Value of LNG-IUS as Fertility-preserving Treatment of EAH and EC
Study Details
Study Description
Brief Summary
Primary end points:
This clinical trial is aimed to analyze the effectiveness of Levonorgestrel-Releasing Intrauterine System (LNG-IUS, Mirena®) in the fertility-sparing treatment of atypical endometrial hyperplasia and early endometrial carcinoma, including pathology response and pregnancy outcome.
Second end points:
To analyze the appearances of side-effects.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 2/Phase 3 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: MPA for EC without progesterone contraindication The enrolled patient (endometrial cancer without contraindication of oral high dose progesterone) is allocated to one of three groups, MPA only, MPA+LNG-IUS, LNG-IUS only, by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if endometrial cancer is still present after 3 cycles. |
Drug: Progesterone
MPA oral 250mg-500mg qd for 3 months per cycle
Other Names:
|
Experimental: MPA+Mirena® for EC without contraindication The enrolled patient (endometrial cancer without contraindication of oral high dose progesterone) is allocated to one of three groups, MPA only, MPA+LNG-IUS, LNG-IUS only, by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if endometrial cancer is still present after 3 cycles. |
Drug: Progesterone
MPA oral 250mg-500mg qd for 3 months per cycle
Other Names:
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
|
Experimental: Mirena® for EC without contraindication The enrolled patient (endometrial cancer without contraindication of oral high dose progesterone) is allocated to one of three groups, MPA only, MPA+LNG-IUS, LNG-IUS only, by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if endometrial cancer is still present after 3 cycles. |
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
|
Active Comparator: GnRH agonist+Mirena® for EC with contraindication The enrolled patient (endometrial cancer with contraindication of oral high dose progesterone) is allocated to either GnRH-a+ LNG-IUS or only LNG-IUS by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if endometrial cancer is still present after 3 cycles. |
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
Drug: GnRH agonist
GnRH-a intramuscular injection 3.75mg once a month for 3 months per cycle
Other Names:
|
Experimental: Mirena® for EC with contraindication The enrolled patient (endometrial cancer with contraindication of oral high dose progesterone) is allocated to either GnRH-a+ LNG-IUS or only LNG-IUS by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if endometrial cancer is still present after 3 cycles. |
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
|
Active Comparator: Mirena® for EAH without progesterone contraindication The enrolled patient (atypical endometrial hyperplasia without contraindication of oral high dose progesterone) is allocated to either MPA or LNG-IUS by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if EAH is still present after 3 cycles. |
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
|
Experimental: MPA for EAH without progesterone contraindication The enrolled patient (atypical endometrial hyperplasia without contraindication of oral high dose progesterone) is allocated to either MPA or LNG-IUS by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if EAH is still present after 3 cycles. |
Drug: Progesterone
MPA oral 250mg-500mg qd for 3 months per cycle
Other Names:
|
Active Comparator: Mirena® for EAH with progesterone contraindication The enrolled patient (atypical endometrial hyperplasia with contraindication of oral high dose progesterone) is allocated to either GnRH-a+ LNG-IUS or only LNG-IUS by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if EAH is still present after 3 cycles. |
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
|
Experimental: GnRH-a+Mirena® for EAH with progesterone contraindication The enrolled patient (atypical endometrial hyperplasia with contraindication of oral high dose progesterone) is allocated to either GnRH-a+ LNG-IUS or only LNG-IUS by randomization. Continuous treatment for 3 months is one cycle. Hysteroscopic evaluation and biopsy will procedure every cycle. Patients with partial response or in stable condition, after 2 cycles, will receive continuous treatment for one more cycle again. Patients with complete response after 2 or 3 cycles are encouraged to pregnancy. The consideration of giving up fertility-sparing treatment is recommended: 1) if patient have documented progression on the biopsies; 2) if EAH is still present after 3 cycles. |
Device: Mirena®
levonorgestrel intrauterine sustained release system (LNG-IUS) placed in uterus for 3 months per cycle
Other Names:
Drug: GnRH agonist
GnRH-a intramuscular injection 3.75mg once a month for 3 months per cycle
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Pathologic Response [6-12 months]
Pathologic response to medicine treatment is categorized as complete response (CR), partial response (PR), no change (NC), and progressive disease (PD). CR is defined as the absence of any hyperplastic or cancerous lesion. PR is defined as the residual lesion with degeneration and atrophy of endometrial glands. NC is defined as residual lesion without degeneration or atrophy of endometrial glands. PD is defined as the appearance of endometrial cancer for EAH and grade 2 (G2) or 3 for EC.
