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Simultaneous Study of Gemcitabine-Docetaxel Combination Adjuvant Treatment, as Well as Extended Bisphosphonate and Surveillance-Trial

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ClinicalTrials.gov Identifier: NCT02181101
Recruitment Status : Completed
First Posted : July 3, 2014
Last Update Posted : July 3, 2014
Sponsor:
Collaborators:
AstraZeneca
Chugai Pharma USA
Eli Lilly and Company
Novartis
Sanofi
Janssen Diagnostics, LLC
Information provided by (Responsible Party):
Prof. Dr. med. Harald Leo Sommer, Ludwig-Maximilians - University of Munich

Brief Summary:

This is an open-label, multicenter, 2x2 factorial design, randomized controlled, Phase III study comparing the disease free survival after randomisation in patients treated with 3 cycles of Epirubicin-Fluorouracil-Cyclophosphamide(FEC)-chemotherapy, followed by 3 cycles of Docetaxel(Doc)-chemotherapy versus 3 cycles of Epirubicin-Fluorouracil-Cyclophosphamide(FEC), followed by 3 cycles of Gemcitabine-Docetaxel(DocGemzar)-chemotherapy, and to compare the disease free survival after randomisation in patients treated with 2 years of Zoledronate versus 5 years of Zoledronate in patients with early primary breast cancer. Patients will be required to have histopathological proof of axillary lymph node metastases (pN1-3) or high risk node negative, defined as: 'pT≥2 or histopathological grade 3, or age ≤ 35 or negative hormone receptor', but are not allowed to have evidence of distant disease. Patients will have to be entered into the study no later than 6 weeks after complete resection of the primary tumor. No other antineoplastic treatment other than surgical treatment, the defined cytotoxic and endocrine treatment and radiotherapy will be allowed prior to study entry and during the course of the study.

After surgery, leading to R0 resection of the invasive and intraductal components of the primary tumor, patients will be randomized to one of the following treatments:

First randomization

AA: 3 cycles of 5-Fluorouracil 500 mg/m² i.v. body surface area and Epirubicin 100 mg/m² i.v. and Cyclophosphamide 500 mg/m² i.v., (FEC100), each administered on day 1, repeated on day 22, subsequently followed by 3 cycles of Docetaxel 75 mg/m² body surface area i.v. (Doc), and Gemcitabine 1000 mg/m² i.v. (30 min infusion) (Gemzar), administered on day 1, followed by Gemcitabine 1000 mg/m² i.v. (30 min infusion) on day 8, repeated on day 22

AB: 3 cycles of 5-Fluorouracil 500 mg/m² i.v. body surface area and Epirubicin 100 mg/m² i.v. and Cyclophosphamide 500 mg/m² i.v., (FEC100), each administered on day 1, repeated on day 22, subsequently followed by 3 cycles of Docetaxel 100 mg/m² body surface area i.v. (Doc), administered on day 1, repeated on day 22

Second randomization B

BA: Zoledronic acid 4 mg i.v., every 3 months for the duration of two years, subsequently followed by zoledronic acid 4 mg i.v., every 6 months for the duration of additional three years

BB: Zoledronic acid 4 mg i.v., every 3 months for the duration of two years

During the zoledronic acid treatment period, patients will receive 500 mg Calcium p.o. qid and 400 i.E. Vitamin D p.o. qid.

Patients with positive hormone receptor status (≥ 10 % positively stained cells for estrogen and/or progesterone) of the primary tumor will receive Tamoxifen treatment 20 mg p.o. per day for 2 years, after the end of chemotherapy. Subsequent to chemotherapy, postmenopausal patients with positive hormone receptor status will be treated with Anastrozole (Arimidex®) 1 mg p.o. for additional 3 years, premenopausal patients will continue Tamoxifen treatment for additional 3 years. In addition to tamoxifen, all patients with positive hormone receptor status of the primary tumor and under the age of 40 or restart of menstrual bleeding within 6 months after the completion of cytostatic treatment or with premenopausal hormone levels as defined below will receive Goserelin (Zoladex®) 3.6 mg subcutaneously every 4 weeks over a period of 2 years following chemotherapy. Premenopausal endocrine status will be assumed, if the following serum levels are met: Luteinizing hormone (LH) < 20 mIE/ml, follicle stimulating hormone (FSH) < 20 mIE/ml and estradiol (E2) > 20 pg/ml. Endocrine therapy will start after the end of chemotherapy.

All patients with breast conserving therapy or more than 3 axillary lymph node metastases or in the following cases after mastectomy:

  • T3/T4-carcinoma
  • T2-carcinoma > 3 cm
  • multicentric tumor growth
  • lymphangiosis carcinomatosa or vessel involvement
  • involvement of the pectoralis fascia or a safety margin < 5 mm.

will receive adjuvant radiotherapy.


