Safety and Efficacy Study of Concomitant Radiotherapy and Zoledronic Acid for Bone Metastases Palliation

This study has been completed.
Sponsor:
Collaborator:
Novartis
Information provided by:
The Cleveland Clinic
ClinicalTrials.gov Identifier:
NCT00264420
First received: December 6, 2005
Last updated: December 20, 2010
Last verified: December 2010
  Purpose

Zoledronic acid (Zometa) belongs to a class of drugs called bisphosphonates. Bisphosphonates are used in bone metastases to keep the cancerous lesion under control in the bone and to help prevent calcium level elevations in the blood. Cancer cell-culture studies at the Cleveland Clinic showed that zoledronic acid and radiation together have more cell killing effect than either one used alone. The purpose of this study is to monitor the healing of bone lesions when using zoledronic acid together with radiation treatment.


Condition Intervention Phase
Bone Metastases
Breast Cancer
Lung Cancer
Prostate Cancer
Drug: zoledronic acid
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I Pilot Trial to Study the Safety and Efficacy of Concomitant Radiotherapy and Zoledronic Acid for the Palliation of Bone Metastases From Breast Cancer, Prostate Cancer and Lung Cancer

Resource links provided by NLM:


Further study details as provided by The Cleveland Clinic:

Primary Outcome Measures:
  • PET-CT [ Time Frame: baseline and 6 months ]

Secondary Outcome Measures:
  • X-ray, baseline [ Time Frame: 3 months, 6 months ]
  • physical exam [ Time Frame: Radiaton Oncology - visits 1, 14, 17 ]
  • physical exam [ Time Frame: Medical Oncology - visits 1, 13, 17 ]

Enrollment: 4
Study Start Date: December 2005
Study Completion Date: March 2007
Arms Assigned Interventions
Experimental: 1
zoledronic acid plus radiation therapy
Drug: zoledronic acid
At baseline 4 mg IV zoledronic acid over 15 min. every 4 weeks for 6 months plus radiation therapy 30 Gy in 10 fractions (5 times per week for first two weeks)

Detailed Description:

Bone metastases are frequently one of the first signs of disseminated disease in cancer patients. Skeletal complications due to metastatic disease include (severe) bone pain, impaired mobility, spinal cord compression, pathological fractures, and hypercalcemia. Radiotherapy and surgery are the options for the specific local treatment of bone metastases. Chemotherapy, hormonotherapy and bisphosphonates are systemic weapons used in the treatment of bone metastases with or without hypercalcemia. Cancers with propensity to metastasize to bones such as breast, prostate, lung and myeloma may possess the capacity to interact with osteoclasts. Osteoclasts are specialized bone cells, which erode mineralized bone by secreting acids and lysosomal enzymes. In normal bone remodeling, osteoclastic bone resorption is coupled to and is in equilibrium with osteoblastic bone formation. The lytic bone destruction associated with malignant bone metastases develops because tumor cells synthesize and release soluble factors that stimulate osteoclasts to resorb bone. The malignant activation of osteoclasts results in a disruption of normal bone remodeling wherein the equilibrium between bone resorption and bone formation is shifted toward increased bone resorption. This relative increase in osteoclastic bone resorption results in a net loss of bone.

Zoledronic acid (Zometa®, CGP42446) is a member of a class of compounds known as bisphosphonates. Bisphosphonates are effective inhibitors of osteoclastic bone resorption. They have therapeutic efficacy in the treatments of hypercalcemia of malignancy, lytic bone disease associated with multiple myeloma, and mixed lytic and blastic bone metastases associated with breast cancer, prostate cancer and lung cancer. In the clinical setting, zoledronic acid is the most potent bisphosphonate.

Conventionally, external beam radiotherapy (RT) is a primary treatment method for the palliation of bone metastases. The aim of RT in bone metastases treatment is to eradicate malignant cells without damaging surrounding normal cells. RT is typically given to the lesion area, in order to spare as much bone marrow as possible. RT is indicated in solitary, lytic and painful bone lesions of multiple myeloma as well as bone metastases from solid tumors such as breast, prostate and lung cancer to prevent the fracture risk or to relieve the pain.

