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The PROMISE Study: Duavee in Women With DCIS

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ClinicalTrials.gov Identifier: NCT02694809
Recruitment Status : Recruiting
First Posted : March 1, 2016
Last Update Posted : June 14, 2019
Sponsor:
Collaborators:
National Cancer Institute (NCI)
Pfizer
University of Chicago – Department for Cancer Research
University of California, San Francisco
Information provided by (Responsible Party):
Northwestern University

Brief Summary:
The main purpose of this study is to determine if taking the study drug, conjugated estrogens/bazedoxifene (Duavee®) causes any changes in the proliferation markers within the breast tissue of the study subjects. The study drug is approved by the US Food and Drug Administration in healthy postmenopausal women to treat certain symptoms of menopause such as hot flashes. Since it is not approved in women with DCIS, its use in this study is experimental. This study will also look at whether taking the study drug causes any significant or undesirable side effects in women with DCIS. The researchers hope that this study will help them determine if taking the study drug is safe in women taking DCIS and if it can possibly reduce the risk of developing breast cancer in women with DCIS.

Condition or disease Intervention/treatment Phase
Ductal Breast Carcinoma In Situ Postmenopausal Drug: Conjugated Estrogens/Bazedoxifene Other: Laboratory Biomarker Analysis Other: Pharmacological Study Other: Placebo Procedure: Quality-of-Life Assessment Other: Questionnaire Administration Phase 2

Detailed Description:

PRIMARY OBJECTIVES;

• To determine if CE/BZA reduces proliferation as measured by Ki-67 protein expression

Secondary Objectives:

  • To determine if CE/BZA modulates expression of ERα, progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2).
  • To determine if CE/BZA modulates a previously validated set of epithelial markers of progression.
  • To determine if TSECs will restore expression of the stromal marker CD36 and repress pro-tumorigenic ECM proteins and soluble factors.
  • To determine if a short intervention with CE/BZA results in any difference in Quality of Life (QOL) as it relates to menopausal symptoms in postmenopausal women with DCIS.
  • To determine if a short intervention with CE/BZA has a favorable side effect profile compared with other endocrine therapy interventions using the validated Breast Cancer Prevention Trial Eight Symptom Scale (BESS) questionnaire.

Exploratory Objectives

  • To determine if CE/BZA alters expression of estrogen-modulated genes and elicits novel ER dependent-gene signatures in breast epithelium
  • To demonstrate that CE/BZA does not upregulate Anterior Gradient 2 (AGR2), a marker of ERα agonist activity.
  • To determine if CE/BZA will modulate some aspects of immune function as measured by a switch to a M2-type pro-tumorigenic macrophage signature and an immunosuppressive T cell signature.
  • To determine if a short intervention with CE/BZA alters expression of estrogen-modulated genes and elicits novel ER dependent-gene signatures in the breast stroma.
  • To determine if CE/BZA affects plasma concentrations of BZA in patients with the UGT1A1*28 gene polymorphism.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive conjugated estrogens/bazedoxifene orally (PO) once daily (QD) for 28 +/- 7 days in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery.

ARM II: Patients receive placebo PO QD for 28 +/- 7 days in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 160 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: A Large-scale Multicenter Phase II Study Evaluating the Protective Effect of a Tissue Selective Estrogen Complex (TSEC) in Women With Newly Diagnosed Ductal Carcinoma in Situ
Study Start Date : January 2017
Estimated Primary Completion Date : August 2021
Estimated Study Completion Date : July 2022

Resource links provided by the National Library of Medicine

Drug Information available for: Estrogens

Arm Intervention/treatment
Experimental: Arm I (conjugated estrogens/bazedoxifene)
Patients receive conjugated estrogens/bazedoxifene orally (PO) once daily (QD) for 28 +/- 7 days in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery.
Drug: Conjugated Estrogens/Bazedoxifene
Given PO

Other: Laboratory Biomarker Analysis
Correlative studies

Other: Pharmacological Study
Correlative studies

Procedure: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment

Other: Questionnaire Administration
Ancillary studies

Placebo Comparator: Arm II (placebo)
Patients receive placebo PO QD for 28 +/- 7 days in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery.
Other: Laboratory Biomarker Analysis
Correlative studies