Condition or disease Intervention/treatment Phase
Breast Neoplasms Drug: FEC-DocGemzar adjuvant chemotherapy Drug: FEC-Doc adjuvant chemotherapy Drug: Zoledronic acid i.v. 2 years Drug: Zoledronic acid i.v. 5 years Phase 3

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 3754 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Study Start Date : September 2005
Actual Primary Completion Date : September 2013
Actual Study Completion Date : September 2013

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: AA-BA
FEC-DocGemzar adjuvant chemotherapy; zoledronic acid i.v. 5 years
Drug: FEC-DocGemzar adjuvant chemotherapy
Drug: Zoledronic acid i.v. 5 years
Experimental: AB-BA
FEC-Doc adjuvant chemotherapy; zoledronic acid i.v. 5 years
Drug: FEC-Doc adjuvant chemotherapy
Drug: Zoledronic acid i.v. 5 years
Experimental: AA-BB
FEC-DocGemzar adjuvant chemotherapy; zoledronic acid i.v. 2 years
Drug: FEC-DocGemzar adjuvant chemotherapy
Drug: Zoledronic acid i.v. 2 years
Active Comparator: AB-BB
FEC-Doc adjuvant chemotherapy; zoledronic acid i.v. 2 years
Drug: FEC-Doc adjuvant chemotherapy
Drug: Zoledronic acid i.v. 2 years



Primary Outcome Measures :
  1. Disease free survival [ Time Frame: 5 years ]

Secondary Outcome Measures :
  1. Overall survival [ Time Frame: 5 years ]
  2. Number of adverse events related to cancer therapy observed [ Time Frame: 5 years ]
  3. Quality of life [ Time Frame: 5 years ]
    Changes in quality of life over time as defined by EORTC QLQ-C30 and QLQ-BR23 questionnaire

  4. Number of skeletal/bone-related adverse events observed including osteonecrosis of the jaw [ Time Frame: 5 years ]
  5. Number of patients who develop malignant disease other than recurrence of the breast cancer treated within the trial [ Time Frame: 5 years ]
  6. Distant disease free survival [ Time Frame: 5 years ]
    Disease free survival excluding ipsilateral breast tumor recurrence, regional invasive recurrences, contralateral breast cancer, and all in situ carcinomas



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Primary epithelial invasive carcinoma of the breast pT1-4, pM0
  • Histopathological proof of axillary lymph node metastases (pN1-3) or high risk pN0/NX, defined as: 'pT ≥ 2 or histopathological grade 3 or age ≤ 35 or negative hormone receptor status'
  • Complete resection the primary tumor with margins of resection free of invasive carcinoma not more than 6 weeks ago
  • Females ≥ 18 years of age
  • Performance Status ≤ 2 on Eastern Cooperative Oncology Group (ECOG) Scale
  • Adequate bone marrow reserve: leucocytes ≥ 3.0 x 10^9/l and platelets ≥ 100 x 10^9/l
  • Bilirubin within one fold of the reference laboratory's normal range, aspartate aminotransferase (ASAT) (serum glutamate oxalacetate transaminase, SGOT), alanine aminotransferase (ALAT) (serum glutamate pyruvate transaminase, SGPT) and alkaline phosphatase (AP) within 1,5 fold of the reference laboratory's normal range for patients
  • Intention of regular follow-up visits for the duration of the study
  • Ability to understand the nature of the study and to give written informed consent

Exclusion Criteria:

  • Inflammatory breast cancer
  • Previous or concomitant cytotoxic or other systemic antineoplastic treatment which is not part of or allowed within this study
  • History of treatment or disease affecting bone metabolism (e.g., Paget's disease, primary hyperparathyroidism)
  • Prior treatment with bisphosphonates within the last 6 months
  • Severe renal insufficiency as evidenced by creatinine clearance < 30 ml/min as calculated using the Cockcroft-Gault formula
  • Second primary malignancy (except in situ carcinoma of the cervix or adequately treated basal cell carcinoma of the skin)
  • Cardiomyopathy with impaired ventricular function (New York Heart Association Functional Classification Class (NYHA) > II), cardiac arrythmias influencing left ventricular ejection fraction (LVEF) and requiring medication, history of myocardial infarction or angina pectoris within the last 6 months, or arterial hypertension not being controlled by medication
  • Any known hypersensitivity against docetaxel, epirubicin, cyclophosphamide, fluorouracil, gemcitabine or any other medication included in the study protocol
  • Use of any investigational agent within 3 weeks prior to inclusion
  • Patients in pregnancy or breast feeding (in premenopausal women anticonception has to be assured: intra uterine devices, surgical methods of sterilization, or, in hormone unsensitive tumors only, oral, subcutaneous or transvaginal hormonal, non estrogen containing contraceptives)
  • 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)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02181101


Locations
Germany
Klinikum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt
Munich, Bavaria, Germany, 80337
Sponsors and Collaborators
Ludwig-Maximilians - University of Munich
AstraZeneca
Chugai Pharma USA
Eli Lilly and Company
Novartis
Sanofi
Janssen Diagnostics, LLC
Investigators
Study Director: Harald L Sommer, Prof. Dr. med. Ludwig-Maximilians - University of Munich

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Prof. Dr. med. Harald Leo Sommer, Ludwig-Maximilians - University of Munich
ClinicalTrials.gov Identifier: NCT02181101     History of Changes
Other Study ID Numbers: SUCCESS-A
2005-000490-21 ( EudraCT Number )
First Posted: July 3, 2014    Key Record Dates
Last Update Posted: July 3, 2014
Last Verified: July 2014

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Zoledronic acid
Diphosphonates
Bone Density Conservation Agents
Physiological Effects of Drugs