Capecitabine oral chemotherapy with radium-223 in breast cancer patients with bone metastases (CARBON)

ISRCTN	ISRCTN92755158
DOI	https://doi.org/10.1186/ISRCTN92755158
ClinicalTrials.gov (NCT)	Nil known
Clinical Trials Information System (CTIS)	2015-003979-29
Protocol serial number	CPMS 20654
Sponsor	Sheffield Teaching Hospitals NHS Trust
Funders	Bayer HealthCare, Yorkshire Cancer Research

Submission date: 17/02/2016
Registration date: 17/02/2016
Last edited: 06/03/2024

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

https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-capecitabine-and-radium-223-for-advanced-breast-cancer-carbon

Contact information

Miss Amber Reid
Public

Clinical Trials Research Unit (CTRU)
Leeds Institute of Clinical Trials Research
University of Leeds
Leeds
LS2 9JT
United Kingdom

Study information

Primary study design	Interventional
Study design	Interventional; Design type: Treatment
Secondary study design	Randomised controlled trial
Study type	Participant information sheet
Scientific title	A randomized phase IB/IIA study of CApecitabine plus Radium-223 (Xofigo) in breast cancer patients with BONe metastases (CARBON): an open-label interventional study
Study acronym	CARBON
Study objectives	In advanced breast cancer, most patients with bone involvement also have metastases in other organs. Thus, a bone-targeted treatment alone is unlikely to be relevant to the majority of patients. Combination strategies with established systemic breast cancer treatments are needed. This is an open-label study which comprises an initial safety phase to establish the feasibility and safety of combining radium-223 at the licensed dose and to the same maximum recommended total dose, but given on a 6 weekly schedule to enable combination with oral capecitabine administered with the usual two weeks on and one week off treatment schedule. The safety phase, if treatment proves to be safe and feasible, will be followed by a randomised extension phase to further characterise the safety profile and provide preliminary information on efficacy.
Ethics approval(s)	London - Fulham Research Ethics Committee, 03/02/2016, ref: 16/LO/0052
Health condition(s) or problem(s) studied	Topic: Cancer; Subtopic: Breast Cancer; Disease: Bone, Breast
Intervention	Patients in the initial safety phase will receive capecitabine plus radium-223. Patients in the randomised extension phase will be randomised to receive either oral capecitabine alone or capecitabine plus radium-223 (added 07/03/2016). Usual hospital stock of capecitabine 500mg and 150mg tablets will be used and supplied as trial specific stock according to standard operating procedures within the treating centre. Patients should swallow capecitabine tablets with water 30 min after a meal twice a day. Standard care should be followed regarding missed and vomited doses Radium-223 50 kBq/kg b.w (55 kBq/kg after implementation of NIST update) will be administered as a slow i.v. injection 6 times at 6 weekly intervals. This treatment can be administered on an outpatient basis. It will be administered on day 1 of each alternate cycle (cycles 2, 4, 6, 8, 10 and 12). A cycle is 21 days in accordance with the standard administration of capecitabine. Follow Up Length: 12 month(s)
Intervention type	Mixed
Primary outcome measure(s)	As of 07/03/2016: Initial safety phase 1. Dose limiting toxicities Randomised extension phase 1. Frequency of CTC grade III-IV toxicities with a focus on diarrhoea as the primary dose limiting toxicity 2. Decrease in uNTX from baseline to end of cycle 5 (approximately 15 weeks post trial entry). For patients who progress prior to the end of cycle 5, the decrease in uNTX from baseline to their end of study treatment visit will be used. Previous primary outcome measures: To evaluate the safety and toxicity of the combination of radium-223 and capecitabine
Key secondary outcome measure(s)	As of 07/03/2016: 1. Safety endpoints 1.1. Adverse events (AEs) and serum biochemistry and haematology abnormalities graded according to the Common Toxicity Criteria for Adverse Events (CTC) version 4.03 1.2. Serious adverse events 1.3. Dose delays and reductions due to toxicity 2. Efficacy endpoints 2.1. Changes from baseline in serum bone turnover markers (B-ALP, uNTX, P1NP, CTX and 1CTP) throughout the study period 2.2. Time to occurrence of 1st symptomatic skeletal event (SSE). This is time from registration / randomisation to 1ST SSE. Patients who do not experience an SSE by the time of final analysis will be censored at the last time known to have not experienced as SSE, study withdrawal, start of new treatment or death 2.3. Time to progression of bone disease based on unequivocal progression of existing bone lesions or appearance of one or more new osteolytic bone lesions. This is time from registration/randomisation to progression in bone. Patients who do not progress in bone by time of final analysis will be censored at the last time known to have not progressed in bone, study withdrawal, start of new treatment or death 2.4. Time to progression of extraskeletal disease. This is time from registration / randomisation to progression in extraskeletal non bony sites. Patients who do not progress outside bone by time of final analysis will be censored at the last time known to have not progressed outside bone, study withdrawal, start of new treatment or death 3. Clinical benefit endpoints 3.1. Pain scores using the Brief Pain Inventory (BPI) 3.2. Quality of life using the EORTC BM-22 bone metastases module Previous secondary outcome measures: To evaluate the effect of radium-223 on other bone turnover markers (P1NP, CTX, 1CTP, B-ALP)
Completion date	02/08/2021

