Adjuvant Tamoxifen Compared With Anastrozole in Treating Postmenopausal Women With Ductal Carcinoma In Situ

NCT ID: NCT00072462

Last Updated: 2024-09-19

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

2980 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-09-30

Study Completion Date

2021-05-31

Brief Summary

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RATIONALE: Estrogen can stimulate the growth of breast cancer cells. Hormone therapy using either tamoxifen or anastrozole may fight breast cancer by blocking the use of estrogen. It is not yet known whether tamoxifen is more effective than anastrozole in preventing breast cancer after surgery for ductal carcinoma in situ.

PURPOSE: This randomized phase III trial is studying how well adjuvant tamoxifen works compared to anastrozole in treating postmenopausal women who have undergone surgery to remove ductal carcinoma in situ.

Detailed Description

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OBJECTIVES:

Primary

* Compare the efficacy of adjuvant tamoxifen vs anastrozole, in terms of local control and prevention of contralateral disease, in postmenopausal women with locally excised ductal carcinoma in situ.
* Compare side effect profiles of these drugs in these patients.

Secondary

* Compare the efficacy of these drugs, according to the receptor status of the primary or recurrent cancer in these patients.
* Compare the rate of breast cancer recurrence and growth of new contralateral tumors after cessation of treatment with these drugs in these patients.
* Compare breast cancer mortality in patients treated with these drugs.
* Compare the effect of these drugs on other cancers, cardiovascular disease, fracture rates, and non-breast cancer deaths in these patients.
* Compare the tolerability and acceptability of side effects experienced by patients treated with these drugs.

OUTLINE: This is a randomized, double-blind, multicentre study. Patients are stratified according to participating centre. Patients are randomized to 1 of 2 treatment arms.

* Arm I: Patients receive oral tamoxifen and oral placebo once daily.
* Arm II: Patients receive oral anastrozole and oral placebo once daily. In both arms, treatment continues for 5 years in the absence of disease recurrence or unacceptable toxicity.

Patients are followed annually for 5 years and a further 5 years (minimum) off treatment.

Peer Reviewed and Funded by Cancer Research UK. Sponsored by Queen Mary University of London

ACTUAL ACCRUAL: A total of 2,980 patients were accrued for this study over 9 years.

Conditions

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Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Anastrozole

Group Type ACTIVE_COMPARATOR

Anastrozole

Intervention Type DRUG

Anastrozole 1mg + Tamoxifen placebo

Tamoxifen

Group Type ACTIVE_COMPARATOR

tamoxifen citrate

Intervention Type DRUG

Tamoxifen 20mg + Anastrozole placebo

Interventions

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tamoxifen citrate

Tamoxifen 20mg + Anastrozole placebo

Intervention Type DRUG

Anastrozole

Anastrozole 1mg + Tamoxifen placebo

Intervention Type DRUG

Other Intervention Names

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Nolvadex Arimidex

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Diagnosis of ductal carcinoma in situ within the past 6 months

* Locally excised with tumor-free margins at least 1 mm
* Hormone receptor status:

* Estrogen or progesterone receptor positive

* Equal to or greater than 5% positive cells

PATIENT CHARACTERISTICS:

Age

* 40 to 70

Sex

* Female

Menopausal status

* Postmenopausal, defined as meeting at least 1 of the following criteria:

* Over age 60
* Prior bilateral oophorectomy
* Age 60 or under with a uterus AND amenorrhea for at least the past 12 months
* Age 60 or under without a uterus AND follicle-stimulating hormone greater than 20 IU/L

Performance status

* Not specified

Life expectancy

* At least 10 years

Hematopoietic

* Not specified

Hepatic

* Not specified

Renal

* Not specified

Cardiovascular

* No prior deep vein thrombosis
* No prior transient ischemic attack
* No prior cerebrovascular accident

Pulmonary

* No prior pulmonary embolism

Other

* No unexplained postmenopausal bleeding
* No other cancer within the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
* No other concurrent medical condition that would preclude study therapy, place the patient at unusual risk, or confound study results
* No evidence of osteoporosis
* Fragility fractures within the spine allowed if T-score level is greater than -4 and consist of no more than 2 fractures
* Psychologically and physically suitable for 5 years of study therapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

* Not specified

Chemotherapy

* Not specified

Endocrine therapy

* No prior or concurrent tamoxifen use lasting more than 6 months unless treatment was completed more than 5 years ago. Women in IBIS-I can join if off trial therapy for at least 5 years.
* No prior or concurrent raloxifene use lasting more than 6 months unless treatment was completed more than 5 years ago.
* No other prior or concurrent selective estrogen-receptor modulator use lasting more than 6 months unless treatment was completed more than 5 years ago
* No concurrent systemic estrogen-based hormone replacement therapy, including vaginal estrogen preparations

