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Retinoid 9cUAB30 in Producing a Biologic Effect in Patients With Early Stage Breast Cancer

Primary Purpose

Anatomic Stage I Breast Cancer AJCC v8, Anatomic Stage IA Breast Cancer AJCC v8, Anatomic Stage IB Breast Cancer AJCC v8

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Biospecimen Collection
Retinoid 9cUAB30
Therapeutic Conventional Surgery
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Anatomic Stage I Breast Cancer AJCC v8

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Eastern Cooperative Oncology Group (ECOG) performance status =< 1 or Karnofsky >= 70%
  • Invasive breast cancer diagnosed by needle core biopsy between 0.5 cm and 5 cm in size based on imaging, that is estrogen receptor positive (ER+) or estrogen receptor negative (ER-), Her2neu positive or negative OR ductal carcinoma in situ (DCIS) of the breast diagnosed by core needle biopsy and at least 1.0 cm in size based on imaging. Grade 3 ER+ DCIS will be allowed as well as ER- DCIS of any grade. For DCIS-only lesions, the imaging abnormality corresponding to the cancer must be at least 1.0 cm in size (i.e. calcifications, distortion or mass on mammogram, or mass or non-mass enhancement on magnetic resonance imaging [MRI])
  • White blood cells (WBC) >= 3000/mm^3
  • Platelets >= 100,000/mm^3
  • Hemoglobin > 10 g/dL
  • Bilirubin =< upper limit of institutional normal
  • Aspartate aminotransferase (AST) =< upper limit of institutional normal
  • Creatinine =< upper limit of institutional normal
  • Triglycerides =< 1.5 x upper limit of normal (ULN)
  • Cholesterol =< 1.5 x ULN
  • Participants must agree to discontinue all supplements containing vitamin A while taking study medication and for thirty days after the last dose of study medication.
  • Have not been treated with chemotherapy, or biological therapy in the last 5 years. We do not know if the previous treatment will have an effect on the tissues to be examined.
  • Have not used tamoxifen, raloxifene, or other antiestrogen compounds within 6 months of study entry. If used within 5 years of study entry, total duration of use must be less than 6 months
  • Have not used exogenous hormone replacement therapy or hormonal contraception in the year prior to diagnosis. The use of non-systemic estrogen (such as vaginal estrogen use) is allowed
  • The effects of 9cUAB30 on the developing human fetus are unknown. Since retinoids are known to be teratogenic, to avoid any complications due to unintentional pregnancies only postmenopausal women and some premenopausal women (as outlined below) will be eligible; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately

    • Women will be considered postmenopausal if one of the following is met:

      • Prior bilateral oophorectomy
      • 60 years of age or older
      • Age less than 60 years; amenorrheic for 12 or more months; and follicle stimulating hormone (FSH) in the postmenopausal range
    • Premenopausal women without childbearing potential are eligible to participate if one of the following criteria is met:

      • Prior hysterectomy
      • Prior fallopian tubal ligation (cut, tied, or sealed)
      • Prior placement of permanent intratubal contraceptive devices (e.g. Essure)
      • Partner with prior vasectomy and willing to use barrier method (e.g. condoms)
  • Participants must have the ability to understand, and the willingness to sign, a written informed consent document

Exclusion Criteria:

  • Participant taking medications that might interact with 9cUAB30
  • Participant who has started or increased dosage of lipid-lowering agents in the last 30 days of enrollment
  • Participant receiving any other investigational agents within 30-days of enrollment nor during study participation with the exception of 18F-FFNP investigational imaging agent
  • Participant with a history of allergic reactions attributed to compounds of similar chemical or biologic composition of retinoids
  • Participant with an uncontrolled intercurrent illness including, but not limited to;

    • Ongoing or active infection,
    • Symptomatic congestive heart failure,
    • Unstable angina pectoris,
    • Cardiac arrhythmia,
    • A persistent grade 3 hypertension

