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Tamoxifen +/- GnRH Analogue vs Aromatase Inhibitor + GnRH Analogue in Male Breast Cancer Patients (MALE)

Primary Purpose

Male Breast Cancer

Status
Completed
Phase
Phase 3
Locations
Germany
Study Type
Interventional
Intervention
Tamoxifen
Tamoxifen and GnRH analogue
Exemestane and GnRH analogue
Sponsored by
German Breast Group
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Male Breast Cancer focused on measuring Male breast cancer, neoadjuvant, adjuvant or metastatic situation, anti-hormonal therapy

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion criteria

  1. Written informed consent for all study procedures.
  2. Complete baseline documentation sent to GBG Forschungs GmbH.
  3. Male patients.
  4. Age ≥ 18 years.
  5. Karnofsky-Index ≥ 60%.
  6. Histologically confirmed unilateral or bilateral carcinoma or of the breast at primary diagnosis (enrolment possible in neoadjuvant, adjuvant and metastatic situation).

7: No target lesion necessary for metastatic situation 8. Positive hormone receptor status (e.g. ER and/or PR-receptor positive). 9. Completed staging prior randomisation ( within 8 weeks after diagnose or last therapy (operation, chemotherapy or radiation), minimum: chest X-ray, ultrasound of the liver, bone scan).

In case of positive findings, further investigations are required to verify the findings as clinically indicated.

10. Prior chemotherapy is possible. In case of adjuvant treatment: adequate surgical treatment with histological complete resection including axillary lymph nodes if patients are included as adjuvant treatment. A sentinel lymph node biopsy is possible if the sentinel is not involved.

11. Normal cardiac function must be confirmed by ECG within three months prior to randomisation.

12. Laboratory requirements (≤ 14 days before therapy start): Hematology

  • Hemoglobin ≥ 9 g/dL,
  • Leukocytes 4 - 10 x1000/µL,
  • Thrombocytes 150 - 400 x1000/µL. Hepatic function
  • ASAT (SGOT) or ALAT (SGPT) ≤ 2x UNL,
  • Total bilirubin ≤ 2x UNL. Renal function
  • Serum creatinine ≤ 1.5x UNL,
  • Creatinine clearance > 30 mL/min (if creatinine is above UNL, according to Cockroft-Gault).
  • Cholesterol 200 - 240 mg/dL (5.18 - 6.22 mmol/L),
  • HDL cholesterol > 40 mg/dL (> 1 mmol/L),
  • LDL cholesterol ≤ 160 mg/dL (≤ 4 mmol/L).
  • Prostate specific antigen (PSA) ≤ 2.5 ng/mL. 13. Two serum samples (5 mL) centrally made available. 14. Paraffin tumor tissue block and full blood sample centrally made available (except when the patient does not agree to central biomaterial collection).

    15. The patient must be accessible for treatment. Patients can simultaneously be registered in the register study of the University Hospital of Magdeburg.

Exclusion Criteria

  1. Female patients.
  2. Prior endocrine therapy of breast carcinoma.
  3. Known or suspected hypersensitivity reaction to the compounds or incorporated substances.
  4. No indication for endocrine treatment.
  5. Life expectancy of less than six months.
  6. International Prostate Symptom Score (IPSS) > 17.
  7. Current diagnosis of a Prostate carcinoma.
  8. History of prostate cancer within the last five years and regardless the time frame all patients with hormone receptor positive prostate carcinoma who have received endocrine treatment.
  9. Concurrent neuronal or cardiac disease, poorly controlled arterial hypertension.
  10. Previous thromboembolic event within the last five years (except from thromboembolic events correlated to implanted devices (e.g. port thrombosis)
  11. Currently active hepatitis.
  12. Disease significantly affecting gastrointestinal function, e.g. malabsorption syndrome, resection of the stomach or small bowel.
  13. Concurrent treatment with other experimental drugs or participation in another clinical trial with any investigational, not marketed drug within 30 days prior to study entry.
  14. Patients who are not able to give informed consent as defined according to AMG.

