search
Back to results

Zoledronate in Preventing Bone Loss in Postmenopausal Women Who Are Receiving Letrozole for Stage I, Stage II, or Stage IIIA Breast Cancer

Primary Purpose

Breast Cancer, Osteoporosis

Status
Completed
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
letrozole
zoledronic acid
Sponsored by
Alliance for Clinical Trials in Oncology
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Breast Cancer focused on measuring osteoporosis, stage I breast cancer, stage II breast cancer, stage IIIA breast cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Diagnosis of breast cancer Stage I, II, or IIIA disease Completed ≤ 6 years of adjuvant tamoxifen therapy Total baseline lumbar spine or femoral neck bone mineral density T-score below -2.0 standard deviation (e.g., a patient with a T-score of -2.1 in ineligible; a patient with a T-score of -1.9 is eligible) No clinical or radiological evidence of recurrent or metastatic disease Hormone receptor status: Estrogen receptor- and/or progesterone receptor-positive PATIENT CHARACTERISTICS: Age Postmenopausal Sex Female Menopausal status Postmenopausal, defined by 1 of the following: Over 55 years of age with cessation of menses 55 years of age and under with spontaneous cessation of menses for > 1 year 55 years of age and under with spontaneous cessation of menses for ≤ 1 year, but amenorrheic (e.g., spontaneous or secondary to hysterectomy) with postmenopausal estradiol levels (< 5 ng/dL) Undergone bilateral oophorectomy Performance status ECOG 0-2 Life expectancy At least 5 years Hematopoietic WBC ≥ 3,000/mm^3 Platelet count ≥ 100,000/mm^3 Hepatic Alkaline phosphatase ≤ 3 times upper limit of normal (ULN) AST ≤ 3 times ULN Renal Creatinine < 2.0 mg/dL No hypercalcemia (i.e., calcium > 1 mg/dL above ULN within the past 6 months) No hypocalcemia (i.e., calcium > 0.5 mg/dL below lower limit of normal within the past 6 months) Other No uncontrolled infection No uncontrolled diabetes mellitus No uncontrolled thyroid dysfunction No disease affecting bone metabolism (e.g., hyperparathyroidism, hypercortisolism, Paget's disease, or osteogenesis imperfecta) No malabsorption syndrome No uncontrolled seizure disorder associated with falls No known hypersensitivity to zoledronate or other bisphosphonates, letrozole, calcium, or cholecalciferol (vitamin D) No mental illness that would preclude giving informed consent No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix No other non-malignant systemic disease No clinical or radiologic evidence of existing fracture in the lumbar spine and/or total hip No history of fracture with low intensity or not associated with trauma No contraindication to spinal dual energy x-ray absorptiometry (DEXA) due to any of the following: History of surgery at the lumbosacral spine, with or without implantable devices Scoliosis with a Cobb angle > 15° at the lumbar spine Immobility, hyperostosis, or sclerotic changes at the lumbar spine Evidence of sufficient sclerotic abdominal aorta that would interfere with DEXA scan Any disease of the spine that would preclude proper acquisition of a lumbar spine DEXA Considered reliable PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy No concurrent chemotherapy Endocrine therapy See Disease Characteristics Prior parathyroid hormone allowed provided it was not administered for > 1 week More than 6 months since prior anabolic steroids or growth hormone More than 12 months since prior endocrine therapy (including estrogen) except for the following: Tamoxifen Insulin Oral hypoglycemics Thyroid hormone Steroid inhalers More than 12 months since prior systemic corticosteroids except short-term corticosteroids to prevent or treat chemotherapy-induced nausea and vomiting or acute respiratory illness Concurrent short-term corticosteroids allowed No other concurrent hormonal therapy No concurrent parathyroid hormone Radiotherapy Not specified Surgery Not specified Other Prior systemic sodium fluoride allowed provided it was not administered for > 3 months within the past 2 years More than 3 weeks since prior oral bisphosphonates More than 2 weeks since prior and no concurrent drugs known to affect the skeleton (e.g., calcitonin, mithramycin, or gallium nitrate) More than 30 days since prior systemic investigational drugs and/or devices More than 7 days since prior topical investigational drugs No prior IV bisphosphonates No prior aromatase inhibitor therapy No concurrent calcitonin, sodium fluoride, or Tibolone No other concurrent anticancer therapy No other concurrent bisphosphonates No other concurrent investigational drugs or devices

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Experimental

    Arm Label

    Arm I: letrozole + zoledronate

    Arm II: letrozole + zoledronate

    Arm Description

    Patients receive oral letrozole once daily. Patients also receive zoledronate IV over 15 minutes once every 6 months. Treatment continues for up to 5 years in the absence of disease progression or unacceptable toxicity.

    Patients receive oral letrozole once daily. Patients with radiologic evidence of bone loss after 1 year of letrozole therapy receive zoledronate as in arm I. Treatment continues for up to 5 years in the absence of disease progression or unacceptable toxicity.

