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AR-inhibitor Bicalutamide in Treating Patients With TNBC (Arbre)

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified January 2015 by Xiaoxiang Guan, Jinling Hospital, China.
Recruitment status was:  Not yet recruiting
Sponsor:
ClinicalTrials.gov Identifier:
NCT02353988
First Posted: February 3, 2015
Last Update Posted: February 3, 2015
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. Read our disclaimer for details.
Collaborators:
Wenzhou Medical University
The First People's Hospital of Lianyungang
Wuxi People's Hospital
Nanning Second People's Hospital
Jiangsu Province Hospital of Traditional Chinese Medicine
The Second Hospital of Nanjing Medical University
Information provided by (Responsible Party):
Xiaoxiang Guan, Jinling Hospital, China
  Purpose
Growing studies demonstrated that Androgen Receptor (AR) has an oncogenic role for the patients with AR-positive Triple Negative Breast Cancer (TNBC). AR antagonists in therapy, such as bicalutamide, completely binds to the AR, increasing AR degradation, thus are investigated for the efficacy of the treatment of patients with AR-positive TNBC in the study.

Condition Intervention Phase
Breast Neoplasms Drug: Bicalutamide Other: Physician's Choice Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Bicalutamide in Treating Patients With AR-positive Metastatic Triple Negative Breast Cancer

Resource links provided by NLM:


Further study details as provided by Xiaoxiang Guan, Jinling Hospital, China:

Primary Outcome Measures:
  • Clinical benefit rate(CBR) [ Time Frame: 1 Year ]
    The proportion of stability, partial response and complete response in patients who receive bicalutamide as second-, or third-line therapy for estrogen receptor (ER)/ progesterone receptor (PgR)-negative, human epidermal growth factor receptor (HER-2)-negative and AR-positive Metastatic Breast Cancer

  • Progression-free survival [ Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months ]

Secondary Outcome Measures:
  • Quality of life [ Time Frame: 1 Year ]
    FACT(Functional Assessment of Cancer Therapy) -B :a 36-item compilation, subdivided into four primary QOL (Quality of life) domains and a disease specific domain - additional concerns for breast cancer

  • Number of adverse events (AE) and serious adverse events (SAE) during the course of the study [ Time Frame: 1 Year ]

Estimated Enrollment: 60
Study Start Date: January 2015
Estimated Study Completion Date: May 2017
Estimated Primary Completion Date: January 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: bicalutamide
This is a multi-center, open-label, phase II study to evaluate the anti-tumor activity and safety of bicalutamide administered orally daily to patients with estrogen receptor (ER)-negative/ progesterone receptor (PgR)-negative/ androgen receptor (AR)-positive metastatic breast cancer. Eligible patients will receive bicalutamide at a dose of 150mg PO daily.
Drug: Bicalutamide

Patients in experimental group are designated to take bicalutamide orally, 150mg on a continuous schedule. The investigator should pay attention to the patients' adverse event. Every month, the patients will be evaluated for the adverse event by the criterion National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0. Every 2 months, the patients will be evaluated for the clinical effects. If disease progressed, the patients would be ruled out.

Treatment continued until disease progression, unacceptable toxic effects, patient or physician request to discontinue, or serious protocol non-compliance. A maximum of 2 dose reductions for grade >= 3 toxicity were allowed (100 and 50 mg). A maximum of 2 weeks was permitted for treatment delays due to toxicity.

Other Name: immunohistochemistry staining method
Active Comparator: Physician's Choice
Treatment of the Physician's Choice defined as any single agent chemotherapy, hormonal treatment or biological therapy approved for the treatment of cancer; or palliative treatment or radiotherapy, administered according to local practice, if applicable
Other: Physician's Choice

The comparator group, treatment of physician's choice (TPC), represented a mix of agents (both approved and non-approved for metastatic breast cancer) to mirror clinical practice at the time in this setting.

The 60 patients are enrolled in the study, before randomized to the two arms, each of them will be assessed for eligibility and then their proposed TPC.

Treatment continued until disease progression, unacceptable toxic effects, patient or physician request to discontinue, or serious protocol non-compliance.


Detailed Description:

More than 70% of human breast cancers express the androgen receptor (AR), and in retrospective analysis, the expression of AR in Triple-Negative Breast Cancer (TNBC) varies from 10-43%. Recently emerging preclinical and clinical data suggest that AR may play a role in tumor proliferation. For example, Hu et al (2011) analyzed AR expression in 211 TNBC cases. He found that AR is related with an 83% increase in overall mortality, when compared with AR-negative TNBC. McGhan et al (2014) also found that AR expression tends to exist in TNBC patients with higher tumor stage and lymph metastases.

The role of AR has also been extensively studied in vitro. With targeting AR with small interfering RNA (siRNA) and treatment with anti-androgen bicalutamide, studies showed that AR has a proliferative role in TNBC cells. Robinson et al (2011) also clarified that AR can mimic estrogen receptor α (ERα) in a transcriptionally active manner directed by the forkhead box protein A1 (FoxA1). These indicate that, in ER-negative disease, AR can promote tumor progression, therefore, could serve as a therapeutic target in TNBC.

