Endocrine Therapy in Treating Patients With HER2 Negative, Low Risk Breast Cancer

NCT ID: NCT03238703

Last Updated: 2018-12-27

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

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-01

Study Completion Date

2025-03-14

Brief Summary

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This pilot clinical trial studies how well endocrine therapy works in treating patients with HER2 negative, low risk breast cancer. Estrogen can cause the growth of breast cancer cells. Endocrine therapies such as aromatase inhibitors and selective estrogen receptor modulators may lessen the amount of estrogen made by the body.

Detailed Description

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PRIMARY OBJECTIVES:

I. To estimate the conversion rate from a standard low-toxicity approach to guideline-directed therapy which includes surgery +/- radiation therapy as a result of progression of disease or patient/provider choice.

II. To examine factors that might differ between those who convert from the low-toxicity approach to the guideline-directed therapy and those do not convert.

SECONDARY OBJECTIVES:

I. To measure the safety and clinical effectiveness of systemic endocrine therapy used in a prolonged neoadjuvant fashion.

II. To evaluate the impact of risk-stratified care in Quality-Adjusted Life Years (QALY) and QALY gains.

III. To estimate the cost savings of indefinitely delaying surgery and radiation in favor of systemic endocrine therapy alone.

OUTLINE:

Patients receive exemestane orally (PO) once daily (QD), anastrozole PO QD, letrozole PO QD, tamoxifen citrate PO QD, or toremifene citrate PO QD at the discretion of the treating physician. Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically.

Conditions

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HER2/Neu Negative Invasive Breast Carcinoma Postmenopausal Stage 0 Breast Cancer Stage IA Breast Cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Treatment (AI, SERM)

Patients receive exemestane PO QD, anastrozole PO QD, letrozole PO QD, tamoxifen citrate PO QD, or toremifene citrate PO QD at the discretion of the treating physician. Treatment continues in the absence of disease progression or unacceptable toxicity.

Group Type EXPERIMENTAL

Anastrozole

Intervention Type DRUG

Given PO

Exemestane

Intervention Type DRUG

Given PO

Laboratory Biomarker Analysis

Intervention Type OTHER

Correlative studies

Letrozole

Intervention Type DRUG

Given PO

Quality-of-Life Assessment

Intervention Type OTHER

Ancillary studies

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Tamoxifen Citrate

Intervention Type DRUG

Given PO

Toremifene Citrate

Intervention Type DRUG

Given PO

Interventions

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Anastrozole

Given PO

Intervention Type DRUG

Exemestane

Given PO

Intervention Type DRUG

Laboratory Biomarker Analysis

Correlative studies

Intervention Type OTHER

Letrozole

Given PO

Intervention Type DRUG

Quality-of-Life Assessment

Ancillary studies

Intervention Type OTHER

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Tamoxifen Citrate

Given PO

Intervention Type DRUG

Toremifene Citrate

Given PO

Intervention Type DRUG

Other Intervention Names

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Anastrazole Arimidex ICI D1033 ICI-D1033 ZD-1033 Aromasin FCE-24304 CGS 20267 Femara Quality of Life Assessment Apo-Tamox Clonoxifen Dignotamoxi Ebefen Emblon Estroxyn Fentamox Gen-Tamoxifen Genox ICI 46,474 ICI-46474 Jenoxifen Kessar Ledertam Lesporene Nolgen Noltam Nolvadex Nolvadex-D Nourytam Novo-Tamoxifen Novofen Noxitem Oestrifen Oncotam PMS-Tamoxifen Soltamox TAM Tamax Tamaxin Tamifen Tamizam Tamofen Tamoxasta Tamoxifeni Citras Zemide Acapodene Fareston FC-1157a GTx-006

Eligibility Criteria

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Inclusion Criteria

* Able to provide written informed consent
* A diagnosis of invasive breast cancer, with or without an in situ component, that is:

* Originally identified by screening mammography
* Characterized by standard diagnostic mammography +/- breast ultrasound
* Clinically node negative
* Confirmed by breast magnetic resonance imaging (MRI) in a facility that maintains active American College of Radiology (ACR) accreditation to be of low clinical stage (=\< 2 cm, node negative, unifocal invasive)
* Estrogen receptor (ER) and progesterone receptor (PR) Allred scored, each \> 5/8
* Her2 negative using American Society of Clinical Oncology (ASCO)-College of American Pathologists (CAP) guidelines
* ki-67 proliferation scored, \< 20%
* Clinical Nottingham grade 1 or 2
* Scored on the MammaPrint 70-gene breast cancer recurrence assay as low risk
* Prior to the discovery of the breast cancer, clinically post-menopausal as defined as: i) one or more years from last menses; or ii) history of oophorectomy; or iii) follicle stimulating hormone (FSH) test result in the post-menopause reference range
* Willing to accept oral endocrine therapy with a third generation aromatase inhibitor (AI) or selective estrogen receptor modifier (SERM)
* Willing to undergo routine surveillance with breast ultrasound and/or mammography

Exclusion Criteria

* Known contraindication to aromatase inhibitor or SERM therapy
* Pregnant at time of or within prior year of diagnosis
* Clinically detected or palpable disease prior to biopsy in either breast or ipsilateral axilla
* Prior history of invasive breast cancer or ductal breast carcinoma in situ (DCIS)
* Prior use of aromatase inhibitor therapy apart from assisted reproduction
* Prior use of SERM
* Unmanaged/uncontrolled mental health disorder
* Life expectancy \< 6 months (m) for any cause
* Biopsy confirmed multifocal, multicentric, or contralateral disease that is invasive or non-invasive
* DCIS with focal invasion
Minimum Eligible Age

60 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Fred Hutchinson Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Vijayakrishna Gadi

Role: PRINCIPAL_INVESTIGATOR

Fred Hutch/University of Washington Cancer Consortium

Locations

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Fred Hutch/University of Washington Cancer Consortium

Seattle, Washington, United States

Site Status

Countries

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United States

Other Identifiers

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NCI-2017-00724

Identifier Type: REGISTRY

Identifier Source: secondary_id

9764

Identifier Type: OTHER

Identifier Source: secondary_id

P30CA015704

Identifier Type: NIH

Identifier Source: secondary_id

View Link

9764

Identifier Type: -

Identifier Source: org_study_id