    Outcomes

    Primary Outcome Measures

    Average intra-patient change in total lumbar spine (L1-L4) bone mineral density (BMD) as measured by dual energy x-ray absorptiometry at baseline and 1 year after completion of study treatment

    Secondary Outcome Measures

    BMD (lumbar spine) annually for 5 years after completion of study treatment
    Incidence of osteoporosis
    Loss of bone density
    Incidence of bone fractures
    Time to disease progression

    Full Information

    First Posted
    April 5, 2005
    Last Updated
    December 2, 2016
    Sponsor
    Alliance for Clinical Trials in Oncology
    Collaborators
    National Cancer Institute (NCI)
    search

    1. Study Identification

    Unique Protocol Identification Number
    NCT00107263
    Brief Title
    Zoledronate in Preventing Bone Loss in Postmenopausal Women Who Are Receiving Letrozole for Stage I, Stage II, or Stage IIIA Breast Cancer
    Official Title
    A Randomized, Controlled, Open-Label Trial of Empiric Prophylactic vs. Delayed Use of Zoledronic Acid for Prevention of Bone Loss in Postmenopausal Women With Breast Cancer Initiating Therapy With Letrozole After Tamoxifen
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    December 2016
    Overall Recruitment Status
    Completed
    Study Start Date
    January 2005 (undefined)
    Primary Completion Date
    March 2007 (Actual)
    Study Completion Date
    August 2012 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Alliance for Clinical Trials in Oncology
    Collaborators
    National Cancer Institute (NCI)

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using letrozole may fight breast cancer by lowering the amount of estrogen the body makes. Zoledronate may prevent bone loss in patients who are receiving letrozole. It is not yet known which schedule of zoledronate is more effective in preventing bone loss in patients with breast cancer. PURPOSE: This randomized phase III trial is studying two different schedules of zoledronate to compare how well they work in preventing bone loss in postmenopausal women who are receiving letrozole for stage I, stage II, or stage IIIA breast cancer.
    Detailed Description
    OBJECTIVES: Compare the effectiveness of zoledronate vs standard care in reducing bone loss during the first 12 months of study treatment in postmenopausal women with stage I-IIIA breast cancer initiating letrozole after prior treatment with tamoxifen. Compare the effect of immediate vs delayed zoledronate, annually at 2-5 years post-baseline, in reducing bone loss in these patients. OUTLINE: This is a randomized, open-label, multicenter study. Patients are stratified according to duration of prior tamoxifen therapy (≤ 2 years vs > 2 years); time since tamoxifen therapy was discontinued (< 1 vs ≥ 1 year); prior adjuvant chemotherapy (yes vs no); and baseline total lumbar spine or femoral neck bone mineral density (BMD) T-score (> -1 standard deviation [SD] vs between -1 to -2 SD). Patients are randomized to 1 of 2 treatment arms. Arm I (immediate therapy): Patients receive oral letrozole once daily. Patients also receive zoledronate IV over 15 minutes once every 6 months. Arm II (delayed therapy): Patients receive oral letrozole as in arm I. Patients with radiologic evidence of bone loss after 1 year of letrozole therapy receive zoledronate as in arm I. In both arms, treatment continues for up to 5 years in the absence of disease progression or unacceptable toxicity. PROJECTED ACCRUAL: A total of 550 patients (275 per treatment arm) will be accrued for this study within 28 months.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Breast Cancer, Osteoporosis
    Keywords
    osteoporosis, stage I breast cancer, stage II breast cancer, stage IIIA breast cancer

    7. Study Design

    Primary Purpose
    Supportive Care
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    558 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Arm I: letrozole + zoledronate
    Arm Type
    Experimental
    Arm Description
    Patients receive oral letrozole once daily. Patients also receive zoledronate IV over 15 minutes once every 6 months. Treatment continues for up to 5 years in the absence of disease progression or unacceptable toxicity.
    Arm Title
    Arm II: letrozole + zoledronate
    Arm Type
    Experimental
    Arm Description
    Patients receive oral letrozole once daily. Patients with radiologic evidence of bone loss after 1 year of letrozole therapy receive zoledronate as in arm I. Treatment continues for up to 5 years in the absence of disease progression or unacceptable toxicity.
    Intervention Type
    Drug
    Intervention Name(s)
    letrozole
    Intervention Type
    Drug
    Intervention Name(s)
    zoledronic acid
    Primary Outcome Measure Information:
    Title
    Average intra-patient change in total lumbar spine (L1-L4) bone mineral density (BMD) as measured by dual energy x-ray absorptiometry at baseline and 1 year after completion of study treatment
    Time Frame
    at 12 months
    Secondary Outcome Measure Information:
    Title
    BMD (lumbar spine) annually for 5 years after completion of study treatment
    Time Frame
    Up to 5 years
    Title
    Incidence of osteoporosis
    Time Frame
    Up to 5 years
    Title
    Loss of bone density
    Time Frame
    Up to 5 years
    Title
    Incidence of bone fractures
    Time Frame
    Up to 5 years
    Title
    Time to disease progression
    Time Frame
    Up to 5 years

