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Changes in Breast Density and...

Changes in Breast Density and Blood Hormone Levels in Postmenopausal Women Receiving Anastrozole or Exemestane for Breast Cancer

Last Updated: 2016-07-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

140 participants

Study Classification

OBSERVATIONAL

Study Start Date

2007-09-30

Study Completion Date

2009-12-31

Brief Summary

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RATIONALE: Studying changes in breast density and blood hormone levels in women receiving anastrozole or exemestane for breast cancer may help doctors learn more about the long-term effects of treatment and may help the study of breast cancer in the future.

PURPOSE: This clinical trial is studying changes in breast density and blood hormone levels in postmenopausal women receiving anastrozole or exemestane for breast cancer.

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Detailed Description

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OBJECTIVES:

* To assess the changes in percent breast density (in response to 1 year of aromatase inhibitor therapy) from levels prior to the initiation of treatment.
* To assess the changes in dense area (in response to 1 year of aromatase inhibitor therapy) from levels prior to the initiation of treatment.
* To examine whether changes in percent breast density (in response to 1 year of aromatase inhibitor therapy) from pre-treatment levels correlate with changes in plasma hormone levels (estrone, estrone-sulfate, estradiol, and SHBG) and drug levels (anastrozole or exemestane) over the same time period.
* To examine whether changes in dense area (in response to 1 year of aromatase inhibitor therapy) from pre-treatment mammogram correlate with changes in plasma hormone levels (estrone, estrone-sulfate, estradiol, and SHBG) and drug levels (anastrozole or exemestane) over the same time period.
* To assess whether women with high pre-treatment percent density (upper tertile) experience greater decreases in percent breast density after 1 year of aromatase inhibitor therapy than women with low pre-treatment percent density (lower tertile).
* To assess whether women with high pre-treatment dense area (upper tertile) experience greater decreases in dense area after 1 year of aromatase inhibitor therapy than women with low pre-treatment dense area (lower tertile).
* To examine the associations of haplotype-tagged single nucleotide polymorphisms in genes in the aromatase pathway identified through the Mayo Clinic and Indiana University Pharmacogenomics Research Network Projects, with changes in percent and area density, plasma hormone levels, and drug levels after 1 year of aromatase inhibitor therapy.

OUTLINE: This is a multicenter study.

Patients undergo blood sample collection at baseline and at 1 year after initiation of aromatase inhibitor therapy (anastrozole or exemestane). Samples are analyzed for estrogen and testosterone levels and additional hormone levels and growth factors that have been previously linked with breast density and that could be altered by aromatase inhibitor use (i.e., sex hormone-binding globulin \[SHBG\], DHEA, DHEA sulfate, progesterone, prolactin, insulin-like growth factor-1 \[IGF-1\], and insulin-like growth factor binding protein 3 \[IGF BP3\]). Samples are also analyzed for anastrozole and exemestane levels by HPLC. Pharmacogenetic studies are also performed. Haplotype-tagged single nucleotide polymorphisms in genes in the aromatase pathway are examined.

Patients also undergo mammogram at baseline (≤ 6 months prior to study registration) and at 1 year after initiation of aromatase inhibitor therapy.

Conditions

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Breast Cancer

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Group 1

Patients undergo blood sample collection at baseline and at 1 year after initiation of aromatase inhibitor therapy (anastrozole or exemestane). Samples are analyzed for estrogen and testosterone levels and additional hormone levels and growth factors that have been previously linked with breast density and that could be altered by aromatase inhibitor use (i.e., sex hormone-binding globulin \[SHBG\], DHEA, DHEA sulfate, progesterone, prolactin, insulin-like growth factor-1 \[IGF-1\], and insulin-like growth factor binding protein 3 \[IGF BP3\]). Samples are also analyzed for anastrozole and exemestane levels by HPLC. Pharmacogenetic studies are also performed. Haplotype-tagged single nucleotide polymorphisms in genes in the aromatase pathway are examined.

Patients also undergo mammogram at baseline (≤ 6 months prior to study registration) and at 1 year after initiation of aromatase inhibitor therapy.

polymorphism analysis

Intervention Type GENETIC

high performance liquid chromatography

Intervention Type OTHER

laboratory biomarker analysis

Intervention Type OTHER

radiomammography

Intervention Type PROCEDURE

Interventions

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polymorphism analysis

Intervention Type GENETIC

high performance liquid chromatography

Intervention Type OTHER

laboratory biomarker analysis

Intervention Type OTHER

radiomammography

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Must have histologically confirmed invasive breast cancer, as defined by the following TNM staging criteria:

* pT1, pT2, or pT3
* pNx, pN0, pN1, pN2, or pN3\*

* Patients with positive sentinel node biopsies (pN1) must have subsequent axillary dissection to be eligible
* Patients with negative sentinel node biopsies (pN0) do not require axillary surgery for study eligibility
* M0, according to the following radiologic studies:

* Bone scan (required only if alkaline phosphatase is \> 2 x institutional upper limit of normal \[ULN\] and/or there are symptoms of metastatic disease)

* A confirmatory x-ray or other imaging study, such as CT scan or MRI, is required if the results from the bone scan are questionable
* Abdominal ultrasound or CT scan of the abdomen (required only if AST/ALT or alkaline phosphatase is \> 2 x ULN unless the elevation is in the bone fraction)
* Chest x-ray NOTE: \*Only when the sole basis for this classification is the presence of 10 or more involved axillary nodes
* Completely resected disease

* Surgical margins must be clear of invasive carcinoma and ductal carcinoma in situ or lobular carcinoma in situ
* Must have one intact, noncancerous breast with no history of previous breast surgery in that breast (other than a breast biopsy)

