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ETHAN - ET for Male BC

Primary Purpose

Male Breast Cancer, Hormone Receptor-positive Breast Cancer, Hormone Receptor Negative Breast Carcinoma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Tamoxifen
Anastrozole
Degarelix
Abemaciclib
Sponsored by
Jose Pablo Leone
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, Hormone Receptor-positive Breast Cancer, Hormone Receptor Negative Breast Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Men aged 18 years or older, with diagnosis of invasive breast cancer who have not undergone surgical resection of the primary tumor and axillary nodes.
  • Stage I, II, or III per American Joint Committee on Cancer (AJCC) staging 8th edition (112).
  • Breast cancer must be hormone receptor-positive and HER2-negative according to definition below assessed by local pathology.

    • Hormone receptor-positive is defined as: positivity for at least one of the hormone receptors (estrogen receptor [ER] or progesterone receptor [PR]) by IHC. ER and PR assays are considered positive if there are > 1% positive tumor nuclei in the samples.
    • HER2-negative is defined per the current American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline (113).
  • Patients with multifocal or multicentric disease are eligible if the treating investigator has determined the patient should be treated as ER-positive and HER2-negative.
  • Bilateral breast cancers are allowed if the treating investigator has determined the patient should be treated as ER-positive and HER2-negative.
  • Patients with a history of ipsilateral or contralateral DCIS or LCIS are eligible.
  • ECOG performance status ≤ 2.
  • Required laboratory values demonstrating adequate organ function:

    • ANC ≥ 1000/mm3
    • Hemoglobin ≥ 8 g/dl
    • Platelets ≥ 50,000/mm3
    • Serum creatinine ≤ 3.0 x ULN (institutional)
    • Total bilirubin ≤ 2.0 x ULN (institutional).
    • AST and ALT ≤ 5.0 x ULN (institutional)
  • Men with partners of childbearing potential must be willing to use one highly effective form of non-hormonal contraception or two effective forms of non-hormonal contraception by the patient and/or partner and continue its use for the duration of the study treatment and for 6 months after the last dose of study treatment.
  • Non-English-speaking patients are eligible but will be exempt from patient-completed questionnaires.
  • Willing and able to sign informed consent.
  • Willing to undergo breast biopsy after completion of window phase.
  • Patient is able to swallow oral medications.

Exclusion Criteria:

  • Prior endocrine therapy, chemotherapy, radiation therapy, or investigational therapy for the current breast cancer diagnosis.
  • Prior endocrine therapy, systemic therapy, radiation therapy, or investigational therapy for any other malignancy within the past 12 months.
  • Diagnosis of inflammatory breast cancer (T4d).
  • Other concurrent serious diseases that may interfere with planned treatment, including severe cardiac disease, congestive heart failure (CHF) of New York Heart Association (NYHA) Class III or higher, severe pulmonary conditions/illness, uncontrolled infections.
  • The patient has serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance <30ml/min], history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea).
  • The patient has active systemic bacterial infection (requiring intravenous [IV] antibiotics at time of initiating study treatment), fungal infection, or detectable viral infection (such as known human immunodeficiency virus positivity or with known active hepatitis B or C [for example, hepatitis B surface antigen positive]. Screening is not required for enrollment.
  • The patient has a personal history of any of the following conditions: syncope of cardiovascular etiology, ventricular arrhythmia of pathological origin (including, but not limited to, ventricular tachycardia and ventricular fibrillation), or sudden cardiac arrest.

Sites / Locations

  • Dana Farber Cancer InstituteRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Window Phase Arm A: Tamoxifen

Window Phase Arm B: Anastrozole

Window Phase Arm C: Anastrozole + Degarelix

Neoadjuvant Phase Arm D: Tamoxifen

Neoadjuvant Phase Arm E: Tamoxifen + Abemaciclib

Neoadjuvant Phase Arm F: Anastrozole and Degarelix

Neoadjuvant Phase Arm G: Anastrozole + Degarelix + Abemaciclib

Arm Description

Participants will be randomly assigned to receive Tamoxifen 1x daily for 3 weeks (21days).

