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GCC 1366: Anti-Proliferative Response to NeoAdjuvant AIs in Overweight and Obese Patients

This study is currently recruiting participants.
Verified September 2017 by Emily Bellavance, University of Maryland
Sponsor:
ClinicalTrials.gov Identifier:
NCT02095184
First Posted: March 24, 2014
Last Update Posted: September 5, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
Information provided by (Responsible Party):
Emily Bellavance, University of Maryland
  Purpose

More than three quarter of patients with breast cancer are treated by hormone pills called tamoxifen and aromatase inhibitors (AIs). AIs are drugs that stop female hormone production. This hormone production mostly happens in fat, muscle, and breast tissue in postmenopausal women. The female hormone estrogen is an important hormone for the growth of breast cancer cells. Anastrozole (Arimidex®) and Letrozole (Femara®) are AIs that are approved by the Food and Drug Administration (FDA). They have been used since 2005 to treat women with early stage breast cancer.

When given before surgery (neoadjuvant), both anastrozole and letrozole have been shown to successfully shrink breast cancer tumors in most patients. In over 50% of patients, anastrozole and letrozole when given for about 4 months also helped to improve surgery outcomes. On top of that, whether or not a patient responds to anastrozole and letrozole before surgery can help the doctor decide whether that patient needs additional chemotherapy.

One of the things may influence the level of hormone is body weight. It has been previously shown that postmenopausal women with higher body fat have higher level of female hormone as well as an increased risk of breast cancer. This is likely due to an increase in aromatase activity in the fatty tissue. However, at the current time AIs are used at the same doses in all women with breast cancer no matter whether they have different body weight. Currently, we do not know for certain whether the same doses of AIs work as well in patients with higher body fat compared to patients with less body fat.

The purpose of this study is to see if women with higher body fat respond differently to AI treatment compared to women with lower body fat.


Condition Intervention
Breast Cancer Drug: Anastrozole Drug: Letrozole

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: GCC 1366: A Prospective Study of Neoadjuvant Non-Steroidal Aromatase Inhibitors to Evaluate Anti-Proliferative Response in Obese and Overweight Patients

Resource links provided by NLM:


Further study details as provided by Emily Bellavance, University of Maryland:

Primary Outcome Measures:
  • Percent change in proliferative index (Ki67) after treatment with the standard dose anastrozole or letrozole in normal, obese, and overweight patients [ Time Frame: 2-4 weeks Post-treatment ]
    Core biopsy


Secondary Outcome Measures:
  • To evaluate differences in baseline GP88 level [ Time Frame: B,0-Prior to starting anastrozole or letrozole ]
    GP88-6ml Blood Serum Sample

  • To evaluate differences in baseline GP88 level [ Time Frame: B,1-On the day of surgery or within 3 days of surgery ]
    GP88-6ml Blood Serum Sample

  • To evaluate differences in baseline GP88 level [ Time Frame: B,2-obtained 2-4 weeks after initiation of AI therapy( for persons rec. extended neoadjuvant tx) ]
    GP88-6ml Blood Serum Sample

  • To assess estradiol levels at baseline and after treatment (in primary ER positive breast tumors) [ Time Frame: Baseline ]
    10ml Blood Serum Sample

  • To assess estradiol levels at baseline and after treatment (in primary ER positive breast tumors) [ Time Frame: 2-4 weeks Post treatment ]
    10ml Blood Serum Sample

  • To evaluate the association of AI-induced Ki67 response [ Time Frame: Baseline ]
    (IHC)--Immunohistochemistry

  • To evaluate the association of AI-induced Ki67 response [ Time Frame: 2-4 weeks Post-Treatment ]
    (IHC)--Immunohistochemistry

  • To evaluate differences in Oncotype Dx [ Time Frame: Baseline(T0) ]
    Tumor Tissue Assay

  • To evaluate differences in Oncotype Dx [ Time Frame: 2-4 Post-treatment ]
    Tumor Tissue Assay


Other Outcome Measures:
  • Metabolomic Profiling [ Time Frame: B-0 ]
    10ml Blood Serum Sample

