Clinical Trials /

Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer

NCT01272037

Description:

This randomized phase III clinical trial studies how well tamoxifen citrate, anastrozole, letrozole, or exemestane with or without chemotherapy work in treating patients with breast cancer that has spread from where it began in the breast to surrounding normal tissue (invasive). Estrogen can cause the growth of breast cancer cells. Hormone therapy, using tamoxifen citrate, may fight breast cancer by blocking the use of estrogen by the tumor cells. Aromatase inhibitors, such as anastrozole, letrozole, and exemestane, may fight breast cancer by lowering the amount of estrogen the body makes. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving tamoxifen citrate, anastrozole, letrozole, or exemestane is more effective with combination chemotherapy in treating patients with breast cancer.

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer
  • Official Title: A Phase III, Randomized Clinical Trial of Standard Adjuvant Endocrine Therapy +/- Chemotherapy in Patients With 1-3 Positive Nodes, Hormone Receptor-Positive and HER2-Negative Breast Cancer With Recurrence Score (RS) of 25 or Less. RxPONDER: A Clinical Trial Rx for Positive Node, Endocrine Responsive Breast Cancer

Clinical Trial IDs

  • ORG STUDY ID: NCI-2011-02623
  • SECONDARY ID: NCI-2011-02623
  • SECONDARY ID: S12-03603
  • SECONDARY ID: CDR0000692475
  • SECONDARY ID: PS1007_A11PAMDREVW01
  • SECONDARY ID: SWOG-S1007
  • SECONDARY ID: S1007
  • SECONDARY ID: S1007
  • SECONDARY ID: U10CA180830
  • SECONDARY ID: U10CA180888
  • SECONDARY ID: U10CA032102
  • NCT ID: NCT01272037

Conditions

  • Breast Ductal Carcinoma In Situ
  • Invasive Breast Carcinoma
  • Multicentric Breast Carcinoma
  • Multifocal Breast Carcinoma
  • Synchronous Bilateral Breast Carcinoma

Interventions

DrugSynonymsArms
AnastrozoleAnastrazole, Arimidex, ICI D1033, ICI-D1033, ZD-1033Arm I (chemotherapy and endocrine therapy)
ExemestaneAromasin, FCE-24304Arm I (chemotherapy and endocrine therapy)
LetrozoleCGS 20267, FemaraArm I (chemotherapy and endocrine therapy)
Systemic ChemotherapyArm I (chemotherapy and endocrine therapy)
Tamoxifen CitrateApo-Tamox, Clonoxifen, Dignotamoxi, Ebefen, Emblon, Estroxyn, Fentamox, Gen-Tamoxifen, Genox, ICI 46,474, ICI-46474, Jenoxifen, Kessar, Ledertam, Lesporene, Nolgen, Noltam, Nolvadex, Nolvadex-D, Nourytam, Novo-Tamoxifen, Novofen, Noxitem, Oestrifen, Oncotam, PMS-Tamoxifen, Soltamox, TAM, Tamax, Tamaxin, Tamifen, Tamizam, Tamofen, Tamoxasta, Tamoxifeni Citras, ZemideArm I (chemotherapy and endocrine therapy)

Purpose

This randomized phase III clinical trial studies how well tamoxifen citrate, anastrozole, letrozole, or exemestane with or without chemotherapy work in treating patients with breast cancer that has spread from where it began in the breast to surrounding normal tissue (invasive). Estrogen can cause the growth of breast cancer cells. Hormone therapy, using tamoxifen citrate, may fight breast cancer by blocking the use of estrogen by the tumor cells. Aromatase inhibitors, such as anastrozole, letrozole, and exemestane, may fight breast cancer by lowering the amount of estrogen the body makes. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving tamoxifen citrate, anastrozole, letrozole, or exemestane is more effective with combination chemotherapy in treating patients with breast cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the effect of chemotherapy in patients with node positive breast cancer who
      do not have high recurrence scores (RS) by Oncotype DX.

      SECONDARY OBJECTIVES:

      I. To compare overall survival (OS), distant disease-free survival (DDFS) and local
      disease-free interval (LDFI) by receipt of chemotherapy or not and its interaction with RS.

