Studying Blood Samples From Women With Breast Cancer or Ductal Carcinoma In Situ Who Are Receiving Tamoxifen

NCT ID: NCT00764322

Last Updated: 2017-08-01

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

501 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-06-18

Study Completion Date

2011-07-01

Brief Summary

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RATIONALE: Studying samples of blood from patients with cancer in the laboratory may help doctors learn more about differences in DNA and predict how well patients will respond to treatment and plan better treatment.

PURPOSE: This clinical trial is studying blood samples from women with breast cancer or ductal carcinoma in situ who are receiving tamoxifen.

Detailed Description

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OBJECTIVES:

Primary

* To evaluate the change in endoxifen levels after an increase in tamoxifen citrate dose from 20 mg to 40 mg in women with breast cancer or ductal breast carcinoma in situ with intermediate-metabolizing CYP2D6 genotypes.

Secondary

* To evaluate the tolerability of increasing the dose of tamoxifen citrate from 20 to 40 mg per day in these patients.
* To assess the feasibility of obtaining pharmacogenomic information from patients in the clinical setting and using it to guide changes in therapy.
* To examine CYP2D6 allele frequencies and endoxifen levels among African-American women taking tamoxifen citrate.
* To evaluate the change in plasma endoxifen levels after an increase in the tamoxifen citrate dose from 20 mg to 40 mg daily in patients with poor-metabolizing genotypes.
* To study patient understanding of pharmacogenomics and obstacles to participation in clinical trials based upon germline DNA.

OUTLINE: This is a multicenter study.

Blood samples are collected at baseline to determine CYP2D6 genotype and tamoxifen citrate metabolic status: poor-metabolizing (PM), intermediate-metabolizing (IM), or extensive-metabolizing (EM) alleles. Samples are also analyzed for plasma levels of endoxifen and N-desmethyltamoxifen and for endoxifen/N-desmethyltamoxifen ratio. Patients found to be IM or PM are notified to increased tamoxifen citrate to 40 mg/day for 4 months (in the absence of unacceptable toxicity) with repeat endoxifen and N-desmethyltamoxifen levels (and the ratio) at the end of this time.

All patients complete Quality Of Life (QOL) and Menopausal Symptoms Scale (MSS) questionnaires at baseline and after 4 months of treatment. Toxicities are assessed at the end of 4 months. Patients undergo repeat questionnaire assessment of their understanding of the use of pharmacogenomics in clinical decision-making. Some patients also undergo a 30-minute, baseline interview regarding attitudes and experience towards participation in a pharmacogenomics study.

Patients who choose to be informed of the results of their genotyping are contacted by letter, along with their physicians, and offered genetic counseling to discuss the significance of these results.

After completion of study therapy, patients are followed at 3-6 months, including toxicity assessment and QOL and MSS questionnaires.

Conditions

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Breast Cancer Menopausal Symptoms

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Tamoxifen 20

One arm, containing the ultra-rapid and extensive metabolizer genotypes, continues treatment with tamoxifen at 20mg.

Group Type EXPERIMENTAL

tamoxifen citrate

Intervention Type DRUG

Women found to be IM or PM will undergo increased tamoxifen to 40 mg/day (20 mg bid). Drug is given orally on a daily basis.

gene expression analysis

Intervention Type GENETIC

Genetic analysis of blood sample.

pharmacogenomic studies

Intervention Type OTHER

Genetic analysis of blood sample.

questionnaire administration

Intervention Type OTHER

Questionnaire called the survey of participants. Questionnaires is self administered on paper documents and given pre-study, and at 4 months

quality-of-life assessment

Intervention Type PROCEDURE

Self administration of a multiquestion questionnaire called the Functional Assessment of Cancer Therapy -Breast (FACT-B). Given pre-study, at 4 months and at 8-10 months.

Tamoxifen 40

This arm, containing the intermediate and poor metabolizer genotypes, receives escalated treatment with tamoxifen at 40mg.

Group Type ACTIVE_COMPARATOR

tamoxifen citrate

Intervention Type DRUG

Women found to be IM or PM will undergo increased tamoxifen to 40 mg/day (20 mg bid). Drug is given orally on a daily basis.

gene expression analysis

Intervention Type GENETIC

Genetic analysis of blood sample.

pharmacogenomic studies

Intervention Type OTHER

Genetic analysis of blood sample.

questionnaire administration

Intervention Type OTHER

Questionnaire called the survey of participants. Questionnaires is self administered on paper documents and given pre-study, and at 4 months

quality-of-life assessment

Intervention Type PROCEDURE

Self administration of a multiquestion questionnaire called the Functional Assessment of Cancer Therapy -Breast (FACT-B). Given pre-study, at 4 months and at 8-10 months.

