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Efficacy of Denosumab on Normal BMD in Women Receiving Adjuvant Aromatase Inhibitors for Early Breast Cancer

Primary Purpose

Breast Cancer

Status
Active
Phase
Phase 3
Locations
Japan
Study Type
Interventional
Intervention
Denosumab Injection
Sponsored by
Kyoto Prefectural University of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Breast Cancer focused on measuring bone health, hormone-sensitive breast cancer, postmenopausal, aromatase inhibitor, bone mineral density

Eligibility Criteria

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

Inclusion Criteria:

Patients must meet all of the following items at the time of case registration:

  1. Patients with infiltrative breast cancer, aged ≥20 years, meeting the following definitions:

    • Those pathologically diagnosed with stage I, II, or IIIA breast cancer (Cancer Management Regulations, 11th version)
    • Those who underwent appropriate surgery, such as mastectomy and breast-preserving surgery
  2. Estrogen receptor (ER)- or progesterone receptor (PgR)-positive patients on immunohistochemical (IHC) staining
  3. Females meeting one of the following criteria for menopause:

    • Those, aged ≥55 years, without menstruation
    • Those, aged <55 years, with amenorrhea for ≥12 months, or those diagnosed with menopause by attending physicians based on the FSH and estradiol levels
    • Those who underwent bilateral oophorectomy
  4. Patients in whom the BMD for the lumbar vertebrae (L1-L4) on DXA before the start of this study is ≥-1.0SD of the mean value of young adult females (YAM), and the BMD for the femoral neck is ≥-1.0SD of YAM
  5. Patients without lumbar vertebral or femoral fracture
  6. Those with an ECOG PS of 0-2
  7. Those with adequate organ functions (laboratory data within 4 weeks before case registration)

    • Leukocyte count, ≥3,000/mm3 or Neutrophil count, ≥1,500/mm3
    • AST, ALT, ≤1.5-fold of the upper limit of the institutional reference range
    • Serum creatinine, ≤1.5-fold of the upper limit of the institutional reference range
  8. Case registration should be performed before the following point:Twelve weeks after the completion of surgery or postoperative chemotherapy (The completion of chemotherapy refers to the completion of the final course, involving the recovery phase.)
  9. Patients with an interval of ≥4 weeks after the discontinuation of therapy with bisphosphonates (oral preparations), estrogen preparations, raloxifene, calcitonin preparations, vitamin K preparations, active vitamin D preparations, or ipriflavone preparations, which influence bones
  10. Those from whom written informed consent regarding study participation was obtained

Exclusion Criteria:

Whether each patient meets any of the following items must be checked on case registration:

  1. Patients in whom distant metastasis was confirmed clinically or using imaging procedures at the time of case registration
  2. Those with bilateral breast cancer
  3. Those for whom postoperative hormonal therapy was started before consenting to study participation
  4. Those who received endocrine therapy within 52 weeks before consenting to study participation
  5. Those to whom bisphosphonate preparations were intravenously administered within 52 weeks before consenting to study participation
  6. Those with the following diseases that may affect DXA

    • Severe scoliosis, immobility, hyperostosis or osteosclerosis of the lumbar vertebrae, calcification of the abdominal aorta, and vertebral disease
  7. Those with a history of malignant tumors other than breast cancer within 260 weeks before consenting to study participation
  8. Those with dental diseases, such as infectious diseases of the teeth or jaw and tooth trauma. Those for whom tooth or jaw surgery is scheduled within 6 weeks after consenting to study participation (tooth extraction, implantation)
  9. Others who are considered to be ineligible by the chief investigator

Sites / Locations

  • Hisako Ono

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

AI+denosumab VS only AI

Arm Description

We compare AI intake+denosumab injection and AI intake only in patients with normal BMD to whom Letrozole or Arimidex will be administered as postoperative endocrine therapy, and we assess the efficacy of denosumab injection on bone loss by adjuvant endocrine therapy.

Outcomes

Primary Outcome Measures

percentage change in the bone mineral density (BMD) for the lumbar vertebrae (L1-L4) on dual-energy X-ray absorptiometry (DXA)
The change is a value obtained by subtracting 1 from the BMD after 12 months/baseline BMD is expressed as a percentage