  • Metabolomic Profiling [ Time Frame: B-1 ]
    10ml Blood Serum Sample

  • Metabolomic Profiling [ Time Frame: B-2 ]
    10ml Blood Serum Sample


Estimated Enrollment: 90
Study Start Date: May 25, 2015
Estimated Study Completion Date: March 2019
Estimated Primary Completion Date: March 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Cohort 1: Normal Weight Anastrozole
Cohort 1: Patients with BMI < 25.0 kg/m2 treated with anastrozole
Drug: Anastrozole
1 mg daily
Other Name: Arimidex
Active Comparator: Cohort 2: Overweight Anastrozole
Cohort 2: Patients with BMI ≥ 25.0-29.9 kg/m2 treated with anastrozole
Drug: Anastrozole
1 mg daily
Other Name: Arimidex
Active Comparator: Cohort 3: Obese
Cohort 3: Patients with BMI ≥ 30 kg/m2 treated with anastrozole
Drug: Anastrozole
1 mg daily
Other Name: Arimidex
Active Comparator: Cohort 4: Normal Weight Letrozole
Cohort 4: Patients with BMI < 25.0 kg/m2 treating with letrozole
Drug: Letrozole
2.5 mg daily
Other Name: Femara
Active Comparator: Cohort 5: Overweight Letrozole
Cohort 5: Patients with BMI ≥ 25.0-29.9 kg/m2 treating with letrozole
Drug: Letrozole
2.5 mg daily
Other Name: Femara
Active Comparator: Cohort 6: Obese Letrozole
Cohort 6: Patients with BMI ≥ 30 kg/m2 treating with letrozole
Drug: Letrozole
2.5 mg daily
Other Name: Femara

  Show Detailed Description

  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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

Inclusion Criteria:

  1. Female greater than or equal to 18 years.
  2. Postmenopausal status, defined by no menstrual cycle for 12 months or surgical removal of ovaries.
  3. Histologically confirmed adenocarcinoma of the breast.
  4. Evidence of hormone sensitive, ER rich primary tumor defined by an Allred score of ≥6.
  5. Human estrogen receptor -2 (HER2) negative in the primary tumor tissue as defined by:

    1. Grade 0 or 1+ staining intensity (on a scale of 0 to 3) by means of IHC analysis OR
    2. Grade 2+ staining intensity by means of immuno-histochemical (IHC) analysis with gene amplification on fluorescence in situ hybridization (FISH) < 2.0 OR
    3. Gene amplification on fluorescence in situ hybridization (FISH) < 2.0.
  6. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 3
  7. Unresected operable breast cancer stage I-III with primary tumor ≥ 2.0 cm.
  8. Ability to understand and the willingness to sign a written informed consent document.
  9. Patients must not have received any prior chemotherapy, radiation therapy, or endocrine therapy for their current breast cancer. Patients who received tamoxifen or raloxifene or another agent for prevention of breast cancer may be included as long as the patient has discontinued the treatment at least one month prior to baseline study biopsy.
  10. Patients must have an adequate tumor tissue sample prior to enrollment available for correlative studies as defined below: Core needle biopsy or incisional biopsy samples that can provide ≥ 5 unstained sections of 5 micron thickness. Fine needle aspiration (FNA) sample alone is not sufficient.
  11. Patients must have adequate organ function as defined below:

    1. Total bilirubin within normal institutional limits
    2. aspartate aminotransferase (AST)(SGOT)/alanine aminotransferase (ALT)(SGPT) < 2.5 x institutional upper limit of normal
    3. Creatinine clearance ≥ 10 mL/min/1.73 m2

Exclusion Criteria:

  1. Previous or current systemic malignancy within the past 3 years other than breast cancer or adequately treated cervical carcinoma in situ or basal/squamous carcinoma of the skin.
  2. Patients may not be receiving any other investigational agent.
  3. History of allergic reactions or hypersensitivity to compounds of similar chemical or biologic composition to anastrozole or letrozole.
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02095184


Contacts
Contact: Emily C Bellavance, MD 410-328-7320 ebellavance@som.umaryland.edu

Locations
United States, Maryland
University of Maryland Greenebaum Cancer Center Recruiting
Baltimore, Maryland, United States, 21201
Contact: Nancy Tait, R.N.    410-328-3546    ntait@umm.edu   
Principal Investigator: Susan Kesmodel, M.D.         
Sponsors and Collaborators
University of Maryland
Investigators
Principal Investigator: Emily C Bellavance, M.D. University of Maryland
  More Information

Responsible Party: Emily Bellavance, Assistant Professor of Medicine, University of Maryland
ClinicalTrials.gov Identifier: NCT02095184     History of Changes
Other Study ID Numbers: HP-00060250
First Submitted: March 20, 2014
First Posted: March 24, 2014
Last Update Posted: September 5, 2017
Last Verified: September 2017

Keywords provided by Emily Bellavance, University of Maryland:
Breast Cancer
Postmenopausal
Hormone-Receptor Positive

Additional relevant MeSH terms:
Overweight
Body Weight
Signs and Symptoms
Letrozole
Anastrozole
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
Antineoplastic Agents, Hormonal