Carbon Dioxide Fractional Laser in Treating Participants With Stage 0-III Hormone Receptor-Positive Breast Cancer With Vulvovaginal Atrophy
Primary Purpose
Anatomic Stage 0 Breast Cancer AJCC v8, Anatomic Stage I Breast Cancer AJCC v8, Anatomic Stage IA Breast Cancer AJCC v8
Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Carbon Dioxide Fractional Laser
Questionnaire Administration
Sponsored by
About this trial
This is an interventional treatment trial for Anatomic Stage 0 Breast Cancer AJCC v8
Eligibility Criteria
Inclusion Criteria:
- Histological confirmation of adenocarcinoma of the breast stage 0-III
- Evidence of hormone sensitivity with estrogen receptor (ER) and/or progesterone receptor (PR) positive >= 1% of primary tumor tissue
- Currently or will be starting on aromatase inhibitor (letrozole, anastrozole, or exemestane)
- Willingness to self-report vaginal itching, dryness, or dyspareunia
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2
- Obtained =< 28 days prior to registration: Hemoglobin >= 8.0 g/dL
- Obtained =< 28 days prior to registration: Absolute neutrophil count (ANC) >= 1500/mm^3
- Obtained =< 28 days prior to registration: Platelet count >= 75,000/mm^3
- Obtained =< 28 days prior to registration: Total bilirubin =< 3.0 x upper limit of normal (ULN)
- Obtained =< 28 days prior to registration: Aspartate transaminase (AST) =< 3 x ULN
- Obtained =< 28 days prior to registration: Prothrombin time (PT)/international normalized ratio (INR)/activated partial thromboplastin time (aPTT) =< 2 x ULN OR if patient is receiving anticoagulant therapy and PT/INR or partial thromboplastin time (PTT) is within therapeutic range of intended use of coagulants
- Obtained =< 28 days prior to registration: Calculated creatinine clearance =< 3 x ULN
- Recent negative Papanicolaou (PAP) smear within 1 year. In patients who do not have recent PAP smear, PAP smear should be obtained as per standard of care during the screening process prior to enrollment
- Ability to complete questionnaire(s) by themselves or with assistance
- Provide written informed consent
- Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
Exclusion Criteria:
- Previous use of CO2 fractional within 1 year
- Receiving any form of hormone replacement therapy, including topical estrogens, testosterone, and dehydroepiandrosterone (DHEA) or selective estrogen receptor modulator (SERM), including tamoxifen and ospemifene
- History of or current dysplastic nevi in the area that will be treated
- Prolapse uterus > stage II according to the International Continence Society pelvic organ prolapse quantification (ICS-POP-Q) system
- Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of the treatment
- Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy. NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
- 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
- Evidence of urinary tract infection (UTI) based on the urinalysis (UA) at the time of the screening. Patients with evidence of UTI can be enrolled after UTI is treated and repeated UA and/or urine culture shows no further evidence of ongoing infection
- Evidence of injuries, bleeding, or evidence suggestive of dysplasia in the external vaginal area or vaginal canal
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Treatment (carbon dioxide fractional laser)
Arm Description
Participants undergo carbon dioxide fractional laser therapy over 10-15 minutes on day 1. Treatment repeats every 28 days for up to 3 courses in the absence of disease progression or unacceptable toxicity.
Outcomes
Primary Outcome Measures
Reduction in Vulvovaginal Symptom Questionnaire (VSQ) (symptoms, emotions, and life-impact)
Descriptive statistics (mean, standard deviation [SD], median, interquartile range [IQR]) using frequency table and histogram will be used to summarize the reduction in the sum of VSQ total score first three scales of the VSQ (symptoms, emotions, and life-impact) at 3 months after treatment versus (vs.) baseline.
