Surgery in Preventing Ovarian Cancer in Patients With Genetic Mutations
Study Details
Study Description
Brief Summary
This phase II trial studies how well surgery works in preventing ovarian cancer in patients with genetic mutations at risk of ovarian cancer. Risk reducing salpingo oophorectomy (RRSO) is surgery to remove the fallopian tubes and ovaries at the same time. Interval salpingectomy with delayed oophorectomy (ISDO) is surgery to remove the fallopian tubes. It is not known whether ISDO works better than RRSO at lowering risk of ovarian cancer and improving the sexual function and psychosocial well-being in patients with genetic mutation.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
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N/A |
Detailed Description
PRIMARY OBJECTIVES:
- To examine changes in female sexual function with the strategy of interval salpingectomy and delayed oophorectomy (ISDO) compared to the strategy of risk-reducing salpingo-oophorectomy (RRSO) for patients who carry genetic mutations that predispose them to ovarian cancer.
SECONDARY OBJECTIVES:
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To estimate the onset and severity of menopausal symptoms with ISDO compared to RRSO.
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To estimate quality of life with ISDO compared to RRSO. III. To examine participants' satisfaction level and cancer worry level with their choice of prophylactic procedures.
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To estimate the impact of ISDO compared to RRSO on mental health, including depression, anxiety, and sleep quality.
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To determine the compliance with ISDO compared to RRSO. VI. To estimate the number of fallopian tube, ovarian, or primary peritoneal malignancies and other malignancies over the course of the study.
OUTLINE: Patients are assigned to 1 of 2 arms.
ARM I: Patients undergo ISDO.
ARM II: Patients undergo RRSO.
After completion of study treatment, patients are followed up at 1 and 6 months, 1 year, and 2 years.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Arm I (ISDO) Patients undergo ISDO. |
Other: Laboratory Biomarker Analysis
Correlative studies
Procedure: Oophorectomy
Undergo ISDO
Other Names:
Other: Quality-of-Life Assessment
Ancillary studies
Other Names:
Procedure: Salpingectomy
Undergo ISDO
Other Names:
|
| Active Comparator: Arm II (RRSO) Patients undergo RRSO. |
Other: Laboratory Biomarker Analysis
Correlative studies
Other: Quality-of-Life Assessment
Ancillary studies
Other Names:
Procedure: Salpingo-Oophorectomy
Undergo RRSO
|
Outcome Measures
Primary Outcome Measures
- Percent of women with clinically meaningful change in the Female Sexual Function Index (FSFI) score [From baseline to 6 months]
Will be calculated using the Cochran-Mantel-Haenszel test stratified by age, with 5-year age groups. We will use propensity score methods to account for potential differences between interval salpingectomy with delayed oophorectomy (ISDO) and risk-reducing bilateral salpingectomy with oophorectomy (RRSO) arms with respect to age, baseline survey scores, and other potential confounders, and we will use the propensity scores as inverse weights in logistic regression to model the logit of the probability of having a clinically meaningful change in FSFI score from baseline to 6 months as our primary analysis.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Premenopausal women with a documented deleterious mutation in one of the following ovarian cancer genes: BRCA1, BRCA2, BRIP1, PALB2, RAD51C, RAD51D, BARD1, MSH2, MSH6, MLH1, or PMS2, or EPCAM; (please note: menopause is defined as >= 12 months of amenorrhea; however, for those patients with >= 12 months of amenorrhea who may be pre-menopausal, levels of follicle-stimulating hormone [FSH], luteinizing hormone [LH], and estradiol in the pre-menopausal range will be acceptable)
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Willing to undergo two surgical procedures (if participant chooses the ISDO arm)
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Presence of at least 1 fallopian tube and 1 ovary; (please note: prior unilateral salpingectomy is allowed; prior bilateral salpingectomy is not allowed)
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Patients who have undergone a prior tubal ligation will be eligible
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Participants may have a personal history of non-ovarian malignancy, but must: a) be without evidence of disease at enrollment b) remain premenopausal c) have completed treatment (including surgery, chemotherapy, radiotherapy or hormonal therapy) > 3 months prior to enrollment (other than non-melanoma skin cancer)
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Willingness to return to the enrolling site for the study surgical procedures, including pre-operative and post-operative care; (patients in the ISDO arm must be willing to return to the enrolling site for yearly ovarian cancer assessment)
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Patients must understand that they will be permanently sterilized
Exclusion Criteria:
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Women with a personal history of ovarian, fallopian tube, or primary peritoneal cancer
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Current treatment with tamoxifen or aromatase inhibitors
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Medical comorbidities making surgery unsafe as determined by the patient's surgeon
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Women who are pregnant or post-partum (within 3 months of delivery); patients are deemed not pregnant by virtue of urine pregnancy test (UPT), transvaginal ultrasound, beta human chorionic gonadotropin (HCG), or best judgement of the investigator; pregnancy testing is not required per protocol to determine study eligibility; women who become pregnant on the ISDO arm via reproductive technology can remain on study; however, data collection will be suspended during pregnancy and 3 months post-partum
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Women with elevated levels of CA125 (> 50) or transvaginal ultrasound suggesting cancer, unless findings are consistent with endometriosis; CA125 and transvaginal ultrasounds must be the most recent, but no older than 1 year from the date of enrollment
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Inability to provide informed consent
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Inability to read or speak English
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Chicago Comprehensive Cancer Center | Chicago | Illinois | United States | 60637 |
| 2 | Dana-Farber Cancer Institute | Boston | Massachusetts | United States | 02215 |
| 3 | Mayo Clinic | Rochester | Minnesota | United States | 55905 |
| 4 | Siteman Cancer Center at Washington University | Saint Louis | Missouri | United States | 63110 |
| 5 | Laura and Isaac Perlmutter Cancer Center at NYU Langone | New York | New York | United States | 10016 |
| 6 | Memorial Sloan Kettering Cancer Center | New York | New York | United States | 10065 |
| 7 | University of Pennsylvania/Abramson Cancer Center | Philadelphia | Pennsylvania | United States | 19104 |
| 8 | M D Anderson Cancer Center | Houston | Texas | United States | 77030 |
| 9 | University of Washington Medical Center | Seattle | Washington | United States | 98195 |
Sponsors and Collaborators
- M.D. Anderson Cancer Center
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Karen H Lu, M.D. Anderson Cancer Center
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- 2015-0814
- NCI-2016-00778
- 2015-0814