STARS Breast Trial (Study of Anastrozole and Radiotherapy Sequencing) (STARS)
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ClinicalTrials.gov Identifier: NCT00887380 |
Recruitment Status :
Active, not recruiting
First Posted : April 24, 2009
Last Update Posted : November 18, 2022
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Condition or disease | Intervention/treatment | Phase |
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Breast Cancer | Drug: Pre-radiotherapy commencement of anastrozole Radiation: Radiotherapy Drug: Post radiotherapy commencement of anastrozole | Phase 3 |
Adjuvant radiotherapy is well established as the primary modality to enhance local control in breast cancer. The use of adjuvant hormone therapy such as tamoxifen has shown to improve local control to a relatively minor amount on its own and does enhance local control of adjuvant radiotherapy. There is, however, conflicting invitro and clinical data regarding the effects or different sequences on tamoxifen and radiotherapy in terms of both local control and enhancement of radiotherapy toxicities.
Aromatase inhibitors such as anastrozole are establishing themselves as a class of drug superior to tamoxifen for the control of estrogen dependent breast cancers and overall are better tolerated with the exception of greater bone loss.
As the key question is whether the sequencing of the aromatase inhibitor anastrozole alters local control by acting as an enhancer of the radiation breast cancer cell kill, it is therefore the aim of this study to compare 3 months of anastrozole prior to radiotherapy versus 3 months of anastrozole after radiotherapy with a specific objective of reducing the baseline ratio of in-field radiotherapy failure from 6% to 3%.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 2023 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Randomised Comparison of Anastrozole Commenced Before and Continued During Adjuvant Radiotherapy for Breast Cancer Versus Anastrozole and Subsequent Anti-oestrogen Therapy Delayed Until After Radiotherapy. |
Actual Study Start Date : | September 16, 2009 |
Estimated Primary Completion Date : | December 2024 |
Estimated Study Completion Date : | December 2024 |

Arm | Intervention/treatment |
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Active Comparator: Arm A: Concurrent
Investigational treatment: Anastrozole commenced before (Pre-radiotherapy commencement of anastrozole) and continued during radiotherapy.
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Drug: Pre-radiotherapy commencement of anastrozole
Anastrozole: 1mg per day will be prescribed for 12 weeks. Commencing within 1 week of randomisation, to be administered from a min of 1 week before and a max of 4 weeks before commencement of radiotherapy and continued throughout radiotherapy. After 12 weeks administration of anastrozole according to trial regimen, anastrozole can be continued at the treating clinician's discretion and in accordance with the preference selected at the time of randomisation and stratification. The alternative options to long-term anastrozole are tamoxifen or cessation of anti-oestrogen therapy.
Other Name: Arimidex Radiation: Radiotherapy Radiotherapy must commence within 1 month of randomisation. Radiotherapy planning and treatment is as per the protocol.
Other Name: RT, Radiation Therapy |
Active Comparator: Arm B: Sequential
Standard Treatment: Anastrozole and subsequent anti-oestrogen therapy delayed until after radiotherapy (Post radiotherapy commencement of anastrozole)
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Radiation: Radiotherapy
Radiotherapy must commence within 1 month of randomisation. Radiotherapy planning and treatment is as per the protocol.
Other Name: RT, Radiation Therapy Drug: Post radiotherapy commencement of anastrozole Anastrozole 1mg per day will be prescribed for 12 weeks after radiotherapy is completed. Anastrozole should commence within 1 week of the last fraction of radiotherapy and be continued for a total of 12 weeks. After 12 weeks administration according to the trial regimen, any subsequent hormone therapy is as for the concurrent arm.
Other Name: Arimidex |
- To determine if commencement of anastrozole prior to radiotherapy results in improved local control compared to anastrozole commenced after radiotherapy. [ Time Frame: 10 years post radiotherapy ]
- Rates of distant failure [ Time Frame: 10 years post radiotherapy ]
- Overall Survival [ Time Frame: 10 years post radiotherapy ]
- Normal tissue complications [ Time Frame: 10 years post radiotherapy ]
- Cosmesis [ Time Frame: 10 years post radiotherapy ]

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Women aged 18 years or older
- Post total mastectomy or lumpectomy. All planned cancer resection surgery complete.
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Histologic or pathologic reports must verify either:
- No tumour contacting the inked margin of surgically removed tissue, or
- Focal involvement (<2mm front) if the margin is at the deep (posterior part) of the breast and the surgeon confirms that surgery extended to the deep fascia, or
- Focal involvement (<2mm front) if the margin is superficial (anterior part of the breast or subcutaneous) and the surgeon confirms that surgery extended to the subcutis NB: In the case of focally involved deep or superficial margins, the medical records or multidisciplinary meeting notes or correspondence from the surgeon must indicate that the surgeon confirms the surgery extended to the deep fascia or subcutis as appropriate. Patients should routinely receive a lumpectomy bed boost in the conserved breast setting if there is focal superficial or focal deep involvement as defined above.
- Tumour oestrogen receptor and/or progesterone receptor positive (≥10% cells positive).
- Radiotherapy not yet commenced
- Planned radiotherapy dose prescribed to ICRU reference points in the irradiated breast / chest wall volumes at least the biological equivalent of 45 Gy in 25 fractions or more. (BED Gy4 ≥ 65, BED Gyx=D(1+n/x) where D=total dose, n=dose per fraction, x=alpha beta ratio, Gy4 selected as appropriate alpha-beta ratio for human breast cancer lines)
- An ECOG performance status score of 2 or less.
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Female and post menopausal shown by satisfying at least one of the following criteria (as per the ATAC study criteria16):
- bilateral oophorectomy
- age greater than 60
- age 45-59 years with intact uterus and amenorrhoeic at least 12 months
- Amenorrhoeic less than 12 months with follicle stimulating hormone (FSH) levels within the post menopausal range (including patients with amenorrhoea due to chemotherapy, LHRH use or who have had hormone replacement following hysterectomy) Note: it is recommended for women under the age of 45 who have been rendered menopausal by chemotherapy that they be enrolled onto the strata which switches to Tamoxifen after the initial 3 months of anastrozole.
- Is not receiving chemotherapy, or is receiving chemotherapy but the course will be completed at least 3 weeks prior to commencing radiotherapy
- Unilateral treatment
- Has provided written informed consent for participation in this trial
Exclusion Criteria:
- Previous radiotherapy to the area to be treated
- Previous invasive malignancy within 5 years of current breast cancer diagnosis with the exception of cervix in-situ or skin cancer other than melanoma.
- Patients with clinical evidence of metastatic disease.
- Previous hormonal breast cancer therapy.
- Ongoing hormone replacement therapy

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00887380

Study Chair: | Peter Graham, MBBS | Trans Tasman Radiation Oncology Group |
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | Trans Tasman Radiation Oncology Group |
ClinicalTrials.gov Identifier: | NCT00887380 |
Other Study ID Numbers: |
TROG 08.06 ACTRN12610000307000 ( Registry Identifier: ANZCTR ) |
First Posted: | April 24, 2009 Key Record Dates |
Last Update Posted: | November 18, 2022 |
Last Verified: | November 2022 |
Breast Cancer Timing of Radiotherapy Local control |
Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Anastrozole Antineoplastic Agents, Hormonal Antineoplastic Agents |
Aromatase Inhibitors Steroid Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Estrogen Antagonists Hormone Antagonists Hormones, Hormone Substitutes, and Hormone Antagonists Physiological Effects of Drugs |