Does Adjuvant Zoledronic acid redUce REcurrence in patients with high risk localised breast cancer?

ISRCTN ISRCTN79831382
DOI https://doi.org/10.1186/ISRCTN79831382
ClinicalTrials.gov number NCT00072020
Secondary identifying numbers N/A
Submission date
20/08/2003
Registration date
20/08/2003
Last edited
29/10/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Mrs Claire Davies
Scientific

Senior Trial Manager
Clinical Trials Research Unit
University of Leeds
Leeds
LS2 9JT
United Kingdom

Phone +44 (0)113 343 1498
Email c.l.davies@leeds.ac.uk

Study information

Study designRandomised controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Not specified
Study typeTreatment
Scientific title-
Study acronymAZURE
Study objectivesAdjuvant treatment with 4mg zoledronic acid plus chemotherapy and/or endocrine therapy is superior to chemotherapy and/or endocrine therapy alone in improving the disease-free and bone metastasis-free survival of women with breast cancer at high risk of relapse.
Ethics approval(s)West Midlands Research Ethics Committee (ref: 03/7/029)

Protocol Version 1.1, dated April 2003 - 19/05/2003;
Protocol Version 1.2, dated June 2003 - 31/07/2003;
Protocol Version 2, dated December 2003 - 08/01/2004;
Protocol Version 3, dated February 2004 - 24/02/2004;
Protocol Version 4, dated July 2005 - 23/07/2005;
Protocol Version 5, dated September 2007 - 08/10/2007;
Protocol Version 6, dated August 2008 - 24/09/2008;
Protocol Version 7, dated August 2010 - 26/08/2010

All other centres will seek ethics approval before recruitment of the first participant.
Health condition(s) or problem(s) studiedBreast cancer
InterventionPatients are randomised to receive either (neo)adjuvant chemotherapy and/or endocrine therapy alone, or (neo)adjuvant chemotherapy and/or hormonal therapy plus zoledronic acid.

The AZURE trial reached target recruitment and therefore closed to recruitment on 20th Jan 2006.
Intervention typeOther
Primary outcome measureTo determine whether zoledronic acid with chemotherapy and/or endocrine therapy is superior to chemotherapy and/or endocrine therapy alone in improving disease-free survival
Secondary outcome measuresTo determine whether zoledronic acid with chemotherapy and/or endocrine therapy is superior to chemotherapy and/or endocrine therapy alone in terms of:
1. Invasive disease-free survival (Added 05/05/2011)
2. Time to bone metastases as first recurrence
3. Time to bone metastases per se
4. Time to distant metastases
5. Overall survival
6. Reducing skeletal-related events* prior to development of bone metastases
7. Reducing skeletal-related events* following development of bone metastases
Additional secondary objectives are:
1. To assess the safety and toxicity of zoledronic acid in this clinical setting
2. To evaluate the influence of prognostic factors, such as estrogen receptor (ER)/progesterone receptor (PR) status, tumour, node, metastasis (TNM) stage, tumour grade, human epidermal growth factor receptor 2 (HER2/neu) (if available) and menopausal status on treatment outcome
3. To use proteomics, tissue micro-array and other modern techniques to identify more specific prognostic indicators for the development of bone metastases and factors that are able to predict specific benefit from bisphosphonate treatment (to be investigated via sub-studies)
* Defined as: fractures, spinal cord compression, radiation therapy to bone, surgery to bone and hypercalcaemia
Overall study start date01/09/2003
Completion date30/09/2006

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexFemale
Target number of participantsAdded 05/05/2011: target 3300 (3352 at time of registration), recruited 3360
Total final enrolment3360
Key inclusion criteriaPatients with stage II or III primary breast cancer

