Clinical trial NCT04263298: Fulvestrant Versus Capecitabine as Maintenance Therapy After First-line Chemotherapy in Patients With HR+/HER2- Metastatic Breast Cancer
Official title: A Randomized, Multi-center, Open-label, Phase III Trial of Fulvestrant Versus Capecitabine as Maintenance Therapy After First-line Chemotherapy in Patients With Hormone Receptor Positive, Human Epidermal Growth Factor Receptor-2 Negative Metastatic Breast Cancer (FAMILY)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Metastatic Breast Cancer
Lead sponsor: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Sponsor class: OTHER
First posted: 2020-02-10
Enrollment: 210
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This phase III trial aims to compare the efficacy and safety of fulvestrant or capecitabine as maintenance therapy after first-line chemotherapy in hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer.

Detailed description: Metastatic breast cancer (MBC) is incurable. Although first-line endocrine therapy is preferred to hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) MBC, chemotherapy may be reserved as the initial treatment for patients with rapid clinical progression, life-threatening visceral metastases, and need for rapidly symptom control. Either prolonged chemotherapy or endocrine therapy may be used as maintenance after disease control. However, which maintenance strategy is superior in terms of delaying disease progression as well as maintaining quality of life (QOL) remains uncertain. This phase III trial aims to compare the efficacy and safety of fulvestrant or capecitabine as maintenance therapy after first-line chemotherapy in HR+/HER2- MBC.

Eligibility criteria: Inclusion Criteria:

* Adult female patients with advanced breast cancer diagnosed by pathology (aged 18-75, including 18 and 75 years old), not suitable for surgical resection or radiation therapy for the purpose of cure;
* Pathological examination confirmed ER and / or PR positive, HER-2 negative (Positive ER expression: immunohistochemistry \>1% tumor cell staining; Positive PR expression: immunohistochemistry \>1% tumor cell staining; HER-2 negative: immunohistochemistry is 0,1+, or FISH/CISH negative when immunohistochemistry is 2+);
* Patients with advanced breast cancer who have no disease progression after a 4-8-course first-line chemotherapy regimen (the effect is evaluated as complete response/ partial response/ stable disease). Capecitabine monotherapy as first-line chemotherapy is allowed and the courses of treatment should be limited to 6.
* WHO physical status 0-1 points, estimated lifetime at least 3 months;
* Imaging examinations within 3 weeks before enrollment were required for assessing tumor lesions before maintenance treatment (Examination results from local Tertiary A hospital are available);
* Previous treatment-related toxicity should be relieved to ≤ Grade 1 according to NCI CTCAE (version 4.03) before randomization (Except for hair loss and other toxicities that are not at risk to the patient's safety based on the investigator's judgment);
* The routine blood test was normal within 1 week before enrollment: WBC ≥3.0×10\^9／L, b. ANC ≥1.5×10\^9／L, c. PLT ≥100×10\^9／L;
* The liver and kidney function test was normal within 1 week before enrollment (Take the normal value of the laboratory of each research center as the standard): a. TBIL≤1.5× Upper Limit of Normal (ULN)b. ALT/AST≤2.5×ULN（Liver metastasis patients ≤5xULN） c. Serum Cr ≤1.5×ULN, or Ccr ≥60 ml/min;
* Informed consent form signed before enrollment.

Exclusion Criteria:

Cannot be grouped if any of the following is true:

* Newly developed central nervous system metastasis or symptom control of central nervous system is less than 4 weeks. (Patients with asymptomatic brian metastases which was stable more than 4 weeks by imaging assessment and do not need corticosteroid therapy are allowed to enrollment)
* Diagnosis of any other malignant tumor within 3 years before randomization, except for adequately treated basal cells or squamous cell skin cancer or cervical cancer in situ;
* Endocrine therapy for advanced disease;
* Pregnant or breast-feeding patients;
* Patients with accompanying disease or situation that may interfere with the study, or any serious medical problems that may affect the safety of the subject (for example, uncontrolled heart disease or high blood pressure, active or uncontrolled infection, active hepatitis B virus infection);
* Patients who were unable to tolerate capecitabine toxicity were first identified in first-line treatment;
* Patients with recurrent metastatic disease within 2 years of adjuvant endocrine therapy (including 2 years);

Primary outcomes:
measure: Progression free survival (PFS)
timeFrame: Estimated 18 months
Secondary outcomes:
measure: Overall Survival (OS)
timeFrame: Estimated 60 months
measure: Objective Response Rate (ORR)
timeFrame: Estimated 18 months
measure: Clinical Benefit Rate (CBR)
timeFrame: Estimated 18 months
measure: Quality Of Life (QOL)
timeFrame: Estimated up to 60 months
measure: Adverse Events and Serious Adverse Events
timeFrame: From informed consent through 28 days following treatment completion
Other outcomes:
Locations:
city: Guangzhou
country: China
facility: Guangdong Provincial People's Hospital
state: Guangdong
city: Guangzhou
country: China
facility: Public Health Institute of Sun Yat-sen University
state: Guangdong
city: Guangzhou
country: China
facility: Sun Yat-sen Memorial Hospital, Sun Yat-sen University
state: Guangdong
city: Guangzhou
country: China
facility: Sun Yat-sen University Cancer Center
state: Guangdong
city: Guangzhou
country: China
facility: The First Affiliated Hospital of Guangzhou University of Chinese Medicine
state: Guangdong
city: Guangzhou
country: China
facility: The First Affiliated Hospital of Sun Yat-sen University
state: Guangdong
city: Shantou
country: China
facility: Shantou Central Hospital
state: Guangdong
city: Shenzhen
country: China
facility: Cancer Hospital, Chinese Academy of Medical Sciences, Shenzhen Center
state: Guangdong
city: Shenzhen
country: China
facility: Shenzhen People's Hospital
state: Guangdong
city: Zhangjiang
country: China
facility: Affiliated Hospital of Guangdong Medical University
state: Guangdong
city: Zhuhai
country: China
facility: Fifth Subsidiary Sun Yat-sen University Hospital
state: Guangdong
city: Nanning
country: China
facility: Affiliated Cancer Hospital of Guangxi Medical University
state: Guangxi
city: Changsha
country: China
facility: Hunan Cancer Hospital
state: Hunan
Study officials:
affiliation: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
name: Herui Yao, PhD
role: STUDY_CHAIR
affiliation: Sun Yat-sen University
name: Shusen Wang, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Guangdong Provincial People's Hospital
name: Kun Wang, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Fifth Subsidiary Sun Yat-sen University Hospital
name: Peijian Peng, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Public Health Institute of Sun Yat-sen University
name: Li Ling, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Affiliated Cancer Hospital of Guangxi Medical University
name: Yongkui Lu, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Hunan Cancer Hospital
name: Quchang Ouyang, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: First Affiliated Hospital, Sun Yat-Sen University
name: Ying Lin, phD
role: PRINCIPAL_INVESTIGATOR
affiliation: Affiliated Hospital of Guangdong Medical University
name: Ying Zhang, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: The First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine
name: Mei Huang, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Shantou Central Hospitalv
name: Zhiyong Wu, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Chinese Academy of Medical Sciences
name: Cai'wen Du, PhD
role: PRINCIPAL_INVESTIGATOR
References: