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    Clinical Trial Results:
    Influence of Zoledronic acid (Zometa®) on bone mineral density and bone ultrasonometry in premenopausal women with hormone receptor negative breast cancer andneoadjuvant or adjuvant chemotherapeutic treatment

    Summary
    EudraCT number
    2004-002831-14
    Trial protocol
    DE  
    Global end of trial date
    02 Dec 2013

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2016
    First version publication date
    31 Jul 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CZOL446GDE13
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00333229
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002, Basel, Switzerland,
    Public contact
    Clinical Disclosure Office, Novartis Pharma AG, 41 613241111,
    Scientific contact
    Clinical Disclosure Office, Novartis Pharma AG, 41 613241111,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    02 Dec 2013
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    02 Dec 2013
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Primary Objective: to demonstrate superiority of Zometa® vs. placebo in improving bone mineral density at lumbar spine (L2-L4) in premenopausal hormone receptor negative patients with breast cancer and neoadjuvant or adjuvant chemotherapeutic treatment.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and the International Conference on Harmonization (ICH) Good Clinical Practice (GCP) guidelines. All the local regulatory requirements pertinent to safety of trial subjects were also followed during the conduct of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Mar 2006
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 11
    Worldwide total number of subjects
    11
    EEA total number of subjects
    11
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    11
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    11 patients were enrolled in the study. The safety and the ITT population consisted of 11 patients. In total 11 patients were treated in the study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Zoledronic Acid
    Arm description
    Patients randomized into the Zometa arm received a total of 8 study drug infusions which were applied every 3 months. Patients received treatment for 24 months every 3 months.
    Arm type
    Experimental

    Investigational medicinal product name
    Zoledronic Acid
    Investigational medicinal product code
    ZOL446
    Other name
    Zometa®
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    4 mg Zoledronic acid in 5 mL concentrate solutioninfusion every 3 months for 24 months

    Arm title
    Placebo
    Arm description
    Patients randomized into the Placebo Arm received a total of 8 placebo infusions which were applied every 3 months. Patients received treatment for 24 months every 3 months.
    Arm type
    Experimental

    Investigational medicinal product name
    Placebo to Zoledronic Acid
    Investigational medicinal product code
    ZOL446
    Other name
    Placebo
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Placebo to match Zoledronic acid in 5 mL concentrate solutioninfusion every 3 months for 24 months

    Number of subjects in period 1
    Zoledronic Acid Placebo
    Started
    6
    5
    Completed
    6
    4
    Not completed
    0
    1
         Lack of efficacy
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Zoledronic Acid
    Reporting group description
    Patients randomized into the Zometa arm received a total of 8 study drug infusions which were applied every 3 months. Patients received treatment for 24 months every 3 months.

    Reporting group title
    Placebo
    Reporting group description
    Patients randomized into the Placebo Arm received a total of 8 placebo infusions which were applied every 3 months. Patients received treatment for 24 months every 3 months.

    Reporting group values
    Zoledronic Acid Placebo Total
    Number of subjects
    6 5 11
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    6 5 11
        From 65-84 years
    0 0 0
        85 years and over
    0 0 0
    Age Continuous |
    Units: Years
        arithmetic mean (standard deviation)
    41.2 ± 6.2 43.2 ± 2.6 -
    Gender, Male/Female
    Units: Participants
        Female
    6 5 11
        Male
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Zoledronic Acid
    Reporting group description
    Patients randomized into the Zometa arm received a total of 8 study drug infusions which were applied every 3 months. Patients received treatment for 24 months every 3 months.

    Reporting group title
    Placebo
    Reporting group description
    Patients randomized into the Placebo Arm received a total of 8 placebo infusions which were applied every 3 months. Patients received treatment for 24 months every 3 months.

    Primary: Change in bone mineral density (BMD) measured by DXA at lumbar spine (L2-L4) between baseline and 24 months.