Due to the demonstration of oncogenic role for the AR in TNBC, clinical trials are underway to study the role of inhibiting androgen signaling for the treatment for TNBC. For example, Gucalp et al (2013) performed a sing-arm phase II study to investigate the role of bicalutamide in AR-positive TNBC. A total of 26 patients were enrolled in the study, and the study demonstrated a general well tolerated effect and a 6-month clinical benefit rate of 19%. Furthermore, future clinical trials are also designed to show the anti-androgen therapy such as Enzalutamide, the 17alpha-hydroxylase/C(17,20)-lyase inhibitor abiraterone acetate and orteronel for AR-positive TNBC. This study is investigated to study the role of bicalutamide for AR-positive TNBC, and it may help clarify the effect of bicalutamide for the specific breast cancer subtype. Furthermore, it may provide an additional therapy to treat the difficult to treat population.

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Female patients with histologically or cytologically confirmed carcinoma of the breast. Every effort should be made to make paraffin embedded tissue or slides from the diagnostic biopsy or surgical specimen available for confirmation of diagnosis.
  • Receptor status: Estrogen receptor- and progesterone receptor-negative,HER-2-negative, Androgen receptor-positive* NOTE: Samples are considered positive if greater than 10% of cell nuclei are immunoreactive.
  • Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 2. Life expectancy of >= 3 months.
  • Adequate organ and marrow function as defined below:

leukocytes >3,000/mL; absolute neutrophil count >1,500/ml; platelets >100,000/mL; total bilirubin within normal institutional limits; aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) <2.5×institutional upper limit of normal (ULN); creatinine within normal institutional limits OR creatinine clearance >60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal.

  • Patients with metastatic disease progressed after one therapeutic regimen for metastatic disease, and there is no limit for the regimens of prior therapy.
  • Measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria.
  • Women of childbearing potential, but using (1) surgically sterile or (2) adequate measures of contraception in the opinion of the Investigator. Peri-menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential.
  • Patients have no other malignancy, except breast cancer.
  • Patients willing and able to comply with the study protocol for the duration of the study.
  • Written informed consent prior to any study-specific screening procedures with the understanding that the patient may withdraw consent at any time without prejudice.

Exclusion Criteria:

  • Patients who have received any of the following treatments within four weeks before Bicalutamide or TPC treatment start: chemotherapy, radiation, trastuzumab, hormonal therapy, surgery, or any investigational drug within four weeks.
  • Patients with a hypersensitivity to Bicalutamide or selected TPC treatment.
  • Women who are pregnant or breast-feeding; women of childbearing potential refuse to use any measures of contraception.
  • Patients have active brain metastases or leptomeningeal disease.
  • Patients have important organ failure or serious marrow suppression.
  • Severe/uncontrolled intercurrent illness/infection.
  • Significant cardiovascular impairment (history of congestive heart failure > New York Heart Association grade II, severe valvular heart disease,unstable angina or myocardial infarction within the past six months, or serious cardiac arrhythmia, or resistant hypertension).
  • Patients can't comply with the study protocol for the duration of the study.
  • Patients have had a prior malignancy within five years, other than previous breast cancer.
  • Participation in another clinical trial with any investigational agents within 3 weeks prior to study screening.
  • Patients with known Central Nervous System (CNS) disease (primary or secondary) or leptomeningeal disease because of their poor prognosis and because they often develop progressive neurological dysfunction that would confound the evaluation of neurological and other adverse events.
  • Gastrointestinal disorders interfering with absorption of the study drug.
  • Difficulties with swallowing study capsules/tablets.
  • Psychiatric disorders or altered mental status precluding understanding of the informed consent process and/or completion of the necessary studies.
  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): NCT02353988


Contacts
Contact: Xiaoxiang Guan, MD; PhD +86 13512510329 xguan@nju.edu.cn

Sponsors and Collaborators
Jinling Hospital, China
Wenzhou Medical University
The First People's Hospital of Lianyungang
Wuxi People's Hospital
Nanning Second People's Hospital
Jiangsu Province Hospital of Traditional Chinese Medicine
The Second Hospital of Nanjing Medical University
  More Information

Publications:

Responsible Party: Xiaoxiang Guan, Bicalutamide in Treating Patients With AR-positive Metastatic Triple Negative Breast Cancer, Jinling Hospital, China
ClinicalTrials.gov Identifier: NCT02353988     History of Changes
Other Study ID Numbers: JinlingH-001
First Submitted: January 26, 2015
First Posted: February 3, 2015
Last Update Posted: February 3, 2015
Last Verified: January 2015

Keywords provided by Xiaoxiang Guan, Jinling Hospital, China:
AR-positive
Androgen Antagonists
Bicalutamide
TNBC
metastatic

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases
Bicalutamide
Androgen Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents