Higher Dose Preoperative taMOxifen in Premenopausal bREast Cancer Patients

NCT ID: NCT04997941

Last Updated: 2024-04-23

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

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

238 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-21

Study Completion Date

2028-12-31

Brief Summary

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MORE-T trial is designed to investigate the effect of Tamoxifen 40mg (vs. Tamoxifen 20mg) for 2wks in presurgical setting.

The greater reduction in Ki-67 might be observed in Tamoxifen 40mg arm compared to the Tamoxifen 20mg arm.

Open Label, Phase 2, Randomized with 1:1 allocation

Detailed Description

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Tamoxifen

* Selective estrogen receptor modulator
* It has been the main endocrine treatment for decades
* Tamoxifen is a major endocrine treatment option, particularly for women who still have a significant ovarian estrogenic activity that cannot be controlled by aromatase inhibitors.
* The prospective clinical trials have shown that tamoxifen 20mg has comparable efficacy against tamoxifen 40mg with fewer toxicities in breast cancer patients. However, most of the trials comparing tamoxifen 20mg and 40mg were done in postmenopausal women.
* Previous studies have suggested that the higher dose of tamoxifen can induce higher serum levels of the drugs, and increasing tamoxifen dose up to 40mg can induce clinical responses in tumors resistant to 20mg of tamoxifen. A recent prospective trial demonstrated that increasing the dose of tamoxifen from 20 mg to 40 mg can compensate for the reduced endoxifen level in intermediate or poor metabolizer tamoxifen metabolizers based on CYP2D6 genotyping.

Ki-67

* Ki-67 antigen, a nuclear antigen, and marker of cell proliferation, is expressed during all cell-cycle phases except for G0, with levels peaking during mitosis.
* Reduction in Ki67 expression is reported to correlate with treatment response to endocrine therapy in ER+ breast cancer, and Ki-67 in short-term neoadjuvant studies has been shown to predict outcome in long-term adjuvant trials.

As the investigators have a higher proportion of young aged, premenopausal breast cancer patients in Korea, the investigators had an opportunity to examine the prognostic impact of young age in breast cancer recurrences and survivals. The institutional database and the Korean nationwide breast cancer registry data have all shown that the poor prognostic effect of a young age was exclusively seen in women with hormone receptor-positive breast cancers, and the effect was potentially due to the resistance to the tamoxifen. As therapeutic options diversify, studies on factors predictive of sensitivity to various endocrine therapies are needed to help select the appropriate treatment for young premenopausal breast cancer patients.

Conditions

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Premenopausal Breast Cancer Hormone Receptor-positive Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Tamoxifen 40mg

Tamoxifen 20mg b.i.d - Participants will be treated for 14 days.

Group Type EXPERIMENTAL

Tamoxifen Oral Product

Intervention Type DRUG

Experimental arm will have tamoxifen 40mg and active comparator arm will have tamoxifen 20mg for 14 days.

Assessment of Ki-67

Intervention Type DIAGNOSTIC_TEST

Paired biopsies (before and after tamoxifen therapy) will be required for the assessment of Ki-67.

Surgery

Intervention Type PROCEDURE

The surgery date should be fixed before randomization. The surgery is to be performed within 1 day after the last dose of study treatment.

Tamoxifen 20mg

Tamoxifen 10mg b.i.d - Participants will be treated for 14 days.

Group Type ACTIVE_COMPARATOR

Tamoxifen Oral Product

Intervention Type DRUG

Experimental arm will have tamoxifen 40mg and active comparator arm will have tamoxifen 20mg for 14 days.

Assessment of Ki-67

Intervention Type DIAGNOSTIC_TEST

Paired biopsies (before and after tamoxifen therapy) will be required for the assessment of Ki-67.

Surgery

Intervention Type PROCEDURE

The surgery date should be fixed before randomization. The surgery is to be performed within 1 day after the last dose of study treatment.

Interventions

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Tamoxifen Oral Product

Experimental arm will have tamoxifen 40mg and active comparator arm will have tamoxifen 20mg for 14 days.

Intervention Type DRUG

Assessment of Ki-67

Paired biopsies (before and after tamoxifen therapy) will be required for the assessment of Ki-67.

Intervention Type DIAGNOSTIC_TEST

Surgery

The surgery date should be fixed before randomization. The surgery is to be performed within 1 day after the last dose of study treatment.

Intervention Type PROCEDURE

Other Intervention Names

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Tamoxifen 40mg vs. 20mg

Eligibility Criteria

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Inclusion Criteria

1. Histopathologically and immunohistochemically confirmed ER+ and HER2- Premenopausal BC patients
2. Tumor size \>0.5cm on USG
3. Stage I-IIIA BC and planned curative surgery
4. ECOG 0-2
5. Patients with adequate bone marrow function

\- Hemoglobin \> 10 g/dL, Plt \> 100,000/mm3
6. Patients with adequate kidney function

\- serum Cr ≤ 1.4 mg/dL
7. Patients with adequate liver function

* Bilirubin: ≤ 1.5 times of upper normal limit
* AST/ALT: ≤ 1.5 times of upper normal limit
* Alkaline phosphatase: ≤ 1.8 times of upper normal limit
8. Patients who decided to voluntarily participate in this trial with written informed consent
9. Premenopausal women : women who has not removed both ovaries, women who had menses in recent 1 year and FSH level is less than 30mIU/ml

Exclusion Criteria

1. Previous history of ipsilateral invasive breast cancer, in situ lesion
2. Previous history of chemotherapy or endocrine therapy on contralateral BC for the past 2 years
3. Patients who has distant metastasis
4. Patients who is pregnant or breastfeeding
5. Hormon receptor negative BC
6. Her-2 positive BC
7. Diagnosed pituitary adenoma
8. Women who has endometriosis, unknown vaginal bleeding
9. Inability to understand and willingness to sign a written informed consent
10. Patients with endometriosis or unexplained vaginal bleeding
11. Patients with a history of bleeding constitution, coagulopathy, or thromboembolism
12. Patients who have administered a CYP3A inhibitor or inducer, CYP2D6 inhibitor, etc. within 4 weeks prior to randomization
Minimum Eligible Age

20 Years

Maximum Eligible Age

48 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Seoul National University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Hyeong-Gon Moon

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hyeong-Gon Moon

Role: PRINCIPAL_INVESTIGATOR

Seoul National University Hospital

Locations

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Seoul National University Hospital

Seoul, , South Korea

Site Status

Countries

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South Korea

Other Identifiers

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MORE-T trial

Identifier Type: -

Identifier Source: org_study_id

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