Resumen

Este ensayo clínico aleatorizado de fase 3 evalúa el efecto de denosumab para determinar si puede prevenir la recurrencia de la enfermedad en el hueso o en cualquier otra parte del cuerpo cuando se administra como terapia adyuvante en mujeres con cáncer de mama en estadio temprano con alto riesgo de recurrencia.

Descripción detallada

Los participantes elegibles fueron aleatorizados en una proporción 1:1 para recibir denosumab 120 mg o placebo por vía subcutánea (SC) durante hasta 5 años. La aleatorización se estratificó según: 1. Terapia del cáncer de mama/estado de ganglios linfáticos (GL): terapia neoadyuvante/cualquier estado de GL versus terapia adyuvante/GL negativo (basado en disección axilar de GL o en el estado del ganglio centinela) versus terapia adyuvante/GL positivo 2. Estado del receptor hormonal (receptor de estrógeno [RE]/receptor de progesterona [RP]): RE y/o RP positivo versus RE y RP negativo 3. Estado del receptor 2 del factor de crecimiento epidérmico humano (HER-2): HER-2 positivo versus HER-2 negativo 4. Edad: < 50 años versus ≥ 50 años 5. Región geográfica: Japón versus otras regiones. El análisis primario se realizó una vez que todos los participantes incluidos tuvieron la oportunidad de completar 5 años de tratamiento a partir del día 1 del estudio.

Elegibilidad

Edad mínima: 18 YearsSexo: FEMALE

Criterios de inclusión

Histologically confirmed, American Joint Committee on Cancer (AJCC) stage II or III breast cancer
High risk of breast cancer recurrence, defined as documented evidence of one or more of the following criteria:
i) Biopsy evidence of breast cancer in regional lymph node(s) (LN) (node-positive disease); Nodal micrometastases only are not considered node positive ii) Tumor size \> 5 cm (T3) or locally advanced disease (T4)
Documented pathological evaluation of the breast cancer for hormone receptor (estrogen receptor \[ER\] and progesterone receptor \[PR\]) status and HER-2 status
Subjects must be receiving or be scheduled to receive standard of care systemic adjuvant or neoadjuvant chemotherapy and/or endocrine therapy and/or HER-2 targeted therapy
For subjects receiving adjuvant therapy only:
subjects must have undergone complete resection of the primary tumor with clean surgical margins, or subjects must have undergone resection of the primary tumor and be scheduled for further treatment of the primary tumor with curative intent. Definitive treatment must be planned to be completed within approximately 9 months of randomization
Time between definitive surgery and randomization must be ≤ 12 weeks. Definitive surgery may include secondary interventions (e.g. to clear inadequate surgical margins)
Subjects with node positive disease must have undergone treatment of axillary LN with curative intent, or subjects must be scheduled for further treatment of regional lymph nodes with curative intent. Definitive treatment must be planned to be completed within approximately 9 months of randomization
Subjects must not have received prior neoadjuvant treatment. Endocrine treatment for less than 30 days prior to surgery is not considered prior neoadjuvant treatment
For subjects receiving neoadjuvant therapy only:
Time between start of neoadjuvant treatment and randomization must be ≤ 8 weeks and subjects must be scheduled to undergo definitive treatment (including surgery and/or radiotherapy) with curative intent within approximately 9 months of starting neoadjuvant treatment
Female subjects with age ≥ 18 years
Subjects with reproductive potential must have a negative pregnancy test within 14 days before randomization
Serum calcium or albumin-adjusted serum calcium ≥ 2.0 mmol/L (8.0 mg/dL) and ≤ 2.9 mmol/L (11.5 mg/dL)
Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Written informed consent before any study-specific procedure is performed

Criterios de exclusión

Prior or current evidence of any metastatic involvement of any distant site
History of breast cancer (other than ductal carcinoma in situ \[DCIS\] or lobular carcinoma in situ \[LCIS\]) prior to the current diagnosis
Osteoporosis requiring treatment at the time of randomization or treatment considered likely to become necessary within the subsequent six months
Any prior or synchronous malignancy (other than breast cancer), except i) Malignancy treated with curative intent and with no evidence of disease for ≥ 5 years prior to enrollment and considered to be at low risk for recurrence by the treating physician ii) Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
Active infection with Hepatitis B virus or Hepatitis C virus
Known infection with human immunodeficiency virus (HIV)
Prior history or current evidence of osteomyelitis/osteonecrosis of the jaw
Active dental or jaw condition which requires oral surgery
Planned invasive dental procedure for the course of the study
Non-healed dental or oral surgery
Use of oral bisphosphonates within the past 1 year
Prior or current IV bisphosphonate administration
Prior administration of denosumab
Subject currently is enrolled in or has not yet completed at least 30 days since ending other investigational device or investigational drug study(s), or subject is receiving other investigational agent(s)
Subject is pregnant or breast feeding, or planning to become pregnant within 7 months after the end of treatment.
Subject is of child bearing potential and is not willing to use, in combination with her partner, 2 highly effective methods of contraception or abstinence during treatment and for 5 months after the end of treatment
Subject has known sensitivity to any of the products to be administered during the study (e.g., mammalian derived products, calcium, or vitamin D)
Subject has any kind of disorder that compromises the ability of the subject to give written informed consent and/or to comply with study procedures.
Any major medical or psychiatric disorder that in the opinion of the investigator prevent the subject from completing the study or interfere with the interpretation of the study results

Ubicaciones

Research Site

Quilmes, Buenos Aires, Argentina

Research Site

Quilmes, Buenos Aires, Argentina

Research Site

San Martín, Buenos Aires, Argentina

Research Site

Provincia de Santa Fe, Santa Fe Province, Argentina

Research Site

San Miguel de Tucumán, Tucumán Province, Argentina

Estudio de fase 3 aleatorizado, doble ciego, controlado con placebo y multicéntrico para evaluar denosumab como tratamiento adyuvante en mujeres con cáncer de mama en estadio temprano con alto riesgo de recurrencia (D-CARE)

Resumen

Descripción detallada

Elegibilidad

Criterios de inclusión

Criterios de exclusión

Intervenciones

Placebo

Denosumab

Ubicaciones

Research Site

Research Site

Research Site

Research Site

Research Site

Research Site

Patrocinadores