Participants will be randomly assigned to receive Anastrozole 1x daily for 3 weeks (21days).

Participants will be randomly assigned to receive Anastrozole 1x daily for 3 weeks (21days) and Degarelix on day 1 only.

Participants will be randomly assigned to receive Tamoxifen 1x daily for 4 cycles (4 months); each study cycle is 28 days.

Participants will be randomly assigned to receive Tamoxifen 1x daily and Abemaciclib 2x daily for 4 cycles (4 months); each study cycle is 28 days.

Participants will be randomly assigned to receive Anastrozole 1x daily and Degarelix on day 1 of each cycle for 4 cycles (4 months); each study cycle is 28 days.

Participants will be randomly assigned to receive Anastrozole 1x daily, Degarelix on day 1 of each cycle and Abemaciclib 2x daily for 4 cycles (4 months); each study cycle is 28 days.

Outcomes

Primary Outcome Measures

Change in Ki-67
Ki-67 will be evaluated by ImmunoHistoChemistry (IHC) following consensus recommendations using imaging analysis methods.
RCB index
RCB will be determined using data from each participating institution pathology department, and will be reviewed by the study team pathologist.

Secondary Outcome Measures

Changes in estradiol levels
To evaluate the physiologic endocrine changes that occur as a result of treatment with tamoxifen, anastrozole and anastrozole and degarelix as measured by estradiol levels at baseline and at the end of the three-week window period
Changes in testosterone levels
To evaluate the physiologic endocrine changes that occur as a result of treatment with tamoxifen, anastrozole and anastrozole and degarelix as measured by testosterone levels at baseline and at the end of the three-week window period
Preoperative Endocrine Prognostic Index (PEPI) score
To evaluate the comparative efficacy of the experimental treatments as measured by PEPI score at surgery.

Full Information

First Posted
August 10, 2022
Last Updated
October 20, 2023
Sponsor
Jose Pablo Leone
Collaborators
Eli Lilly and Company, Translational Breast Cancer Research Consortium (TBCRC)
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1. Study Identification

