Alternative Dosing of Exemestane Before Surgery in Treating Postmenopausal Patients With Stage 0-II Estrogen Positive Breast Cancer
Study Details
Study Description
Brief Summary
This phase IIb trial studies how well alternative dosing of exemestane before surgery works in treating in postmenopausal patients with stage 0-II estrogen positive breast cancer. Chemoprevention is the use of drugs to keep breast cancer from forming or coming back. The use of exemestane may treat early stage (stage 0-II) breast cancer. Comparing the exemestane standard dose regimen versus two alternative, less frequent dose regimens may decrease undesirable symptoms and have similar efficacy in reducing serum estradiol.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
PRIMARY OBJECTIVE:
- Non-inferiority of percent change in time of serum unconjugated estradiol levels, adjusted for baseline levels, following four up to six weeks of exemestane 25 mg given three times per week or one time per week compared with exemestane 25 mg daily dosing.
SECONDARY OBJECTIVES:
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To assess safety and toxicity. II. To support the preventive activity of exemestane we will investigate the change in Ki-67 and progesterone receptor (PgR) levels in tumor cells and the adjacent intraepithelial neoplasia or benign histologic structures.
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To assess possible association of estradiol level with tissue and circulating biomarkers.
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To investigate possible pharmacogenetic markers. V. To assess drug levels on tissue samples. VI. To investigate tissue proteomics profiling.
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients receive exemestane orally (PO) once daily (QD) on days 1-7.
ARM II: Patients receive exemestane PO QD on days 1, 3, and 5. Patients also receive placebo PO QD on days 2, 4, 6, and 7.
ARM III: Patients receive exemestane PO QD on day 1 and placebo PO QD on days 2-7.
In all arms, cycles repeat every 7 days for 4-6 weeks in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on days 29, 36, or 43.
After completion of study treatment, patients are followed up at 20-30 days.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Arm I (exemestane) Patients receive exemestane PO QD on days 1-7. Cycles repeat every 7 days for 4-6 weeks in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on days 29, 36, or 43. |
Drug: Exemestane
Given PO
Other Names:
Other: Laboratory Biomarker Analysis
Correlative studies
Other: Pharmacological Study
Correlative studies
Other: Quality-of-Life Assessment
Ancillary studies
Other Names:
Other: Questionnaire Administration
Ancillary studies
Procedure: Therapeutic Conventional Surgery
Undergo surgery
|
| Experimental: Arm II (exemestane, placebo) Patients receive exemestane PO QD on days 1, 3, and 5. Patients also receive placebo PO QD on days 2, 4, 6, and 7. Cycles repeat every 7 days for 4-6 weeks in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on days 29, 36, or 43. |
Drug: Exemestane
Given PO
Other Names:
Other: Laboratory Biomarker Analysis
Correlative studies
Other: Pharmacological Study
Correlative studies
Other: Placebo Administration
Given PO
Other: Quality-of-Life Assessment
Ancillary studies
Other Names:
Other: Questionnaire Administration
Ancillary studies
Procedure: Therapeutic Conventional Surgery
Undergo surgery
|
| Experimental: Arm III (exemestane, placebo) Patients receive exemestane PO QD on day 1 and placebo PO QD on days 2-7. Cycles repeat every 7 days for 4-6 weeks in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on days 29, 36, or 43. |
Drug: Exemestane
Given PO
Other Names:
Other: Laboratory Biomarker Analysis
Correlative studies
Other: Pharmacological Study
Correlative studies
Other: Placebo Administration
Given PO
Other: Quality-of-Life Assessment
Ancillary studies
Other Names:
Other: Questionnaire Administration
Ancillary studies
Procedure: Therapeutic Conventional Surgery
Undergo surgery
|
Outcome Measures
Primary Outcome Measures
- Percentage change of serum unconjugated estradiol concentration [Baseline to up to day 43]
Full distribution and median values of estradiol at baseline (before treatment), at post (after treatment) will be presented, and changes and percentage changes (with interquartile ranges) of estradiol level, from baseline to post, by arms. Differences by arms of percent change, change and final values will be tested considering t-test and analysis of covariance (ANCOVA) models. Estradiol at baseline will be included as explanatory variable together with other possible confounders such as BMI, age and time since last dose. Normal distribution of residuals from full model will be checked and, if needed, a transformation will be considered. Percentages of patients with final values of estradiol below the detectable level will be compared by arms with Chi-square tests and logistic models.
Secondary Outcome Measures
- Incidence of toxicity graded according to the Common Terminology Criteria for Adverse Events version 4.0 and Menopause-Specific Quality of Life Questionnaire [Up to day 43]
- Change in Ki67 expression [Baseline to up to day 43]
Full distributions and median values of circulating biomarkers, Ki67, in tissue at baseline, after treatment and also of changes and percentage changes (with interquartile ranges) of all continuous variable, will be presented by arms. ANCOVA models will evaluate the associations of post values (after treatment) and changes from baseline by study arms adjusting for baseline values, explanatory variables and possible confounders (such as age and BMI). Normal distribution of residuals from full models will be checked and, if needed, a transformation will be considered.
