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Fulvestrant as Maintenance Therapy After First-line Chemotherapy in HER2 - Postmenopausal MBC Patients (FUMANCE)

Primary Purpose

Metastatic Breast Cancer

Status
Unknown status
Phase
Phase 3
Locations
Italy
Study Type
Interventional
Intervention
Fulvestrant
Sponsored by
Consorzio Oncotech
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Metastatic Breast Cancer focused on measuring Breast cancer, Metastatic, HER2 negative, postmenopausal, maintenance therapy, fulvestrant

Eligibility Criteria

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

Inclusion Criteria:

  1. Histologically or cytologically diagnosis of breast cancer;
  2. Presence of metastatic disease either measureable or non-measureable but evaluable bone disease as defined by the Response Evaluation Criteria in Solid Tumors;
  3. Diagnosis of hormone receptor positive (HR+), HER2 negative breast cancer. To fulfill the requirement for HR+ disease, a breast cancer must express, by immunohistochemistry (IHC), at least one of the hormone receptors (estrogen receptor [ER], progesterone receptor [PR]). To fulfill the requirement for HER2 negative disease, a breast cancer must not demonstrate over-expression of HER2 by either IHC or fluorescence in-situ hybridization (FISH);
  4. Post-menopausal status at the time of randomization.
  5. Previous treatment with either an antiestrogen or an aromatase inhibitor for adjuvant or metastatic disease is allowed;
  6. Age >18;
  7. One line chemotherapy for metastatic disease discontinued for 21-28 days. Patient has to have response or stability from the first-line chemotherapy. The patient may have received prior systemic chemotherapy in the neo-adjuvant or adjuvant setting;
  8. Patients with measurable or evaluable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria;
  9. Performance Status (ECOG) <2;
  10. No brain metastases;
  11. No clinically serious concurrent illnesses;
  12. Adequate organ function
  13. Use of bisphosphonates are allowed;
  14. Use of antiangiogenetic drugs (bevacizumab associated to paclitaxel) is allowed, but discontinued 21-28 days before start study;
  15. Life expectancy > 12 weeks;
  16. Are willing to participate for the duration of the study and to follow study procedures;
  17. Written informed consent prior to any study-specific procedures Written informed consent;

Exclusion Criteria:

  1. Treatment with a drug that has not received regulatory approval for any indication within 21-28 days from the randomization;
  2. Drug (chemotherapy or biological drug) after the end of first-line chemotherapy for maintenance phase;
  3. Significant known cardiovascular impairment (NYHA CHF > grade 2, unstable angina, myocardial infarction within the previous 6 months prior to randomization, or existing serious cardiac arrhythmia). VECF (Ventricular Ejection Cardiac Fraction) ≤ 50%;
  4. Prior malignancy (other than breast cancer) except for non-melanoma skin cancer and carcinoma in situ (of the cervix or bladder), unless diagnosed and definitively treated more than 5 years prior to randomization;
  5. Severe/uncontrolled intercurrent illness within the previous 28 days prior to randomization.
  6. Any other significant co-morbid conditions that in the opinion of the Investigator would impair study participation or cooperation;
  7. Patients with psychiatric illness, social situation or geographical situation that would preclude informed consent or limit compliance with study requirements, as determined by the Investigator;

Sites / Locations

  • A.S.U.R. Zona Territoriale 6 Fabriano U.O. Oncologia Medica
  • Ospedale Unico Versilia U.O. Oncologia MedicaRecruiting
  • Presidio Ospedaliero di Macerata
  • Ospedale 'Felice Lotti' - Azienda USL 5 di Pisa U.O. di Oncologia MedicaRecruiting
  • Ospedale Oncologico Regionale - Centro di Riferimento Oncologico di Basilicata U.O. di Oncologia MedicaRecruiting
  • Ospedale C. e G. Mazzoni di Ascoli Piceno - Area Vasta 5
  • P.O. Avezzano Via G. di Vittorio, 6
  • Ospedale degli Infermi - FaenzaRecruiting
  • A.O.U Ospedali Riuniti di Foggia
  • A.S.L. LT - Ospedale Santa Maria Goretti U.O.C. di Oncologia Medica
  • Ospedale Vito FazziRecruiting
  • P.O. Campo di MarteRecruiting
  • Azienda Ospedaliera Fatebenefratelli e Oftalmico
  • Università di Napoli Federico II Dipartimento di Medicina clinica e ChirurgiaRecruiting
  • Istituto Nazionale dei Tumori - Fondazione G. Pascale U.O. Oncologia Medica SenologicaRecruiting
  • A.O.R.N. "A. Cardarelli"Recruiting
  • Ospedale di RavennaRecruiting
  • Istituto Regina Elena per lo studio e la cura dei tumori S.C. Oncologia Medica ARecruiting
  • Ospedale fatebenefratelli - Villa S Pietro (Roma)
  • Ospedale civile "Madonna del Soccorso" - Area Vasta 5

