Description:
To compare the efficacy and safety of neoadjuvant aromatase inhibitor plus ovarian
suppression with chemotherapy in premenopausal patients with hormone receptor-positive breast
cancer.
Title
- Brief Title: Neoadjuvant Aromatase Inhibitor(AI) With Ovarian Suppression Versus Chemotherapy in Premenopausal Breast Cancer Patients
- Official Title: Comparison of Neoadjuvant Aromatase Inhibitors With Ovarian Suppression Versus Chemotherapy in Premenopausal Patients With Hormone Receptor-positive Breast Cancer (COMPETE): a Randomized Phase 3 Trial
Clinical Trial IDs
- ORG STUDY ID:
RJBC1505
- NCT ID:
NCT02532400
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Neoadjuvant endocrine therapy | Goserelin and AI | Neoadjuvant endocrine therapy |
Neoadjuvant chemotherapy | TEC | Neoadjuvant chemotherapy |
Purpose
To compare the efficacy and safety of neoadjuvant aromatase inhibitor plus ovarian
suppression with chemotherapy in premenopausal patients with hormone receptor-positive breast
cancer.
Detailed Description
Neoadjuvant therapy is nowadays the standard treatment for both early stage and locally
advanced breast cancer, and exhibited similar benefit compared with adjuvant therapy in terms
of disease free and overall survival. Patients achieved pathological complete response(pCR)
after neoadjuvant chemotherapy have superior outcome compared with those with residual tumors
in breast and/or axilla. pCR is now the most wildly accepted surrogate marker for long-term
survival of patients, especially in those with triple negative or human epidermal growth
factor receptor-2(HER2)-positive breast cancer. However, in luminal HER2-negative breast
cancer, neoadjuvant chemotherapy is not as effective as in other subtypes of breast cancer,
pCR is less noted and seems barely correlated to long-term survival benefit.
In postmenopausal patients with hormone receptor-positive breast cancer, neoadjuvant
endocrine therapy of aromatase inhibitor achieved similar clinical response rate compared
with neoadjuvant chemotherapy, and in premenopausal hormone receptor-positive, HER2-negative
breast cancer patients, neoadjuvant aromatase inhibitor plus ovarian function
suppression(OFS) has showed more pronounced efficacy than tamoxifen plus OFS.
In adjuvant setting, aromatase inhibitor combined with OFS in premenopausal patients with
hormone receptor-positive breast cancer has demonstrated superior benefit in terms of disease
free survival, and has been established as one of the routine options of adjuvant endocrine
therapy. Notwithstanding the remarkable performance of combination of aromatase inhibitor and
OFS in adjuvant therapy, the role of this treatment strategy in neoadjuvant setting has yet
not been proved when compared with neoadjuvant chemotherapy.
The aim of this study is to prospectively compare the efficacy and safety of neoadjuvant
aromatase inhibitor plus OFS with chemotherapy in premenopausal patients with hormone
receptor-positive HER2-negative breast cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
Neoadjuvant endocrine therapy | Experimental | Six months of exemestane or anastrozole plus goserelin. | - Neoadjuvant endocrine therapy
|
Neoadjuvant chemotherapy | Active Comparator | Six cycles of docetaxel plus epirubicin and cyclophosphamide(TEC). | |
Eligibility Criteria
Inclusion Criteria:
1. Written informed consent
2. Women aged ≥ 18 years
3. Histologically confirmed invasive breast cancer
4. American Joint Committee on Cancer (AJCC) stage: ⅡA-ⅢC, no evidence of metastasis
5. At least one measurable disease in breast and/or axilla
6. ER and/or progesterone receptor(PgR) positive(≥10% of the cells by IHC)
7. HER2 negative(by IHC and/or FISH)
8. Premenopause status (estradiol in premenopausal range or with normal menstrual cycle
in the past 6 months with no use of hormonal drugs)
9. Eastern Cooperative Oncology Group(ECOG)score 0-1, an estimated life expectancy of at
least 12 months
10. Adequate bone marrow function: Leukocyte ≥ 3.0*109/L; Neutrophil ≥ 1.5*109/L; Hb ≥
100g/L; Platelet(PLT) ≥ 80*109/L
11. Adequate liver, renal function and coagulation function: Alanine transaminase(ALT)
and/or Aspartate transaminase(AST)≤ 1.5 upper normal limit(UNL), total bilirubin
≤upper normal limit, creatinine ≤ 110umol/L, Creatinine clearance > 60ml/min, blood
urea nitrogen(BUN) ≤ 7.1mmol/L, activated partial thromboplastin time(APTT) ≤ 1.5
upper normal limit(UNL)
12. Women with child-bearing potential must have a negative pregnancy test (urine or
serum) within 7 days of drug administration and agree to use an acceptable method of