Radiotherapy

* Not specified

Surgery

* See Disease Characteristics
* No prior mastectomy
* No planned prophylactic mastectomy

Other

* At least 3 months since prior unapproved or experimental agents
* No concurrent anticoagulants
Minimum Eligible Age

40 Years

Maximum Eligible Age

70 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Cancer Research UK

OTHER

Sponsor Role collaborator

Queen Mary University of London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jack Cuzick, PhD

Role: STUDY_CHAIR

Queen Mary University of London

Anthony Howell

Role: STUDY_CHAIR

University of Manchester

Locations

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Australia

Newcastle, , Australia

Site Status

Austrian Breast & Colorectal Cancer Study Group

Vienna, , Austria

Site Status

Belgium

Leuven, , Belgium

Site Status

Chile

Santiago, , Chile

Site Status

Institut Sainte Catherine

Avignon, , France

Site Status

Institut Bergonie

Bordeaux, , France

Site Status

Polyclinique Bordeaux Nord Aquitaine

Bordeaux, , France

Site Status

Clinique Tivoli

Bordeaux, , France

Site Status

CHU Hopital A. Morvan

Brest, , France

Site Status

Centre Regional Francois Baclesse

Caen, , France

Site Status

Centre Jean Perrin

Clermont-Ferrand, , France

Site Status

Centre de Lutte Contre le Cancer Georges-Francois Leclerc

Dijon, , France

Site Status

Centre Hospitalier de Lagny

Lagny-sur-Marne, , France

Site Status

CMC Les Ormeaux

Le Havre, , France

Site Status

Centre Oscar Lambret

Lille, , France

Site Status

Centre Hospital Regional Universitaire de Limoges

Limoges, , France

Site Status

Centre Hospitalier de Mulhouse

Mulhouse, , France

Site Status

Centre Regional Rene Gauducheau

Nantes, , France

Site Status

Clinique Saint - Pierre

Perpignan, , France

Site Status

Institut Jean Godinot

Reims, , France

Site Status

Centre Eugene Marquis

Rennes, , France

Site Status

Centre Henri Becquerel

Rouen, , France

Site Status

Institut Claudius Regaud

Toulouse, , France

Site Status

Institut Gustave Roussy

Villejuif, , France

Site Status

Germany

Neu-Isenburg, , Germany

Site Status

Hungary

Szeged, , Hungary

Site Status

Cork Infirmary

Cork, , Ireland

Site Status

Cork University Hospital

Cork, , Ireland

Site Status

Beaumont Hospital

Dublin, , Ireland

Site Status

St. Vincent's University Hospital

Dublin, , Ireland

Site Status

University College Hospital

Galway, , Ireland

Site Status

Mid-Western Regional Hospital

Limerick, , Ireland

Site Status

Sligo General Hospital

Sligo, , Ireland

Site Status

The Adelaide and Meath Hospital

Tallaght, , Ireland

Site Status

European Institute of Oncology

Milan, , Italy

Site Status

Sir Paul Boffa Hospital,

Floriana, , Malta

Site Status

Sweden

Lund, , Sweden

Site Status

Inselspital Bern

Bern, , Switzerland

Site Status

Oncocare Sonnenhof-Klinik Engeriedspital

Bern, , Switzerland

Site Status

Hopital Cantonal Universitaire de Geneve

Geneva, , Switzerland

Site Status

Centre Hospitalier Universitaire Vaudois

Lausanne, , Switzerland

Site Status

Kantonspital

Lucerne, , Switzerland

Site Status

Ospedale Beata Vergine

Mendrisio, , Switzerland

Site Status

Tumor Zentrum ZeTup St. Gallen und Chur

Sankt Gallen, , Switzerland

Site Status

Switzerland(St. Gallen)

Sankt Gallen, , Switzerland

Site Status

Regionalspital

Thun, , Switzerland

Site Status

Turkey(Istanbul University)

Istanbul, , Turkey (Türkiye)

