Study of the Efficacy of Chloroquine in the Treatment of Ductal Carcinoma in Situ (The PINC Trial)
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Purpose
The purpose of this study is to test the hypothesis that chloroquine will reduce the ability of ductal carcinoma in situ (DCIS) to survive and spread. Participants will receive either chloroquine standard dose (500mg/week) or chloroquine low dose (250mg/week) for 1 month prior to surgical removal of the tumor.
| Condition | Intervention | Phase |
|---|---|---|
|
Carcinoma, Intraductal, Noninfiltrating DCIS Ductal Carcinoma In Situ |
Drug: Chloroquine Standard Dose (500mg/week) Drug: Chloroquine Low Dose (250mg/week) Procedure: Breast Biopsy |
Phase 1 Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Preventing Invasive Breast Neoplasia With Chloroquine (PINC) Trial |
- Tumor response evaluated by RECIST criteria as measured by breast MRI. [ Time Frame: Immediately preceding study drug treatment and again after treatment prior to surgery. ] [ Designated as safety issue: No ]
- Evaluate the safety and dosing efficacy of chloroquine in the treatment of patients with DCIS. [ Time Frame: Continually ] [ Designated as safety issue: Yes ]
- Evaluate the effect of therapy on the progenitor cell yield and invasive capacity ex vivo. [ Time Frame: At the time of breast biopsy and again at time of surgery. ] [ Designated as safety issue: No ]
- Evaluate the effect of treatment on the proteomic and molecular cytogenetic profiles of the DCIS lesions. [ Time Frame: At the time of breast biopsy and again at the time of surgery. ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 90 |
| Study Start Date: | December 2009 |
| Estimated Study Completion Date: | December 2013 |
| Estimated Primary Completion Date: | December 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Chloroquine Standard Dose (500mg/week)
Patients with ER+ or ER- DCIS regardless of histologic grade will be randomly assigned to receive one month standard dose chloroquine (500 mg/week).
|
Drug: Chloroquine Standard Dose (500mg/week)
Patients will receive chloroquine (500 mg/once a week) for 1 month prior to surgical removal of the DCIS lesion.
Other Name: Aralen
Procedure: Breast Biopsy
Patients diagnosed with DCIS will undergo a breast biopsy prior to the start of study treatment. This biopsy is entirely voluntary and is not required to remain in the study. The biopsy will allow researchers to study the tissue for biomarkers and to determine how the DCIS tissue changes during treatment. Additional samples of the DCIS tissue will be collected at the time of surgery.
Other Names:
|
|
Experimental: Chloroquine Low Dose (250mg/week)
Patients with ER+ or ER- DCIS regardless of histologic grade will be randomly assigned to receive one month low dose chloroquine (250mg/week).
|
Drug: Chloroquine Low Dose (250mg/week)
Patients will receive chloroquine (250 mg/once a week) for 1 month prior to surgical removal of the DCIS lesion.
Other Name: Aralen
Procedure: Breast Biopsy
Patients diagnosed with DCIS will undergo a breast biopsy prior to the start of study treatment. This biopsy is entirely voluntary and is not required to remain in the study. The biopsy will allow researchers to study the tissue for biomarkers and to determine how the DCIS tissue changes during treatment. Additional samples of the DCIS tissue will be collected at the time of surgery.
Other Names:
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Detailed Description:
The purpose of this study is to test the hypothesis that inhibiting the autophagy pathway in DCIS will reduce the capacity of DCIS to survive and invade. The study will examine the safety and effectiveness of neoadjuvant chloroquine administration for a one month period to patients with low, intermediate grade, or high grade DCIS. We will evaluate whether this treatment will reduce the capacity of DCIS neoplastic cells, existing within the duct, to survive, induce lesion regression, and kill the invasive DCIS progenitor cells.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients must have a tissue diagnosis of low, intermediate or high grade ductal carcinoma in situ or ductal carcinoma in situ with microinvasion.
- Patients with ductal carcinoma in situ undergoing either lumpectomy/radiation or mastectomy.
- Patients must be female at least 18 years of age.
- Patients must have a signed tissue acquisition consent and have at minimum, adequate samples of primary fresh tissue or blood available for use in this study.
- No history of a previous invasive cancer in the last five years with the exception of minimally invasive non-melanoma skin cancer.
- Normal liver function based on Liver Function Tests (Total Bilirubin and AST <1.5 X Upper Limit of Normal).
- Normal WBC (3.5-10.8 x 103µL), PLT (140-400 x 103µL), and HCT (37-52%)
- Potassium within the normal range of 3.5-5.3 mEq/L
- Adequate renal sufficiency (serum creatinine <1.5 mg/dL).
- ECOG performance status 0-2.
- Are able to swallow and retain oral medication.
- No underlying ocular/retinal pathology.
- No medically documented preexisting auditory damage.
