Neoplasms

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Skin and Connective Tissue Diseases

Neoplasm Metastasis

Breast Neoplasms

Breast Diseases

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Bone Density Conservation Agents

All Drugs and Chemicals

Zoledronic Acid

Zoledronic acid as a 15-minute (at least) intravenous (i.v.) infusion every three months. The dose of study drug will be the same administered before the study entry, that is 4 mg or a reduced dose, i.e. 3.5 mg, or 3.3 mg or 3.0 mg. Randomized patients will receive a maximum of 4 infusions in this group.

Zoledronic acid as a 15-minute (at least) intravenous (i.v.) infusion every 4 weeks. The dose of study drug will be the same administered before the study entry, that is 4 mg or a reduced dose, i.e. 3.5 mg, or 3.3 mg or 3.0 mg. Patients randomized to this group will receive up to 12 infusions.

Zoledronic acid as a 15-minute (at least) intravenous (i.v.) infusion. The dose of study drug will be the same administered before the study entry, that is 4 mg or a reduced dose, i.e. 3.5 mg, or 3.3 mg or 3.0 mg.

Zoledronic acid

Novartis Pharmaceuticals

The objective of this study is to assess the clinical benefit of two different dosing schedules of zoledronic acid in patients with metastatic bone lesions from breast cancer who have already been treated with zoledronic acid for about one year.

Safety and Efficacy of Zoledronic Acid in Patients With Breast Cancer With Metastatic Bone Lesions

A Prospective, Randomized, Multi-center Comparative 2-arm Trial of Efficacy and Safety of Zoledronic Acid (Every 3-months vs. Every 4 Weeks) Beyond Approximately 1 Year of Treatment With Zoledronic Acid in Patients With Bone Lesions From Breast Cancer

The SMR was computed by summing all Skeletal Related Event(s) (SREs)which occurred during the observation period and dividing it by the ratio "days of observation period / 365.25", for each participant. SRE was defined as: pathologic bone fracture, spinal cord compression, surgery to bone both curative and prophylactic, radiation therapy to bone, or hypercalcemia of malignancy.

SMR (years) = 365.25 x SMR(days) where SMR (days) = total number of SREs / total SRE risk period (days). Risk period for SMR was computed as the days from randomization date to the date of last visit.

Skeletal Related Events (SREs) are defined as a:

* pathologic bone fracture such as non-vertebral and vertebral compression fractures
* spinal cord compression identified by positive diagnosis documented by X-ray evidence
* surgery to bone both curative and prophylactic
* radiation therapy to bone including palliative, therapeutic or prophylactic
* hypercalcemia of malignancy, defined as a corrected serum calcium \> 12 mg/dl (3.00 mmol/l) or a lower level of hypercalcemia which is symptomatic and which requires active treatment other than rehydration.

Skeletal Related Events (SREs) are defined as a:

* pathologic bone fracture such as non-vertebral and vertebral
* spinal cord compression identified by X-rays evidence
* surgery to bone both curative and prophylactic
* radiation therapy to bone including palliative, therapeutic or prophylactic
* hypercalcemia of malignancy, defined as a corrected serum calcium \> 12 mg/dl (3.00 mmol/l) or a lower level of hypercalcemia which is symptomatic and which requires active treatment other than rehydration. Annual incidence for each SRE was computed in the same way as annual overall SMR.

Median Time to first skeletal related event (SRE) is defined as the time from randomization to the date of first occurrence of any SRE which includes at least one of the following: radiation therapy to bone, pathologic bone fracture, spinal cord compression, surgery to bone, and hypercalcemia of malignancy (HCM). Due to the few numbers of SRE, Kaplan-Meier estimate never reaches a failure probability \>=25%; so median time, 25th and 75th percentiles are not determined.For this reason only the estimated percentage of patient SRE free are reported at each time point.

Percentage of participants SRE free is defined as the Kaplan-Meier estimate of participants free of any Skeletal Related Events(SRE) at each time point.

Skeletal Related Events (SREs) are:

* pathologic bone fracture; non-vertebral and vertebral
* spinal cord compression identified by X-rays
* surgery to bone both curative and prophylactic
* radiation therapy to bone (palliative, therapeutic or prophylactic)
* hypercalcemia of malignancy, defined as a corrected serum calcium \> 12 mg/dl (3.00 mmol/l) or a lower level which is symptomatic and requires treatment other than rehydration.

