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A Partially-Blind Phase III Randomized Trial of Fulvestrant (Faslodex™) With or Without Concomitant Anastrozole (Arimidex™) Compared With Exemestane in Postmenopausal Women With ER+ve Locally Advanced/Metastatic Breast Cancer Following Progression on Non-Steroidal Aromatase Inhibitors


Phase 3
N/A
N/A
Open (Enrolling)
Female
Breast Cancer

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Trial Information

A Partially-Blind Phase III Randomized Trial of Fulvestrant (Faslodex™) With or Without Concomitant Anastrozole (Arimidex™) Compared With Exemestane in Postmenopausal Women With ER+ve Locally Advanced/Metastatic Breast Cancer Following Progression on Non-Steroidal Aromatase Inhibitors


OBJECTIVES:

Primary

- Compare progression-free survival of postmenopausal women with estrogen receptor-
and/or progesterone receptor-positive, locally advanced or metastatic breast cancer
that relapsed or progressed during prior treatment with nonsteroidal aromatase
inhibitors treated with fulvestrant with vs without anastrozole vs exemestane alone.

Secondary

- Compare the objective complete response (CR) and partial response (PR) rate and
duration of response in patients treated with these regimens.

- Compare the clinical benefit (i.e., 6-month CR, PR, and stable disease) rate and
duration of clinical benefit in patients treated with these regimens.

- Compare time to treatment failure in patients treated with these regimens.

- Compare the overall survival of patients treated with these regimens.

- Compare the tolerability of these regimens in these patients.

OUTLINE: This is a randomized, partially double-blind and placebo-controlled, multicenter
study. Patients are stratified according to the setting in which prior nonsteroidal
aromatase-inhibitor therapy was given (adjuvant therapy vs first-line therapy) and
participating center. Patients are randomized to 1 of 3 treatment arms.

- Arm I (fulvestrant and anastrozole): Patients receive fulvestrant intramuscularly (IM)
on days 1, 15, and 29 and then once monthly. Patients receive oral anastrozole once
daily.

- Arm II (fulvestrant and placebo): Patients receive fulvestrant as in arm I and oral
placebo once daily.

- Arm III (exemestane alone): Patients receive oral exemestane once daily. In all arms,
treatment repeats every month in the absence of disease progression or unacceptable
toxicity.

After completion of study treatment, patients are followed periodically for survival.

PROJECTED ACCRUAL: A total of 750 patients (250 per treatment arm) will be accrued for this
study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed adenocarcinoma of the breast

- Locally advanced or metastatic disease

- Metastatic disease must be measurable or evaluable

- Patients with bone only metastases are eligible provided there is an evaluable
site of bone metastasis that can be followed by x-ray, MRI, or CT scan

- Relapsed or progressed during prior treatment with single-agent nonsteroidal
aromatase inhibitor (NSAI)*, meeting either of the following criteria:

- NSAI given as adjuvant therapy that lasted ≥ 12 months

- Achieved an objective complete response, partial response, or stable disease
that lasted ≥ 6 months after prior first-line therapy with NSAI for locally
advanced or metastatic disease

- Chemotherapy as part of the first-line therapy given before initiation of
NSAI allowed NOTE: *Patients are required to continue to take NSAI until
beginning of study treatment.

- No rapidly progressive visceral disease (i.e., lymphangitis carcinomatosa or diffuse
hepatic involvement)

- Hormone receptor status:

- Estrogen receptor (ER) and/or progesterone receptor positive tumor

- No ER-unknown disease

PATIENT CHARACTERISTICS:

Sex

- Female

Menopausal status

- Postmenopausal, as defined by 1 of the following criteria:

- Age 60 and over

- Age 45 to 59 AND ≥ 12 months since last menstrual period with no prior
hysterectomy

- Any age with prior bilateral oophorectomy

Performance status

- WHO 0-2

Life expectancy

- More than 3 months

Hematopoietic

- Neutrophil count ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

- No thrombocytopenia

- Hemoglobin ≥ 10 g/dL

Hepatic

- AST and ALT ≤ 2.5 times upper limit of normal (ULN)

- Alkaline phosphatase ≤ 5 times ULN (unless due to bone metastases)

- No liver disease

Renal

- Creatinine < 1.97 mg/dL

Other

- 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

PRIOR CONCURRENT THERAPY:

Chemotherapy

- See Disease Characteristics

- Prior neoadjuvant or adjuvant chemotherapy allowed

Endocrine therapy

- See Disease Characteristics

- Prior tamoxifen as neoadjuvant or adjuvant therapy allowed

- No systemic corticosteroids that lasted > 15 days within the past 4 weeks

Other

- More than 4 weeks since prior investigational drugs

- Concurrent bisphosphonates for bone metastases allowed provided bisphosphonate
therapy has been established for ≥ 6 months

- Concurrent initiation of bisphosphonate allowed provided patient has soft tissue
or visceral metastases as the measurable or evaluable target lesion

- No concurrent anticoagulant therapy

- No concurrent unlicensed noncancer investigational agents

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Double-Blind, Primary Purpose: Treatment

Outcome Measure:

Progression-free survival

Safety Issue:

No

Principal Investigator

Stephen R. D. Johnston, MD, PhD, FRCP

Investigator Role:

Study Chair

Investigator Affiliation:

Royal Marsden NHS Foundation Trust

Authority:

United States: Federal Government

Study ID:

CDR0000448616

NCT ID:

NCT00253422

Start Date:

March 2004

Completion Date:

Related Keywords:

  • Breast Cancer
  • recurrent breast cancer
  • stage IV breast cancer
  • stage IIIB breast cancer
  • stage IIIC breast cancer
  • Breast Neoplasms

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