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Ductal Breast Carcinoma In SituPhase 2NCT02993159

Testing an Active Form of Tamoxifen (4-hydroxytamoxifen) Delivered Through Breast Skin to Control Ductal Carcinoma in Situ (DCIS) of the Breast

A Phase 2 study testing Afimoxifene, Laboratory Biomarker Analysis and Tamoxifen Citrate in people with Ductal Breast Carcinoma In Situ and Estrogen Receptor Positive, run by Northwestern University at 6 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This randomized phase IIB trial studies how well tamoxifen or afimoxifene works in treating patients with estrogen receptor positive breast cancer. Estrogen can cause the growth of breast cancer cells. Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Afimoxifene, Laboratory Biomarker Analysis and Tamoxifen Citrate
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
100 participants
Where
6 sitesUnited States
Study dates
31 May 2017to 24 Jan 2022
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Screen-detected, estrogen receptor (ER) positive DCIS of the breast proven on core needle biopsy, defined as 10% positive cells; the presence of a focus suspicious for microinvasion will be allowed; the size of the DCIS in the core biopsy sample must total 5 mm (multiple cores can be summed) and must be estimated on the deepest step section (if step sections are taken)
  • Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%)
  • Participants must have acceptable organ and marrow function as defined below:
  • Baseline lab parameters are not standard of care for initiation of tamoxifen therapy; a minimal panel will therefore be appropriate.
  • Leukocytes >= 3,000/microliter
  • Absolute neutrophil count >= 1,500/microliter
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  • Platelets >= 100,000/microliter
  • Total bilirubin within "≤1.5 x institutional upper limit of normal (ULN)institutional limits
  • Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 1.5 x institutional upper limit of normal (ULN)
  • Creatinine within "≤1.5 x institutional upper limit of normal (ULN) institutional limits
  • Women of childbearing potential and their male partners must agree to use TWO effective forms of birth control (abstinence is not an allowed method) prior to study entry and for the duration of study participation, and for two months following the last dose of study medications; effective birth control methods are: copper IUD [intrauterine device], diaphragm/cervical cap/shield, spermicide, contraceptive sponge, condoms; women of childbearing potential must have a negative urine pregnancy test within seven days before starting study medications; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately
  • Willingness to avoid exposing breast skin to natural or artificial sunlight (i.e. tanning beds) for the duration of the study
  • Ability to understand and the willingness to sign a written informed consent document

Who cannot join

  • DCIS presentation as a palpable mass
  • Exogenous sex steroid use within 4 weeks prior to core needle biopsy
  • Prior ipsilateral breast cancer radiotherapy will be excluded; prior contralateral breast cancer therapy within 2 years will also be excluded
  • Skin lesions on the breast that disrupt the stratum corneum (eg eczema, ulceration)
  • History of endometrial neoplasia
  • History of thromboembolic disease (history of varicose veins and superficial phlebitis is allowed)
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  • Current smokers
  • Current users of potent inhibitors of tamoxifen metabolism must be able to discontinue their use and switch to an alternative medication for the duration of participation, under the advice of their physician; if the physician feels that an alternative medication is not appropriate for the subject and the current medication is medically necessary, the subject will not be eligible; the drugs are listed below; many of these are not in clinical use at the moment; bupropion, celecoxib, chlorpheniramine, chlorpromazine, cimetidine, citalopram, clemastine, clomipramine, clozapine, cocaine, delavirdine, desipramine, diphenhydramine, doxepin, duloxetine, escitalopram, fluoxetine, haloperidol, halofantrine, hydroxyzine, imipramine, isoniazid, ketoconazole, methadone, methimazole, mibefradil, miconazole, nicardipine, paroxetine, pergolide, perphenazine, pioglitazone, pyrimethamine, quinidine, quinine, ranitidine, ritonavir, ropinirole, sertraline, terbinafine, thioridazine, ticlopidine, tranylcypromine, trazodone, tripelennamine
  • Prior use of SERMS or AIs including tamoxifen, raloxifene, anastrozole, letrozole, or exemestane for prevention or therapy within 5 years
  • Participants may not be receiving any other investigational agents within 30 days of enrollment or during this study
  • History of allergic reactions attributed to tamoxifen or compounds of similar chemical or biologic composition
  • 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
  • Pregnant women are excluded from this study; breastfeeding should be discontinued by nursing mothers who agree to participate in the study
  • Men are excluded from this study since DCIS of the breast is exceedingly rare in men, and there are no data regarding skin penetration of 4-OHT though male chest wall skin (which is thicker and hairier than female chest wall skin)