      II. To compare the toxicity across the treatment arms. III. To perform other assays or tests
      (in particular the prediction analysis of microarray [PAM50] risk of relapse score), as they
      are developed and validated that measure potential benefit of chemotherapy and compare them
      to Oncotype DX.

      IV. To determine the impact of management with Oncotype DX on patient-reported anxiety
      (co-primary Health-Related Quality of Life [HRQL] outcome) prior to screening, after
      disclosure of test results, and during the randomized trial.

      V. To determine the impact of Oncotype DX on the initial management cost of node-positive,
      hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative
      breast cancer.

      VI. To compare patient-reported utilities (e.g., quality of life [QOL]) for those randomized
      to chemotherapy versus no chemotherapy.

      VII. Using modeling and DFS information from the trial, to estimate the cost-effectiveness of
      management with Oncotype DX vs usual care.

      VIII. To determine the role of other assays (e.g., PAM50) as predictors of DFS, DDFS, and
      LDFI for patients randomized to chemotherapy versus no chemotherapy.

      IX. To determine the impact of treatment with chemotherapy versus no chemotherapy on
      patient-reported fatigue and cognitive concerns (secondary HRQL outcomes).

      X. To determine the impact of management with Oncotype DX on patient-reported decision
      conflict, perceptions regarding Oncotype DX testing, and survivor concerns prior to
      screening, after disclosure of test results, and during the randomized trial (secondary HRQL
      outcomes).

      OUTLINE: Patients are randomized to 1 of 2 treatment arms.

      ARM I: Patients receive a protocol-approved chemotherapy regimen based on the patient and/or
      physician preference. Patients then receive a protocol-approved adjuvant endocrine therapy
      comprising tamoxifen citrate, an aromatase inhibitor (anastrozole, letrozole, or exemestane),
      or both for 5-10 years in the absence of disease progression or unacceptable toxicity.

      ARM II: Patients receive a protocol-approved endocrine therapy comprising tamoxifen citrate,
      an aromatase inhibitor (anastrozole, letrozole, or exemestane), or both for 5-10 years in the
      absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 3 months for 1 year,
      every 6 months for 4 years, and then yearly for 15 years.
    

Trial Arms

NameTypeDescriptionInterventions
Arm I (chemotherapy and endocrine therapy)ExperimentalPatients receive a protocol-approved chemotherapy regimen based on the patient and/or physician preference. Patients then receive a protocol-approved adjuvant endocrine therapy comprising tamoxifen citrate, an aromatase inhibitor (anastrozole, letrozole, or exemestane), or both for 5-10 years in the absence of disease progression or unacceptable toxicity.
  • Anastrozole
  • Exemestane
  • Letrozole
  • Systemic Chemotherapy
  • Tamoxifen Citrate
Arm II (endocrine therapy)ExperimentalPatients receive a protocol-approved endocrine therapy comprising tamoxifen citrate, an aromatase inhibitor (anastrozole, letrozole, or exemestane), or both for 5-10 years in the absence of disease progression or unacceptable toxicity.
  • Anastrozole
  • Exemestane
  • Letrozole
  • Tamoxifen Citrate

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must have a histologically confirmed diagnosis of node positive (1-3 nodes)
             invasive breast carcinoma with positive estrogen and/or progesterone receptor status,
             and negative HER-2 status; estrogen and progesterone receptor positivity must be
             assessed according to American Society of Clinical Oncology (ASCO)/College of American
             Pathologists (CAP) guidelines as either estrogen receptor (ER) or progesterone
             receptor (PR) >= 1% positive nuclear staining; HER-2 test result negativity must be
             assessed as per ASCO/CAP 2013 guidelines using immunohistochemistry (IHC), in situ
             hybridization (ISH) or both; HER-2 is negative if a single test (or all tests)
             performed in a tumor specimen show: a) IHC negative (0 or 1+) or b) ISH negative using
             single probe or dual probe (average HER-2 copy number < 4.0 signals per cell by single
             probe or HER-2/CEP ration < 2.0 with an average copy number < 4.0 signals per cell by
             dual probe); if HER-2 IHC is 2+, evaluation for gene amplification (ISH) must be
             performed and the ISH must be negative; ISH is not required if IHC is 0 or 1+; HER-2
             equivocal is not eligible

          -  Patients with multifocal, multicentric and synchronous bilateral breast cancers are
             allowed

