Intermittent Letrozole Therapy in Postmenopausal Women With Metastatic Breast Cancer

• ClinicalTrials.gov Identifier: NCT00549822
• Recruitment Status: Terminated
• First Posted: October 26, 2007
• Results First Posted: March 22, 2017
• Last Update Posted: March 22, 2017
• Sponsor: Massachusetts General Hospital
• Collaborators: Dana-Farber Cancer Institute; Novartis
• Information provided by (Responsible Party): Paul Goss, MD, PhD, Massachusetts General Hospital

Study Description

Brief Summary:

The purpose of this research study is to study the effects of using aromatase inhibitor (AI) therapy intermittently on participants with breast cancer. AIs are a class of drugs used to treat breast cancer in postmenopausal women. They work by decreasing the level of estrogen, which is believed to stimulate the growth of tumor tissue. Breast cancer that progresses despite therapy with an AI is thought to have become resistant to AI therapy. There is scientific evidence to suggest that resistant breast cancer cells learn to grow at the very low levels of estrogen present on AI therapy, and that increasing estrogen levels even slightly by stopping AI therapy may inhibit the breast cancer cells.

Condition or disease	Intervention/treatment	Phase
Breast Cancer	Drug: Letrozole	Phase 2

Detailed Description:

• This study involves treating participants with intermittent AI therapy. The AI will be stopped at the time they enter the study. We plan on monitoring a marker in the participants blood called CA 15-3 (or CA 27.29) every 4 weeks to help us make a decision of when to re-start treatment with letrozole (femara). This marker is known to rise when disease is progressing and drop when the disease is responding to treatment. We will be stopping and re-starting therapy based on the changes of CA 15-3 in the participants blood.
• In addition to bloodwork, the following tests and procedures will be performed on a monthly basis: medical history; physical examination and performance status.
• Every 8 weeks the following will be performed: Tumor assessment by physical exam (if possible); Chest x-ray or CT scan or chest; CT scans of abdomen and pelvis; and bone scan.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 3 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase II Clinical Trial of Intermittent Letrozole Therapy in Postmenopausal Women With CA 15-3 Positive (Carcinoma Antigen 15-3), Hormone Receptor Positive, Metastatic Breast Cancer
• Actual Study Start Date: October 2007
• Actual Primary Completion Date: May 2010
• Actual Study Completion Date: September 2013

Arms and Interventions

Arm

Intervention/treatment

Experimental: Intermittent letrozole therapy; Letrozole 2.5 mg administered by mouth daily during each 28 day treatment cycle. Treatment is intermittent with possible breaks between each 28 day treatment cycle based on CA 15-3 or CA 27.29 levels. Letrozole is administered until the participant has disease progression as determined by RECIST (Response Evaluation Criteria In Solid Tumors), experiences severe side effects, or decides to stop treatment.

Drug: Letrozole; Treatment is intermittent with possible breaks between each 28 day treatment cycle if CA 15-3 or CA 27.29 level that has decreased by at least 50% of that individual patient's baseline or peak level on firstline letrozole or anastrozole therapy or has decreased into the normal reference range per institutional parameters. Letrozole or anastrozole therapy will be interrupted until CA 15-3 or CA 27.29 levels rise by at least 25% above trough CA 15-3 or CA 27.29 level. If the trough level is in the normal reference range then the CA 15-3 or CA 27.29 must rise into the normal reference range.; Other Name: Femara

Outcome Measures

Primary Outcome Measures :

1. Number of Patients With Decline in Serum CA 15-3 (Carcinoma Antigen 15-3) [ Time Frame: 3 years ]
   The Number of patients that have have a response of a decrease in CA 15-3 or CA 27.29 levels by at least 50% of that individual patient's baseline or peak level after re-introducing Letrozole therapy following a break in therapy as described in the intervention.