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

United States6 sites
  • Northwestern University

    Chicago, Illinois, 60611

  • Cleveland Clinic

    Cleveland, Ohio, 44106

  • Duke University Medical Center

    Durham, North Carolina, 27710

  • Saint Elizabeth Medical Center South

    Edgewood, Kentucky, 41017

  • Memorial Sloan-Kettering Cancer Center

    New York, New York, 10065

  • Mayo Clinic

    Rochester, Minnesota, 55905

Other trials in United States

About this study

Official title: Phase IIB Pre-Surgical Trial of Oral Tamoxifen Versus Transdermal 4-hydroxytamoxifen in Women With DCIS of the Breast

This randomized phase IIB trial studies how well tamoxifen or afimoxifene works in treating patients with estrogen receptor positive breast cancer. Estrogen can cause the growth of breast cancer cells. Hormone therapy using tamoxifen citrate or afimoxifene may fight breast cancer by blocking the use of estrogen by the tumor cells.

Read the detailed description

PRIMARY OBJECTIVES:

  1. To demonstrate that 2 mg once daily per breast of 4-hydroxytamoxifen (4-OHT) topical gel results in a reduction in the Ki-67 labeling index of ductal breast carcinoma in situ (DCIS) lesions that is not inferior to that seen with 20 mg daily oral tamoxifen citrate (TAM) for 4-10 weeks, when comparing the base-line diagnostic core biopsy to the therapeutic surgical excision sample.

SECONDARY OBJECTIVES:

  1. To compare post-therapy changes in the oncotype DCIS-score between arms (this is a validated reverse transcriptase-polymerase chain reaction [RT-PCR] assay for Ki67, STK15, survivin, cyclin B1, MYBL2, PR, GSTM1).

II. To compare between-group post-therapy changes in immunohistochemistry (IHC) markers: CD-68 macrophage marker as a surrogate for response to therapy, p16 and COX-2.

III. To compare post-therapy changes in breast density, quantitative estimate, between arms.

IV. To compare post-therapy breast tissue and plasma levels of TAM and its metabolites (N-desmethyl tamoxifen [NDT], [E] and [Z] isomers of 4-hydroxytamoxifen [4-OHT], N-desmethyl-4-hydroxytamoxifen [endoxifen]).

  1. To compare post-therapy breast tissue and plasma levels of estradiol and progesterone between arms (optional).

VI. To compare the post-therapy fraction of participants demonstrating "no residual DCIS".

VII. To compare post-therapy changes in plasma proteins involved in coagulation: factors VIII and IX, von Willebrand factor, total protein S between arms.

VIII. To compare post-therapy changes in plasma markers of systemic estrogenic effect (IGF-1, SHBG).

IX. To compare post-therapy changes in symptoms as captured in the breast cancer prevention trial (BCPT) Eight Symptom Scale (BESS) questionnaire and skin reactions to 4-OHT gel.

OUTLINE: Patients are randomized into 1 of 2 arms.

ARM I: Patients apply afimoxifene gel to both breasts and receive placebo orally (PO) daily for 4-10 weeks in the absence of disease progression or unexpected toxicity.

ARM II: Patients apply placebo gel to both breasts and receive tamoxifen citrate orally PO daily for 4-10 weeks in the absence of disease progression or unexpected toxicity.

After completion of study treatment, patients are followed up at 1-2 weeks and 1 month after surgery.

Being tested
Afimoxifene, Laboratory Biomarker Analysis, Placebo, Tamoxifen Citrate
Medical subject headings
Carcinoma, Intraductal, Noninfiltrating

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AfimoxifeneDrug

    Also called 4-Hydroxy-Tamoxifen, 4-Hydroxytamoxifen, 4-OHT

    Applied to the breast

  • Laboratory Biomarker AnalysisOther

    Correlative studies

  • PlaceboOther

    Also called placebo therapy, PLCB, sham therapy

    Given PO

  • PlaceboOther

    Also called placebo therapy, PLCB, sham therapy

    Applied to the breast

  • Tamoxifen CitrateDrug

    Also called Apo-Tamox, Clonoxifen, Dignotamoxi, Ebefen

    Given PO

Study groups in NCT02993159
Study groupRoleWhat they receive
Arm I (afimoxifene, placebo)ExperimentalPatients apply afimoxifene gel to both breasts and receive placebo PO daily for 4-10 weeks in the absence of disease progression or unexpected toxicity.
Receives: Drug: Afimoxifene; Other: Laboratory Biomarker Analysis; Other: Placebo
Arm II (placebo, tamoxifen citrate)Active comparatorPatients apply placebo gel to both breasts and receive tamoxifen citrate orally PO daily for 4-10 weeks in the absence of disease progression or unexpected toxicity.
Receives: Other: Laboratory Biomarker Analysis; Other: Placebo; Drug: Tamoxifen Citrate