- Subjects should be willing to abstain from use of hormonal therapies (e.g. hormone replacement therapy, oral contraceptive pills, hormone-containing IUDs, and E-string) and chronic NSAID's for the duration of the study (chronic use of NSAID's is defined as a frequency >3 times/week for more than two weeks per year and includes low dose aspirin).
- Subjects with child-bearing potential must agree to use adequate contraception (total abstinence (no sexual intercourse), use of condom with spermicide or sterilization surgery, including tubal ligation (tubes tied) or hysterectomy (removal of the uterus or womb)) prior to study entry and for the duration of study treatment phase. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately.
If a subject is of child-bearing potential (women are considered not of child-bearing potential if they are at least one year postmenopausal and/or surgically sterile), she must have a documented negative serum or urine pregnancy test before starting treatment.
Exclusion Criteria:
- Patients with a prior history of chemotherapy, hormonal ablation therapy and/or radiation therapy.
- History of other invasive cancer in the previous 5 years other than minimally invasive non-melanoma skin cancer.
- Patient desires not to participate in the study.
- Inability to consent.
- Current or recent pregnancy (within 12 months),
- Current use of hormone-containing forms of birth control such as implants (i.e. Norplants, or injectables ( i.e. depo-provera)
- Currently lactating.
- Patients with history of renal or hepatic insufficiency.
- Current diagnosis for depression, including treatment with an SSRI.
- History of prior treatment with chloroquine for malaria within past 24 months.
- History of allergic reactions to quinalones or chloroquine.
- Active diagnosis of psoriasis or currently receiving treatment for psoriasis.
- History of porphyria.
- History of known Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency.
- Alcoholism or hepatic disease.
- History of epilepsy or seizures in the past 20 years.
- History of deep vein thrombosis or pulmonary embolism.
- History of HIV disease and/or treatment with anti-HIV agents.
- Receiving concurrent treatment with prohibited medications (refer to Table 1 for details on prohibited medications); Examples include: ampicillin, antacids, cimetidine, cyclosporine, kaolin, magnesium trisilicate, coumarin-type anticoagulants, macrolide antibiotics (e.g., clarithromycin, isoniazid, and erythromycin), anti-HIV agents (e.g., ritonavir and delavirdine), antidepressants (e.g. fluoxetine and fluvoxamine), calcium channel blockers (e.g. verapamil and diltiazem), steroids and their modulators (e.g., gestodene, raloxifene, and mifepristone), and several herbal and dietary components (e.g. bergamottin and glabridin).
- Used an investigational drug within 30 days or 5 half-lives, whichever is longer, preceding the first dose of study medication.
Contacts and Locations| Contact: Emil Kamar, BA | 703-776-3565 | Emil.Kamar@inova.org |
| Contact: Kirsten Edmiston, MD, FACS | 703-776-8675 | Kirsten.Edmiston@inova.org |
| United States, Virginia | |
| Virginia Cancer Specialists, PC | Recruiting |
| Fairfax, Virginia, United States, 22031 | |
| Sub-Investigator: Nicholas Robert, MD | |
| Medical Oncology and Hematology Associates of Northern Virginia | Recruiting |
| Fairfax, Virginia, United States, 22031 | |
| Sub-Investigator: Mary Wilkinson, MD | |
| Virginia Surgery Associates | Recruiting |
| Fairfax, Virginia, United States, 22033 | |
| Principal Investigator: Kirsten Edmiston, MD | |
| Inova Fairfax Hospital | Recruiting |
| Falls Church, Virginia, United States, 22042 | |
| Contact: Emil Kamar, BA 703-776-3565 emil.kamar@inova.org | |
| Principal Investigator: Kirsten Edmiston, MD | |
| Principal Investigator: | Kirsten H Edmiston, MD, FACS | Inova Fairfax Hospital Cancer Center |
More Information
No publications provided by Inova Health Care Services
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Inova Health Care Services |
| ClinicalTrials.gov Identifier: | NCT01023477 History of Changes |
| Other Study ID Numbers: | IFHCC 09-002 |
| Study First Received: | December 1, 2009 |
| Last Updated: | March 25, 2013 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Inova Health Care Services:
|
Ductal Carcinoma In Situ Carcinoma, Intraductal, Noninfiltrating DCIS Carcinoma, Intraductal Breast Cancer Breast Tumors chloroquine |
autophagy Autophagic Cell Death Autophagocytosis Programmed Cell Death, Type II Autophagy, Cellular Autophagic Programmed Cell Death |
Additional relevant MeSH terms:
|
Carcinoma, Ductal, Breast Carcinoma Carcinoma in Situ Carcinoma, Intraductal, Noninfiltrating Carcinoma, Ductal Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Adenocarcinoma Neoplasms, Ductal, Lobular, and Medullary Breast Neoplasms Neoplasms by Site Breast Diseases Skin Diseases Chloroquine |
Chloroquine diphosphate Amebicides Antiprotozoal Agents Antiparasitic Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Antimalarials Antirheumatic Agents Anti-Inflammatory Agents, Non-Steroidal Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs |
ClinicalTrials.gov processed this record on May 19, 2013