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German Adjuvant Intergroup Node-Positive Study: A Phase III Trial to Compare Oral Ibandronate Versus Observation in Patients With High-Risk Early Breast Cancer

Identifieur interne : 000645 ( Main/Exploration ); précédent : 000644; suivant : 000646

German Adjuvant Intergroup Node-Positive Study: A Phase III Trial to Compare Oral Ibandronate Versus Observation in Patients With High-Risk Early Breast Cancer

Auteurs : Gunter Von Minckwitz [Allemagne] ; Volker Möbus [Allemagne] ; Andreas Schneeweiss [Allemagne] ; Jens Huober [Allemagne] ; Christoph Thomssen [Allemagne] ; Michael Untch [Allemagne] ; Christian Jackisch [Allemagne] ; Ingo J. Diel [Allemagne] ; Dirk Elling [Allemagne] ; Bettina Conrad [Allemagne] ; Rolf Kreienberg [Allemagne] ; Volkmar Müller [Allemagne] ; Hans-Joachim Lück [Allemagne] ; Ingo Bauerfeind [Allemagne] ; Michael Clemens [Allemagne] ; Marcus Schmidt [Allemagne] ; Stefanie Noeding [Allemagne] ; Helmut Forstbauer [Allemagne] ; Jana Barinoff [Allemagne] ; Antje Belau [Allemagne] ; Valentina Nekljudova [Allemagne] ; Nadia Harbeck [Allemagne] ; Sibylle Loibl [Allemagne]

Source :

RBID : Pascal:13-0323872

Descripteurs français

English descriptors

Abstract

Purpose Bisphosphonates prevent skeletal-related events in patients with metastatic breast cancer. Their effect in early breast cancer is controversial. Ibandronate is an orally and intravenously available amino-bisphosphonate with a favorable toxicity profile. It therefore qualifies as potential agent for adjuvant use. Patients and Methods The GAIN (German Adjuvant Intergroup Node-Positive) study was an open-label, randomized, controlled phase III trial with a 2 × 2 factorial design. Patients with node-positive early breast cancer were randomly assigned 1:1 to two different dose-dense chemotherapy regimens and 2:1 to ibandronate 50 mg per day orally for 2 years or observation. In all, 2,640 patients and 728 events were estimated to be required to demonstrate an increase in disease-free survival (DFS) by ibandronate from 75% to 79.5% by using a two-sided α = .05 and 1-β of 80%. We report here the efficacy analysis for ibandronate, which was released by the independent data monitoring committee because the futility boundary was not crossed after 50% of the required DFS events were observed. Results Between June 2004 and August 2008, 2,015 patients were randomly assigned to ibandronate and 1,008 to observation. Patients randomly assigned to ibandronate showed no superior DFS or overall survival (OS) compared with patients randomly assigned to observation (DFS: hazard ratio, 0.945; 95% CI, 0.768 to 1.161; P = .589; OS: HR, 1.040; 95% CI, 0.763 to 1.419; P = .803). DFS was numerically longer if ibandronate was used in patients younger than 40 years or older than 60 years compared with patients age 40 to 59 years (test for interaction P = .093). Conclusion Adjuvant treatment with oral ibandronate did not improve outcome of patients with high-risk early breast cancer who received dose-dense chemotherapy.