- Change in serum drug measurements of exemestane and 17-dihydroxyexemestane at the end of treatment [Baseline to up to day 43]
Full distributions and median values of circulating biomarkers, exemestane and 17dihydroxyexemestane in tissue at baseline, after treatment and also of changes and percentage changes (with interquartile ranges) of all continuous variable, will be presented by arms. ANCOVA models will evaluate the associations of post values (after treatment) and changes from baseline by study arms adjusting for baseline values, explanatory variables and possible confounders (such as age and BMI). Normal distribution of residuals from full models will be checked and, if needed, a transformation will be considered.
- Serum concentrations of unconjugated and total estrone and estrone sulfate measured by liquid chromatography coupled with tandem mass spectrometry [Up to day 43]
- Serum concentrations of androstenedione and testosterone measured by liquid chromatography coupled with tandem mass spectrometry [Up to day 43]
- Serum testosterone determined by a chemiluminescent immunoassay [Up to day 43]
- Sex hormone binding globulin serum levels measured by a chemiluminescent microparticle immunoassay [Up to day 43]
- Change in concentrations of insulin, glucose (homeostatic model assessment index), and lipid profile (total cholesterol, high-density lipoprotein cholesterol and triglycerides [Baseline up to day 43]
- Change in leptin and adiponectin serum concentrations measured by enzyme linked immunoassays [Baseline to up to day 43]
The change in leptin and adiponectin serum concentrations will be analyzed and compared among the different treatment arms.
- Measurement exemestane and 17-dihydroxyexemestane [Up to day 43]
Will be performed on frozen tissue samples (normal breast and breast cancer tissue).
- Breast estradiol and estrone concentration in tumor and normal breast tissue [At time of surgery]
- Changes in estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67 expression levels [Baseline to up to day 43]
- Ki67 in adjacent intraepithelial neoplasia and or grossly benign tissue [Up to day 43]
- Proteomic analysis [Up to day 43]
- UGT2B17 gene analysis assessed by the Taqman copy number variation assay [Up to day 43]
- Changes in the occurrence of crown like structures in mammary fat tissue by immunohistochemistry [Baseline to up to day 43]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Postmenopausal women (postmenopausal: age >= 60 years, or amenorrhea >= 12 months, or bilateral oophorectomy, or - in women with hysterectomy only - follicle stimulating hormone [FSH] in the menopausal levels as per local institutional guidelines if < 60 years old) with histologically-confirmed estrogen receptor (ER)-positive (>= 10%) primary breast cancer stage cT0-2, cN0-1, Mx; women with larger tumors who refuse chemotherapy (chemo) and/or endocrine neoadjuvant therapy can be eligible
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Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%)
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Leukocytes >= 3,000/microliter
-
Absolute neutrophil count >= 1,500/microliter
-
Platelets >= 100,000/microliter
-
Total bilirubin =< 2 x institutional upper limit of normal (ULN)
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Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 1.5 x institutional ULN
-
Serum creatinine =< 1.5 times institutional ULN
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Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
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Body mass index (BMI) < 18.5 Kg/m^2
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Previous treatment for breast cancer including chemotherapy, endocrine therapy and radiotherapy; women with prior ductal breast carcinoma in situ (DCIS) who were treated with surgery only and whose treatment ended >= 2 years prior to enrollment are eligible for the trial
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Women who are planned to receive neoadjuvant therapy
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Participants may not be receiving investigational agents
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History of allergic reactions attributed to compounds of similar chemical or biologic composition to exemestane
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Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
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Other co-existing invasive malignancies (with the exclusion of basal cell carcinoma or skin squamous cell carcinoma) diagnosed during the last 2 years before randomization
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History of severe osteoporosis (T score =< -4 either spine or hip), or presence of vertebral fracture
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Use of systemic hormone replacement therapy (HRT) in the last 30 days prior to the randomization; the use of non-systemic estrogen (such as vaginal estrogen use) is allowed
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Use of any chemopreventive agents (selective estrogen receptor modulators [SERM]) in the last 3 months
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Concomitant use of CYP3A4 inducer medication (rifampicin, phenytoin, carbamazepine, phenobarbital, and St. John's wort)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Moffitt Cancer Center | Tampa | Florida | United States | 33612 |
| 2 | NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center | New York | New York | United States | 10032 |
| 3 | M D Anderson Cancer Center | Houston | Texas | United States | 77030 |
| 4 | Galliera Hospital | Genoa | Italy | 16128 | |
| 5 | European Institute of Oncology | Milano | Italy | 20141 |
Sponsors and Collaborators
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Bernardo Bonanni, M.D. Anderson Cancer Center
Study Documents (Full-Text)
More Information
Publications
None provided.- NCI-2015-01821
- NCI-2015-01821
- HHSN26120120034I
- N01-CN-2012-00034
- 2016-0276
- MDA2014-04-01
- N01CN00034
- P30CA016672