- Pregnancy Rate [7-144 months]
The percentage of successful pregnancies in the CR patients.
- Live Birth Rate [16-144 months]
The percentage of successfully alive baby delivery in the pregnant patients.
Secondary Outcome Measures
- Side-Affects Rate [1-144 months]
The appearances of side-effects include weight gain, irregular vaginal bleeding, breast pain, appetite changes, nausea, vomiting, rash, jaundice, thromboembolism, hypertension, liver dysfunction, kidney dysfunction, glucose intolerance, and diabetes.
Eligibility Criteria
Criteria
For Patients With Endometrial Cancer:
Inclusion Criteria:
-
≤40 years of age:
-
Having a strong desire for fertility preservation;
-
Histological diagnosis is confirmed as well-differentiated (grade 1) endometrioid adenocarcinoma by the designated gynecological pathologists, and the progesterone receptors (PgRs) is positive in immunohistochemistry;
-
Disease limited to the endometrium (stage 1A) on MRI;
-
Serum CA125/199 level is within normal limit (Laparoscopic exploration to rule out ovarian tumor or another metastasis if necessary);
-
Patients should have undergone counseling to learn fertility-preserving treatment is not standard of care for the treatment of EC, volunteered to participate in this study, signed the informed consent form, and agreed to participated in clinical follow-up.
Exclusion Criteria:
-
Patients have allergies or contraindications (except for thromboembolic disease, liver dysfunction, hypertension, and diabetes) for the involved drugs;
-
Patients have lynch syndrome (LS);
-
Patients have contraindications for pregnancy;
-
Patients have serious underlying disease, malignancies at other site(s), acute liver or kidney disease, acute liver or kidney diseases, acute or subacute genital tract infections and congenital or acquired abnormal uterine development (that may make intrauterine device placement impossible);
-
Patients refuse to participate in clinical follow-up or sign the informed consent form.
For Patients With Endometrial atypical hyperplasia:
Inclusion Criteria:
-
≤ 40 years of age
-
Having a strong desire for fertility preservation
-
Histological diagnosis is confirmed as atypical endometrial hyperplasia (EAH) by the designated gynecological pathologists
-
Having volunteered to participate in this study, signed the informed consent form, and agreed to participate in clinical follow-up
Exclusion Criteria:
-
Patients have allergies or contraindications (except for thromboembolic disease, liver dysfunction, hypertension, and diabetes) for the involved drugs
-
Patients have contraindications for pregnancy
-
Patients have serious underlying disease, malignancies at other site(s), acute liver or kidney disease, acute or subacute genital tract infections, and congenital or acquired abnormal uterine development (that may make intrauterine device placement impossible)
-
Patients refuse to participate in clinical follow-up or sign the informed consent form.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | West China Second University Hospital | Chengdu | Sichuan | China | 610000 |
Sponsors and Collaborators
- West China Second University Hospital
Investigators
None specified.Study Documents (Full-Text)
More Information
Publications
- Chinese Medical Association Department of Gynecologic Oncology., Guidelines on Clinical Fertility-Sparing Treatment of Gynecologic Cancer. Chinese Journal of OBsterics and Gynecology, 2014(4):9-9
- Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C; ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Radiother Oncol. 2015 Dec;117(3):559-81. doi: 10.1016/j.radonc.2015.11.013. Epub 2015 Dec 9.
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- ZHENG Ying