Eligibility

Participant type(s)	Patient
Age group	Adult
Lower age limit	18 Years
Sex	Female
Target sample size at registration	48
Total final enrolment	34
Key inclusion criteria	Current inclusion criteria, as of 19/03/2018: 1. Female patients with histological evidence of primary breast cancer 2. Bone metastases (with or without soft tissue, lymph node or visceral metastases; brain metastases allowed if stable and untreated for = 8 weeks) 3. = 2 bone lesions confirmed on imaging (plain radiographs, CT or MRI) 4. Systemic chemotherapy with capecitabine is felt to be appropriate by the treating physician due to recent progression of metastatic disease 5. Received = 2 lines of chemotherapy in the metastatic setting. Prior cytotoxic therapy must have been completed = 28 days prior to initiation of study treatment 6. Patient has been on bone targeted therapy (bisphosphonate or denosumab) for at least 6 weeks prior to start of study treatment and no change to bone targeted therapy is expected during the treatment phase of the study. 7. ECOG performance status 0-2 8. Life expectancy = 6 months 9. Laboratory requirements: 9.1. WBC =3.0 x10 9 /l 3000/mm3 9.2. ANC =1.5 x10 9 /l1500/mm3 9.3. Platelet count =100x109/l 9.4. Haemoglobin =10.0g/dL 9.5. Total bilirubin level =1.5 times ULN in treating institution 9.6. AST and ALT = 3 times ULN in treating institution 9.7. Calculated creatinine clearance or estimated GFR > 50mls/min (Cockcroft and Gault or Wright formula may be used according to local practice) 10. Patient must be willing and able to comply with the protocol, including follow-up visits and investigations and use effective contraception if relevant throughout the study and for at least 6 months after treatment completion 11. Must be fully informed about the study and has signed the informed consent form 12. Age at least 18 years Previous inclusion criteria: 1. Female patients with histological evidence of primary breast cancer 2. Bone metastases (with or without soft tissue, lymph node or visceral metastases; brain metastases allowed if stable and untreated for = 8 weeks) 3. = 2 bone lesions confirmed on imaging (plain radiographs, CT or MRI) 4. Systemic chemotherapy with capecitabine is felt to be appropriate by the treating physician due to recent progression of metastatic disease 5. Received = 2 lines of chemotherapy in the metastatic setting. Prior cytotoxic therapy must have been completed = 28 days prior to initiation of study treatment 6. Patient has been on bone targeted therapy (bisphosphonate or denosumab) for at least 3 months prior to start of study treatment and no change to bone targeted therapy is expected during the treatment phase of the study 7. ECOG performance status 0-2 8. Life expectancy = 6 months 9. Laboratory requirements: 9.1. WBC =3.0 x10 9 /l 3000/mm3 9.2. ANC =1.5 x10 9 /l1500/mm3 9.3. Platelet count =100x109/l 9.4. Haemoglobin =10.0g/dL 9.5. Total bilirubin level =1.5 times ULN in treating institution 9.6. AST and ALT = 3 times ULN in treating institution 9.7. Calculated creatinine clearance or estimated GFR > 50mls/min (Cockcroft and Gault or Wright formula may be used according to local practice) 10. Patient must be willing and able to comply with the protocol, including follow-up visits and investigations and use effective contraception if relevant throughout the study and for at least 6 months after treatment completion 11. Must be fully informed about the study and has signed the informed consent form 12. Age at least 18 years
Key exclusion criteria	1. Received an investigational drug within 4 weeks prior to the first study treatment 2. Received external beam radiotherapy within 4 weeks prior to the first study treatment 3. Presence of imminent or established spinal cord compression based on clinical findings and/or MRI 4. Presence of other currently active (diagnosis within the last 5 years) malignancy (except treated non-melanoma skin cancer (basal or squamous), carcinoma in situ of cervix and superficial bladder cancers). 5. Patients who have had severe and unexpected reactions to fluoropyrimidine therapy or have been diagnosed with dihydropyrimidine dehydrogenase deficiency 6. Received a blood transfusion or Use of erythropoietin within 4 weeks of study treatment 7. Pregnant or breast-feeding women. 8. Treatment with sorivudine or its chemically related analogues, such as brivudine 9. Treatment with phenytoin or warfarin 10. Patients with any other serious illness or medical condition, such as, but not limited to: 10.1. Any uncontrolled infection 10.2. Clinical heart failure (NYHA Heart Failure Class III or IV) 10.3. Active Crohn’s disease or ulcerative colitis 10.4. Bone marrow myelodysplasia 10.5. Uncontrolled coronary artery disease 10.6. Active peptic ulcers 10.7. Malabsorption 11. Any exclusions as per the Xofigo or Capecitabine SmPC
Date of first enrolment	28/09/2016
Date of final enrolment	20/03/2019

