E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients with radically treated isolated local and/or regional recurrence of invasive breast cancer after mastectomy or breast-conserving surgery. |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 8.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10006190 |
E.1.2 | Term | Breast cancer invasive NOS |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the efficacy of adjuvant chemotherapy after radical local treatment of a first loco-regional recurrence of breast cancer. Treatment comparisons will be based upon the following endpoints: • Disease-free survival (primary end point) • Overall survival, systemic relapse and systemic disease-free survival |
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E.2.2 | Secondary objectives of the trial |
Treatment comparisons will also be based upon the following additional endpoints: • Sites of first recurrence after randomization to this trial • Incidence of second (non-breast) malignancies • Causes of deaths without relapse of breast cancer |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Histologically verified first local and/or regional (ipsilateral axillary or internal mammary lymph node) recurrence of invasive breast cancer following primary treatment with mastectomy or lumpectomy/quadrantectomy with clear surgical margins. Regional lymph node staging and radiation therapy at primary treatment are not eligibility criteria. Local failure is defined as tumor recurrence in any soft tissue of the ipslateral conserved breast or the chest wall, mastectomy scar, and/or skin. Regional failure is defined as a tumor recurrence in the ipsilateral axillary lymph nodes, extranodal soft tissue of the ipsilateral axilla, and/or ipsilateral internal mammography. Regional failure does not include supraclavicular lymph nodes or tumor in the opposite breast.
Surgical resection of the recurrence with uninvolved (“clear”) margins (R0). Planned radiotherapy with ≥40 Gy for patients who had no adjuvant radiation treatment OR Mastectomy of the recurrence with uninvolved ('clear') margins (R0) after lumpectomy/quadrantectomy alone for the primary. Radiotherapy is recommended but NOT mandatory OR Surgical resection with microscopically involved margins (R1): Patients are eligible only if radiation treatment with ≥40 Gy is planned. The radiation therapy must at least involve the positive resection margin and a safety margin. Localized fields with techniques using an adequate radiation dose ( such as electron beam therapy or brachytherapy) are permitted.
No evidence of distant metastasis on standard staging examinations (x-ray or CT scan of the chest, ultrasound or CT scan of the abdomen and pelvis, bone scintigraphy) only if alkaline phosphatase is > 2x normal or if medically indicated (e.g. bone pain).
Measurement of hormone receptors in the recurrent tumor by the locally preferred method (immunohistochemistry and/or ligand binding assay). Each institution should use its own standard for defining endocrine-responsive disease (ER+ and/or PgR+). These standards should be defined prospectively.
Medically suitable for chemotherapy of 3 to 6 months duration.
Written informed consent.
Patients must be informed of, and agree to, data and material transfer and handling, in accordance with national data protection guidelines.
Patients must be geographically accessible for follow-up. |
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E.4 | Principal exclusion criteria |
Patients with macroscopically incomplete surgery.
Patients with microscopically involved margins of resection and impossibility (because of prior radiotherapy) to apply ≥40 Gy of local radiation therapy.
Patients with bilateral malignancy (except in situ carcinoma), or with a suspicious mass in the opposite breast, unless that mass has been proven by biopsy to be benign.
Evidence of distant metastasis (including ipsilateral supraclavicular lymph nodes).
Patients who have had a prior recurrence in any site, including local (except the first loco-regional recurrence described under inclusion criteria).
Patients, who, before randomization, have skeletal pain of unknown cause, elevated alkaline phosphatase, or a bone scan showing hot spots for which metastases cannot be ruled out by X-ray, MRI and/or CT.
Patients with other primary malignant tumors except adequately treated carcinoma in situ of the uterine cervix and non-melanoma skin cancer.
Patients with non-malignant systemic diseases that would prevent them from undergoing any of the treatment options, or would prevent prolonged follow-up.
Patients with psychiatric or addictive disorders that would prevent them from giving informed consent to randomization and therapy.
Patients with a history of noncompliance to medical regimens and patients who are considered potentially unreliable. |
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E.5 End points |
E.5.1 | Primary end point(s) |
First confirmation of recurrence (local, regional or distant), second primary (including non-breast) tumor, and/or death.
Disease-free survival (DFS) is defined as the time from randomization to local, regional or distant recurrence (including recurrence restricted to the breast after breast conserving treatment), appearance of a second primary tumor, beginning of a new cancer-specific therapy, or death from any cause, whichever occurs first. An in situ recurrence either in the ipsilateral or in the contralateral breast is not considered a recurrence. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
No adjuvant chemotherapy (observation) |
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E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 15 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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After maximal treatment duration of 32 weeks, follow-up will take place every 3 months during years 1-2, every six months years 3-5 and yearly thereafter lifelong.
The target number of events for the study is 124, and the interim analysis will be planned after 70 events have been observed. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 8 |
E.8.9.2 | In all countries concerned by the trial months | 8 |