               -  Multifocal disease is defined as more than one invasive cancer < 2 cm from the
                  largest lesion within the same breast quadrant; (NOTE: the Oncotype DX testing
                  must be completed on the largest lesion)

               -  Multicentric disease is defined as more than one invasive cancer >= 2 cm from the
                  largest lesion within the same breast quadrant or more than one lesion in
                  different quadrants (NOTE: Oncotype DX testing should be completed on all tumors
                  and the determination for eligibility should be made on the highest recurrence
                  score)

               -  Synchronous bilateral disease is defined as invasive breast cancer with positive
                  lymph nodes (axillary or intramammary) in at least one breast, diagnosed within
                  30 days of each other; (NOTE: the Oncotype DX testing should be completed on both
                  tumors and the tumor with the highest recurrence score should be used)

          -  Patients will have undergone axillary staging by sentinel node biopsy or axillary
             lymph nodes dissection (ALND); patients must have at least one, but no more than three
             known positive lymph nodes (pN1a, pN1b or pN1c); patients with micrometastases as the
             only nodal involvement (pN1mi) are not eligible; patients with positive sentinel node
             are not required to undergo full axillary lymph node dissection; this is at the
             discretion of the treating physician; axillary node evaluation is to be performed per
             the standard of care at each institution

          -  Patients must not have inflammatory breast cancer and must not have metastatic disease

          -  Patients with a prior diagnosis of contralateral ductal carcinoma in situ (DCIS) are
             eligible if they underwent a mastectomy or lumpectomy with whole breast radiation;
             prior partial breast irradiation, including brachytherapy, is not allowed; patients
             with a prior diagnosis of ipsilateral DCIS or invasive breast cancer who received
             radiation to that breast are not eligible

          -  Patients must have had either breast-conserving surgery with planned radiation therapy
             or total mastectomy (with or without planned postmastectomy radiation); patients must
             have clear margins from both invasive breast cancer and DCIS (as per local
             institutional guidelines); lobular carcinoma in situ (LCIS) at the margins is allowed

          -  Registration of patients who have not yet undergone Oncotype DX screening must occur
             no later than 56 days after definitive surgery; (for all patients, Step 2 Registration
             must occur within 84 days after definitive surgery); if the Oncotype DX Breast Cancer
             Assay has not been performed, patients must be willing to submit tissue samples for
             testing to determine the Recurrence Score value; a representative block or unstained
             sections from the representative block are sent directly to Genomic Health for
             Oncotype DX Breast Cancer Assay which will be performed according to the standard
             commercial process

               -  If the Oncotype DX Recurrence Score is already known and is 25 or less, the
                  patient must be registered to Step 2 immediately following Step 1 registration;
                  if the Oncotype DX Recurrence Score is already known and is greater than 25, the
                  patient is ineligible

          -  Patients must have a complete history and physical examination within 28 days prior to
             registration

          -  Patients must have a performance status of 0-2 by Zubrod criteria

          -  Patients must be able to receive taxane and/or anthracycline based chemotherapy

          -  Patients must not have begun chemotherapy or endocrine therapy for their breast cancer
             prior to registration

          -  Patients must not require chronic treatment with systemic steroids (inhaled steroids
             are allowed) or other immunosuppressive agents

          -  Patients must not have received an aromatase inhibitor (AI) or a selective estrogen
             receptor modulator (SERM) such as tamoxifen or raloxifene within 5 years prior to
             registration

          -  Patients must not be pregnant or nursing; women of reproductive potential must have
             agreed to use an effective contraceptive method; a woman is considered to be of
             "reproductive potential" if she has had menses at any time in the preceding 12
             consecutive months; in addition to routine contraceptive methods, "effective
             contraception" also includes heterosexual celibacy and surgery intended to prevent
             pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy,
             bilateral oophorectomy or bilateral tubal ligation; however, if at any point a
             previously celibate patient chooses to become heterosexually active during the time
             period for use of contraceptive measures outlined in the protocol, he/she is
             responsible for beginning contraceptive measures

          -  No other prior malignancy is allowed except for adequately treated basal cell (or
             squamous cell) skin cancer, in situ cervical cancer, or other cancer for which the
             patient has been disease-free for 5 years