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Fulvestrant

No intervention

Arm Description

In Arm A maintenance Fulvestrant will be given until disease progression, unacceptable toxicity or refused of patient to the treatment.

Patients will be randomized to receive fulvestrant (experimental arm) or no treatment

Outcomes

Primary Outcome Measures

Maintenance-progression-free survival (mPFS)
Time between the date of randomization and the date of progression or death, whichever occurs first

Secondary Outcome Measures

Full Information

First Posted
February 26, 2015
Last Updated
June 14, 2016
Sponsor
Consorzio Oncotech
Collaborators
Clinical Research Technology S.r.l.
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1. Study Identification

Unique Protocol Identification Number
NCT02383030
Brief Title
Fulvestrant as Maintenance Therapy After First-line Chemotherapy in HER2 - Postmenopausal MBC Patients
Acronym
FUMANCE
Official Title
Randomized Phase III Study of Fulvestrant as Maintenance Therapy After First-line Chemotherapy in HER2 Negative Postmenopausal Metastatic Breast Cancer Patients
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Unknown status
Study Start Date
November 2015 (undefined)
Primary Completion Date
September 2017 (Anticipated)
Study Completion Date
December 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Consorzio Oncotech
Collaborators
Clinical Research Technology S.r.l.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Breast cancer is one of the most prevalent cancers among women, and represents 20 - 25% of all female cancers. Despite earlier diagnosis and improvement in adjuvant therapies, some patients will present metastatic recurrence. Treatment of breast cancer is determined by the extent of the disease. Early or localized breast cancer is treated by a combination of surgery and radiotherapy. Adjuvant systemic therapy, consisting of chemotherapy and/or endocrine therapy, in tumors deemed hormone responsive, can prolong the disease-free interval and improve overall survival. However, approximately 30% to 40% of patients with early breast cancer will ultimately relapse, with either local recurrence or distant metastases, and require further systemic treatment for advanced disease. Since breast cancer that recurs or progresses after initial treatment is considered incurable, the therapy options available for advanced disease are concerned with disease control and palliation of symptoms. Hormonal therapy has become the treatment of choice in postmenopausal women with hormone sensitive breast cancer. Even though the treatment of advanced breast cancer in postmenopausal women has improved with the introduction of agents such as aromatase inhibitors, these agents still have limitations, and disease management continues to be sub-optimal. The use of systemic therapies such as hormonal therapy, chemotherapy or new biological treatment is to reduce tumour masses, improve survival and preserve quality of life. Whatever the initial efficacy of the treatment undertaken in metastatic setting, almost every patient will relapse. The main goal is to improve progression free survival (PFS). To achieve this, the type of chemotherapy, the optimal duration of chemotherapy, the benefit of maintenance chemotherapy, the benefit of maintenance hormonal treatment are debatable.
Detailed Description
The search for prognostic and predictive factors that could influence the survival of patients treated for metastatic breast cancer has already been the subject of several studies. It seems that 2 components in the natural outcome of tumors must be considered. The first category is related to the primary characteristics such as initial histological grade, hormonal receptor status. The second category is linked to the metastatic characteristics: proliferation index reflected by the length of disease-free interval, type and number of metastatic sites involved. On the other hand, some prognostic factors are linked to the treatments undertaken, stressing their impact on the natural outcome of the disease: type of hormonotherapy, type of chemotherapy, type of response achieved by treatment. The impact of some factors remains debatable, such the duration of treatment. The optimal duration of chemotherapy in patients who respond or have stable disease is not identified. Definitively, the major limit to the use of prolonged regimens of chemotherapy is related to their toxicity, all the more so as they are cumulative (cardiac toxicity of anthracyclins, neurologic toxicity of taxanes, haematological cumulative toxicities with any chemotherapy…). The proposition to give hormonal treatment to prolong therapy in hormonal-positive tumors is another possible option. In the literature, data focused on this strategy are rare. One can object that the choice of patient/tumor characteristics for who would or would not receive the maintenance hormonal therapy was not random, or controlled in any way. This may have led to a selection of better prognosis patients. Investigators cannot know whether they are observing natural history or impacting it in such a trial. Nevertheless the major impact obtained by maintenance hormonal treatment after the first line chemotherapy might indicate that this strategy should be recommended in patients with an ER or PgR positive tumor. Based on the amplitude of the benefit observed, it may be ethically debatable to conduct a prospective randomized study. Moreover, randomized trials which assess the benefit of a new chemotherapy regimen should allow the possibility to give maintenance hormonal treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Breast Cancer
Keywords
Breast cancer, Metastatic, HER2 negative, postmenopausal, maintenance therapy, fulvestrant