Other: Pharmacological Study
Correlative studies

Other: Placebo
Given PO
Other Names:
  • placebo therapy
  • PLCB
  • sham therapy

Procedure: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment

Other: Questionnaire Administration
Ancillary studies




Primary Outcome Measures :
  1. Change in Ki-67 protein expression [ Time Frame: Up to 5 weeks ]
    Evaluating if CE/BZA reduces proliferation as measured by Ki-67 protein expression. Change in Ki-67 between baseline and end of the intervention will be measured.


Secondary Outcome Measures :
  1. Expression of ERα [ Time Frame: Up to 5 weeks ]
    Determine if CE/BZA modulates expression of ERα.

  2. Expression of progesterone receptor (PR) [ Time Frame: Up to 5 weeks ]
    Evaluate if CE/BZA modulates expression of PR

  3. Expression of human epidermal growth factor receptor 2 (HER-2) [ Time Frame: Up to 5 weeks ]
    Determine if CE/BZA modulates expression of HER-2.

  4. Epithelial markers of progression [ Time Frame: Up to 5 weeks ]
    Evaluate if CE/BZA modulates a previously validated set of epithelial markers of progression.

  5. Expression of the stromal marker CD36 [ Time Frame: Up to 5 weeks ]
    Determine if TSECs will restore expression of the stromal marker CD36.

  6. Repression of pro-tumorigenic ECM proteins [ Time Frame: Up to 5 weeks ]
    Determine if TSECs will repress pro-tumorigenic ECM proteins.

  7. Repression of soluble factors [ Time Frame: Up to 5 weeks ]
    Determine if TSECs will repress soluble factors.

  8. Quality of Life (QOL) [ Time Frame: Up to 5 weeks ]
    Evaluate if a short intervention with CE/BZA results in any difference in Quality of Life (QOL) as it relates to menopausal symptoms in postmenopausal women with DCIS.

  9. Breast Cancer Prevention Trial Eight Symptom Scale (BESS) questionnaire [ Time Frame: Up to 5 weeks ]
    Determine if a short intervention with CE/BZA has a favorable side effect profile compared with other endocrine therapy interventions using the validated Breast Cancer Prevention Trial Eight Symptom Scale (BESS) questionnaire.


Other Outcome Measures:
  1. Expression of estrogen-modulated genes in breast epithelium [ Time Frame: Up to 5 weeks ]
    Determine if CE/BZA alters expression of estrogen-modulated genes in breast epithelium.

  2. Novel ER dependent-gene signatures in breast epithelium [ Time Frame: Up to 5 weeks ]
    Evaluate if CE/BZA elicits novel ER dependent-gene signatures in breast epithelium.

  3. Anterior Gradient 2 (AGR2) [ Time Frame: Up to 5 weeks ]
    Demonstrate that CE/BZA does not upregulate Anterior Gradient 2 (AGR2), a marker of ERα agonist activity.

  4. M2-type pro-tumorigenic macrophage signature [ Time Frame: Up to 5 weeks ]
    Determine if CE/BZA will modulate some aspects of immune function as measured by a switch to a M2-type pro-tumorigenic macrophage signature.

  5. Immunosuppressive T cell signature [ Time Frame: Up to 5 weeks ]
    Determine if CE/BZA will modulate some aspects of immune function as measured by a switch to a an immunosuppressive T cell signature.

  6. Estrogen-modulated genes in the breast stroma [ Time Frame: Up to 5 weeks ]
    Evaluate if a short intervention with CE/BZA alters expression of estrogen-modulated genes in the breast stroma.

  7. Novel ER dependent-gene signatures in the breast stroma [ Time Frame: Up to 5 weeks ]
    Determine if a short intervention with CE/BZA elicits novel ER dependent-gene signatures in the breast stroma.