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<title xml:lang="en" level="a">German Adjuvant Intergroup Node-Positive Study: A Phase III Trial to Compare Oral Ibandronate Versus Observation in Patients With High-Risk Early Breast Cancer</title>
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<country>Allemagne</country>
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<region type="land" nuts="3">Berlin</region>
<settlement type="city">Berlin</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Jackisch, Christian" sort="Jackisch, Christian" uniqKey="Jackisch C" first="Christian" last="Jackisch">Christian Jackisch</name>
<affiliation wicri:level="1">
<inist:fA14 i1="07">
<s1>Klinikum Offenbach</s1>
<s2>Offenbach</s2>
<s3>DEU</s3>
<sZ>7 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Offenbach</wicri:noRegion>
<wicri:noRegion>Klinikum Offenbach</wicri:noRegion>
<wicri:noRegion>Klinikum Offenbach</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Diel, Ingo J" sort="Diel, Ingo J" uniqKey="Diel I" first="Ingo J." last="Diel">Ingo J. Diel</name>
<affiliation wicri:level="3">
<inist:fA14 i1="08">
<s1>Schwerpunktpraxis für gynäkologische Onkologie</s1>
<s2>Mannheim</s2>
<s3>DEU</s3>
<sZ>8 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Karlsruhe</region>
<settlement type="city">Mannheim</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Elling, Dirk" sort="Elling, Dirk" uniqKey="Elling D" first="Dirk" last="Elling">Dirk Elling</name>
<affiliation wicri:level="1">
<inist:fA14 i1="09">
<s1>Sana Klinikum Lichtenberg</s1>
<s2>Lichtenberg</s2>
<s3>DEU</s3>
<sZ>9 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Lichtenberg</wicri:noRegion>
<wicri:noRegion>Sana Klinikum Lichtenberg</wicri:noRegion>
<wicri:noRegion>Sana Klinikum Lichtenberg</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Conrad, Bettina" sort="Conrad, Bettina" uniqKey="Conrad B" first="Bettina" last="Conrad">Bettina Conrad</name>
<affiliation wicri:level="3">
<inist:fA14 i1="10">
<s1>Frauenklinik</s1>
<s2>Kassel</s2>
<s3>DEU</s3>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="1">Hesse (Land)</region>
<region type="district" nuts="2">District de Kassel</region>
<settlement type="city">Cassel (Hesse)</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Kreienberg, Rolf" sort="Kreienberg, Rolf" uniqKey="Kreienberg R" first="Rolf" last="Kreienberg">Rolf Kreienberg</name>
<affiliation wicri:level="3">
<inist:fA14 i1="11">
<s1>University Hospital Ulm</s1>
<s2>Ulm</s2>
<s3>DEU</s3>
<sZ>11 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="1">Bade-Wurtemberg</region>
<region type="district" nuts="2">District de Tübingen</region>
<settlement type="city">Ulm</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Muller, Volkmar" sort="Muller, Volkmar" uniqKey="Muller V" first="Volkmar" last="Müller">Volkmar Müller</name>
<affiliation wicri:level="3">
<inist:fA14 i1="12">
<s1>University Hospital Hamburg</s1>
<s2>Hamburg</s2>
<s3>DEU</s3>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<settlement type="city">Hambourg</settlement>
<region type="land" nuts="2">Hambourg</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Luck, Hans Joachim" sort="Luck, Hans Joachim" uniqKey="Luck H" first="Hans-Joachim" last="Lück">Hans-Joachim Lück</name>
<affiliation wicri:level="1">
<inist:fA14 i1="13">
<s1>Praxis Hannover</s1>
<s3>DEU</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Praxis Hannover</wicri:noRegion>
<wicri:noRegion>Praxis Hannover</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Bauerfeind, Ingo" sort="Bauerfeind, Ingo" uniqKey="Bauerfeind I" first="Ingo" last="Bauerfeind">Ingo Bauerfeind</name>
<affiliation wicri:level="1">
<inist:fA14 i1="15">
<s1>Frauenklinik Landshut</s1>
<s2>Landshut</s2>
<s3>DEU</s3>
<sZ>14 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Landshut</wicri:noRegion>