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
156 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Fulvestrant
Arm Type
Experimental
Arm Description
In Arm A maintenance Fulvestrant will be given until disease progression, unacceptable toxicity or refused of patient to the treatment.
Arm Title
No intervention
Arm Type
No Intervention
Arm Description
Patients will be randomized to receive fulvestrant (experimental arm) or no treatment
Intervention Type
Drug
Intervention Name(s)
Fulvestrant
Other Intervention Name(s)
Faslodex
Intervention Description
After randomization patients will receive (Arm A, experimental Arm) fulvestrant as the following schedule: 500 mg i.m. on Days 0, 14, 28 followed by fulvestrant 500 mg im given every 28 days until progression disease. Study will start after 42 days from the last cycle of chemotherapy
Primary Outcome Measure Information:
Title
Maintenance-progression-free survival (mPFS)
Description
Time between the date of randomization and the date of progression or death, whichever occurs first
Time Frame
36 months

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically diagnosis of breast cancer; Presence of metastatic disease either measureable or non-measureable but evaluable bone disease as defined by the Response Evaluation Criteria in Solid Tumors; Diagnosis of hormone receptor positive (HR+), HER2 negative breast cancer. To fulfill the requirement for HR+ disease, a breast cancer must express, by immunohistochemistry (IHC), at least one of the hormone receptors (estrogen receptor [ER], progesterone receptor [PR]). To fulfill the requirement for HER2 negative disease, a breast cancer must not demonstrate over-expression of HER2 by either IHC or fluorescence in-situ hybridization (FISH); Post-menopausal status at the time of randomization. Previous treatment with either an antiestrogen or an aromatase inhibitor for adjuvant or metastatic disease is allowed; Age >18; One line chemotherapy for metastatic disease discontinued for 21-28 days. Patient has to have response or stability from the first-line chemotherapy. The patient may have received prior systemic chemotherapy in the neo-adjuvant or adjuvant setting; Patients with measurable or evaluable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria; Performance Status (ECOG) <2; No brain metastases; No clinically serious concurrent illnesses; Adequate organ function Use of bisphosphonates are allowed; Use of antiangiogenetic drugs (bevacizumab associated to paclitaxel) is allowed, but discontinued 21-28 days before start study; Life expectancy > 12 weeks; Are willing to participate for the duration of the study and to follow study procedures; Written informed consent prior to any study-specific procedures Written informed consent; Exclusion Criteria: Treatment with a drug that has not received regulatory approval for any indication within 21-28 days from the randomization; Drug (chemotherapy or biological drug) after the end of first-line chemotherapy for maintenance phase; Significant known cardiovascular impairment (NYHA CHF > grade 2, unstable angina, myocardial infarction within the previous 6 months prior to randomization, or existing serious cardiac arrhythmia). VECF (Ventricular Ejection Cardiac Fraction) ≤ 50%; Prior malignancy (other than breast cancer) except for non-melanoma skin cancer and carcinoma in situ (of the cervix or bladder), unless diagnosed and definitively treated more than 5 years prior to randomization; Severe/uncontrolled intercurrent illness within the previous 28 days prior to randomization. Any other significant co-morbid conditions that in the opinion of the Investigator would impair study participation or cooperation; Patients with psychiatric illness, social situation or geographical situation that would preclude informed consent or limit compliance with study requirements, as determined by the Investigator;
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alessandra Fabi, MD
Phone
652666919
Email
fabi@ifo.it