Site Status

Frenchay Hospital

Bristol, England, United Kingdom

Site Status

Colchester General Hospital

Colchester, England, United Kingdom

Site Status

Leeds Cancer Centre at St. James's University Hospital

Leeds, England, United Kingdom

Site Status

Royal Liverpool University Hospital

Liverpool, England, United Kingdom

Site Status

Whittington Hospital

London, England, United Kingdom

Site Status

St. Thomas' Hospital

London, England, United Kingdom

Site Status

Christie Hospital

Manchester, England, United Kingdom

Site Status

Newcastle Upon Tyne Hospitals NHS Trust

Newcastle upon Tyne, England, United Kingdom

Site Status

Nottingham City Hospital

Nottingham, England, United Kingdom

Site Status

Royal South Hants Hospital

Southampton, England, United Kingdom

Site Status

Centre for Cancer Research and Cell Biology at Queen's University Belfast

Belfast, Northern Ireland, United Kingdom

Site Status

St. Bartholomew's Hospital

London, Please Select, United Kingdom

Site Status

Royal Marsden Hospital

London, Please Select, United Kingdom

Site Status

Ninewells Hospital

Dundee, Scotland, United Kingdom

Site Status

Royal Infirmary of Edinburgh at Little France

Edinburgh, Scotland, United Kingdom

Site Status

University Hospital of Wales

Cardiff, Wales, United Kingdom

Site Status

Aberdeen Royal Infirmary

Aberdeen, , United Kingdom

Site Status

Tameside General Hospital

Ashton-under-Lyne, , United Kingdom

Site Status

Royal Bolton Hospital

Bolton, , United Kingdom

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Royal Bournemouth Hospital

Bournemouth, , United Kingdom

Site Status

St Lukes Hospital

Bradford, , United Kingdom

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Royal Sussex County Hospital

Brighton, , United Kingdom

Site Status

Bristol Infirmary

Bristol, , United Kingdom

Site Status

Queens Hospital Burton

Burton, , United Kingdom

Site Status

Cheltenham General Hospital

Cheltenham, , United Kingdom

Site Status

Countess of Chester Hospital

Chester, , United Kingdom

Site Status

Derbyshire Royal Infirmary

Derby, , United Kingdom

Site Status

St Margaret's Hospital

Epping, , United Kingdom

Site Status

Royal Devon and Exeter Hospital

Exeter, , United Kingdom

Site Status

Frimley Park Hospital NHS Trust

Frimley, , United Kingdom

Site Status

Grantham & District Hospital

Grantham, , United Kingdom

Site Status

Conquest Hospital, The Ridge

Hastings, , United Kingdom

Site Status

Huddersfield Royal Infirmary

Huddersfield, , United Kingdom

Site Status

Castle Hill Hospital

Hull, , United Kingdom

Site Status

Airedale General Hospital

Keighley, , United Kingdom

Site Status

Leeds St James.

Leeds, , United Kingdom

Site Status

Lincoln County Hospital

Lincoln, , United Kingdom

Site Status

Derriford Hospital

Plymouth, , United Kingdom

Site Status

Royal Hospital Haslar

Portsmouth, , United Kingdom

Site Status

Scarborough NHS Trust

Scarborough, , United Kingdom

Site Status

Weston Park Hospital

Sheffield, , United Kingdom

Site Status

Staffordshire General Hospital

Stafford, , United Kingdom

Site Status

Singleton Hospital

Swansea, , United Kingdom

Site Status

Treliske Royal Cornwall Hospital

Truro, , United Kingdom

Site Status

Clayton Hospital, Northgate

Wakefield, , United Kingdom

Site Status

Welwyn Garden City Hospital

Welwyn, , United Kingdom

Site Status

Wishaw General Hospital

Wishaw, , United Kingdom

Site Status

Worthing Hospital

Worthing, , United Kingdom

Site Status

Yeovil District Hospital

Yeovil, , United Kingdom

Site Status

York Hospital

York, , United Kingdom

Site Status

Countries

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Australia Austria Belgium Chile France Germany Hungary Ireland Italy Malta Sweden Switzerland Turkey (Türkiye) United Kingdom

References

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Juraskova I, Butow P, Lopez A, Seccombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF. Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS). Health Expect. 2008 Sep;11(3):252-62. doi: 10.1111/j.1369-7625.2008.00498.x.

Reference Type BACKGROUND
PMID: 18816321 (View on PubMed)

Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones L, Ellis I, Cuzick J; IBIS-II investigators. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet. 2016 Feb 27;387(10021):866-73. doi: 10.1016/S0140-6736(15)01129-0. Epub 2015 Dec 11.

Reference Type BACKGROUND
PMID: 26686313 (View on PubMed)

Sestak I, Smith SG, Howell A, Forbes JF, Cuzick J. Early participant-reported symptoms as predictors of adherence to anastrozole in the International Breast Cancer Intervention Studies II. Ann Oncol. 2018 Feb 1;29(2):504-509. doi: 10.1093/annonc/mdx713.

Reference Type BACKGROUND
PMID: 29126161 (View on PubMed)

Related Links

Other Identifiers

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EU-20226

Identifier Type: -

Identifier Source: secondary_id

BIG-5-02

Identifier Type: -

Identifier Source: secondary_id

IBCSG-31-03-DCIS

Identifier Type: -

Identifier Source: secondary_id

ISRCTN31488319

Identifier Type: -

Identifier Source: secondary_id

ISRCTN37546358

Identifier Type: -

Identifier Source: org_study_id

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