birth control to avoid pregnancy for the duration of the study
13. Serological records of hepatitis B virus(HBV)and hepatitis C virus(HCV) testing.
Exclusion Criteria:
1. Stage IV breast cancer
2. Prior systemic or loco-regional treatment of breast cancer
3. Any anti-neoplastic treatment within 28 days before the beginning of study
4. Known severe hypersensitivity to any drugs in this study
5. History of malignancy within 5 years except carcinoma in situ of cervix or skin basal
cell carcinoma that had received adequate treatment
6. Peripheral neuropathy ≥ 2°, according to National Cancer Institute(NCI) Common
Terminology Criteria for Adverse Events(CTCAE)(Version 4.0)
7. Any cardiac or pulmonary dysfunction defined as following:
(1) ≥ 3° symptomatic congestive heart failure (CHF) according to NCI CTCAE(Version 4.0) or
≥ 2° CHF according to New York Heart Association(NYHA)
(2) Angina that needs anti-anginal drugs, advanced conduction abnormality or significant
vascular disease
(3) Uncontrolled high-risk arrhythmia: atrial tachycardia that silent heart rate >100/min,
significant ventricular arrythmia or advanced atrioventricular block(2° type II
atrioventricular or 3° atrioventricular block)
(4) Poorly controlled hypertension (systolic BP > 180 mmHg or diastolic BP > 100 mmHg)
(5) Transmural myocardial infarction in EKG
(6) Long-term oxygen therapy
8. Uncontrolled severe systemic disease(clinically significant cardiovascular
disease,pulmonary disease or metabolic disease, wound healing disorder, ulcer, severe
infection)
9. Pregnant or breast feeding
10. Major operation, obvious trauma within 28 days before randomization or planned major
operation during the study
11. Known active hepatic disease due to hepatitis B virus, hepatitis C virus, auto-immune
liver disease or sclerosing cholangitis
12. Known HIV infection
13. Any reasons investigators consider that not suitable for the study
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall response rate(ORR) |
Time Frame: | up to 7 months |
Safety Issue: | |
Description: | Overall response rate(ORR) is defined as complete response rate plus partial response rate. |
Secondary Outcome Measures
Measure: | Pathological complete response(pCR) |
Time Frame: | up to 7 months |
Safety Issue: | |
Description: | |
Measure: | Breast conserving surgery(BCS) rate |
Time Frame: | up to 7 months |
Safety Issue: | |
Description: | |
Measure: | Incidence of neutropenia fever |
Time Frame: | participants will be followed during the six months of neoadjuvant therapy |
Safety Issue: | |
Description: | |
Measure: | Incidence of hot flushes/flashes |
Time Frame: | participants will be followed during the six months of neoadjuvant therapy |
Safety Issue: | |
Description: | |
Measure: | Incidence of osteoporosis |
Time Frame: | participants will be followed during the six months of neoadjuvant therapy |
Safety Issue: | |
Description: | |
Measure: | Incidence of grade 3-4 adverse events |
Time Frame: | participants will be followed during the six months of neoadjuvant therapy |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 3 |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | Ruijin Hospital |
Trial Keywords
- Breast Neoplasms
- Neoadjuvant Endocrine Therapy
- Ovarian Function Suppression
- Neoadjuvant chemotherapy
Last Updated
March 11, 2020