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A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women

Primary Purpose

Epithelial Ovarian Cancer

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
CA125 assay on Abbott Architect i1000SR platform
HE4 assay on Architect i1000SR platform
Transvaginal Ultrasound
Sponsored by
Fred Hutchinson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional screening trial for Epithelial Ovarian Cancer focused on measuring Ovarian Cancer, Screening, Biomarkers

Eligibility Criteria

25 Years - 80 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

Risk Group 1, Women ages 25 - 80:

  • The subject has tested positive for a deleterious germ line mutation in BRCA1 or BRCA2.

Risk Group 2, Women ages 35 - 80, Pedigree conditions can be satisfied by multiple primary cancers in the same person:

  • The subject has a personal history of breast cancer diagnosed before or at age 50.
  • OR the subject has a personal history of bilateral breast cancer
  • OR the subject has one first-degree relative with breast cancer diagnosed before or at age 50.
  • OR the subject has two breast cancers in the first or second degree relatives, same lineage, with at least one breast cancer diagnosed before or at age 50.
  • OR the subject has three or more first or second degree relatives, same lineage, with breast cancer diagnosed at any age.
  • OR The family contains at least one ovarian cancer diagnosed at any age in the first or second degree relatives.
  • OR the subject is of Ashkenazi ancestry and has had breast cancer diagnosed at any age.
  • OR The subject is of Ashkenazi Jewish ethnicity and has one first or second degree relative with breast cancer diagnosed at any age (must be in the same lineage as the Ashkenazi ancestry)
  • OR The subject has a male relative with breast cancer diagnosed at any age
  • OR The subject has a personal history of a positive genetic test result for a deleterious germline mutation in the P53 gene.
  • OR The subject has tested positive for a deleterious germline mutation in one of the DNA mismatch repair (MMR) genes associated with the Hereditary Non-Polyposis Colorectal Cancer Syndrome (HNPCC, also known as Lynch Syndrome) The MMR genes include MLH1, MSH2, MSH6 and PMS2.
  • OR the subject has a first or second degree relative with an identified deleterious germline BRCA1 or BRCA2 mutation, but has not yet undergone testing herself.
  • OR the subject has a first or second degree relative with an identified deleterious germline MMR gene mutation, but has not yet undergone testing herself.
  • OR Probability of carrying a BRCA1 or BRCA2 mutation given family pedigree of breast and ovarian cancers exceeds 20% by any existing BRCA mutational probability model.

Risk Group 3, Women ages 45 - 80:

  • Have measurement of CA125, HE4, MMP7 or Mesothelin exceeding the 95th percentile;
  • OR have a relative risk of at least 2 based on the EpiRisk logistic regression model including age, family history, and other risk factors.

Exclusion Criteria:

  • Removal of both ovaries for any reason.
  • History of ovarian, fallopian tube cancer or peritoneal carcinomatosis.
  • Currently pregnant.
  • Unable or unwilling to provide informed consent.
  • Unwilling to provide the name of a physician.
  • Unwilling to sign informed consent and/or medical records release form.
  • Current untreated malignancy (other than non-melanoma skin cancer).
  • Currently receiving adjuvant chemotherapy or radiation therapy for cancer (except tamoxifen or aromatase inhibitors +/- lupron). Patients who are being treated may enroll 3 months after completion of last treatment.
  • Intraperitoneal surgery within the last 3 months (laparoscopy or laparotomy).
  • A medical condition that would place subject at risk as a result of the blood donation, including but not limited to bleeding disorders, chronic infectious disease, emphysema or serious anemia.
  • Subject has a family member who is a carrier of a BRCA or MMR gene mutation and the subject has undergone genetic testing that included the family mutation and no mutation was found, and there are no cases of ovarian cancer in the family.

Sites / Locations

  • City of Hope
  • Cedars-Sinai Medical Center
  • Stanford University
  • Fox Chase Cancer Center
  • Fred Hutchinson Cancer Research Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

CA125 every screen, HE4 at confirmatory screen.

CA125 and HE4 at every screen.

Arm Description

CA125 will be used at every screen. Women with a parametric empirical Bayes (PEB) longitudinal algorithm score above the 90th percentile will be asked to return for early recall screening. Women with a PEB score above the 95th percentile will be referred for confirmatory measurements of CA125 and HE4. If confirmatory test results are higher than expected, a transvaginal ultrasound will be performed.

CA125 and HE4 will both be used at every screen. Women with a PEB score above the 95th percentile on either CA125 or HE4 will be referred for confirmatory measurements of CA125 and HE4. If confirmatory test results are higher than expected, a transvaginal ultrasound will be performed.

Outcomes

Primary Outcome Measures

Positive predictive value of each of the two screening protocols
Calculated as number of women with a significant lesion identified at a protocol-indicated procedure divided by number of women with protocol-indicated surgical procedures performed.