      • For grade 1, grade 2, and non-persistent grade 3 hypertension, repeat blood pressure reading after 5 minutes. If the average reading of the two measurements is grade 3 (systolic BP >=160 mm Hg or diastolic BP >=100 mm Hg) the patient is not eligible. If the average reading of the two measurements is less than or equal to grade 2, then the participant is eligible. If the average of the 2 readings is grade 1 or grade 2 hypertension, document the appropriate level hypertension on the baseline symptom form.
    • Psychiatric illness/social situations that will limit compliance with study requirements
  • Participant who is breastfeeding or planning to breastfeed for a month post last dose of study agent
  • Participant known to be human immunodeficiency virus (HIV)-positive, as we do not know the effects of study drug on suppression of the immune system.
  • Participant with a history of a second cancer diagnosis or reoccurrence < 2 years from study entry with the exception of a history of squamous or basal cell carcinoma of the skin < 2 years from study entry will not be excluded from this study. This is to eliminate the residual effects of any previous treatments for those cancers
  • Participant with history of ipsilateral breast radiation
  • Participant's core biopsy slides suggest that later re-sectioning will not contain sufficient tumor to allow for an adequate evaluation of Ki67 and caspase 3 assays, at a minimum

Sites / Locations

  • University of Alabama at Birmingham Cancer Center
  • Northwestern University
  • University of Iowa/Holden Comprehensive Cancer Center
  • University of Minnesota/Masonic Cancer Center
  • University of Wisconsin Carbone Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (retinoid 9cUAB30)

Arm Description

Patients receive retinoid 9cUAB30 PO QD for 14 to 28 days. Patients then undergo tumor resection surgery. Patients undergo blood and urine sample collection throughout the study.

Outcomes

Primary Outcome Measures

Absolute change in Ki-67 expression in breast epithelial cells of patients treated with 9cUAB30
Will be assessed by immunohistochemistry. The baseline, post-exposure, absolute change in Ki-67, and difference in absolute change between the treated and matched controls will all be summarized with descriptive statistics. The primary analysis will compare the difference in absolute change in Ki-67 between treatment and matched "control" group using a one-tailed paired t-test or Wilcoxon signed-rank test, as appropriate, at a significance level of 0.05.

Secondary Outcome Measures

Change in apoptosis in breast epithelial cells of patients treated with 9cUAB30
Will be assessed by caspase 3 assays and immunohistochemistry. Change between the treated and matched controls will be summarized with descriptive statistics. Difference in apoptosis will be compared between treatment and matched "control" group using a one-tailed paired t-test or Wilcoxon signed-rank test, as appropriate, at a significance level of 0.05.
Change in gene expression of breast cancer samples using a custom gene panel from Nanostring Technologies
Change in gene expression will be summarized with descriptive statistics.
Change in maximum concentration (Cmax)
Will be tested by a one-sided one-sample student t-test.
Incidence of observed adverse events
Will be graded according to Common Terminology Criteria for Adverse Events version 4.0. Will be compared to know retinoid toxicity. These will be described in descriptive statistics and analyzed.

Full Information

First Posted
August 19, 2016
Last Updated
July 31, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02876640
Brief Title
Retinoid 9cUAB30 in Producing a Biologic Effect in Patients With Early Stage Breast Cancer
Official Title
Phase Ib 9cUAB30 in Early Stage Breast Cancer to Evaluate Biologic Effect
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 16, 2018 (Actual)
Primary Completion Date
June 3, 2022 (Actual)
Study Completion Date
June 3, 2024 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase 1b trial studies the biologic effect of 9cUAB30 on early stage breast cancer. 9cUAB30 is a retinoid X receptor (RXR)-selective retinoid that acts in a tissue selective manner with the goal of minimizing side effects, a necessary feature of agents under development for cancer prevention.
Detailed Description
PRIMARY OBJECTIVE: I. Compare molecular analysis of pre- and post-treatment tissue samples of breast cancers of patients treated with 14-28 days of oral retinoid X receptor (RXR)-selective retinoid 9cUAB30 (9 cUAB30) will demonstrate significantly reduced proliferation. SECONDARY OBJECTIVES: I. Determine if 14-28 days of oral RXR-selective 9c-UAB30 treatment increases apoptotic index, as measured by cleaved caspase 3 assay. II. Examine the differences in gene expression from baseline to post-exposure breast cancer samples using a custom gene panel from Nanostring Technologies. III. To examine if the maximum concentration (Cmax) and safety of 9cUAB30 in the first 5 participants is affected by reducing the number of capsules at the 240 mg dose level. IV. To examine the Cmax of all participants at baseline and on the day of surgery. V. Determine if treatment with 2-4 weeks of 9cUAB30 prior to surgery will increase gene expression of type I immune cells in the tumor immune environment of all participants except the first 5. VI. Assess the overall safety of 9cUAB30 in comparison with known retinoid toxicity. EXPLORATORY OBJECTIVE: I. Determine if treatment with 2-4 weeks of 9cUAB30 prior to surgery will increase activated type I dendritic cells in peripheral blood. OUTLINE: Patients receive retinoid 9cUAB30 orally (PO) once daily (QD) for 14 to 28 days. Patients then undergo tumor resection surgery. Patients undergo blood and urine sample collection throughout the study. After completion of study treatment, patients are followed up at 7 days and 4-5 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anatomic Stage I Breast Cancer AJCC v8, Anatomic Stage IA Breast Cancer AJCC v8, Anatomic Stage IB Breast Cancer AJCC v8, Anatomic Stage II Breast Cancer AJCC v8, Anatomic Stage IIA Breast Cancer AJCC v8, Anatomic Stage IIB Breast Cancer AJCC v8, Breast Ductal Carcinoma In Situ, Early Stage Breast Carcinoma, Invasive Breast Carcinoma