    10. Eligibility

    Sex
    Female
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    DISEASE CHARACTERISTICS: Diagnosis of breast cancer Stage I, II, or IIIA disease Completed ≤ 6 years of adjuvant tamoxifen therapy Total baseline lumbar spine or femoral neck bone mineral density T-score below -2.0 standard deviation (e.g., a patient with a T-score of -2.1 in ineligible; a patient with a T-score of -1.9 is eligible) No clinical or radiological evidence of recurrent or metastatic disease Hormone receptor status: Estrogen receptor- and/or progesterone receptor-positive PATIENT CHARACTERISTICS: Age Postmenopausal Sex Female Menopausal status Postmenopausal, defined by 1 of the following: Over 55 years of age with cessation of menses 55 years of age and under with spontaneous cessation of menses for > 1 year 55 years of age and under with spontaneous cessation of menses for ≤ 1 year, but amenorrheic (e.g., spontaneous or secondary to hysterectomy) with postmenopausal estradiol levels (< 5 ng/dL) Undergone bilateral oophorectomy Performance status ECOG 0-2 Life expectancy At least 5 years Hematopoietic WBC ≥ 3,000/mm^3 Platelet count ≥ 100,000/mm^3 Hepatic Alkaline phosphatase ≤ 3 times upper limit of normal (ULN) AST ≤ 3 times ULN Renal Creatinine < 2.0 mg/dL No hypercalcemia (i.e., calcium > 1 mg/dL above ULN within the past 6 months) No hypocalcemia (i.e., calcium > 0.5 mg/dL below lower limit of normal within the past 6 months) Other No uncontrolled infection No uncontrolled diabetes mellitus No uncontrolled thyroid dysfunction No disease affecting bone metabolism (e.g., hyperparathyroidism, hypercortisolism, Paget's disease, or osteogenesis imperfecta) No malabsorption syndrome No uncontrolled seizure disorder associated with falls No known hypersensitivity to zoledronate or other bisphosphonates, letrozole, calcium, or cholecalciferol (vitamin D) No mental illness that would preclude giving informed consent No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix No other non-malignant systemic disease No clinical or radiologic evidence of existing fracture in the lumbar spine and/or total hip No history of fracture with low intensity or not associated with trauma No contraindication to spinal dual energy x-ray absorptiometry (DEXA) due to any of the following: History of surgery at the lumbosacral spine, with or without implantable devices Scoliosis with a Cobb angle > 15° at the lumbar spine Immobility, hyperostosis, or sclerotic changes at the lumbar spine Evidence of sufficient sclerotic abdominal aorta that would interfere with DEXA scan Any disease of the spine that would preclude proper acquisition of a lumbar spine DEXA Considered reliable PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy No concurrent chemotherapy Endocrine therapy See Disease Characteristics Prior parathyroid hormone allowed provided it was not administered for > 1 week More than 6 months since prior anabolic steroids or growth hormone More than 12 months since prior endocrine therapy (including estrogen) except for the following: Tamoxifen Insulin Oral hypoglycemics Thyroid hormone Steroid inhalers More than 12 months since prior systemic corticosteroids except short-term corticosteroids to prevent or treat chemotherapy-induced nausea and vomiting or acute respiratory illness Concurrent short-term corticosteroids allowed No other concurrent hormonal therapy No concurrent parathyroid hormone Radiotherapy Not specified Surgery Not specified Other Prior systemic sodium fluoride allowed provided it was not administered for > 3 months within the past 2 years More than 3 weeks since prior oral bisphosphonates More than 2 weeks since prior and no concurrent drugs known to affect the skeleton (e.g., calcitonin, mithramycin, or gallium nitrate) More than 30 days since prior systemic investigational drugs and/or devices More than 7 days since prior topical investigational drugs No prior IV bisphosphonates No prior aromatase inhibitor therapy No concurrent calcitonin, sodium fluoride, or Tibolone No other concurrent anticancer therapy No other concurrent bisphosphonates No other concurrent investigational drugs or devices
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Stephanie Hines, MD
    Organizational Affiliation
    Mayo Clinic
    Official's Role
    Study Chair

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    19214743
    Citation
    Hines SL, Mincey B, Dentchev T, Sloan JA, Perez EA, Johnson DB, Schaefer PL, Alberts S, Liu H, Kahanic S, Mazurczak MA, Nikcevich DA, Loprinzi CL. Immediate versus delayed zoledronic acid for prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen-N03CC. Breast Cancer Res Treat. 2009 Oct;117(3):603-9. doi: 10.1007/s10549-009-0332-2. Epub 2009 Feb 12.
    Results Reference
    result

    Learn more about this trial

    Zoledronate in Preventing Bone Loss in Postmenopausal Women Who Are Receiving Letrozole for Stage I, Stage II, or Stage IIIA Breast Cancer

    We'll reach out to this number within 24 hrs