          -  The Quality of Life and Economic Substudy is permanently closed to accrual effective
             12/1/12; patients who consented to QOL prior to 12/1/12 should continue to complete
             QOL forms per their expectation report; patients who are able to complete a
             questionnaire in English must be offered the opportunity to participate in the Quality
             of Life and Economic Substudy; (The Quality of Life and Economic Substudy is available
             to U.S. INSTITUTIONS ONLY); patients who are not able to complete a questionnaire in
             English are registered to S1007 without participating in the Quality of Life and
             Economic Substudy

               -  Patients who consent to participate in the Quality of Life and Economic Substudy
                  and who do not yet know the results of their Oncotype DX screening must agree to
                  complete the S1007 Health-Related Quality of Life Questionnaire: Enrollment
                  between 14 days prior to and 7 days after Step 1 Registration

               -  Patients who consent to participate in the Quality of Life and Economic Substudy
                  and who do already know their Oncotype DX Recurrence Score (and it is 25 or less)
                  will proceed to Step 2 Registration without completing the S1007 Health-Related
                  Quality of Life Questionnaire Enrollment Form (but will complete the S1007
                  Health-Related Quality of Life Questionnaire: Randomized Study Form)

          -  Patients or their legally authorized representative must be informed of the
             investigational nature of this study and must sign and give written informed consent
             in accordance with institutional and federal guidelines; for Step 1 registration of
             patients who have not yet submitted specimens for the Oncotype DX Breast Cancer Assay,
             the appropriate consent form is the Step 1 Consent Form; for both Step 1 and Step 2
             registration of patients whose Recurrence Score is already known and is 25 or less,
             the appropriate consent form is the Step 2 Consent Form

          -  As a part of the Oncology Patient Enrollment Network (OPEN) registration process the
             treating institution's identity is provided in order to ensure that the current
             (within 365 days) date of institutional review board approval for this study has been
             entered in the system

          -  STEP 2 REGISTRATION

          -  Recurrence score (RS) by Oncotype DX must be =< 25

          -  Step 2 Registration must take place within 84 days after definitive surgery; patients
             must not have begun chemotherapy or endocrine therapy for their breast cancer prior to
             randomization

          -  Patients randomized to either arm may also co-enroll in phase III trials that compare
             local therapies, or compare systemic therapies (such as chemotherapy, if randomized to
             Arm I of S1007)

          -  The Quality of Life and Economic Substudy is permanently closed to accrual effective
             12/1/12; patients at U.S. INSTITUTIONS who consent to participate in the Quality of
             Life and Economic Substudy must agree to complete the S1007 Health-Related Quality of
             Life Questionnaire: Randomized Study Form after Recurrence Score results and
             randomized treatment status are known but before treatment has been initiated

          -  Patients or their legally authorized representative must be informed of the
             investigational nature of this study and must sign and give written informed consent
             in accordance with institutional and federal guidelines; for all patients the
             appropriate consent form for this registration is the Step 2 Consent
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Recurrence scores (RS), as measured by Oncotype DX
Time Frame:Up to 15 years
Safety Issue:
Description:The interaction of the linear RS term and chemotherapy benefit will be tested in a Cox regression model of disease-free survival (DFS). If the interaction is statistically significant and there is a point of equivalence between the two randomized treatments for some RS value in the range 0-25, a clinical cutpoint for recommending chemotherapy will be estimated. This estimated cutpoint is the upper bound of the 95% confidence interval on the point of equivalence. Kaplan-Meier curves comparing randomized arms generated separately for RS values below and above this cutpoint and tested with stratified log-rank tests.

Secondary Outcome Measures

Measure:Overall survival (OS)
Time Frame:The time from the second registration (randomization) to death due to any cause, assessed up to 15 years
Safety Issue:
Description:
Measure:Distant disease-free survival (DDFS)
Time Frame:The time from second registration to distant recurrence, new invasive primary, or death due to any cause, assessed up to 15 years
Safety Issue:
Description:
Measure:Local disease-free interval
Time Frame:The time from second registration to local/regional recurrence, assessed up to 15 years
Safety Issue:
Description:Local disease-free interval will use a competing risk framework to accommodate informative censoring due to distant recurrence or death.
Measure:Toxicities using standard National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0
Time Frame:Up to 5 years
Safety Issue:
Description:Compared between the two arms using logistic regression.

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:National Cancer Institute (NCI)

Last Updated

August 27, 2021