Bone pain was assessed by means of a pain score obtained using the Brief Pain Inventory (BPI) questionnaire. The BPI can produce three pain scores: worst pain, a composite pain score, and a pain interference score. The composite pain score, which is the average of questions 3, 4, 5 and 6 of the questionnaire was used in this study. Pain was rated on a scale of 0 (no pain) to 10 (pain as bad as you can imagine). The outcome is given as the median score for participants at baseline, and 3, 6, 9 and 12 months of treatment

Pain intensity at rest and on movement is rated by the patient by means of a validated 6-point Verbal Rating Scale (VRS) and refers to the pain which occurred during the last week before the assessment. Median score value is the median of all the observed scores (none=0, very mild=1, mild=2, moderate=3, severe=5 and very severe=6) at each time point.

The analgesic score used for this study is modified from the Radiation Therapy Oncology Group (RTOG) analgesic score scale. The scale represents type of medication administered from 0 to 4 where:

0 = None

1. = Minor analgesics (aspirin, NSAID, acetaminophen, propoxyphene, etc.)
2. = Tranquilisers, antidepressants, muscle relaxants, and steroids
3. = Mild narcotics (oxycodone, meperidine, codeine, etc.)
4. = Strong narcotics (morphine, hydromorphone, etc.) The outcome is given a the median score for the participants at Baseline and 3, 6, 9 and 12 months of treatment

ECOG Performance Score has 4 grades. 0 = Fully active, able to carry out all pre-disease activities; 1 = Restricted in strenuous activity but ambulatory and able to carry out work of light or sedentary nature; 2 = Ambulatory and capable of all self-care but unable to carry out work activities. Active about 50% of waking hours; 3 = Capable of limited self-care, confined to bed/chair more than 50% of waking hours; 4 = Completely disabled; cannot carry on self-care. Totally confined to bed/chair. Outcome is given as median score for participants at Baseline and 3, 6 , 9 and 12 months of treatment

Zoledronic acid given as a 15-minute (at least) i.v. infusion every three months. The dose of study drug was the same as administered before study entry; that is, 4 mg or a reduced dose, i.e. 3.5 mg, or 3.3 mg or 3.0 mg. Randomized participants received a maximum of 4 infusions in this group.

Zoledronic Acid Every 3 Months

Zoledronic acid given as a 15-minute (at least) i.v. infusion every 4 weeks. The dose of study drug was the as same administered before study entry; that is, 4 mg or a reduced dose, i.e. 3.5 mg, or 3.3 mg or 3.0 mg. Participants randomized to this group received up to 12 infusions

Zoledronic Acid Every 4 Weeks

Zoledronic acid given as a 15-minute (at least) i.v. infusion every 4 weeks. The dose of study drug was the as same administered before study entry; that is, 4 mg or a reduced dose, i.e. 3.5 mg, or 3.3 mg or 3.0 mg. Participants randomized to this group received up to 12 infusions.

Total

Age Continuous

Sex: Female, Male

Study Director

Intent-to-treat (ITT) population will include all randomized patients.

Annual Overall Skeletal Morbidity Rate (SMR)

Patient with any SRE

Vertebral pathological fracture

Non vertebral pathological fracture

Spinal cord compression

Radiation to bone

Surgery to bone

Hypercalcemia of malignancy

Percentage of Participants Experiencing Skeletal Related Event(s) (SREs)

Vertebral pathological fracture rate

Non-vertebral pathological fracture rate

Spinal cord compression rate

Radiation to bone rate

Surgery to bone rate

Hypercalcemia of malignancy rate

Annual Incidence of Any Skeletal Related Events (SREs)

Median Time to First Skeletal Related Event(s) (SRE)

At Month 1

At Month 2

At Month 3

At Month 4

At Month 5

At Month 6

At Month 7

At Month 8

At Month 9

At Month 10

At Month 11

At Month 12

Percentage of Participants Skeletal Related Event (SRE) Free

Baseline (N= 186, 185)

Month 3 (N= 156, 163)

Month 6 (N= 143, 160)

Month 9 (N= 131, 130)

Month 12 (N= 135, 124)

Intent-to-treat (ITT) population will include all randomized patients. All ITT patients with BPI questionnaire filled up at baseline were included.

Spots Global Cancer Trial Database for Safety and Efficacy of Zoledronic Acid in Patients With Breast Cancer With Metastatic Bone Lesions

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