<wicri:noRegion>Frauenklinik Landshut</wicri:noRegion>
<wicri:noRegion>Frauenklinik Landshut</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Clemens, Michael" sort="Clemens, Michael" uniqKey="Clemens M" first="Michael" last="Clemens">Michael Clemens</name>
<affiliation wicri:level="1">
<inist:fA14 i1="16">
<s1>Klinikum Trier</s1>
<s2>Trier</s2>
<s3>DEU</s3>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Trier</wicri:noRegion>
<wicri:noRegion>Klinikum Trier</wicri:noRegion>
<wicri:noRegion>Klinikum Trier</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Schmidt, Marcus" sort="Schmidt, Marcus" uniqKey="Schmidt M" first="Marcus" last="Schmidt">Marcus Schmidt</name>
<affiliation wicri:level="3">
<inist:fA14 i1="17">
<s1>University Hospital Mainz</s1>
<s2>Mainz</s2>
<s3>DEU</s3>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="2">Rhénanie-Palatinat</region>
<settlement type="city">Mayence</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Noeding, Stefanie" sort="Noeding, Stefanie" uniqKey="Noeding S" first="Stefanie" last="Noeding">Stefanie Noeding</name>
<affiliation wicri:level="3">
<inist:fA14 i1="14">
<s1>Nordstadt Krankenhaus</s1>
<s2>Hannover</s2>
<s3>DEU</s3>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="2">Basse-Saxe</region>
<settlement type="city">Hanovre</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Forstbauer, Helmut" sort="Forstbauer, Helmut" uniqKey="Forstbauer H" first="Helmut" last="Forstbauer">Helmut Forstbauer</name>
<affiliation wicri:level="1">
<inist:fA14 i1="18">
<s1>Haematologic-Oncologic Praxis</s1>
<s2>Troisdorf</s2>
<s3>DEU</s3>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Troisdorf</wicri:noRegion>
<wicri:noRegion>Haematologic-Oncologic Praxis</wicri:noRegion>
<wicri:noRegion>Haematologic-Oncologic Praxis</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Barinoff, Jana" sort="Barinoff, Jana" uniqKey="Barinoff J" first="Jana" last="Barinoff">Jana Barinoff</name>
<affiliation wicri:level="1">
<inist:fA14 i1="19">
<s1>Klinikum Mitte</s1>
<s2>Essen</s2>
<s3>DEU</s3>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Essen</wicri:noRegion>
<wicri:noRegion>Klinikum Mitte</wicri:noRegion>
<wicri:noRegion>Klinikum Mitte</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Belau, Antje" sort="Belau, Antje" uniqKey="Belau A" first="Antje" last="Belau">Antje Belau</name>
<affiliation wicri:level="1">
<inist:fA14 i1="20">
<s1>University Hospital</s1>
<s2>Greifswald</s2>
<s3>DEU</s3>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Greifswald</wicri:noRegion>
<wicri:noRegion>University Hospital</wicri:noRegion>
<wicri:noRegion>University Hospital</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Nekljudova, Valentina" sort="Nekljudova, Valentina" uniqKey="Nekljudova V" first="Valentina" last="Nekljudova">Valentina Nekljudova</name>
<affiliation wicri:level="1">
<inist:fA14 i1="01">
<s1>German Breast Group</s1>
<s2>Neu-Isenburg</s2>
<s3>DEU</s3>
<sZ>1 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Neu-Isenburg</wicri:noRegion>
<wicri:noRegion>German Breast Group</wicri:noRegion>
<wicri:noRegion>German Breast Group</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Harbeck, Nadia" sort="Harbeck, Nadia" uniqKey="Harbeck N" first="Nadia" last="Harbeck">Nadia Harbeck</name>
<affiliation wicri:level="4">
<inist:fA14 i1="21">
<s1>Universität München</s1>
<s2>München</s2>
<s3>DEU</s3>
<sZ>22 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="1">Bavière</region>
<region type="district" nuts="2">District de Haute-Bavière</region>
<settlement type="city">Munich</settlement>
</placeName>
<orgName type="university">Université Louis-et-Maximilien de Munich</orgName>
</affiliation>
</author>
<author>