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
39 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (retinoid 9cUAB30)
Arm Type
Experimental
Arm Description
Patients receive retinoid 9cUAB30 PO QD for 14 to 28 days. Patients then undergo tumor resection surgery. Patients undergo blood and urine sample collection throughout the study.
Intervention Type
Procedure
Intervention Name(s)
Biospecimen Collection
Other Intervention Name(s)
Biological Sample Collection, Biospecimen Collected, Specimen Collection
Intervention Description
Undergo blood and urine sample collection
Intervention Type
Drug
Intervention Name(s)
Retinoid 9cUAB30
Other Intervention Name(s)
(9Z)-UAB-30, 9cUAB30, UAB-30
Intervention Description
Given PO
Intervention Type
Procedure
Intervention Name(s)
Therapeutic Conventional Surgery
Intervention Description
Undergo tumor resection surgery
Primary Outcome Measure Information:
Title
Absolute change in Ki-67 expression in breast epithelial cells of patients treated with 9cUAB30
Description
Will be assessed by immunohistochemistry. The baseline, post-exposure, absolute change in Ki-67, and difference in absolute change between the treated and matched controls will all be summarized with descriptive statistics. The primary analysis will compare the difference in absolute change in Ki-67 between treatment and matched "control" group using a one-tailed paired t-test or Wilcoxon signed-rank test, as appropriate, at a significance level of 0.05.
Time Frame
Baseline up to 28 days (post-exposure)
Secondary Outcome Measure Information:
Title
Change in apoptosis in breast epithelial cells of patients treated with 9cUAB30
Description
Will be assessed by caspase 3 assays and immunohistochemistry. Change between the treated and matched controls will be summarized with descriptive statistics. Difference in apoptosis will be compared between treatment and matched "control" group using a one-tailed paired t-test or Wilcoxon signed-rank test, as appropriate, at a significance level of 0.05.
Time Frame
Baseline up to 28 days (post-exposure)
Title
Change in gene expression of breast cancer samples using a custom gene panel from Nanostring Technologies
Description
Change in gene expression will be summarized with descriptive statistics.
Time Frame
Baseline up to 28 days (post-exposure)
Title
Change in maximum concentration (Cmax)
Description
Will be tested by a one-sided one-sample student t-test.
Time Frame
Baseline up to day 1
Title
Incidence of observed adverse events
Description
Will be graded according to Common Terminology Criteria for Adverse Events version 4.0. Will be compared to know retinoid toxicity. These will be described in descriptive statistics and analyzed.
Time Frame
Up to 28 days