  8. plasma concentrations of BZA [ Time Frame: Up to 5 weeks ]
    Evaluate if CE/BZA affects plasma concentrations of BZA in patients with the UGT1A1*28 gene polymorphism.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 79 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Women must have newly diagnosed histologically confirmed ER (+) DCIS scheduled to undergo surgical therapy. The pathology report (signed pathology report from attending pathologist) from each individual institution will be used to determine eligibility. Extent of DCIS in imaging per site institutional standard.

Note: After the patient has completed the study and the slides have been sent to NU, our pathologists will review the slides to confirm the diagnosis.

Note: DCIS suspicious for micro invasion is eligible on core biopsy. This is due to the fact that many these patients will not have invasion on final pathology.

Note: Women presenting with bilaterial DCIS are eligible but if both right and left DCIS are ER+, we will only accept tissue from the side with the largest area of DCIS based on imaging and pathology criteria outlined later in the protocol.

  • DCIS must be ≥ 1cm based on extent of calcifications, presence of a mass on ultrasound OR enhancement on MRI OR DCIS must be ≥ 5mm of DCIS on one single core. Can be < 5mm if DCIS is identified on multiple cores (at least 2 cores)
  • Women presenting after excision with positive margins are eligible. Ki-67, Cox-2, P-16, expression in immediately adjacent tissue is similar to what is found in DCIS.

Note: Positive margins are defined as DCIS present at the inked margin or DCIS <1mm from the margin. - Women must be postmenopausal (defined as no menstrual cycle for 12 months or surgical history of bilateral salpingoopherectomy. Postmenopausal women of all races and ethnic groups are eligible to participate for this trial. Men are not eligible.

Note: women who have had a hysterectomy without a bilateral salpingoopherectomy may still be pre-menopausal. Confirmation of postmenopausal status is required for these patients and will be measured by testing levels of estradiol, progesterone and FSH (lab ranges per institutional standards). In addition, confirmation of postmenopausal status may be performed in any patient with unclear menopausal status per treating physician discretion.

  • Women in the age range of ≥18-79 (inclusive)
  • ECOG performance status ≤ 2 (Karnofsky ≥60%, see Appendix A).
  • Patients must have normal organ and marrow function as defined below Leukocytes ≥3,000/mcL Platelets ≥100,000/mcL Hemoglobin ≥ 9g/dl Total Bilirubin ≤ 1.5 x upper limit of normal (ULN) AST (SGOT) and ALT (SGPT)

    • 2.5 × institutional upper limit of normal Serum Creatinine OR Creatinine Clearance
    • 1.5 x ULN ≥60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal (calculated with the Cockcroft-Gault Equation in EPIC)
  • Patients must have the ability to swallow oral medication
  • Ability to understand and the willingness to sign a written informed consent document and comply with all procedures

Exclusion Criteria

  • Patients who are receiving any other investigational agents. A minimum of 4 weeks wash-out period is required for eligibility. Please contact Principal Investigator, Dr. Swati Kulkarni for further clarification
  • Patients with a "currently active" second malignancy other than non-melanoma skin cancers. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for ≥ 3 years.
  • History of allergic reactions/hypersensitivity attributed to compounds of similar chemical or biologic composition to CE/BZA. (I.e. same class of drug as CE/BZA)
  • Current HRT, SERM or Aromatase Inhibitor (AI) use. If yes, the wash-out period is 30 days before diagnostic core needle biopsy.

Note: Local therapy (i.e. estrogen cream) will be permitted due to low systemic absorption of estrogen. Note: if patient is registered prior to completed washout, diagnostic core needle biopsy date will need to be provided.

  • Confirmed current or past diagnosis of invasive breast cancer
  • History of gynecologic malignancy that is estrogen dependent
  • Patients with recurrent ipsilateral DCIS
  • Active deep venous thrombosis, pulmonary embolism, retinal vascular thrombosis, and any arterial thrombosis including stroke and myocardial infarction or history of these conditions
  • Known protein C, protein S, or anti-thrombin deficiency or other known thrombophilic disorders
  • Unexplained/undiagnosed abnormal uterine bleeding (concern for undiagnosed endometrial cancer)
  • Women who are pregnant or lactating. CE/BZA may cause fetal harm when administered to a pregnant woman. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus.
  • Patients receiving any medications or substances that are strong inhibitors or inducers of CYP3A4 and UGT are ineligible. The wash out period for such drugs is a minimum of 7 days or 5 half-lives whichever is shorter. Refer to Appendix C.