Secondary Outcome Measures
Reduction in VSQ score (symptoms, emotions, and life-impact)
Will evaluate the sum of first three scales of the VSQ (symptoms, emotions, and life impact), VSQ total scale, and sub-scales. Descriptive statistics (mean, SD, median, IQR) and longitudinal plots (raw value, change, change in percentage) will be used to summarize the sum of VSQ total score first three scales of the VSQ (symptoms, emotions, and life-impact), VSQ total scale and subscales.
Female Sexual Function Index (FSFI) score
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize FSFI total score and subscales before and after treatment.
Urogenital Distress Inventory (UDI) 6 score
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize UDI-6 score before and after treatment.
Vaginal health index score
Descriptive statistics (frequency table) and histogram will be used to summarize vaginal health index score before and after treatment.
Vaginal caliber
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize vaginal caliber before and after treatment.
Discomfort and pain during carbon dioxide fractional (CO2RE) laser treatment using the visual analog scale
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize the visual analogue pain scale during treatment.
Treatment satisfaction as measured by 5-point Likert scale
Descriptive statistics (frequency table) and histogram will be used to summarize treatment satisfaction after CO2RE laser treatment using 5-point Likert scale during follow-up
Adherence to aromatase inhibitor as measured by the Simplified Medication Adherence Questionnaire
Descriptive statistics (frequency table) and histogram will be used to summarize the Simplified Medication Adherence Questionnaire during follow-up.
Incidence of adverse events graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine adverse event patterns.
Full Information
NCT ID
NCT03666819
First Posted
September 10, 2018
Last Updated
January 5, 2023
Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)
1. Study Identification
Unique Protocol Identification Number
NCT03666819
Brief Title
Carbon Dioxide Fractional Laser in Treating Participants With Stage 0-III Hormone Receptor-Positive Breast Cancer With Vulvovaginal Atrophy
Official Title
Phase II Trial of CO2RE Laser for Patients With Stage 0-III Hormone Receptor-Positive Breast Cancer on Aromatase Inhibitors With Vulvovaginal Atrophy
Study Type
Interventional
2. Study Status
Record Verification Date
October 2018
Overall Recruitment Status
Withdrawn
Why Stopped
Manufacturer will not be supporting this study
Study Start Date
September 10, 2018 (Anticipated)
Primary Completion Date
September 10, 2021 (Anticipated)
Study Completion Date
September 10, 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This phase II trial studies how well carbon dioxide fractional (CO2RE) laser works in treating participants with stage 0-III hormone receptor-positive breast cancer with vulvovaginal atrophy associated with dryness, inflammation or thinning of the epithelial lining of the vulva and vagina. CO2RE laser is a device that delivers controlled CO2 energy to the vaginal tissue and may help treat vaginal symptoms such as itching, burning, painful sexual intercourse, thickened or thin skin of the vulva, and stinging.
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the reduction in Vulvovaginal Symptom Questionnaire (VSQ) score at 3-month follow up after CO2RE laser treatment.
SECONDARY OBJECTIVES:
I. To evaluate the reduction in VSQ score after CO2RE laser treatment 6-month follow-up and 12-month follow-up.
II. To evaluate Female Sexual Function Index (FSFI) score before and after treatment with CO2RE laser.
III. To evaluate Urogenital Distress Inventory (UDI) 6 score before and after treatment with CO2RE laser.
IV. To evaluate vaginal health index score and vaginal caliber before and after treatment with CO2RE laser.
V. To evaluate discomfort and pain during CO2RE laser treatment using the visual analog scale.
VI. To evaluate treatment satisfaction after CO2RE laser treatment using 5-point Likert scale.
VII. To evaluate adherence to aromatase inhibitor at 6 and 12 months after CO2RE laser treatment.
EXPLORATORY OBJECTIVES:
I. To assess the change in the vaginal cytology using vaginal maturation index at baseline and during follow-up.
II. To assess serum estradiol level at baseline and after CO2RE laser treatment.
OUTLINE:
Participants undergo carbon dioxide fractional laser therapy over 10-15 minutes on day 1. Treatment repeats every 28 days for up to 3 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, participants are followed up at 3, 6, and 12 months.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anatomic Stage 0 Breast Cancer AJCC v8, 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, Anatomic Stage III Breast Cancer AJCC v8, Anatomic Stage IIIA Breast Cancer AJCC v8, Anatomic Stage IIIB Breast Cancer AJCC v8, Anatomic Stage IIIC Breast Cancer AJCC v8, Breast Adenocarcinoma, Dyspareunia, Estrogen Receptor Positive, Progesterone Receptor Positive, Prognostic Stage 0 Breast Cancer AJCC v8, Prognostic Stage I Breast Cancer AJCC v8, Prognostic Stage IA Breast Cancer AJCC v8, Prognostic Stage IB Breast Cancer AJCC v8, Prognostic Stage II Breast Cancer AJCC v8, Prognostic Stage IIA Breast Cancer AJCC v8, Prognostic Stage IIB Breast Cancer AJCC v8, Prognostic Stage III Breast Cancer AJCC v8, Prognostic Stage IIIA Breast Cancer AJCC v8, Prognostic Stage IIIB Breast Cancer AJCC v8, Prognostic Stage IIIC Breast Cancer AJCC v8, Vaginal Dryness, Vaginal Itching, Vulvovaginal Atrophy
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Treatment (carbon dioxide fractional laser)
Arm Type
Experimental
Arm Description
Participants undergo carbon dioxide fractional laser therapy over 10-15 minutes on day 1. Treatment repeats every 28 days for up to 3 courses in the absence of disease progression or unacceptable toxicity.
Intervention Type
Device
Intervention Name(s)
Carbon Dioxide Fractional Laser
Other Intervention Name(s)
CO2 Fractional Laser
Intervention Description
Undergo CO2RE laser therapy
Intervention Type
Other
Intervention Name(s)
Questionnaire Administration
Intervention Description
Ancillary studies
Primary Outcome Measure Information:
Title
Reduction in Vulvovaginal Symptom Questionnaire (VSQ) (symptoms, emotions, and life-impact)
Description
Descriptive statistics (mean, standard deviation [SD], median, interquartile range [IQR]) using frequency table and histogram will be used to summarize the reduction in the sum of VSQ total score first three scales of the VSQ (symptoms, emotions, and life-impact) at 3 months after treatment versus (vs.) baseline.
Time Frame
Baseline up to 3 months
Secondary Outcome Measure Information:
Title
Reduction in VSQ score (symptoms, emotions, and life-impact)
Description
Will evaluate the sum of first three scales of the VSQ (symptoms, emotions, and life impact), VSQ total scale, and sub-scales. Descriptive statistics (mean, SD, median, IQR) and longitudinal plots (raw value, change, change in percentage) will be used to summarize the sum of VSQ total score first three scales of the VSQ (symptoms, emotions, and life-impact), VSQ total scale and subscales.
Time Frame
Baseline up to 12 months
Title
Female Sexual Function Index (FSFI) score
Description
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize FSFI total score and subscales before and after treatment.
Time Frame
Baseline up to 12 months
Title
Urogenital Distress Inventory (UDI) 6 score
Description
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize UDI-6 score before and after treatment.
Time Frame
Baseline up to 12 months
Title
Vaginal health index score
Description
Descriptive statistics (frequency table) and histogram will be used to summarize vaginal health index score before and after treatment.
Time Frame
Baseline up to 12 months
Title
Vaginal caliber
Description
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize vaginal caliber before and after treatment.
Time Frame
Baseline up to 12 months
Title
Discomfort and pain during carbon dioxide fractional (CO2RE) laser treatment using the visual analog scale
Description
Descriptive statistics (mean, SD, median, IQR) and will be used to summarize the visual analogue pain scale during treatment.