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female only. The sample size of males affected by breast cancer is limited, hence we will not be able to collect significant data for analysis of the effect of study drug on breast cancer in males Age >= 18 years. Because no dosing or adverse event data is currently available on the use of 9cUAB30 in participants <18 years of age Eastern Cooperative Oncology Group (ECOG) performance status =< 1 or Karnofsky >= 70% Invasive breast cancer diagnosed by needle core biopsy between 0.5 cm and 5 cm in size based on imaging, that is estrogen receptor positive (ER+) or estrogen receptor negative (ER-), Her2neu positive or negative OR ductal carcinoma in situ (DCIS) of the breast diagnosed by core needle biopsy and at least 1.0 cm in size based on imaging. Grade 3 ER+ DCIS will be allowed as well as ER- DCIS of any grade. For DCIS-only lesions, the imaging abnormality corresponding to the cancer must be at least 1.0 cm in size (i.e. calcifications, distortion or mass on mammogram, or mass or non-mass enhancement on magnetic resonance imaging [MRI]) White blood cells (WBC) >= 3000/mm^3 Platelets >= 100,000/mm^3 Hemoglobin > 10 g/dL Bilirubin =< upper limit of institutional normal Aspartate aminotransferase (AST) =< upper limit of institutional normal Creatinine =< upper limit of institutional normal Triglycerides =< 1.5 x upper limit of normal (ULN) Cholesterol =< 1.5 x ULN Participants must agree to discontinue all supplements containing vitamin A while taking study medication and for thirty days after the last dose of study medication. Have not been treated with chemotherapy, or biological therapy in the last 5 years. We do not know if the previous treatment will have an effect on the tissues to be examined. Have not used tamoxifen, raloxifene, or other antiestrogen compounds within 6 months of study entry. If used within 5 years of study entry, total duration of use must be less than 6 months Have not used exogenous hormone replacement therapy or hormonal contraception in the year prior to diagnosis. The use of non-systemic estrogen (such as vaginal estrogen use) is allowed The effects of 9cUAB30 on the developing human fetus are unknown. Since retinoids are known to be teratogenic, to avoid any complications due to unintentional pregnancies only postmenopausal women and some premenopausal women (as outlined below) will be eligible; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately Women will be considered postmenopausal if one of the following is met: Prior bilateral oophorectomy 60 years of age or older Age less than 60 years; amenorrheic for 12 or more months; and follicle stimulating hormone (FSH) in the postmenopausal range Premenopausal women without childbearing potential are eligible to participate if one of the following criteria is met: Prior hysterectomy Prior fallopian tubal ligation (cut, tied, or sealed) Prior placement of permanent intratubal contraceptive devices (e.g. Essure) Partner with prior vasectomy and willing to use barrier method (e.g. condoms) Participants must have the ability to understand, and the willingness to sign, a written informed consent document Exclusion Criteria: Participant taking medications that might interact with 9cUAB30 Participant who has started or increased dosage of lipid-lowering agents in the last 30 days of enrollment Participant receiving any other investigational agents within 30-days of enrollment nor during study participation with the exception of 18F-FFNP investigational imaging agent Participant with a history of allergic reactions attributed to compounds of similar chemical or biologic composition of retinoids Participant with an uncontrolled intercurrent illness including, but not limited to; Ongoing or active infection, Symptomatic congestive heart failure, Unstable angina pectoris, Cardiac arrhythmia, A persistent grade 3 hypertension For grade 1, grade 2, and non-persistent grade 3 hypertension, repeat blood pressure reading after 5 minutes. If the average reading of the two measurements is grade 3 (systolic BP >=160 mm Hg or diastolic BP >=100 mm Hg) the patient is not eligible. If the average reading of the two measurements is less than or equal to grade 2, then the participant is eligible. If the average of the 2 readings is grade 1 or grade 2 hypertension, document the appropriate level hypertension on the baseline symptom form. Psychiatric illness/social situations that will limit compliance with study requirements Participant who is breastfeeding or planning to breastfeed for a month post last dose of study agent Participant known to be human immunodeficiency virus (HIV)-positive, as we do not know the effects of study drug on suppression of the immune system. Participant with a history of a second cancer diagnosis or reoccurrence < 2 years from study entry with the exception of a history of squamous or basal cell carcinoma of the skin < 2 years from study entry will not be excluded from this study. This is to eliminate the residual effects of any previous treatments for those cancers Participant with history of ipsilateral breast radiation Participant's core biopsy slides suggest that later re-sectioning will not contain sufficient tumor to allow for an adequate evaluation of Ki67 and caspase 3 assays, at a minimum
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Helen Krontiras
Organizational Affiliation
University of Wisconsin, Madison
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Alabama at Birmingham Cancer Center
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35233
Country
United States
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
University of Iowa/Holden Comprehensive Cancer Center
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
University of Minnesota/Masonic Cancer Center
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
University of Wisconsin Carbone Cancer Center
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53792
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Retinoid 9cUAB30 in Producing a Biologic Effect in Patients With Early Stage Breast Cancer

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