Secondary Outcome Measures :

1. Median Time to Disease Progression With Intermittent Letrozole. [ Time Frame: 3 years ]
   The median time to disease progression as determined by RECIST (Response Evaluation Criteria In Solid Tumors).
2. Serum HER-2/Neu Levels and Serum/Plasma Angiogenic Mediators [ Time Frame: 2 years ]
   Measurements for the serum HER-2/neu (human epidermal growth factor receptor 2) levels and serum/plasma angiogenic mediators

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Female
• 18 years of age or older
• Postmenopausal
• Histologically or cytologically confirmed adenocarcinoma of the breast with locally advanced or metastatic disease this is not considered amenable to curative treatment with elevation of CA 15-3 documented at the time of diagnosis of metastatic disease and prior to initiation of letrozole or anastrozole therapy
• Current letrozole or anastrozole monotherapy with a documented CA 15-3 level that has decreased by at least 50% of the patients baseline
• Letrozole or anastrozole must be discontinued at the time of study enrollment
• Evidence of hormone sensitivity of primary or secondary tissue.
• Measurable or nonmeasurable (but evaluable-defined as nontarget lesions) disease according to modified RECIST
• Prior antiestrogen therapies including tamoxifen, steroidal AIs, nonsteroidal AIs, or fulvestrant in the adjuvant setting is allowed provided the patient is currently on letrozole or anastrozole monotherapy as first-line therapy for metastatic disease
• Life expectancy of greater than 3 months
• ECOG (Eastern Cooperative Oncology Group) Performance Status of 0,1, or 2
• Normal organ and marrow function as outlined in protocol

Exclusion Criteria:

• Premenopausal
• Trastuzumab or biologic therapy within 2 weeks
• Prior or planned radiation therapy to a site of evaluable disease in the event that the site is the only site of evaluable disease
• Concomitant anticancer treatments including trastuzumab, chemotherapy, or other biologic agents other than letrozole or anastrozole therapy
• Chronic bisphosphonates for hypercalcemia or prevention of bone metastases.
• Treatment with non-approved or investigational agent within 2 weeks before study entry
• Presence of life-threatening metastatic disease, defined as extensive hepatic involvement, or past or present brain or leptomeningeal involvement, or symptomatic pulmonary lymphangitic spread
• Patients who are highly symptomatic from their breast cancer, or who require urgent palliative chemotherapy, as decided by their treating physician
• Previous or current systemic malignancy within the past five years, except for contralateral breast carcinoma, in situ carcinoma of the cervix treated by cone biopsy, or adequately treated basal or squamous cell carcinoma of the skin.
• Any severe concomitant condition believed to render subject undesirable for participation

Contacts and Locations

Locations

United States, Massachusetts

Dana-Farber Cancer Institute

Boston, Massachusetts, United States, 02115

Massachusetts General Hospital

Boston, Massachusetts, United States, 02215

Sponsors and Collaborators

Massachusetts General Hospital

Dana-Farber Cancer Institute

Novartis

Investigators

• Principal Investigator: Paul Goss, MD, PhD; Massachusetts General Hospital

More Information

• Responsible Party: Paul Goss, MD, PhD, Professor of Medicine, Harvard Medical School, Massachusetts General Hospital
• ClinicalTrials.gov Identifier: NCT00549822
• Other Study ID Numbers: 07-109
• First Posted: October 26, 2007
• Results First Posted: March 22, 2017
• Last Update Posted: March 22, 2017
• Last Verified: February 2017

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Keywords provided by Paul Goss, MD, PhD, Massachusetts General Hospital:

aromatase inhibitor; CA 15-3; Hormone receptor positive

Additional relevant MeSH terms:

Breast Neoplasms; Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases; Letrozole; Antineoplastic Agents; Aromatase Inhibitors; Steroid Synthesis Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Estrogen Antagonists; Hormone Antagonists; Hormones, Hormone Substitutes, and Hormone Antagonists; Physiological Effects of Drugs