Time Frame
Up to 12 months
Title
Treatment satisfaction as measured by 5-point Likert scale
Description
Descriptive statistics (frequency table) and histogram will be used to summarize treatment satisfaction after CO2RE laser treatment using 5-point Likert scale during follow-up
Time Frame
Up to 12 months
Title
Adherence to aromatase inhibitor as measured by the Simplified Medication Adherence Questionnaire
Description
Descriptive statistics (frequency table) and histogram will be used to summarize the Simplified Medication Adherence Questionnaire during follow-up.
Time Frame
Up to 12 months
Title
Incidence of adverse events graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Description
The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine adverse event patterns.
Time Frame
Up to 12 months
Other Pre-specified Outcome Measures:
Title
Change in vaginal cytology using vaginal maturation index
Description
Descriptive statistics (mean, SD, median, IQR) and longitudinal plots (raw value, change, change in percentage) will be used to summarize the change in the vaginal cytology using vaginal maturation index.
Time Frame
Baseline up to 12 months
Title
Assessment of serum estradiol levels
Description
Descriptive statistics (mean, SD, median, IQR) and longitudinal plots (raw value, change, change in percentage) will be used to summarize serum estradiol level at baseline and after CO2RE laser treatment and the change from baseline.
Time Frame
Baseline up to 12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Histological confirmation of adenocarcinoma of the breast stage 0-III
Evidence of hormone sensitivity with estrogen receptor (ER) and/or progesterone receptor (PR) positive >= 1% of primary tumor tissue
Currently or will be starting on aromatase inhibitor (letrozole, anastrozole, or exemestane)
Willingness to self-report vaginal itching, dryness, or dyspareunia
Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2
Obtained =< 28 days prior to registration: Hemoglobin >= 8.0 g/dL
Obtained =< 28 days prior to registration: Absolute neutrophil count (ANC) >= 1500/mm^3
Obtained =< 28 days prior to registration: Platelet count >= 75,000/mm^3
Obtained =< 28 days prior to registration: Total bilirubin =< 3.0 x upper limit of normal (ULN)
Obtained =< 28 days prior to registration: Aspartate transaminase (AST) =< 3 x ULN
Obtained =< 28 days prior to registration: Prothrombin time (PT)/international normalized ratio (INR)/activated partial thromboplastin time (aPTT) =< 2 x ULN OR if patient is receiving anticoagulant therapy and PT/INR or partial thromboplastin time (PTT) is within therapeutic range of intended use of coagulants
Obtained =< 28 days prior to registration: Calculated creatinine clearance =< 3 x ULN
Recent negative Papanicolaou (PAP) smear within 1 year. In patients who do not have recent PAP smear, PAP smear should be obtained as per standard of care during the screening process prior to enrollment
Ability to complete questionnaire(s) by themselves or with assistance
Provide written informed consent
Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
Exclusion Criteria:
Previous use of CO2 fractional within 1 year
Receiving any form of hormone replacement therapy, including topical estrogens, testosterone, and dehydroepiandrosterone (DHEA) or selective estrogen receptor modulator (SERM), including tamoxifen and ospemifene
History of or current dysplastic nevi in the area that will be treated
Prolapse uterus > stage II according to the International Continence Society pelvic organ prolapse quantification (ICS-POP-Q) system
Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of the treatment
Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy. NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial
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
Evidence of urinary tract infection (UTI) based on the urinalysis (UA) at the time of the screening. Patients with evidence of UTI can be enrolled after UTI is treated and repeated UA and/or urine culture shows no further evidence of ongoing infection
Evidence of injuries, bleeding, or evidence suggestive of dysplasia in the external vaginal area or vaginal canal
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Saranya Chumsri
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
12. IPD Sharing Statement
Learn more about this trial
Carbon Dioxide Fractional Laser in Treating Participants With Stage 0-III Hormone Receptor-Positive Breast Cancer With Vulvovaginal Atrophy
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