Secondary Outcome Measures

percentage change in the BMD for the lumbar vertebrae (L1-L4) on DXA
percentage change in the BMD for the femoral neck: After 2/3/4/5 years
percentage change in the BMD for the femoral neck
percentage change in the BMD for the femoral neck: After 12 months and 2/3/4/5 years
percentage change in the BMD for the radius (an ultrasonic bone densimeter is used)institutions in which ultrasonic bone densimeters are used)
percentage change in the BMD for the radius (an ultrasonic bone densimeter is used): After 2 and 4 weeks, every 4 weeks thereafter (for 2 years after registration)(only institutions in which ultrasonic bone densimeters are used)
Changes in Ca and bone metabolism markers
Changes in Ca (mg/dL corrected by albumin level) and bone metabolism markers such as TRAP5b, bone-specific alkaline phosphatase (BSAP), blood pentosidine) by blood sampling at every 6 months
Appearance rate of morbid fracture in all participants
Appearance rate of morbid fracture up to 3 years in all participants. Morbid fractures include all types of fractures.
Disease-free survival
Disease-free survival at the end of the study
Overall survival
Overall survival at the end of the study
Appearance of adverse events
Appearance rate of adverse events (such as hypocalcemia and necrosis of the jaw)
Quality of life (QOL)
Quality of life(QOL), Japanese version Euro-Qol (EQ-5D-5L) evaluated by questionnaire at every 6 months

Full Information

First Posted
September 21, 2017
Last Updated
October 5, 2023
Sponsor
Kyoto Prefectural University of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT03324932
Brief Title
Efficacy of Denosumab on Normal BMD in Women Receiving Adjuvant Aromatase Inhibitors for Early Breast Cancer
Official Title
A Multicenter, Randomized, Comparative Study Regarding the Efficacy of Denosumab on Normal Bone Mineral Density in Women Receiving Adjuvant Aromatase Inhibitors for Early Breast Cancer (ENDEAVOR Trial)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
September 25, 2017 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Kyoto Prefectural University of Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This multicenter, randomized, comparative study will evaluate the efficacy of denosumab to prevent the adjuvant therapy of aromatase inhibitors-induced loss of bone mineral density (BMD) in breast cancer patients with normal BMD. Investigators will compare the inhibitory effects of denosumab on bone loss between participants with normal BMD to whom Letrozole or Arimidex will be administered as postoperative endocrine therapy for stage I-IIIA postmenopausal hormone-sensitive breast cancer and controls.
Detailed Description
Normal BMD means T score is ≥-1.0 for the lumbar vertebrae (L1-L4) and/or the femoral neck.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
bone health, hormone-sensitive breast cancer, postmenopausal, aromatase inhibitor, bone mineral density

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
160 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
AI+denosumab VS only AI
Arm Type
Other
Arm Description
We compare AI intake+denosumab injection and AI intake only in patients with normal BMD to whom Letrozole or Arimidex will be administered as postoperative endocrine therapy, and we assess the efficacy of denosumab injection on bone loss by adjuvant endocrine therapy.
Intervention Type
Drug
Intervention Name(s)
Denosumab Injection
Other Intervention Name(s)
pralia
Intervention Description
AI intake + denosumab injection per 6 months VS only AI intake
Primary Outcome Measure Information:
Title
percentage change in the bone mineral density (BMD) for the lumbar vertebrae (L1-L4) on dual-energy X-ray absorptiometry (DXA)
Description
The change is a value obtained by subtracting 1 from the BMD after 12 months/baseline BMD is expressed as a percentage
Time Frame
12 months after the start of this study
Secondary Outcome Measure Information:
Title
percentage change in the BMD for the lumbar vertebrae (L1-L4) on DXA
Description
percentage change in the BMD for the femoral neck: After 2/3/4/5 years
Time Frame
after 2, 3, 4, and 5 years
Title
percentage change in the BMD for the femoral neck
Description
percentage change in the BMD for the femoral neck: After 12 months and 2/3/4/5 years
Time Frame
after 12 months and 2/3/4/5 years
Title
percentage change in the BMD for the radius (an ultrasonic bone densimeter is used)institutions in which ultrasonic bone densimeters are used)
Description
percentage change in the BMD for the radius (an ultrasonic bone densimeter is used): After 2 and 4 weeks, every 4 weeks thereafter (for 2 years after registration)(only institutions in which ultrasonic bone densimeters are used)
Time Frame
after 2 and 4 weeks, every 4 weeks thereafter (for 2 years after registration)(only
Title
Changes in Ca and bone metabolism markers
Description
Changes in Ca (mg/dL corrected by albumin level) and bone metabolism markers such as TRAP5b, bone-specific alkaline phosphatase (BSAP), blood pentosidine) by blood sampling at every 6 months
Time Frame
after 24 weeks
Title
Appearance rate of morbid fracture in all participants
Description
Appearance rate of morbid fracture up to 3 years in all participants. Morbid fractures include all types of fractures.
Time Frame
up to 3 years
Title
Disease-free survival
Description
Disease-free survival at the end of the study
Time Frame
at least 5 year
Title
Overall survival
Description
Overall survival at the end of the study
Time Frame
at least 5 year
Title
Appearance of adverse events
Description
Appearance rate of adverse events (such as hypocalcemia and necrosis of the jaw)
Time Frame
at least 5 year
Title
Quality of life (QOL)
Description
Quality of life(QOL), Japanese version Euro-Qol (EQ-5D-5L) evaluated by questionnaire at every 6 months
Time Frame
after 24 weeks