Secondary Outcome Measures

Screening compliance
Calculated as number of screens performed within 3 months of date scheduled divided by number of screens scheduled.
Cancer related distress and health related quality of life
Assessed using the SF-36 scale assessing HRQOL and versions of the Impact of Events Scale assessing distress associated with worry about cancer risk, and the Cancer Worry Scale

Full Information

First Posted
May 10, 2010
Last Updated
December 11, 2018
Sponsor
Fred Hutchinson Cancer Center
Collaborators
The Marsha Rivkin Center for Ovarian Cancer Research, Canary Foundation, Swedish Medical Center, City of Hope Medical Center, Cedars-Sinai Medical Center, Stanford University, Fox Chase Cancer Center
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1. Study Identification

Unique Protocol Identification Number
NCT01121640
Brief Title
A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women
Official Title
A Randomized Controlled Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women
Study Type
Interventional

2. Study Status

Record Verification Date
December 2018
Overall Recruitment Status
Completed
Study Start Date
November 2009 (undefined)
Primary Completion Date
May 7, 2015 (Actual)
Study Completion Date
May 7, 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fred Hutchinson Cancer Center
Collaborators
The Marsha Rivkin Center for Ovarian Cancer Research, Canary Foundation, Swedish Medical Center, City of Hope Medical Center, Cedars-Sinai Medical Center, Stanford University, Fox Chase Cancer Center

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The Novel Markers Trial will compare the safety, feasibility and effectiveness of two different epithelial ovarian cancer screening strategies that use CA125 and add HE4 as either a first or second line screen. This study is the next step in a larger research effort to develop a blood test that can be used as a screening method for the early detection of epithelial ovarian cancer.
Detailed Description
Epithelial ovarian cancer (EOC) is usually lethal unless it is diagnosed at an early stage, thus early detection is likely to play an important role in reducing its mortality. Within the Ovarian Specialized Programs of Research Excellence Pacific Ovarian Cancer Research Consortium (POCRC) researchers have been working for a decade to discover, develop, and validate biomarkers (proteins or substances found in blood) that could help save lives by detecting EOC early. During the last five years several biomarkers, including CA125, have been evaluated for their ability to detect EOC at an earlier stage. The best markers will now be studied in a new randomized controlled trial of ovarian cancer screening.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epithelial Ovarian Cancer
Keywords
Ovarian Cancer, Screening, Biomarkers

7. Study Design

Primary Purpose
Screening
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
854 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CA125 every screen, HE4 at confirmatory screen.
Arm Type
Other
Arm Description
CA125 will be used at every screen. Women with a parametric empirical Bayes (PEB) longitudinal algorithm score above the 90th percentile will be asked to return for early recall screening. Women with a PEB score above the 95th percentile will be referred for confirmatory measurements of CA125 and HE4. If confirmatory test results are higher than expected, a transvaginal ultrasound will be performed.
Arm Title
CA125 and HE4 at every screen.
Arm Type
Other
Arm Description
CA125 and HE4 will both be used at every screen. Women with a PEB score above the 95th percentile on either CA125 or HE4 will be referred for confirmatory measurements of CA125 and HE4. If confirmatory test results are higher than expected, a transvaginal ultrasound will be performed.
Intervention Type
Procedure
Intervention Name(s)
CA125 assay on Abbott Architect i1000SR platform
Other Intervention Name(s)
Abbott Architect CA125 assay
Intervention Description
Bead-based sandwich ELISA style assay
Intervention Type
Procedure
Intervention Name(s)
HE4 assay on Architect i1000SR platform
Other Intervention Name(s)
Abbott Architect HE4 assay
Intervention Description
Bead-based sandwich ELISA style assay
Intervention Type
Procedure
Intervention Name(s)
Transvaginal Ultrasound
Intervention Description
Sonogram will be obtained only if confirmatory markers are elevated. Exam is restricted to ovarian evaluation.
Primary Outcome Measure Information:
Title
Positive predictive value of each of the two screening protocols
Description
Calculated as number of women with a significant lesion identified at a protocol-indicated procedure divided by number of women with protocol-indicated surgical procedures performed.
Time Frame
From first screen through remaining study period
Secondary Outcome Measure Information:
Title
Screening compliance
Description
Calculated as number of screens performed within 3 months of date scheduled divided by number of screens scheduled.
Time Frame
From first screen through remaining study period
Title
Cancer related distress and health related quality of life
Description
Assessed using the SF-36 scale assessing HRQOL and versions of the Impact of Events Scale assessing distress associated with worry about cancer risk, and the Cancer Worry Scale
Time Frame
At baseline, each screen, 6 weeks post-surgery to remove remaining ovary/ies, and 6 months after post-surgical assessment