Note: As this list is constantly evolving, if a medication is incorrectly documented as prohibited in this protocol, documentation from the site pharmacist to the contrary will be acceptable for the purposes of registration.

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.


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): NCT02694809


Contacts
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Contact: Study Coordinator (312)695-1301 cancertrials@northwestern.edu

Locations
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United States, California
University of Southern California Recruiting
Los Angeles, California, United States, 90089-9235
Contact: Julie E. Lang, MD, FACS    323-442-6868      
Principal Investigator: Julie E. Lang, MD, FACS         
United States, Illinois
Northwestern University Recruiting
Chicago, Illinois, United States, 60611
Contact: Swati A. Kulkarni    312-503-2899    skulkarn@nm.org   
Principal Investigator: Swati A. Kulkarni, MD         
Sub-Investigator: Seema Khan, MD         
Sub-Investigator: Luis S. Blanco Jr., MD         
Northwestern Medicine - Delnor/Warrenville Cancer Centers/Central DuPage Hospital Recruiting
Geneva, Illinois, United States, 60134
Contact: Mary Ahn, MD, FACS    630-307-7799      
Principal Investigator: Mary Ahn, MD, FACS         
Northwestern University Recruiting
Lake Forest, Illinois, United States, 60045
Contact: Denise Monahan, MD, FACS       dmonahan@nm.org   
Principal Investigator: Denise M. Monahan, MD, FACS         
United States, Maryland
John's Hopkins University Recruiting
Baltimore, Maryland, United States, 21287
Contact: David M. Euhus, MD    410-502-0197      
Principal Investigator: David M. Euhus, MD         
United States, Massachusetts
Dana Farber/Partners Cancer Care Inc Recruiting
Boston, Massachusetts, United States, 02115
Contact: Judy E. Garber, MD, MPH    617-632-2282      
Principal Investigator: Judy E. Garber, MD, MPH         
United States, Missouri
Washington University in St. Louis/ Siteman Cancer Center Recruiting
Saint Louis, Missouri, United States, 63110
Contact: Rebecca Aft, MD, PhD    314-362-2280      
Principal Investigator: Rebecca Aft, MD, PhD         
United States, Pennsylvania
University of Pennsylvania/ Abramson Cancer Center Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Julia C. Tchou, MD, PhD, FACS         
Principal Investigator: Julia C. Tchou, MD, PhD, FACS         
Thomas Jefferson University Recruiting
Philadelphia, Pennsylvania, United States, 19107
Contact: Melissa Lazar, MD    215-955-6999      
Principal Investigator: Melissa Lazar, MD         
Sponsors and Collaborators
Northwestern University
National Cancer Institute (NCI)
Pfizer
University of Chicago – Department for Cancer Research
University of California, San Francisco
Investigators
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Principal Investigator: Swati Kulkarni, MD Northwestern University

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Responsible Party: Northwestern University
ClinicalTrials.gov Identifier: NCT02694809     History of Changes
Other Study ID Numbers: NU 15B06
STU00202100 ( CTRP (Clinical Trial Reporting Program) )
NU 15B06 ( Other Identifier: Northwestern University )
P30CA060553 ( U.S. NIH Grant/Contract )
NCI-2016-00066 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
First Posted: March 1, 2016    Key Record Dates
Last Update Posted: June 14, 2019
Last Verified: June 2019
Additional relevant MeSH terms:
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Carcinoma
Breast Neoplasms
Carcinoma in Situ
Carcinoma, Ductal, Breast
Breast Carcinoma In Situ
Carcinoma, Intraductal, Noninfiltrating
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
Carcinoma, Ductal
Adenocarcinoma
Neoplasms, Ductal, Lobular, and Medullary
Bazedoxifene
Estrogens
Estrogens, Conjugated (USP)
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Selective Estrogen Receptor Modulators
Estrogen Receptor Modulators
Hormone Antagonists
Bone Density Conservation Agents