Unique Protocol Identification Number
NCT05501704
Brief Title
ETHAN - ET for Male BC
Official Title
ETHAN: A Phase II Study Comparing Different Endocrine THerapies for mAle Breast caNcer
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 2023 (Anticipated)
Primary Completion Date
April 1, 2026 (Anticipated)
Study Completion Date
April 1, 2036 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jose Pablo Leone
Collaborators
Eli Lilly and Company, Translational Breast Cancer Research Consortium (TBCRC)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This research study is looking to see how well male breast cancer responds to preoperative treatment with endocrine therapy and which endocrine therapy regimen is the most effective treatment for male breast cancer. The drugs used in this study are: Tamoxifen Anastrozole Degarelix Abemaciclib
Detailed Description
This is an open-label, multicenter, randomized trial for men with stage I-III hormone receptor-positive (HR+)/HER2-negative breast cancer. The trial will have two phases: A 3-week window phase containing endocrine therapy followed by a 4-month treatment phase where participants are treated with one of four endocrine therapy treatment combinations. Tamoxifen is the standard of care for the treatment of breast cancer in men. Anastrozole is a standard treatment in women with breast cancer and works more effectively than tamoxifen. This study hopes to learn if anastrozole may also be effective in men. Given that gonadal suppression and CDK 4/6 inhibitors have both improved treatment in women with breast cancer, the study hopes to learn how the addition of Degarelix (gonadal suppression) and Abemaciclib (CDK 4/6 inhibitors) work in comparison to standard of care tamoxifen. The research study procedures include screening for eligibility and study treatment including laboratory evaluations and quality of life questionnaires. After completion of treatment, participants will be followed for up to 10 years It is expected that about 60 men will take part in this research study. Eli Lilly, a pharmaceutical company, is supporting this research study by providing one of the study drugs. This study is also being supported by Johns Hopkins University on behalf of the Translational Breast Cancer Research Consortium (TBCRC).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Male Breast Cancer, Hormone Receptor-positive Breast Cancer, Hormone Receptor Negative Breast Carcinoma
Keywords
Male Breast Cancer, Hormone Receptor-positive Breast Cancer, Hormone Receptor Negative Breast Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Window Phase Arm A: Tamoxifen
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Tamoxifen 1x daily for 3 weeks (21days).
Arm Title
Window Phase Arm B: Anastrozole
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Anastrozole 1x daily for 3 weeks (21days).
Arm Title
Window Phase Arm C: Anastrozole + Degarelix
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Anastrozole 1x daily for 3 weeks (21days) and Degarelix on day 1 only.
Arm Title
Neoadjuvant Phase Arm D: Tamoxifen
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Tamoxifen 1x daily for 4 cycles (4 months); each study cycle is 28 days.
Arm Title
Neoadjuvant Phase Arm E: Tamoxifen + Abemaciclib
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Tamoxifen 1x daily and Abemaciclib 2x daily for 4 cycles (4 months); each study cycle is 28 days.
Arm Title
Neoadjuvant Phase Arm F: Anastrozole and Degarelix
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Anastrozole 1x daily and Degarelix on day 1 of each cycle for 4 cycles (4 months); each study cycle is 28 days.
Arm Title
Neoadjuvant Phase Arm G: Anastrozole + Degarelix + Abemaciclib
Arm Type
Experimental
Arm Description
Participants will be randomly assigned to receive Anastrozole 1x daily, Degarelix on day 1 of each cycle and Abemaciclib 2x daily for 4 cycles (4 months); each study cycle is 28 days.
Intervention Type
Drug
Intervention Name(s)
Tamoxifen
Other Intervention Name(s)
Nolvadex, Soltamox
Intervention Description
Taken orally
Intervention Type
Drug
Intervention Name(s)
Anastrozole
Other Intervention Name(s)
Arimidex
Intervention Description
Taken orally
Intervention Type
Drug
Intervention Name(s)
Degarelix
Intervention Description
Subcutaneous (under the skin) injection
Intervention Type
Drug
Intervention Name(s)
Abemaciclib
Other Intervention Name(s)
Verzenio
Intervention Description
Taken orally
Primary Outcome Measure Information:
Title
Change in Ki-67
Description
Ki-67 will be evaluated by ImmunoHistoChemistry (IHC) following consensus recommendations using imaging analysis methods.
Time Frame
At the end of the 3-week window period.
Title
RCB index
Description
RCB will be determined using data from each participating institution pathology department, and will be reviewed by the study team pathologist.
Time Frame
At time of surgery.
Secondary Outcome Measure Information:
Title
Changes in estradiol levels
Description
To evaluate the physiologic endocrine changes that occur as a result of treatment with tamoxifen, anastrozole and anastrozole and degarelix as measured by estradiol levels at baseline and at the end of the three-week window period
Time Frame
Baseline and at the end of the three-week window period
Title
Changes in testosterone levels
Description
To evaluate the physiologic endocrine changes that occur as a result of treatment with tamoxifen, anastrozole and anastrozole and degarelix as measured by testosterone levels at baseline and at the end of the three-week window period
Time Frame
Baseline and at the end of the three-week window period
Title
Preoperative Endocrine Prognostic Index (PEPI) score
Description
To evaluate the comparative efficacy of the experimental treatments as measured by PEPI score at surgery.
Time Frame
At time of surgery
Other Pre-specified Outcome Measures:
Title
Grade 3 or Higher Treatment-Related Toxicity Rate
Description
All grade 3 or higher adverse events (AE) with treatment attribution of possibly, probably or definite based on CTCAEv5 as reported on case report forms were counted. Rate is the proportion of treated participants experiencing at least one treatment-related grade 3 or higher AE of any type during the time of observation.
Time Frame
Up to 6 months
Title
Trial enrollment
Description
We will evaluate how many patients we are able to enroll to this trial in a period of 3 years
Time Frame
3 years
Title
Trial completion
Description
We will evaluate how many of the enrolled participants successfully complete the study protocol
Time Frame
3 years
Title
EORTC QLC-C30 questionnaire
Description
Patient-reported outcomes (PROs) measures will be conducted using the EORTC QLC-C30 questionnaire.
Time Frame
Up to 6 months
Title
Adapted EORTC BR23 questionnaire
Description
Patient-reported outcomes (PROs) measures will be conducted using the EORTC BR23, adapted by replacing female-specific items with male-specific sexual activity/function items from PR25 (Appendix D of protocol) questionnaire.
Time Frame
Up to 6 months