Sites / Locations

  • Kliniken Essen-Mitte

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Experimental

Arm Label

Tamoxifen

Tamoxifen and GnRH analogue

Exemestane and GnRH analogue

Arm Description

Tamoxifen alone (daily).

Tamoxifen (daily) + GnRH analogue (at randomisation and after three months).

Exemestane (daily) + GnRH analogue (at randomisation and after three months).

Outcomes

Primary Outcome Measures

Estradiol blood concentation
To determine the estradiol suppression between the three treatment arms after three months.

Secondary Outcome Measures

Estradiol blood concentration
To determine the estradiol suppression between the three treatment arms after six months.
Compliance
To compare the compliance in the three treatment arms.
Efficacy
To compare the efficacy in terms of overall response (for neoadjuvant and metastatic patients) in the three treatment arms.
Efficacy perameters
To compare testosterone, dihydrotestosterone (DHT), SHBG, FSH, LH, osteocalcin and CTX in the three treatments arms.
Safety and side effect parameters
To determine the safety and side effect parameters (at every visit): PSA and hemoglobin. Lipids (total cholesterol, high density lipid cholesterol, low density lipid cholesterol).

Full Information

First Posted
July 9, 2012
Last Updated
September 18, 2018
Sponsor
German Breast Group
Collaborators
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT01638247
Brief Title
Tamoxifen +/- GnRH Analogue vs Aromatase Inhibitor + GnRH Analogue in Male Breast Cancer Patients
Acronym
MALE
Official Title
A Prospective, Randomised, Multi-centre Phase II Study Evaluating the Adjuvant, Neoadjuvant or Palliative Treatmant With Tamoxifen +/- GnRH Analogue Versus Aromatase Inhibitor + GnRH Analogue in Male Breast Cancer Patients
Study Type
Interventional