1. Female patients with Stage II/III primary breast cancer, with T stage ≥T1

2. Patients should be receiving/scheduled to receive chemotherapy and/or endocrine therapy

3. Patients receiving neo-adjuvant therapy
a. Must have tumour size of >5 cm (T3), features of locally advanced disease (T4) or biopsy-proven lymph node involvement

b. Should be scheduled to proceed to definitive surgery$ and/or radical radiotherapy with curative intent within 6 months of starting neoadjuvant therapy

c. Time between commencement of neoadjuvant treatment and planned start date of study drug should be ≤30 days

4. Patients receiving adjuvant therapy

a. Must have undergone complete primary tumour resection and treatment of the axillary lymph nodes*, without any prior neoadjuvant therapy#

b. Must have evidence of lymph node involvement

c. Time between definitive surgery and planned start date of study drug should be ≤60 days

5. Performance status: Karnofsky Index ≥80% or Eastern Cooperative Oncology Group (ECOG) 0 and 1

6. Women of childbearing potential must be using a reliable and appropriate method of contraception

7. Age ≥18 years

8. Patient must have given written informed consent prior to any study-specific procedures
$Final definitive surgery is considered to include re-operation for inadequate margins or another bona fide oncological indication
*Patients whose treatment plan is to proceed to further primary tumour resection and/or treatment of the axillary lymph nodes (e.g. clearance or radiotherapy) with curative intent after completion of chemotherapy would be eligible but this must be completed within 9 months of randomisation
#Pre-operative endocrine therapy of less than 30 days would not be classed as prior neoadjuvant therapy
Key exclusion criteria1. Metastatic or recurrent breast cancer or a history of breast cancer (aside from ductal carcinoma in situ [DCIS] or lobular carcinoma in situ [LCIS]) prior to the currently diagnosed case
2. History of prior cancers within the preceding 5 years (including previous contralateral breast cancer), aside from non-melanomatous skin cancer or carcinoma in situ of the uterine cervix treated with curative intent
3. History of diseases with influence on bone metabolism, such as Paget’s disease of bone, primary hyperparathyroidism or osteoporosis requiring treatment at the time of study entry or considered likely to become necessary within the subsequent 6 months
4. Severe physical or psychological concomitant diseases that might impair compliance with the provisions of the study protocol
5. Prior treatment with bisphosphonates within the past year
6. Serum creatinine >1.5 x Upper Limit of Normal
7. Known hypersensitivity to bisphosphonates
8. Current active dental problems including dental abscess or infection of the jawbone (maxilla or mandible), or a current or prior diagnosis of osteonecrosis of the jaw (ONJ)
9. Recent (within 4 weeks of study entry) or planned dental or jaw surgery (e.g. extractions, implants). Recent dental fillings, teeth scaling and polishing or minor gingival surgery do not exclude the patient.
10. Pregnancy or breast-feeding
11. Use of other investigational drugs in the 30 days prior to study entry. (Patients may be receiving treatments within a clinical trial providing the treatment under test has a licensed indication within your country).
Date of first enrolment01/09/2003
Date of final enrolment30/09/2006

Locations

Countries of recruitment

  • Australia
  • England
  • Ireland
  • Portugal
  • Spain
  • Taiwan
  • Thailand
  • United Kingdom

Study participating centre

Senior Trial Manager
Leeds
LS2 9JT
United Kingdom

Sponsor information

The University of Sheffield (UK)
University/education

Western Bank
Sheffield
S10 2TN
England
United Kingdom

ROR logo "ROR" https://ror.org/05krs5044

Funders

Funder type

Industry

Novartis Pharmaceuticals, USA

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing planNot provided at time of registration

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article safety and tolerability results 01/06/2011 Yes No
Results article results 13/10/2011 Yes No
Results article ten-year follow-up results 04/05/2021 25/05/2021 Yes No
Plain English results 19/08/2014 29/10/2021 No Yes

Editorial Notes

29/10/2021: The Cancer Research UK lay results summary has been adde
25/05/2021: The following changes have been made:
1. Publication reference added.
2. The total final enrolment number has been added from the reference.