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must meet all of the following items at the time of case registration: Patients with infiltrative breast cancer, aged ≥20 years, meeting the following definitions: Those pathologically diagnosed with stage I, II, or IIIA breast cancer (Cancer Management Regulations, 11th version) Those who underwent appropriate surgery, such as mastectomy and breast-preserving surgery Estrogen receptor (ER)- or progesterone receptor (PgR)-positive patients on immunohistochemical (IHC) staining Females meeting one of the following criteria for menopause: Those, aged ≥55 years, without menstruation Those, aged <55 years, with amenorrhea for ≥12 months, or those diagnosed with menopause by attending physicians based on the FSH and estradiol levels Those who underwent bilateral oophorectomy Patients in whom the BMD for the lumbar vertebrae (L1-L4) on DXA before the start of this study is ≥-1.0SD of the mean value of young adult females (YAM), and the BMD for the femoral neck is ≥-1.0SD of YAM Patients without lumbar vertebral or femoral fracture Those with an ECOG PS of 0-2 Those with adequate organ functions (laboratory data within 4 weeks before case registration) Leukocyte count, ≥3,000/mm3 or Neutrophil count, ≥1,500/mm3 AST, ALT, ≤1.5-fold of the upper limit of the institutional reference range Serum creatinine, ≤1.5-fold of the upper limit of the institutional reference range Case registration should be performed before the following point:Twelve weeks after the completion of surgery or postoperative chemotherapy (The completion of chemotherapy refers to the completion of the final course, involving the recovery phase.) Patients with an interval of ≥4 weeks after the discontinuation of therapy with bisphosphonates (oral preparations), estrogen preparations, raloxifene, calcitonin preparations, vitamin K preparations, active vitamin D preparations, or ipriflavone preparations, which influence bones Those from whom written informed consent regarding study participation was obtained Exclusion Criteria: Whether each patient meets any of the following items must be checked on case registration: Patients in whom distant metastasis was confirmed clinically or using imaging procedures at the time of case registration Those with bilateral breast cancer Those for whom postoperative hormonal therapy was started before consenting to study participation Those who received endocrine therapy within 52 weeks before consenting to study participation Those to whom bisphosphonate preparations were intravenously administered within 52 weeks before consenting to study participation Those with the following diseases that may affect DXA Severe scoliosis, immobility, hyperostosis or osteosclerosis of the lumbar vertebrae, calcification of the abdominal aorta, and vertebral disease Those with a history of malignant tumors other than breast cancer within 260 weeks before consenting to study participation Those with dental diseases, such as infectious diseases of the teeth or jaw and tooth trauma. Those for whom tooth or jaw surgery is scheduled within 6 weeks after consenting to study participation (tooth extraction, implantation) Others who are considered to be ineligible by the chief investigator
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hisako Ono, PhD
Organizational Affiliation
Kyoto Prefectural University of Medicine
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Tetsuya Taguchi, PhD
Organizational Affiliation
Kyoto Prefectural University of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hisako Ono
City
Kyoto
ZIP/Postal Code
6028566
Country
Japan

12. IPD Sharing Statement

Citations:
PubMed Identifier
30054855
Citation
Nakatsukasa K, Koyama H, Ouchi Y, Ono H, Sakaguchi K, Matsuda T, Kato M, Ishikawa T, Yamada K, Yoshimura M, Koizumi K, Sakurai T, Shigematsu H, Takahashi S, Taira S, Suzuki M, Narui K, Niikura N, Hasegawa Y, Miura D, Konishi E, Taguchi T; Collaborative Study Group of Scientific Research of the Japanese Breast Cancer Society. Effect of denosumab on low bone mineral density in postmenopausal Japanese women receiving adjuvant aromatase inhibitors for non-metastatic breast cancer: 24-month results. Breast Cancer. 2019 Jan;26(1):106-112. doi: 10.1007/s12282-018-0896-y. Epub 2018 Jul 27.
Results Reference
background
PubMed Identifier
31393399
Citation
Sakaguchi K, Ono H, Nakatsukasa K, Ishikawa T, Hasegawa Y, Takahashi M, Niikura N, Koizumi K, Sakurai T, Shigematsu H, Takahashi S, Taira S, Suzuki M, Narui K, Miura D, Yamada K, Yoshimura M, Shioya H, Konishi E, Isao Y, Imai K, Fujikawa K, Taguchi T; Collaborative Study Group of Scientific Research of the Japanese Breast Cancer Society. Efficacy of denosumab for restoring normal bone mineral density in women receiving adjuvant aromatase inhibitors for early breast cancer. Medicine (Baltimore). 2019 Aug;98(32):e16770. doi: 10.1097/MD.0000000000016770.
Results Reference
derived

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Efficacy of Denosumab on Normal BMD in Women Receiving Adjuvant Aromatase Inhibitors for Early Breast Cancer

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