* Mammogram of the intact, noncancerous breast required ≤ 6 months prior to study registration (both a craniocaudal \[top down\] and mediolateral oblique view \[side view\] must be available)
* Must be registered on this study ≥ 3 weeks but ≤ 3 months after completion of chemotherapy OR primary surgery\*

* Adjuvant chemotherapy and radiation therapy as prescribed by the local institution is allowed provided patient is registered on this study and hormonal treatment is begun as soon as patient has sufficiently recovered from chemotherapy NOTE: \*Primary surgery is defined as the last surgical procedure to remove invasive or in situ disease
* Planning to receive anastrozole or exemestane for ≥ 1 year for treatment of breast cancer
* Hormone receptor status:

* Estrogen receptor- and/or progesterone receptor-positive (defined as a tumor receptor content of \> 10 fmol/mg protein OR receptor-positive by immunohistochemistry \[ERICA or PgRICA\])

PATIENT CHARACTERISTICS:

* Female
* Postmenopausal, defined by one of the following:

* Age \> 60 years
* Age 45-59 years with spontaneous cessation of menses \> 12 months prior to chemotherapy (if no chemotherapy was given, then prior to study registration)
* Age 45-59 years with cessation of menses for a duration of \< 12 months or secondary to hysterectomy AND an FSH level in the postmenopausal range (or ≥ 34.4 IU/L, if institutional range is not available) prior to chemotherapy (if no chemotherapy was given, then prior to study registration)
* Age 45-59 years with an FSH level in the postmenopausal range according to institutional laboratory standards (or \> 34.4 IU/L, if the institutional range is not available) prior to chemotherapy (if no chemotherapy was given, then prior to study registration)
* Bilateral oophorectomy
* ECOG performance status 0, 1, or 2
* Life expectancy ≥ 5 years

* See Disease Characteristics

Exclusion Criteria

* History of other (non-breast) malignancies, except adequately treated nonmelanoma skin cancer, curatively treated in situ cancer of the cervix, or other curatively treated solid tumors with no evidence of disease for \> 5 years
* Any co-existing medical or psychiatric condition that is likely to interfere with study procedures and/or results

PRIOR CONCURRENT THERAPY:

* Hormone replacement therapy, oral contraceptives, tamoxifen, raloxifene, other selective estrogen-receptor modulators, or gonadotropin releasing-hormone analogues ≤ 6 months prior to the pre-registration mammogram
* Prior treatment with an aromatase inhibitor (e.g., anastrozole, exemestane, letrozole)
* Planned surgery (other than core needle biopsy) to intact non-cancerous breast (e.g., preventive/prophylactic mastectomy)

Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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James N. Ingle, MD

Role: STUDY_CHAIR

Mayo Clinic

Locations

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MBCCOP - Medical College of Georgia Cancer Center

Augusta, Georgia, United States

Site Status

Rush-Copley Cancer Care Center

Aurora, Illinois, United States

Site Status

St. Joseph Medical Center

Bloomington, Illinois, United States

Site Status

Graham Hospital

Canton, Illinois, United States

Site Status

Memorial Hospital

Carthage, Illinois, United States

Site Status

St. Anthony's Memorial Hospital

Effingham, Illinois, United States

Site Status

Eureka Community Hospital

Eureka, Illinois, United States

Site Status

Galesburg Clinic, PC

Galesburg, Illinois, United States

Site Status

Galesburg Cottage Hospital

Galesburg, Illinois, United States

Site Status

Mason District Hospital

Havana, Illinois, United States

Site Status

Hopedale Medical Complex

Hopedale, Illinois, United States

Site Status

Joliet Oncology-Hematology Associates, Limited - West

Joliet, Illinois, United States

Site Status

McDonough District Hospital

Macomb, Illinois, United States

Site Status

Trinity Cancer Center at Trinity Medical Center - 7th Street Campus

Moline, Illinois, United States

Site Status

Moline, Illinois, United States

Site Status

BroMenn Regional Medical Center

Normal, Illinois, United States

Site Status

Community Cancer Center

Normal, Illinois, United States

Site Status

Community Hospital of Ottawa

Ottawa, Illinois, United States

Site Status

Oncology Hematology Associates of Central Illinois, PC - Ottawa

Ottawa, Illinois, United States

Site Status

Cancer Treatment Center at Pekin Hospital

Pekin, Illinois, United States

Site Status

Proctor Hospital

Peoria, Illinois, United States

Site Status

CCOP - Illinois Oncology Research Association

Peoria, Illinois, United States

Site Status

Oncology Hematology Associates of Central Illinois, PC - Peoria

Peoria, Illinois, United States

Site Status

Methodist Medical Center of Illinois

Peoria, Illinois, United States

Site Status

OSF St. Francis Medical Center

Peoria, Illinois, United States

Site Status

Illinois Valley Community Hospital

Peru, Illinois, United States

Site Status

Perry Memorial Hospital

Princeton, Illinois, United States

Site Status

St. Margaret's Hospital

Spring Valley, Illinois, United States

Site Status

Carle Cancer Center at Carle Foundation Hospital

Urbana, Illinois, United States

Site Status

CCOP - Carle Cancer Center

Urbana, Illinois, United States

Site Status

St. Francis Hospital and Health Centers - Beech Grove Campus

Beech Grove, Indiana, United States

Site Status

Saint Anthony Memorial Health Centers

Michigan City, Indiana, United States

Site Status

Reid Hospital & Health Care Services

Richmond, Indiana, United States

Site Status

McFarland Clinic, PC

Ames, Iowa, United States

Site Status

Bettendorf, Iowa, United States

Site Status