<name sortKey="Loibl, Sibylle" sort="Loibl, Sibylle" uniqKey="Loibl S" first="Sibylle" last="Loibl">Sibylle Loibl</name>
<affiliation wicri:level="1">
<inist:fA14 i1="01">
<s1>German Breast Group</s1>
<s2>Neu-Isenburg</s2>
<s3>DEU</s3>
<sZ>1 aut.</sZ>
<sZ>21 aut.</sZ>
<sZ>23 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Neu-Isenburg</wicri:noRegion>
<wicri:noRegion>German Breast Group</wicri:noRegion>
<wicri:noRegion>German Breast Group</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series>
<title level="j" type="main">Journal of clinical oncology</title>
<title level="j" type="abbreviated">J. clin. oncol.</title>
<idno type="ISSN">0732-183X</idno>
<imprint>
<date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt>
<title level="j" type="main">Journal of clinical oncology</title>
<title level="j" type="abbreviated">J. clin. oncol.</title>
<idno type="ISSN">0732-183X</idno>
</seriesStmt>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Adjuvant</term>
<term>Antiosteoporotic</term>
<term>Antiresorptive agent</term>
<term>Breast cancer</term>
<term>Cancerology</term>
<term>Chemotherapy</term>
<term>Comparative study</term>
<term>Early</term>
<term>Germany</term>
<term>High risk</term>
<term>Human</term>
<term>Ibandronic acid</term>
<term>Phase III trial</term>
<term>Treatment</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Essai clinique phase III</term>
<term>Allemagne</term>
<term>Adjuvant</term>
<term>Acide ibandronique</term>
<term>Traitement</term>
<term>Etude comparative</term>
<term>Chimiothérapie</term>
<term>Homme</term>
<term>Risque élevé</term>
<term>Cancer du sein</term>
<term>Précoce</term>
<term>Cancérologie</term>
<term>Antirésorptif</term>
<term>Antiostéoporotique</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr">
<term>Allemagne</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr">
<term>Adjuvant</term>
<term>Homme</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">Purpose Bisphosphonates prevent skeletal-related events in patients with metastatic breast cancer. Their effect in early breast cancer is controversial. Ibandronate is an orally and intravenously available amino-bisphosphonate with a favorable toxicity profile. It therefore qualifies as potential agent for adjuvant use. Patients and Methods The GAIN (German Adjuvant Intergroup Node-Positive) study was an open-label, randomized, controlled phase III trial with a 2 × 2 factorial design. Patients with node-positive early breast cancer were randomly assigned 1:1 to two different dose-dense chemotherapy regimens and 2:1 to ibandronate 50 mg per day orally for 2 years or observation. In all, 2,640 patients and 728 events were estimated to be required to demonstrate an increase in disease-free survival (DFS) by ibandronate from 75% to 79.5% by using a two-sided α = .05 and 1-β of 80%. We report here the efficacy analysis for ibandronate, which was released by the independent data monitoring committee because the futility boundary was not crossed after 50% of the required DFS events were observed. Results Between June 2004 and August 2008, 2,015 patients were randomly assigned to ibandronate and 1,008 to observation. Patients randomly assigned to ibandronate showed no superior DFS or overall survival (OS) compared with patients randomly assigned to observation (DFS: hazard ratio, 0.945; 95% CI, 0.768 to 1.161; P = .589; OS: HR, 1.040; 95% CI, 0.763 to 1.419; P = .803). DFS was numerically longer if ibandronate was used in patients younger than 40 years or older than 60 years compared with patients age 40 to 59 years (test for interaction P = .093). Conclusion Adjuvant treatment with oral ibandronate did not improve outcome of patients with high-risk early breast cancer who received dose-dense chemotherapy.</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Allemagne</li>
</country>
<region>
<li>Bade-Wurtemberg</li>