Interventions

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tamoxifen citrate

Women found to be IM or PM will undergo increased tamoxifen to 40 mg/day (20 mg bid). Drug is given orally on a daily basis.

Intervention Type DRUG

gene expression analysis

Genetic analysis of blood sample.

Intervention Type GENETIC

pharmacogenomic studies

Genetic analysis of blood sample.

Intervention Type OTHER

questionnaire administration

Questionnaire called the survey of participants. Questionnaires is self administered on paper documents and given pre-study, and at 4 months

Intervention Type OTHER

quality-of-life assessment

Self administration of a multiquestion questionnaire called the Functional Assessment of Cancer Therapy -Breast (FACT-B). Given pre-study, at 4 months and at 8-10 months.

Intervention Type PROCEDURE

Other Intervention Names

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Nolvadex Soltamox

Eligibility Criteria

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Inclusion Criteria

Histologically confirmed invasive carcinoma of the breast or ductal breast carcinoma in situ Has been receiving tamoxifen citrate at a dose of 20 mg/day for at least 4 months either for the treatment of invasive or non-invasive carcinoma of the breast or for breast cancer recurrence prevention

* Expected duration of tamoxifen citrate treatment at least 6 months Hormone receptor status not specified Concurrent participation in non-treatment studies allowed provided it will not interfere with participation in this study Menopausal status not specified Eastern Cooperative Oncology Group (ECOG) performance status 0-2 Life expectancy ≥ 6 months Absolute Neutrophil Count (ANC) ≥ 1.0 x 10\^9/L Platelet count ≥ 100 x 10\^9/L Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 2.5 times Upper Limit of Normal (ULN) Total bilirubin ≤ 2.5 times ULN Creatinine clearance ≥ 50 mL/min Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

* No limitations to number of prior therapies
* No limitations for prior radiotherapy
* More than 14 days since prior and no other concurrent investigational agent

Exclusion:

Not pregnant or nursing No active, serious infection or medical or psychiatric illness likely to preclude study participation No psychiatric conditions that would preclude study compliance or informed consent No history of venous thromboembolism, transient ischemic attack, or cerebral vascular accident No history of allergic reaction to tamoxifen citrate or any of its reagents No concurrent coumadin

No concurrent medications known to inhibit CYP2D6, including any of the following:

* Amiodarone
* Haloperidol
* Indinavir
* Ritonavir
* Quinidine

No concurrent selective serotonin reuptake inhibitors, except the following:

* Venlafaxine
* Citalopram
Minimum Eligible Age

21 Years

Maximum Eligible Age

120 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

UNC Lineberger Comprehensive Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lisa A. Carey, MD

Role: PRINCIPAL_INVESTIGATOR

UNC Lineberger Comprehensive Cancer Center

William J. Irvin, MD

Role: PRINCIPAL_INVESTIGATOR

Bon Secours Virginia Health System / Bon Secours Cancer Institute

Locations

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Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill

Chapel Hill, North Carolina, United States

Site Status

Blumenthal Cancer Center at Carolinas Medical Center

Charlotte, North Carolina, United States

Site Status

Duke Comprehensive Cancer Center

Durham, North Carolina, United States

Site Status

Moses Cone Regional Cancer Center at Wesley Long Community Hospital

Greensboro, North Carolina, United States

Site Status

Leo W. Jenkins Cancer Center at ECU Medical School

Greenville, North Carolina, United States

Site Status

Rex Cancer Center at Rex Hospital

Raleigh, North Carolina, United States

Site Status

Gibbs Regional Cancer Center at Spartanburg Regional Medical Center

Spartanburg, South Carolina, United States

Site Status

Countries

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United States

Related Links

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https://clinicaltrials.gov/ct2/show/NCT00764322

Clinical trial summary from the National Cancer Institute's PDQ® database

Other Identifiers

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P30CA016086

Identifier Type: NIH

Identifier Source: secondary_id

View Link

08-0483

Identifier Type: OTHER

Identifier Source: secondary_id

LCCC 0801

Identifier Type: -

Identifier Source: org_study_id

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