10. Eligibility

Sex
Male
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men aged 18 years or older, with diagnosis of invasive breast cancer who have not undergone surgical resection of the primary tumor and axillary nodes. Stage I, II, or III per American Joint Committee on Cancer (AJCC) staging 8th edition (112). Breast cancer must be hormone receptor-positive and HER2-negative according to definition below assessed by local pathology. Hormone receptor-positive is defined as: positivity for at least one of the hormone receptors (estrogen receptor [ER] or progesterone receptor [PR]) by IHC. ER and PR assays are considered positive if there are > 1% positive tumor nuclei in the samples. HER2-negative is defined per the current American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline (113). Patients with multifocal or multicentric disease are eligible if the treating investigator has determined the patient should be treated as ER-positive and HER2-negative. Bilateral breast cancers are allowed if the treating investigator has determined the patient should be treated as ER-positive and HER2-negative. Patients with a history of ipsilateral or contralateral DCIS or LCIS are eligible. ECOG performance status ≤ 2. Required laboratory values demonstrating adequate organ function: ANC ≥ 1000/mm3 Hemoglobin ≥ 8 g/dl Platelets ≥ 50,000/mm3 Serum creatinine ≤ 3.0 x ULN (institutional) Total bilirubin ≤ 2.0 x ULN (institutional). AST and ALT ≤ 5.0 x ULN (institutional) Men with partners of childbearing potential must be willing to use one highly effective form of non-hormonal contraception or two effective forms of non-hormonal contraception by the patient and/or partner and continue its use for the duration of the study treatment and for 6 months after the last dose of study treatment. Non-English-speaking patients are eligible but will be exempt from patient-completed questionnaires. Willing and able to sign informed consent. Willing to undergo breast biopsy after completion of window phase. Patient is able to swallow oral medications. Exclusion Criteria: Prior endocrine therapy, chemotherapy, radiation therapy, or investigational therapy for the current breast cancer diagnosis. Prior endocrine therapy, systemic therapy, radiation therapy, or investigational therapy for any other malignancy within the past 12 months. Diagnosis of inflammatory breast cancer (T4d). Other concurrent serious diseases that may interfere with planned treatment, including severe cardiac disease, congestive heart failure (CHF) of New York Heart Association (NYHA) Class III or higher, severe pulmonary conditions/illness, uncontrolled infections. The patient has serious and/or uncontrolled preexisting medical condition(s) that, in the judgment of the investigator, would preclude participation in this study (for example, interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment [e.g. estimated creatinine clearance <30ml/min], history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea). The patient has active systemic bacterial infection (requiring intravenous [IV] antibiotics at time of initiating study treatment), fungal infection, or detectable viral infection (such as known human immunodeficiency virus positivity or with known active hepatitis B or C [for example, hepatitis B surface antigen positive]. Screening is not required for enrollment. The patient has a personal history of any of the following conditions: syncope of cardiovascular etiology, ventricular arrhythmia of pathological origin (including, but not limited to, ventricular tachycardia and ventricular fibrillation), or sudden cardiac arrest.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jose Pablo Leone, MD
Phone
617-789-2903
Email
josep_leone@dfci.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jose Pablo Leone, MD
Organizational Affiliation
Dana-Farber Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jose Pablo Leone, MD
Phone
617-789-2903
First Name & Middle Initial & Last Name & Degree
Jose Pablo Leone, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
IPD Sharing Time Frame
Data can be shared no earlier than 1 year following the date of publication
IPD Sharing Access Criteria
Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu

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ETHAN - ET for Male BC

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