<li>Basse-Saxe</li>
<li>Bavière</li>
<li>Berlin</li>
<li>District de Darmstadt</li>
<li>District de Düsseldorf</li>
<li>District de Haute-Bavière</li>
<li>District de Karlsruhe</li>
<li>District de Kassel</li>
<li>District de Tübingen</li>
<li>Hambourg</li>
<li>Hesse (Land)</li>
<li>Rhénanie-Palatinat</li>
<li>Rhénanie-du-Nord-Westphalie</li>
</region>
<settlement>
<li>Berlin</li>
<li>Cassel (Hesse)</li>
<li>Düsseldorf</li>
<li>Francfort-sur-le-Main</li>
<li>Hambourg</li>
<li>Hanovre</li>
<li>Heidelberg</li>
<li>Mannheim</li>
<li>Mayence</li>
<li>Munich</li>
<li>Ulm</li>
</settlement>
<orgName>
<li>Université Louis-et-Maximilien de Munich</li>
</orgName>
</list>
<tree>
<country name="Allemagne">
<noRegion>
<name sortKey="Von Minckwitz, Gunter" sort="Von Minckwitz, Gunter" uniqKey="Von Minckwitz G" first="Gunter" last="Von Minckwitz">Gunter Von Minckwitz</name>
</noRegion>
<name sortKey="Barinoff, Jana" sort="Barinoff, Jana" uniqKey="Barinoff J" first="Jana" last="Barinoff">Jana Barinoff</name>
<name sortKey="Bauerfeind, Ingo" sort="Bauerfeind, Ingo" uniqKey="Bauerfeind I" first="Ingo" last="Bauerfeind">Ingo Bauerfeind</name>
<name sortKey="Belau, Antje" sort="Belau, Antje" uniqKey="Belau A" first="Antje" last="Belau">Antje Belau</name>
<name sortKey="Clemens, Michael" sort="Clemens, Michael" uniqKey="Clemens M" first="Michael" last="Clemens">Michael Clemens</name>
<name sortKey="Conrad, Bettina" sort="Conrad, Bettina" uniqKey="Conrad B" first="Bettina" last="Conrad">Bettina Conrad</name>
<name sortKey="Diel, Ingo J" sort="Diel, Ingo J" uniqKey="Diel I" first="Ingo J." last="Diel">Ingo J. Diel</name>
<name sortKey="Elling, Dirk" sort="Elling, Dirk" uniqKey="Elling D" first="Dirk" last="Elling">Dirk Elling</name>
<name sortKey="Forstbauer, Helmut" sort="Forstbauer, Helmut" uniqKey="Forstbauer H" first="Helmut" last="Forstbauer">Helmut Forstbauer</name>
<name sortKey="Harbeck, Nadia" sort="Harbeck, Nadia" uniqKey="Harbeck N" first="Nadia" last="Harbeck">Nadia Harbeck</name>
<name sortKey="Huober, Jens" sort="Huober, Jens" uniqKey="Huober J" first="Jens" last="Huober">Jens Huober</name>
<name sortKey="Jackisch, Christian" sort="Jackisch, Christian" uniqKey="Jackisch C" first="Christian" last="Jackisch">Christian Jackisch</name>
<name sortKey="Kreienberg, Rolf" sort="Kreienberg, Rolf" uniqKey="Kreienberg R" first="Rolf" last="Kreienberg">Rolf Kreienberg</name>
<name sortKey="Loibl, Sibylle" sort="Loibl, Sibylle" uniqKey="Loibl S" first="Sibylle" last="Loibl">Sibylle Loibl</name>
<name sortKey="Luck, Hans Joachim" sort="Luck, Hans Joachim" uniqKey="Luck H" first="Hans-Joachim" last="Lück">Hans-Joachim Lück</name>
<name sortKey="Mobus, Volker" sort="Mobus, Volker" uniqKey="Mobus V" first="Volker" last="Möbus">Volker Möbus</name>
<name sortKey="Muller, Volkmar" sort="Muller, Volkmar" uniqKey="Muller V" first="Volkmar" last="Müller">Volkmar Müller</name>
<name sortKey="Nekljudova, Valentina" sort="Nekljudova, Valentina" uniqKey="Nekljudova V" first="Valentina" last="Nekljudova">Valentina Nekljudova</name>
<name sortKey="Noeding, Stefanie" sort="Noeding, Stefanie" uniqKey="Noeding S" first="Stefanie" last="Noeding">Stefanie Noeding</name>
<name sortKey="Schmidt, Marcus" sort="Schmidt, Marcus" uniqKey="Schmidt M" first="Marcus" last="Schmidt">Marcus Schmidt</name>
<name sortKey="Schneeweiss, Andreas" sort="Schneeweiss, Andreas" uniqKey="Schneeweiss A" first="Andreas" last="Schneeweiss">Andreas Schneeweiss</name>
<name sortKey="Thomssen, Christoph" sort="Thomssen, Christoph" uniqKey="Thomssen C" first="Christoph" last="Thomssen">Christoph Thomssen</name>
<name sortKey="Untch, Michael" sort="Untch, Michael" uniqKey="Untch M" first="Michael" last="Untch">Michael Untch</name>
</country>
</tree>
</affiliations>
</record>

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