Locations

Countries of recruitment

United Kingdom
England

Study participating centres

St James' University Hospital

NHS Trust
The Leeds Teaching Hospitals NHS Trust
Beckett Street
Leeds
LS9 7TF
United Kingdom

Weston Park Hospital

Sheffield Teaching Hospitals NHS FT
Whitham Road
Sheffield
S10 2SJ
United Kingdom

Manchester Cancer Research Centre

The Christie NHS Foundation Trust
Wilmslow Road
Manchester
M20 4QL
United Kingdom

Clatterbridge Centre for Oncology NHS Foundation Trust

Clatterbridge Road
Bebington
Wirral
Liverpool
CH63 4JY
United Kingdom

Results and Publications

Individual participant data (IPD) Intention to share	No
IPD sharing plan summary	Not expected to be made available
IPD sharing plan	Not provided at time of registration

Study outputs

Output type	Details	Date created	Date added	Peer reviewed?	Patient-facing?
Results article		24/06/2022	06/03/2024	Yes	No
Protocol article	protocol	15/01/2020	17/01/2020	Yes	No
Basic results		22/07/2022	22/07/2022	No	No
HRA research summary			26/07/2023	No	No
Participant information sheet	Participant information sheet	11/11/2025	11/11/2025	No	Yes

Additional files

ISRCTN92755158_BasicResults_22Jul2022.pdf: Basic results

Editorial Notes

06/03/2024: Publication reference added.
06/02/2023: The following changes were made to the trial record:
1. The recruitment start date was changed from 30/05/2016 to 28/09/2016.
2. The recruitment end date was changed from 31/08/2017 to 20/03/2019.
22/07/2022: The following changes have been made:
1. A basic results summary has been uploaded.
2. The final enrolment number has been added from the basic results.
3. The overall trial end date has been changed from 31/08/2018 to 02/08/2021.
17/01/2020: Publication reference added.
19/03/2018: Inclusion criteria amended.
16/03/2018: Two new trial participating centres were added. Manchester Cancer Research Centre and Clatterbridge Centre for Oncology NHS Foundation Trust.
27/10/2016: Cancer Help UK lay summary link added.
07/04/2016: the recruitment start date was changed from 31/03/2016 to 30/05/2016.
07/03/2016: Significant changes were made to this study record. Changes to the intervention and outcome measures are highlighted in the record. In addition to these, the overall start date was changed from 01/03/2016 to 01/03/2015 and the overall end date was changed from 31/08/2017 to 31/08/2018. The public title was changed from "A randomized phase IB/IIA study of capecitabine plus radium-223 (Xofigo) in breast cancer patients with bone metastases (CARBON)" to "Capecitabine oral chemotherapy with radium-223 in breast cancer patients with bone metastases (CARBON)". The "Participant inclusion criteria: Gender" was changed from "Both" to "Female".