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    End point title
    Change in bone mineral density (BMD) measured by DXA at lumbar spine (L2-L4) between baseline and 24 months. [1]
    End point description
    “No statistical analysis was planned for this primary outcome.”
    End point type
    Primary
    End point timeframe
    24 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: No Statistical Analasis as study was terminated due to slow recruitment. Sample size could not be achieved and the study was terminated after enrolling only 11 patients.
    End point values
    Zoledronic Acid Placebo
    Number of subjects analysed
    0 [2]
    0 [3]
    Units: BMD
        number (not applicable)
    Notes
    [2] - terminated no data to present
    [3] - terminated no data to present
    No statistical analyses for this end point

    Secondary: Bone mineral density (BMD) measured by QUS at os calcis and phalanges after 24 months

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    End point title
    Bone mineral density (BMD) measured by QUS at os calcis and phalanges after 24 months
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Zoledronic Acid Placebo
    Number of subjects analysed
    0 [4]
    0 [5]
    Units: BMD
        number (not applicable)
    Notes
    [4] - terminated no data to present
    [5] - terminated no data to present
    No statistical analyses for this end point

    Secondary: Course of biochemical markers of bone turn over (FSH, estradiol (E2), osteocalcin, PINP, procollagene-I-peptid, deoxypyridinoline in serum)

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    End point title
    Course of biochemical markers of bone turn over (FSH, estradiol (E2), osteocalcin, PINP, procollagene-I-peptid, deoxypyridinoline in serum)
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Zoledronic Acid Placebo
    Number of subjects analysed
    0 [6]
    0 [7]
    Units: BMD
        number (not applicable)
    Notes
    [6] - terminated no data to present
    [7] - terminated no data to present
    No statistical analyses for this end point

    Secondary: Pathologic fractures during 24 month

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    End point title
    Pathologic fractures during 24 month
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Zoledronic Acid Placebo
    Number of subjects analysed
    0 [8]
    0 [9]
    Units: number of fractures
        number (not applicable)
    Notes
    [8] - terminated no data to present
    [9] - terminated no data to present
    No statistical analyses for this end point

    Secondary: Development of metastases as assessed by X-ray, CT, or MRI during 24 months and during 60 months

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    End point title
    Development of metastases as assessed by X-ray, CT, or MRI during 24 months and during 60 months
    End point description
    End point type
    Secondary
    End point timeframe
    2 years
    End point values
    Zoledronic Acid Placebo
    Number of subjects analysed
    0 [10]
    0 [11]
    Units: number of metastases
        number (not applicable)
    Notes
    [10] - terminated no data to present
    [11] - terminated no data to present
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events are collected from First Patient First Visit (FPFV) until Last Patient Last Visit (LPLV). All adverse events reported in this record are from date of First Patient First Treatment until Last Patient Last Visit
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    Zometa
    Reporting group description
    Zometa

