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Hormone Therapy in Preventing Endometrial Cancer in Patients With a Genetic Risk For Hereditary Nonpolyposis Colon Cancer

Primary Purpose

Endometrial Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
medroxyprogesterone
ethinyl estradiol
norgestrel
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Endometrial Cancer

Eligibility Criteria

25 Years - 50 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria: Women with known mutation of an HNPCC-associated gene (hMLH-1, hMSH-2, or hMSH-6) or fulfill Amsterdam Criteria and have had one or more HNPCC-associated cancers No prior hysterectomy; (participants may be scheduled for prophylactic hysterectomy following the study) Voluntary consent documented by a signed and witnessed informed consent Negative serum pregnancy test at baseline evaluation No history of pelvic irradiation for whatever cause No chemotherapy for two years Women >= 40 must have had a screening mammogram within the last 12 months prior to participation in this study Women who are at 50% risk of having a mutation and willing to have genetic testing Exclusion Criteria: Use of oral contraceptives or depoMPA or hormonal exposure, such as hormonal IUD, tamoxifen, raloxifene, or other selective estrogen receptor modulators (SERMs) within four months of initiating study; women will be asked to be off oral contraceptives or other hormonal exposure for 4 months prior to initiating study Medical contraindication to use of oral contraceptives or depoMPA including: Known or suspected pregnancy Undiagnosed vaginal bleeding Known or suspected malignancy of breast or endometrium Active thrombophlebitis, or current or past history of thromboembolic disorders, or cerebral vascular disease Gall bladder disease or liver dysfunction or disease, including hepatic adenomas or carcinoma, or abnormal liver function tests Known hypersensitivity to depoMPA contraceptive injection (medroxyprogesterone acetate or any of its other ingredients) Depression that is currently not under control, in the judgement of the Principal Investigator History of epilepsy History of diabetes Coronary artery disease Age >=35 and a current tobacco smoker Known inability to participate in the scheduled follow-up tests (i.e., alcohol dependence or illicit drug use) Significant medical history or psychiatric problems which would make the participant a poor protocol candidate, in the opinion of the principal investigator Post surgical removal of both ovaries Postmenopausal women with amenorrhea greater than 12 months Previous history of endometrial biopsy, hysteroscopy, dilatation and curettage, or IUD in place within the past 3 months Known participation in a concurrent protocol with a pharmacological intervention Recent or concurrent use of systemic steroids (i.e. prednisone) within the past four months of initiating study Positive serum pregnancy test at baseline evaluation Fasting triglycerides level >= 400 mg/dl Cholesterol level >= 240 mg/dl LDL level >= 160 mg/dl HDL level =< 35 mg/dl Hypertension that is currently not under good control, in the judgement of the principal investigator

Sites / Locations

  • M D Anderson Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm I (medroxyprogesterone)

Arm II (ethinyl estradiol, norgestrel)

Arm Description

Patients receive medroxyprogesterone intramuscularly once on day 1. Approximately 90 days after the injection, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.

Patients receive OCP comprising ethinyl estradiol and norgestrel once daily on days 1-21. Treatment repeats every 28 days for 3-4 courses (3-4 packs of OCP) in the absence of unacceptable toxicity. Approximately 1 week after starting the fourth pack of OCP, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.

Outcomes

Primary Outcome Measures

Change in potential SEBs relevant to endometrial carcinogenesis.

Secondary Outcome Measures

Changes in histology and ultrasound appearance of the endometrium in women with HNPCC

Full Information

First Posted
April 9, 2002
Last Updated
May 2, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00033358
Brief Title
Hormone Therapy in Preventing Endometrial Cancer in Patients With a Genetic Risk For Hereditary Nonpolyposis Colon Cancer
Official Title
Modulation Of Putative Surrogate Endpoint Biomarkers In Endometrial Biopsies From Women With HNPCC
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
February 2002 (undefined)
Primary Completion Date
October 2007 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
Randomized phase II trial to compare two different hormone therapy regimens in preventing endometrial cancer in women who have a genetic risk for hereditary nonpolyposis colon cancer. Hormone therapy may prevent the development of endometrial cancer in women with a genetic risk for hereditary nonpolyposis colon cancer. It is not yet known which hormone therapy regimen is more effective in preventing endometrial cancer.
Detailed Description
PRIMARY OBJECTIVES: I. The primary objective is to evaluate the effect of progesterone therapy versus combination estrogen and progesterone therapy on potential surrogate endpoint biomarkers (SEBs) relevant to endometrial carcinogenesis. II. To evaluate changes in histology and ultrasound appearance of the endometrium in women with HNPCC after 3 months of progesterone therapy versus combination estrogen and progesterone therapy compared with baseline. III. To establish a point estimate of the baseline frequency of endometrial abnormalities looking at histological and molecular markers in a cohort of females carrying an HNPCC gene mutation. OUTLINE: Patients are randomized to 1 of 2 arms. All patients undergo a baseline transvaginal ultrasound and endometrial biopsy. Arm I: Patients receive medroxyprogesterone intramuscularly once on day 1. Approximately 90 days after the injection, patients undergo a repeat transvaginal ultrasound and endometrial biopsy. Arm II: Patients receive oral contraceptive pills (OCP) comprising ethinyl estradiol and norgestrel once daily on days 1-21. Treatment repeats every 28 days for 3-4 courses (3-4 packs of OCP) in the absence of unacceptable toxicity. Approximately 1 week after starting the fourth pack of OCP, patients undergo a repeat transvaginal ultrasound and endometrial biopsy. Patients are followed at 6 weeks and are encouraged to return in 6 months to participate in continued endometrial screening.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Endometrial Cancer