First Name & Middle Initial & Last Name or Official Title & Degree
Elena Abrami, BD
Email
info@oncotech.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Francesco Cognetti
Organizational Affiliation
Regina Elena National Cancer Institute Via Elio Chianesi 53, 00144 Rome, Italy
Official's Role
Study Chair
Facility Information:
Facility Name
A.S.U.R. Zona Territoriale 6 Fabriano U.O. Oncologia Medica
City
Fabriano
State/Province
Ancona
ZIP/Postal Code
60044
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
ROSA RITA SILVA, Md
Facility Name
Ospedale Unico Versilia U.O. Oncologia Medica
City
Lido Di Camaiore
State/Province
Lucca
ZIP/Postal Code
55041
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Domenico Amoroso, Md
Facility Name
Presidio Ospedaliero di Macerata
City
Mecerata
State/Province
MC
ZIP/Postal Code
62100
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Luciano LL Latini, Doctor
Facility Name
Ospedale 'Felice Lotti' - Azienda USL 5 di Pisa U.O. di Oncologia Medica
City
Pontedera
State/Province
Pisa
ZIP/Postal Code
56025
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giacomo Allegrini, MD
Facility Name
Ospedale Oncologico Regionale - Centro di Riferimento Oncologico di Basilicata U.O. di Oncologia Medica
City
Rionero in vulture
State/Province
Potenza
ZIP/Postal Code
85028
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Michele Aieta, MD
Facility Name
Ospedale C. e G. Mazzoni di Ascoli Piceno - Area Vasta 5
City
Ascoli Piceno
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giorgio De Signoribus
Facility Name
P.O. Avezzano Via G. di Vittorio, 6
City
Avezzano
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giovanna Amiconi
Facility Name
Ospedale degli Infermi - Faenza
City
Faenza
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Laura Amaducci
Facility Name
A.O.U Ospedali Riuniti di Foggia
City
Foggia
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sante Romito
Facility Name
A.S.L. LT - Ospedale Santa Maria Goretti U.O.C. di Oncologia Medica
City
Latina
ZIP/Postal Code
04100
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
ENZO VELTRI, Md
Facility Name
Ospedale Vito Fazzi
City
Lecce
ZIP/Postal Code
73100
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mariangela Ciccarese, MD
First Name & Middle Initial & Last Name & Degree
Mariangela Ciccarese, MD
Facility Name
P.O. Campo di Marte
City
Lucca
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Editta Baldini
Facility Name
Azienda Ospedaliera Fatebenefratelli e Oftalmico
City
Milano
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nicla La Verde
Facility Name
Università di Napoli Federico II Dipartimento di Medicina clinica e Chirurgia
City
Naples
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sabino De Placido
Facility Name
Istituto Nazionale dei Tumori - Fondazione G. Pascale U.O. Oncologia Medica Senologica
City
Napoli
ZIP/Postal Code
80131
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
MICHELINO DE LAURENTIIS, Md
Facility Name
A.O.R.N. "A. Cardarelli"
City
Napoli
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ferdinando Riccardi
Facility Name
Ospedale di Ravenna
City
Ravenna
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amelia Tienghi
Facility Name
Istituto Regina Elena per lo studio e la cura dei tumori S.C. Oncologia Medica A
City
Roma
ZIP/Postal Code
00144
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alessandra Fabi, mD
Facility Name
Ospedale fatebenefratelli - Villa S Pietro (Roma)
City
Roma
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arianna Pellegrino
Facility Name
Ospedale civile "Madonna del Soccorso" - Area Vasta 5
City
San Benedetto del Tronto
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Giorgio De signoribus

12. IPD Sharing Statement

Plan to Share IPD
No

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Fulvestrant as Maintenance Therapy After First-line Chemotherapy in HER2 - Postmenopausal MBC Patients

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