The goal of this study will be to evaluate the safety and efficacy of concomitant standard RT and standard zoledronic acid on the bone metastases of breast, prostate or lung cancer patients. We chose zoledronic acid to use in this study, as it is the most effective FDA approved aminobisphosphonate.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • >18 years of age
  • biopsy proven breast, lung, and/or prostate cancer
  • boney metastases with an indication for radiation, either diagnosed radiologically or biopsy proven
  • Karnofsky Performance Status >60
  • Life expectancy of at least 6 months
  • Serum creatinine level ≤ 2.0 mg/dL and calculated creatinine clearance of > 60 mL/min
  • Leukocyte count ≥ 3500/mm3
  • Hemoglobulin > 11 g/dl
  • Platelets > 100,000 / mm3
  • Total bilirubin < 2.5 mg/dl

Exclusion Criteria:

  • pregnant and lactating women (breast and lung cancer)
  • hormonotherapy started less than 3 months prior to randomization (prostate cancer)
  • history of allergic reactions to bisphosphonates
  • receiving concomitant nephrotoxic chemotherapy
  • participation in another clinical trial with an investigational drug or completed an investigational drug trial within the past 30 days
  • liver function tests > 1.5 times normal values
  • IV calcitonin administration less than 30 days prior to randomization
  • laboratory evidence of renal disease
  • previous RT to the region of bone metastasis which will be treated in this study
  • currently receiving oral or IV bisphosphonate therapy
  • presence of ascites
  • clinically significant electrocardiographic changes
  • hypercalcemia, pathologic fracture, or epidural spinal cord compression
  • other organ metastasis
  • known hypersensitivity to Zometa® (zoledronic acid) or other bisphosphonates
  • current active dental problems including infection of the teeth or jawbone (maxilla or mandibular); dental or fixture trauma, or a current or prior diagnosis of osteonecrosis of the jaw (ONJ), of exposed bone in the mouth, or of slow healing after dental procedures.
  • recent (within 6 weeks) or planned dental or jaw surgery (e.g.. extraction, implants)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00264420

Sponsors and Collaborators
The Cleveland Clinic
Novartis
Investigators
Principal Investigator: Roger Macklis, MD The Cleveland Clinic
  More Information

Publications:
Major RJ, Chen BL, et al. Multiple event analysis of zoledronic acid trials in patients with cancer metastatic to bone. Proc Am Soc Clin Oncol 22:762, 2003

Responsible Party: Dawn Miller, Program Coordinator, Cleveland Clinic Foundation
ClinicalTrials.gov Identifier: NCT00264420     History of Changes
Other Study ID Numbers: IRB7743, Case 8Y04
Study First Received: December 6, 2005
Last Updated: December 20, 2010
Health Authority: United States: Institutional Review Board

Keywords provided by The Cleveland Clinic:
bone metastases
breast cancer
lung cancer
prostate cancer
zoledronic acid
radiation therapy

Additional relevant MeSH terms:
Bone Marrow Diseases
Bone Neoplasms
Breast Neoplasms
Lung Neoplasms
Neoplasm Metastasis
Neoplasms, Second Primary
Prostatic Neoplasms
Bone Diseases
Breast Diseases
Genital Diseases, Male
Genital Neoplasms, Male
Hematologic Diseases
Lung Diseases
Musculoskeletal Diseases
Neoplasms
Neoplasms by Site
Neoplastic Processes
Pathologic Processes
Prostatic Diseases
Respiratory Tract Diseases
Respiratory Tract Neoplasms
Skin Diseases
Thoracic Neoplasms
Urogenital Neoplasms
Diphosphonates
Zoledronic acid
Bone Density Conservation Agents
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on October 22, 2014