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I (medroxyprogesterone)
Arm Type
Experimental
Arm Description
Patients receive medroxyprogesterone intramuscularly once on day 1. Approximately 90 days after the injection, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.
Arm Title
Arm II (ethinyl estradiol, norgestrel)
Arm Type
Experimental
Arm Description
Patients receive OCP comprising ethinyl estradiol and norgestrel once daily on days 1-21. Treatment repeats every 28 days for 3-4 courses (3-4 packs of OCP) in the absence of unacceptable toxicity. Approximately 1 week after starting the fourth pack of OCP, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.
Intervention Type
Drug
Intervention Name(s)
medroxyprogesterone
Other Intervention Name(s)
Depo-Provera, medroxyprogesterone acetate, MPA, Provera, Provera Dosepak
Intervention Description
Given intramuscularly
Intervention Type
Drug
Intervention Name(s)
ethinyl estradiol
Other Intervention Name(s)
Diogyn E, EE, Estinyl, Ethinoral, Eticylol
Intervention Description
Given orally
Intervention Type
Drug
Intervention Name(s)
norgestrel
Other Intervention Name(s)
Microlut, NORGES, Ovrette, Wy-3707
Intervention Description
Given orally
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Change in potential SEBs relevant to endometrial carcinogenesis.
Time Frame
From baseline to completion of hormone therapy
Secondary Outcome Measure Information:
Title
Changes in histology and ultrasound appearance of the endometrium in women with HNPCC
Time Frame
From baseline to 3 months

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Women with known mutation of an HNPCC-associated gene (hMLH-1, hMSH-2, or hMSH-6) or fulfill Amsterdam Criteria and have had one or more HNPCC-associated cancers No prior hysterectomy; (participants may be scheduled for prophylactic hysterectomy following the study) Voluntary consent documented by a signed and witnessed informed consent Negative serum pregnancy test at baseline evaluation No history of pelvic irradiation for whatever cause No chemotherapy for two years Women >= 40 must have had a screening mammogram within the last 12 months prior to participation in this study Women who are at 50% risk of having a mutation and willing to have genetic testing Exclusion Criteria: Use of oral contraceptives or depoMPA or hormonal exposure, such as hormonal IUD, tamoxifen, raloxifene, or other selective estrogen receptor modulators (SERMs) within four months of initiating study; women will be asked to be off oral contraceptives or other hormonal exposure for 4 months prior to initiating study Medical contraindication to use of oral contraceptives or depoMPA including: Known or suspected pregnancy Undiagnosed vaginal bleeding Known or suspected malignancy of breast or endometrium Active thrombophlebitis, or current or past history of thromboembolic disorders, or cerebral vascular disease Gall bladder disease or liver dysfunction or disease, including hepatic adenomas or carcinoma, or abnormal liver function tests Known hypersensitivity to depoMPA contraceptive injection (medroxyprogesterone acetate or any of its other ingredients) Depression that is currently not under control, in the judgement of the Principal Investigator History of epilepsy History of diabetes Coronary artery disease Age >=35 and a current tobacco smoker Known inability to participate in the scheduled follow-up tests (i.e., alcohol dependence or illicit drug use) Significant medical history or psychiatric problems which would make the participant a poor protocol candidate, in the opinion of the principal investigator Post surgical removal of both ovaries Postmenopausal women with amenorrhea greater than 12 months Previous history of endometrial biopsy, hysteroscopy, dilatation and curettage, or IUD in place within the past 3 months Known participation in a concurrent protocol with a pharmacological intervention Recent or concurrent use of systemic steroids (i.e. prednisone) within the past four months of initiating study Positive serum pregnancy test at baseline evaluation Fasting triglycerides level >= 400 mg/dl Cholesterol level >= 240 mg/dl LDL level >= 160 mg/dl HDL level =< 35 mg/dl Hypertension that is currently not under good control, in the judgement of the principal investigator
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Karen Lu
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Hormone Therapy in Preventing Endometrial Cancer in Patients With a Genetic Risk For Hereditary Nonpolyposis Colon Cancer

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