Letrozole and Goserelin or Leuprolide in Treating Premenopausal Estrogen Receptor-Positive Patients With Stage IV Breast Cancer

This study has been terminated.
National Cancer Institute (NCI)
Information provided by:
University of Washington
ClinicalTrials.gov Identifier:
First received: July 10, 2007
Last updated: May 7, 2013
Last verified: May 2013

RATIONALE: Aromatase inhibitors, such as letrozole, prevent the formation of estradiol, a female hormone. Giving letrozole together with goserelin, leuprolide, or surgery may be an effective treatment in women with hormone-dependent breast cancer.

PURPOSE: This phase II trial is studying how well giving letrozole together with goserelin or leuprolide works in treating premenopausal estrogen receptor-positive patients with stage IV breast cancer.

Condition Intervention Phase
Breast Cancer
Drug: goserelin
Drug: letrozole
Drug: leuprolide acetate
Procedure: conventional surgery
Phase 2

Study Type: Interventional
Study Design: Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Pilot of Aromatase Inhibitor Therapy With Femara® (Letrozole) and Ovarian Suppression in Premenopausal Estrogen Receptor Positive Women With Stage IV Carcinoma of the Breast

Resource links provided by NLM:

Further study details as provided by University of Washington:

Primary Outcome Measures:
  • Overall response rate as measured by RECIST [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Time to treatment failure [ Designated as safety issue: No ]
  • Time to progression [ Designated as safety issue: No ]
  • Time to death [ Designated as safety issue: No ]
  • Clinical benefit rate [ Designated as safety issue: No ]
  • Qualitative and quantitative toxicity as assessed by NCI CTCAE v3.0 [ Designated as safety issue: Yes ]
  • Disease-free survival [ Designated as safety issue: No ]
  • Overall survival [ Designated as safety issue: No ]
  • Safety [ Designated as safety issue: Yes ]
  • Comparison of response with results of previous studies of postmenopausal women treated with aromatase inhibitor (AI) therapy and of premenopausal women treated with ovarian suppression (OS) and tamoxifen [ Designated as safety issue: No ]
  • Determination of adequacy of estrogen suppression by AI therapy and OS [ Designated as safety issue: No ]

Enrollment: 1
Study Start Date: February 2007
Study Completion Date: November 2008
Primary Completion Date: December 2007 (Final data collection date for primary outcome measure)
Detailed Description:



  • To measure overall response rate (ORR) in premenopausal women treated with an aromatase inhibitor (AI) and ovarian suppression (OS).


  • To measure time to treatment failure (TTF) in premenopausal women treated with an AI and OS.
  • To measure time to progression (TTP) in premenopausal women treated with an AI and OS.
  • To measure time to death in premenopausal women treated with an AI and OS.
  • To assess the clinical benefit rate (CBR) in premenopausal women treated with an AI and OS.
  • To measure the qualitative and quantitative toxicity of an AI and OS.
  • To determine whether ORR, TTP, and CBR are similar to what is seen in postmenopausal women treated with an AI.
  • To determine whether ORR, TTP, and CBR are similar to what is seen in premenopausal women treated with tamoxifen and OS.
  • To determine if levels of estrogen (i.e., estradiol or estrone) are adequately suppressed in premenopausal women on an AI and OS.

OUTLINE: This is a pilot, open-label study.

Patients undergo surgical ovarian suppression (OS) or medical OS with luteinizing hormone-releasing hormone (LHRH) agonist (i.e., goserelin or leuprolide acetate, intramuscularly once monthly for 3 months and then every 2 months thereafter for the duration of study therapy). Beginning on day 14 after initiation of LHRH-agonist therapy or surgery, patients receive oral letrozole once daily. Treatment continues in the absence of disease progression or unacceptable toxicity.

Menopausal status is tested periodically during study by measuring serum estradiol levels. Patients not converting to a menopausal state after the first month of study therapy, receive a higher dose of LHRH and undergo repeat estradiol testing in the second month. If the patient continues to be premenopausal, they are then considered for bilateral salpingo-oophorectomy or removed from study.

