
| Determination of the factors measured prior to treatment initiation which are associated to the onset of grade ≥2 radiodermatitis (phototype) | At inclusion | Phototype |
| Doses of radiation therapy received | Through radiotherapy completion, an average of 5 weeks | Doses of radiation therapy received during each radiotherapy session |
| Delay of onset of the first cutaneous event (radiodermatitis or prurit) grade ≥2 | Up to 30+/-4 days after the end of radiotherapy | Onset of the first grade \>= 2 cutaneous event (radiodermatitis or prurit) |
| Compliance with the Cicaderma ointment application (experimental arm) | Up to 30+/-4 days after the end of radiotherapy | Compliance evaluated according to the ointment tubes brought back by the patients (not used or partially used) and patient's diary |
| Determination of the factors measured prior to treatment initiation which are associated to the onset of grade ≥2 radiodermatitis (cup size) | At inclusion | Cup size |
| Rate of prurit onset whatever the grade | Up to 30+/-4 days after the end of radiotherapy interruption | Prurit onset whatever the grade observed |
Countries
France
Contacts
Primary ContactSéverine METZGER
Outcome results
None listed