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Risk Group 1, Women ages 25 - 80: The subject has tested positive for a deleterious germ line mutation in BRCA1 or BRCA2. Risk Group 2, Women ages 35 - 80, Pedigree conditions can be satisfied by multiple primary cancers in the same person: The subject has a personal history of breast cancer diagnosed before or at age 50. OR the subject has a personal history of bilateral breast cancer OR the subject has one first-degree relative with breast cancer diagnosed before or at age 50. OR the subject has two breast cancers in the first or second degree relatives, same lineage, with at least one breast cancer diagnosed before or at age 50. OR the subject has three or more first or second degree relatives, same lineage, with breast cancer diagnosed at any age. OR The family contains at least one ovarian cancer diagnosed at any age in the first or second degree relatives. OR the subject is of Ashkenazi ancestry and has had breast cancer diagnosed at any age. OR The subject is of Ashkenazi Jewish ethnicity and has one first or second degree relative with breast cancer diagnosed at any age (must be in the same lineage as the Ashkenazi ancestry) OR The subject has a male relative with breast cancer diagnosed at any age OR The subject has a personal history of a positive genetic test result for a deleterious germline mutation in the P53 gene. OR The subject has tested positive for a deleterious germline mutation in one of the DNA mismatch repair (MMR) genes associated with the Hereditary Non-Polyposis Colorectal Cancer Syndrome (HNPCC, also known as Lynch Syndrome) The MMR genes include MLH1, MSH2, MSH6 and PMS2. OR the subject has a first or second degree relative with an identified deleterious germline BRCA1 or BRCA2 mutation, but has not yet undergone testing herself. OR the subject has a first or second degree relative with an identified deleterious germline MMR gene mutation, but has not yet undergone testing herself. OR Probability of carrying a BRCA1 or BRCA2 mutation given family pedigree of breast and ovarian cancers exceeds 20% by any existing BRCA mutational probability model. Risk Group 3, Women ages 45 - 80: Have measurement of CA125, HE4, MMP7 or Mesothelin exceeding the 95th percentile; OR have a relative risk of at least 2 based on the EpiRisk logistic regression model including age, family history, and other risk factors. Exclusion Criteria: Removal of both ovaries for any reason. History of ovarian, fallopian tube cancer or peritoneal carcinomatosis. Currently pregnant. Unable or unwilling to provide informed consent. Unwilling to provide the name of a physician. Unwilling to sign informed consent and/or medical records release form. Current untreated malignancy (other than non-melanoma skin cancer). Currently receiving adjuvant chemotherapy or radiation therapy for cancer (except tamoxifen or aromatase inhibitors +/- lupron). Patients who are being treated may enroll 3 months after completion of last treatment. Intraperitoneal surgery within the last 3 months (laparoscopy or laparotomy). A medical condition that would place subject at risk as a result of the blood donation, including but not limited to bleeding disorders, chronic infectious disease, emphysema or serious anemia. Subject has a family member who is a carrier of a BRCA or MMR gene mutation and the subject has undergone genetic testing that included the family mutation and no mutation was found, and there are no cases of ovarian cancer in the family.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nicole Urban, ScD
Organizational Affiliation
Fred Hutchinson Cancer Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Beth Karlan, MD
Organizational Affiliation
Cedars-Sinai Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
City of Hope
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Facility Name
Cedars-Sinai Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Fox Chase Cancer Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19111-2497
Country
United States
Facility Name
Fred Hutchinson Cancer Research Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19945742
Citation
Andersen MR, Goff BA, Lowe KA, Scholler N, Bergan L, Drescher CW, Paley P, Urban N. Use of a Symptom Index, CA125, and HE4 to predict ovarian cancer. Gynecol Oncol. 2010 Mar;116(3):378-83. doi: 10.1016/j.ygyno.2009.10.087. Epub 2009 Nov 28.
Results Reference
background
PubMed Identifier
20042715
Citation
Anderson GL, McIntosh M, Wu L, Barnett M, Goodman G, Thorpe JD, Bergan L, Thornquist MD, Scholler N, Kim N, O'Briant K, Drescher C, Urban N. Assessing lead time of selected ovarian cancer biomarkers: a nested case-control study. J Natl Cancer Inst. 2010 Jan 6;102(1):26-38. doi: 10.1093/jnci/djp438. Epub 2009 Dec 30.
Results Reference
background
PubMed Identifier
19427026
Citation
Lowe KA, Andersen MR, Urban N, Paley P, Dresher CW, Goff BA. The temporal stability of the Symptom Index among women at high-risk for ovarian cancer. Gynecol Oncol. 2009 Aug;114(2):225-30. doi: 10.1016/j.ygyno.2009.03.015. Epub 2009 May 7.
Results Reference
background
PubMed Identifier
30431292
Citation
Andersen MR, Karlan BY, Drescher CW, Paley P, Hawley S, Palomares M, Daly MB, Urban N. False-positive screening events and worry influence decisions about surgery among high-risk women. Health Psychol. 2019 Jan;38(1):43-52. doi: 10.1037/hea0000647. Epub 2018 Nov 15.
Results Reference
derived
Links:
URL
http://www.pocrc.org
Description
homepage of the Pacific Ovarian Cancer Research Consortium

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A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women

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