2. Study Status

Record Verification Date
September 2018
Overall Recruitment Status
Completed
Study Start Date
August 2012 (Actual)
Primary Completion Date
May 2018 (Actual)
Study Completion Date
May 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
German Breast Group
Collaborators
Pfizer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A prospective, randomised multi-centre phase II study evaluating the adjuvant, neoadjuvant or palliative treatment with tamoxifen +/- GnRH analogue versus aromatase inhibitor + GnRH analogue in male breast cancer patients (MALE).
Detailed Description
Breast cancer in men is a rare disease with approximately 0.5- 1% of all breast cancer cases. Each year, about 400 to 450 cases are diagnosed in Germany. Men tend to present with more advanced disease than women, probably due to the lack of awareness of male breast cancer from both, the patient and the physicians. Therefore, at presentation they usually have lump or nipple inversion, and more than 40% of the patients have a stage III or IV disease. The great majority of patients have an invasive ductal (90%), hormone receptor positive (90%), HER2 negative (90%) tumor. The only available information on adjuvant therapies derives from few retrospective cases and retrospective studies with a little number of cases. Therefore, treatment strategies are not based on data from prospective, randomised clinical studies, and optimal treatment is unknown. As a result, current clinical management is generally extrapolated from principles established for the treatment of female breast carcinoma. As the majority of male breast cancer patients have a hormone receptor positive tumor, they receive tamoxifen 20 mg for five years as standard endocrine adjuvant therapy. A lot of withdrawals from the treatment were documented in male breast cancer due to side-effects under tamoxifen therapy. Furthermore, the clinical outcome of tamoxifen-treated male breast cancer patients may be influenced by the activity of cytochrome P450 2D6 enzymes that catalyse the formation of anti-estrogenic metabolites endoxifen and 4-hydroxy-tamoxifen. Therefore a significant proportion of poor to moderate metaboliser is proposed to do not benefit from adjuvant tamoxifen therapy. Although women benefit from adjuvant treatment with aromatase inhibitors (AI) regarding disease-free-survival, overall survival and treatment toxicity, only case reports of men treated with AI exist. Other data show, that under AI, there is only a suppression of estradiol of about 40-50% with an increase of testosterone of about 50%. Among men on AIs, it is possible that the hypothalamic-pituitary feedback loop results in an increase substrate for aromatisation, and thus prevents complete estrogen suppression. However, an optimal suppression (80%) of the peripheral estradiol level would be a necessary condition for a therapeutic benefit of AI in men with breast cancer. By adding a gonadotropin-releasing hormone analogue, the negative feedback loop would be interrupted and complete estrogen suppression may be achieved. In conclusion, there is a great lack on information for the treatment of male patients with breast cancer. Prospective multi-centre, randomised trials in men with breast cancer are necessary in order to prove the effect of tamoxifen + GnRH analogue versus none and versus AI + GnRH analogue as adjuvant or neoadjuvant endocrine treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Male Breast Cancer
Keywords
Male breast cancer, neoadjuvant, adjuvant or metastatic situation, anti-hormonal therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
56 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tamoxifen
Arm Type
Active Comparator
Arm Description
Tamoxifen alone (daily).
Arm Title
Tamoxifen and GnRH analogue
Arm Type
Experimental
Arm Description
Tamoxifen (daily) + GnRH analogue (at randomisation and after three months).
Arm Title
Exemestane and GnRH analogue
Arm Type
Experimental
Arm Description
Exemestane (daily) + GnRH analogue (at randomisation and after three months).
Intervention Type
Drug
Intervention Name(s)
Tamoxifen
Intervention Description
25 mg daily.
Intervention Type
Drug
Intervention Name(s)
Tamoxifen and GnRH analogue
Other Intervention Name(s)
TRENATONE, ZOLADEX
Intervention Description
25 mg Tamoxifen daily and GnRH analogue: Goserelin (10.8 mg s.c. after randomisation and after three months) or Leuprorelin (11.25 mg s.c. after randomisation and after three months).
Intervention Type
Drug
Intervention Name(s)
Exemestane and GnRH analogue
Other Intervention Name(s)
AROMASIN, TRENATONE, ZOLADEX.
Intervention Description
25 mg Exemestane daily and GnRH analogue: Goserelin (10.8 mg s.c. after randomisation and after three months) or Leuprorelin (11.25 mg s.c. after randomisation and after three months).
Primary Outcome Measure Information:
Title
Estradiol blood concentation
Description
To determine the estradiol suppression between the three treatment arms after three months.
Time Frame
3 months.
Secondary Outcome Measure Information:
Title
Estradiol blood concentration
Description
To determine the estradiol suppression between the three treatment arms after six months.
Time Frame
6 months.
Title
Compliance
Description
To compare the compliance in the three treatment arms.
Time Frame
6 months.
Title
Efficacy
Description
To compare the efficacy in terms of overall response (for neoadjuvant and metastatic patients) in the three treatment arms.
Time Frame
6 months.
Title
Efficacy perameters
Description
To compare testosterone, dihydrotestosterone (DHT), SHBG, FSH, LH, osteocalcin and CTX in the three treatments arms.
Time Frame
6 months.
Title
Safety and side effect parameters
Description
To determine the safety and side effect parameters (at every visit): PSA and hemoglobin. Lipids (total cholesterol, high density lipid cholesterol, low density lipid cholesterol).
Time Frame
6 months.