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Ki-67 Labeling Index

    Change in the Ki-67 labelling index of DCIS lesions evaluated using immunohistochemistry

    Measured: baseline to up to 10 weeks

Secondary outcomes (8)
  1. Change in Oncotype DCIS-Score

    Change in Exact Sciences Oncotype Diagnosis Breast Ductal Carcinoma in Situ Score (Oncotype DCIS-Score), a clinical validated clinically validated, commercially available genomic test for patients with DCIS. Oncotype DCIS-Score Range is 0-100. A negative change in scores indicates a lower risk of recurrence (better outcome).

    Measured: baseline to up to 10 weeks

  2. Post-therapy Breast Tissue Levels of Tamoxifen and Its Metabolites

    Post-therapy concentrations of 4-OHT and endoxifen in breast tissue samples

    Measured: up to 10 weeks

  3. Post-therapy Plasma Levels of Tamoxifen and Its Metabolites

    Post-therapy concentrations of 4-OHT and endoxifen in plasma samples

    Measured: up to 10 weeks

  4. Ki-67 Labelling Index in the Terminal Duct Lobular Units (TDLUs)

    Mean change in Ki-67 labelling index in the terminal duct lobular units (TDLUs)

    Measured: baseline to up to 10 weeks

  5. Change in Plasma Proteins Involved in Coagulation

    Mean change in percentage of plasma proteins involved in coagulation: Factor VIII, Factor IX, von Willebrand Factor, and total protein S

    Measured: baseline to up to 10 weeks

  6. Change in Plasma Markers of Systemic Estrogenic Effect (SHBG)

    Mean change in plasma markers of systemic estrogenic effect: SHBG.

    Measured: baseline to up to 10 weeks

  7. Change in Plasma Markers of Systemic Estrogenic Effect (IGF-1)

    Mean change in plasma markers of systemic estrogenic effect: IGF-1

    Measured: baseline to up to 10 weeks

  8. Change in Symptoms as Captured in the Breast Cancer Prevention Trial (BCPT) Eight Symptom Scale (BESS) Questionnaire and Skin Reactions to 4-OHT Gel.

    Mean change in symptoms as captured using the Breast Cancer Prevention Trial (BCPT) Eight Symptom Scale (BESS) questionnaire. A patient reported outcome, scores range from 0 (Not at All) to 4 (Extremely) when asked about experiencing symptoms. A positive change in scores indicates an increase in symptoms experienced and a negative change in scores indicates a decrease in symptoms experienced

    Measured: baseline to up to 10 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Dec 2016 (estimated)
  2. Study start31 May 2017
  3. Primary completion30 Mar 2021
  4. Study completion24 Jan 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
100 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02993159
Sponsor's protocol ID
NCI 2015-06-04
Other IDs
P30CA060553, NCI-2016-01911, N01-CN-2012-00035, NCI 2015-06-04, NWU2015-06-04, N01CN00035
Status last verified
Sep 2024
First submitted
14 Dec 2016
Last updated
18 Dec 2024
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Khan SA, Mi X, Xu Y, Blanco LZ Jr, Akasha AM, Pilewskie M, Degnim AC, AlHilli Z, Amin AL, Hwang ES, Guenther JM, Kocherginsky M, Benante K, Zhang S, Helland T, Hustad SS, Gursel DB, Mellgren G, Dimond E, Perloff M, Heckman-Stoddard BM, Lee O. Presurgical Oral Tamoxifen vs Transdermal 4-Hydroxytamoxifen in Women With Ductal Carcinoma In Situ: A Randomized Clinical Trial. JAMA Surg. 2023 Dec 1;158(12):1265-1273. doi: 10.1001/jamasurg.2023.5113.

    PubMed 37870954

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Afimoxifene, Laboratory Biomarker Analysis and Tamoxifen Citrate in people with Ductal Breast Carcinoma In Situ and Estrogen Receptor Positive, run by Northwestern University at 6 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 18 Dec 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Ki-67 Labeling Index (time frame: baseline to up to 10 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02993159, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Dec 2024.

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