    Reporting group title
    Placebo
    Reporting group description
    Placebo

    Serious adverse events
    Zometa Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 5 (20.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    BENIGN BREAST NEOPLASM
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    HEADACHE
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    VISUAL IMPAIRMENT
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Zometa Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    6 / 6 (100.00%)
    5 / 5 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    MELANOCYTIC NAEVUS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    THYROID NEOPLASM
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Vascular disorders
    HOT FLUSH
         subjects affected / exposed
    2 / 6 (33.33%)
    2 / 5 (40.00%)
         occurrences all number
    2
    2
    LYMPHOEDEMA
         subjects affected / exposed
    5 / 6 (83.33%)
    3 / 5 (60.00%)
         occurrences all number
    5
    3
    General disorders and administration site conditions
    ASTHENIA
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    CHEST PAIN
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    INFLUENZA LIKE ILLNESS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    MUCOSAL DRYNESS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    PAIN
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 5 (20.00%)
         occurrences all number
    1
    1
    Reproductive system and breast disorders
    MENOPAUSAL SYMPTOMS
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 5 (20.00%)
         occurrences all number
    1
    1
    POSTMENOPAUSAL HAEMORRHAGE
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    UTERINE POLYP
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    COUGH
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    DYSPHONIA
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    OROPHARYNGEAL PAIN
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Psychiatric disorders
    CONVERSION DISORDER
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    DEPRESSION
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    SLEEP DISORDER
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 5 (40.00%)
         occurrences all number
    0
    2
    Investigations
    HEPATIC ENZYME INCREASED
         subjects affected / exposed
    1 / 6 (16.67%)
    2 / 5 (40.00%)
         occurrences all number
    1
    2
    Nervous system disorders
    AMNESIA
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    HEADACHE
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    LOSS OF CONSCIOUSNESS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    PARAESTHESIA
         subjects affected / exposed
    2 / 6 (33.33%)
    3 / 5 (60.00%)
         occurrences all number
    2
    5
    SYNCOPE
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Ear and labyrinth disorders
    TINNITUS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    VERTIGO
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    DRY EYE
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    ABDOMINAL PAIN UPPER
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    DYSPEPSIA
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    GASTRITIS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    HAEMORRHOIDS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    NAUSEA
         subjects affected / exposed
    2 / 6 (33.33%)
    2 / 5 (40.00%)
         occurrences all number
    2
    2
    Hepatobiliary disorders
    HEPATIC STEATOSIS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Skin and subcutaneous tissue disorders
    DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Endocrine disorders
    AUTOIMMUNE THYROIDITIS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Musculoskeletal and connective tissue disorders
    ARTHRALGIA
         subjects affected / exposed
    3 / 6 (50.00%)
    3 / 5 (60.00%)
         occurrences all number
    4
    3
    BACK PAIN
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 5 (20.00%)
         occurrences all number
    1
    1
    BONE PAIN
         subjects affected / exposed
    3 / 6 (50.00%)
    2 / 5 (40.00%)
         occurrences all number
    5
    3
    MYALGIA
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    MYOSCLEROSIS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    OSTEOCHONDROSIS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    PAIN IN EXTREMITY
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    RHEUMATIC FEVER
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    Infections and infestations
    FOLLICULITIS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    FURUNCLE
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    INFLUENZA
         subjects affected / exposed
    2 / 6 (33.33%)
    0 / 5 (0.00%)
         occurrences all number
    2
    0
    NASOPHARYNGITIS
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    ORAL HERPES
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    HYPERCHOLESTEROLAEMIA
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1
    HYPOKALAEMIA
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
         occurrences all number
    1
    0
    TYPE 2 DIABETES MELLITUS
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
         occurrences all number
    0
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 Jan 2006
    Amendment 1: The rationale of this amendment is to introduce a dose reduction for Zometa for patients with renal impairment clarify the location for assessment of the bone mineral density for the primary study objectives complete possible methods for detection of metastases as secondary study objections correct a typo in the unit for the estradiol levels defining premenopausal patients expand the eligibility for the study for Node negative and Node positive patients clarify the randomization procedures at the study site and at the pharmacist site adapt the definition of an Adverse events to recent internal modifications
    11 Dec 2006
    Amendment 2: The rationale of this amendment is to allow neoadjuvant chemotherapy clarify possible nodal status for inclusion clarify definition of hormone receptor status clarify definition of premenopausal status exclude patients with other previous or concomitant malignancy specify safety reports on ONJ correct a typo in the unit for the estradiol levels defining premenopausal patients introduce some formal changes to clarify and simplify the protocol
    23 Nov 2007
    Amendment 3: The rationale of this amendment is to exclude the assessment of bone mineral density (BMD) by DXA at os calcis: The reason for this decision is that according to latest news, this measurement does not provide any additional information to measurement by QUS at os calcis. modify tumor assessment according to the German standard of care: According to German standard of care, tumor assessment by X-ray, MRI, bone scan or CT during follow-up of treatment should be performed only if clinically indicated. Therefore, tumor assessment at 24 and 60 months will be performed only if clinically indicated.
    28 Nov 2008
    Amendment 4: Only 10 out of 70 patients have been recruited since 2005. It is very unlikely that the required number of patients can be achieved in a considerable amount of time. Therefore, the enrollment of patients into this study will be stopped. The analysis of the data will be performed after LPLV. The analysis of the data of the included patients will be conducted by simple descriptive statistics and patient data listings.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Study was terminated due to slow recruitment. Sample size could not be achieved and the study was terminated after enrolling only 11 patients.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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