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria Written informed consent for all study procedures. Complete baseline documentation sent to GBG Forschungs GmbH. Male patients. Age ≥ 18 years. Karnofsky-Index ≥ 60%. Histologically confirmed unilateral or bilateral carcinoma or of the breast at primary diagnosis (enrolment possible in neoadjuvant, adjuvant and metastatic situation). 7: No target lesion necessary for metastatic situation 8. Positive hormone receptor status (e.g. ER and/or PR-receptor positive). 9. Completed staging prior randomisation ( within 8 weeks after diagnose or last therapy (operation, chemotherapy or radiation), minimum: chest X-ray, ultrasound of the liver, bone scan). In case of positive findings, further investigations are required to verify the findings as clinically indicated. 10. Prior chemotherapy is possible. In case of adjuvant treatment: adequate surgical treatment with histological complete resection including axillary lymph nodes if patients are included as adjuvant treatment. A sentinel lymph node biopsy is possible if the sentinel is not involved. 11. Normal cardiac function must be confirmed by ECG within three months prior to randomisation. 12. Laboratory requirements (≤ 14 days before therapy start): Hematology Hemoglobin ≥ 9 g/dL, Leukocytes 4 - 10 x1000/µL, Thrombocytes 150 - 400 x1000/µL. Hepatic function ASAT (SGOT) or ALAT (SGPT) ≤ 2x UNL, Total bilirubin ≤ 2x UNL. Renal function Serum creatinine ≤ 1.5x UNL, Creatinine clearance > 30 mL/min (if creatinine is above UNL, according to Cockroft-Gault). Cholesterol 200 - 240 mg/dL (5.18 - 6.22 mmol/L), HDL cholesterol > 40 mg/dL (> 1 mmol/L), LDL cholesterol ≤ 160 mg/dL (≤ 4 mmol/L). Prostate specific antigen (PSA) ≤ 2.5 ng/mL. 13. Two serum samples (5 mL) centrally made available. 14. Paraffin tumor tissue block and full blood sample centrally made available (except when the patient does not agree to central biomaterial collection). 15. The patient must be accessible for treatment. Patients can simultaneously be registered in the register study of the University Hospital of Magdeburg. Exclusion Criteria Female patients. Prior endocrine therapy of breast carcinoma. Known or suspected hypersensitivity reaction to the compounds or incorporated substances. No indication for endocrine treatment. Life expectancy of less than six months. International Prostate Symptom Score (IPSS) > 17. Current diagnosis of a Prostate carcinoma. History of prostate cancer within the last five years and regardless the time frame all patients with hormone receptor positive prostate carcinoma who have received endocrine treatment. Concurrent neuronal or cardiac disease, poorly controlled arterial hypertension. Previous thromboembolic event within the last five years (except from thromboembolic events correlated to implanted devices (e.g. port thrombosis) Currently active hepatitis. Disease significantly affecting gastrointestinal function, e.g. malabsorption syndrome, resection of the stomach or small bowel. Concurrent treatment with other experimental drugs or participation in another clinical trial with any investigational, not marketed drug within 30 days prior to study entry. Patients who are not able to give informed consent as defined according to AMG.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mattea Reinisch, MD
Organizational Affiliation
Kliniken Essen-Mitte
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kliniken Essen-Mitte
City
Essen
State/Province
Nordrhein-Westfalen
ZIP/Postal Code
45136
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
33538790
Citation
Reinisch M, Seiler S, Hauzenberger T, Kamischke A, Schmatloch S, Strittmatter HJ, Zahm DM, Thode C, Furlanetto J, Strik D, Mobus V, Reimer T, Sinn BV, Stickeler E, Marme F, Janni W, Schmidt M, Rudlowski C, Untch M, Nekljudova V, Loibl S. Efficacy of Endocrine Therapy for the Treatment of Breast Cancer in Men: Results from the MALE Phase 2 Randomized Clinical Trial. JAMA Oncol. 2021 Apr 1;7(4):565-572. doi: 10.1001/jamaoncol.2020.7442.
Results Reference
derived
Links:
URL
https://www.gbg.de/de/studien/male.php
Description
Sponsor study homepage

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Tamoxifen +/- GnRH Analogue vs Aromatase Inhibitor + GnRH Analogue in Male Breast Cancer Patients

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