Breast Cancer Clinical Trial
Official title:
A Phase III Study Comparing Anastrozole, Letrozole and Exemestane, Upfront (for 5 Years) or Sequentially (for 3 Years After 2 Years of Tamoxifen), as Adjuvant Treatment of Postmenopausal Patients With Endocrine-responsive Breast Cancer
RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using
tamoxifen may fight breast cancer by blocking use of estrogen by the tumor cells.
Anastrozole, letrozole, and exemestane may fight breast cancer by lowering the amount of
estrogen the body makes. It is not yet known whether giving tamoxifen followed by
anastrozole, letrozole, or exemestane is more effective than giving anastrozole, letrozole,
or exemestane alone in treating breast cancer.
PURPOSE: This randomized phase III trial is studying giving tamoxifen followed by either
anastrozole, letrozole, or exemestane to see how well it works compared to anastrozole,
letrozole, or exemestane alone in treating postmenopausal women with hormone-responsive
invasive breast cancer that has been completely removed by surgery.
OBJECTIVES:
- To compare sequential tamoxifen for 2 years followed by anastrozole, letrozole, or
exemestane for 3 years vs anastrozole, letrozole, or exemestane for 5 years in terms of
disease-free survival in postmenopausal women with nonrecurrent, nonmetastatic invasive
endocrine-responsive breast cancer.
- To compare disease-free survival in patients treated with anastrozole vs letrozole vs
exemestane.
OUTLINE: This is a multicenter study. Patients are stratified according to hormone receptor
status (estrogen receptor [ER]-positive and progesterone [PgR] receptor-positive disease vs
ER-positive and PgR-negative disease vs ER-negative and PgR-positive disease vs ER- or
PgR-positive disease or ER or PgR status unknown), HER-2/neu status (positive [3+ by IHC or
positive by fluorescence in situ hybridization ( FISH)] vs negative vs unknown), prior
chemotherapy (none vs adjuvant vs neoadjuvant vs both adjuvant and neoadjuvant), and nodal
status (pN0 vs pN1 vs pN2 vs pN3). Patients are randomized to 1 of 6 treatment arms.
- Arm I: Patients receive oral anastrozole once daily for 5 years.
- Arm II: Patients receive oral exemestane once daily for 5 years.
- Arm III: Patients receive oral letrozole once daily for 5 years.
- Arm IV: Patients receive oral tamoxifen citrate once daily for 2 years followed by oral
anastrazole once daily for 3 years.
- Arm V: Patients receive oral tamoxifen citrate once daily for 2 years followed by oral
exemestane once daily for 3 years.
- Arm VI: Patients receive oral tamoxifen citrate once daily for 2 years followed by oral
letrozole once daily for 3 years.
Treatment in all arms continues in the absence of disease recurrence or unacceptable
toxicity.
After completion of study therapy, patients are followed periodically.
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