After completion of study therapy, patients are followed every 3 months for 2 years, every 6 months for 2 years, and annually thereafter.


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


  • Histologically confirmed carcinoma of the breast

    • Metastatic disease
  • Measurable disease (i.e., unidimensional by RECIST)
  • No rapidly progressing visceral involvement (e.g., liver or lymphangitic lung disease)
  • No known marrow involvement as evidenced by diffuse uptake by imaging studies or bone marrow biopsy or aspirate
  • No evidence of CNS metastases
  • Estrogen- and/or progesterone-receptor positive status confirmed in primary breast tumor or in recent biopsy of metastatic site


  • Female
  • Premenopausal*, as defined by the following criteria:

    • Less than 12 months from last menstrual period or premenopausal estradiol within the past 12 months
    • No prior bilateral oophorectomy
    • 45 years old or younger with intact ovaries and not a candidate for aromatase inhibitor therapy alone due to the potential for recurrent ovarian function NOTE: *Women are considered premenopausal after prior hysterectomy if they have intact ovaries and follicular hormone levels consistent with the institutional normal values for the premenopausal state
  • Women meeting premenopausal criteria prior to receiving ovarian suppression are eligible
  • ECOG performance status 0-2
  • Life expectancy ≥ 3 months
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective nonhormonal contraception during and for 12 weeks after discontinuation of study therapy
  • ANC ≥ 500 cells/mm³
  • Platelet count ≥ 50,000 cells/mm³
  • Hematocrit ≥ 28%
  • In the absence of liver metastases:

    • AST and ALT ≤ 2.5 times upper limit of normal (ULN)
    • Alkaline phosphatase ≤ 2.5 times ULN
  • In the presence of liver metastases:

    • AST and ALT ≤ 5 times ULN
    • Alkaline phosphatase ≤ 5 times ULN
  • In the presence of bone metastases:

    • AST and ALT ≤ 10 times ULN
    • Alkaline phosphatase ≤ 10 times ULN
  • Total bilirubin ≤ 2 times ULN
  • No significant comorbid conditions, including any of the following:

    • Clinically significant cardiac disease not well controlled with medication (e.g., congestive heart failure, symptomatic coronary artery disease, or cardiac arrhythmias)
    • Myocardial infarction within the past 12 months
    • Serious concurrent infection
  • No lack of physical integrity of the upper gastrointestinal tract
  • No inability to swallow or malabsorption syndrome
  • No other carcinoma within the past 5 years except nonmelanoma skin cancer and treated in situ cervical cancer
  • No mental illness
  • No known hypersensitivity to luteinizing hormone-releasing hormone (LHRH), LHRH-agonist analogues, or any of the components in goserelin


  • No concurrent chemotherapy and/or additional hormonal therapy
  • Concurrent trastuzumab (Herceptin®) for patients with HER2 overexpression allowed
  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: NCT00498901

United States, Washington
Seattle Cancer Care Alliance
Seattle, Washington, United States, 98109-1023
University Cancer Center at University of Washington Medical Center
Seattle, Washington, United States, 98195-6043
Sponsors and Collaborators
University of Washington
National Cancer Institute (NCI)
Principal Investigator: Hannah M. Linden, MD University of Washington
  More Information

Responsible Party: Hannah M. Linden, University Cancer Center at University of Washington Medical Center
ClinicalTrials.gov Identifier: NCT00498901     History of Changes
Other Study ID Numbers: 6412  FHCRC-6412  UWCC-UW 6412  UWCC- 06-4560-H/D  CDR0000553612 
Study First Received: July 10, 2007
Last Updated: May 7, 2013
Health Authority: United States: Federal Government

Keywords provided by University of Washington:
stage IV breast cancer
recurrent breast cancer

Additional relevant MeSH terms:
Breast Neoplasms
Breast Diseases
Neoplasms by Site
Skin Diseases
Antineoplastic Agents
Antineoplastic Agents, Hormonal
Aromatase Inhibitors
Enzyme Inhibitors
Fertility Agents
Fertility Agents, Female
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Reproductive Control Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on April 27, 2016