Oral Tamoxifen vs. TamGel vs. Control in Women With Atypical Hyperplasia or Lobular Carcinoma In Situ
Primary Purpose
Atypical Hyperplasia, Lobular Carcinoma in Situ
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Tamoxifen
Topical 4-OHT( 4-hydroxytamoxifen)gel 4 mg/each breast/day
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Atypical Hyperplasia
Eligibility Criteria
Inclusion Criteria:
- Willing to return to enrolling institution for follow-up
- Willing to complete required testing
- Ability to complete questionnaire by themselves or with assistance
- Female (sex that was assigned at birth)
- Ipsilateral intact breast with histology confirmation of atypical ductal or lobular hyperplasia, or LCIS, within the last 12 months, whether surgically excised or not.
- Eastern Cooperative Oncology Group (ECOG) performance status ≤1
- Willingness to agree to use ONE effective form of birth control (abstinence is not an allowed method) prior to study entry and for the duration of study participation, and for 2 months following the last dose of study medications. Effective birth control methods are: copper IUD [intrauterine device], diaphragm/cervical cap/shield, spermicide, contraceptive sponge, condoms. Women of childbearing potential must have a negative pregnancy test within five days before starting study medications. Should a participant become pregnant or suspect she is pregnant while participating in this study; the participant should inform the study physician immediately.
- Willingness to avoid exposing breast skin to natural or artificial sunlight (i.e. tanning beds) for the duration of the study.
- Participants must have acceptable organ and marrow function as defined below within 30 days of randomization: judged by treating physician's evaluation of baseline laboratory data.
- Negative urine pregnancy test, if of childbearing potential. and / or FSH to verify menopausal status.
Exclusion Criteria:
- Clinically suspicious mass/lesions Breast cancer in the past 5 years.
- Prior thromboembolism within last 5 years (history of varicose veins and superficial phlebitis is allowed) Current pregnancy or lactation History of other prior breast cancer-specific therapy within the previous 2 years (chemotherapy, anti-HER2 agents, endocrine agents, everolimus, CDK4-6 inhibitors).
- Cytotoxic chemotherapy for any indication in last 2 years.
- Prior use of SERMS or AIs including tamoxifen, raloxifene, anastrozole, letrozole, or exemestane for prevention or therapy within 5 years.
- Exogenous sex steroid, including oral contraceptive pill use within 1 month prior to research core needle biopsy (CNB).
- Use of vaginally administered estrogens and hormone coated IUD such as Mirena is permitted History of any prior ipsilateral breast radiotherapy. Previous unilateral radiation of the contralateral side is allowed.
- Skin lesions on the breast that disrupt the stratum corneum (eg eczema, ulceration).
- History of endometrial neoplasia
- Current smoker. Cessation for at least 6 weeks
- Current users of potent inhibitors of tamoxifen metabolism. The potent inhibitors of tamoxifen metabolism are: bupropion, cinacalcet, fluoxetine, paroxetine, quinidine.
- Participants may not be receiving any other investigational agents within 90 days of enrollment or during this study.
- History of allergic reactions to tamoxifen.
- Uncontrolled intercurrent illness that in the judgement of the treating physician would make them unsuitable for study participation
- Anticoagulation meds and clinical concern for discontinuing meds for study research biopsy.
- Identification of a clinically suspicious mass on examination.
Sites / Locations
- Northwestern UniversityRecruiting
- Mayo ClinicRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Experimental
Arm Label
Oral Tamoxifen 10 mg/day
Topical 4-OHT (4-hydroxytamoxifen) gel 4 mg/each breast/day
Control
Arm Description
Oral Tamoxifen 10 mg/day
Topical 4-OHT (4-hydroxytamoxifen) gel 4 mg/each breast/day +oral placebo
Oral and gel placebo
Outcomes
Primary Outcome Measures
The purpose of this research is to evaluate short-term changes in background breast tissue induced by oral tamoxifen or 4-OHT gel in women with atypical hyperplasia or lobular carcinoma in situ (LCIS).
Treatment Evaluation/Measurement of Effect
Secondary Outcome Measures
Full Information
NCT ID
NCT04570956
First Posted
September 28, 2020
Last Updated
June 18, 2023
Sponsor
Amy C. Degnim
Collaborators
National Cancer Institute (NCI)
1. Study Identification
Unique Protocol Identification Number
NCT04570956
Brief Title
Oral Tamoxifen vs. TamGel vs. Control in Women With Atypical Hyperplasia or Lobular Carcinoma In Situ
Official Title
A Phase IIB Randomized Trial of Oral Tamoxifen vs. Topical 4-hydroxytamoxifen Gel vs. Control in Women With Atypical Hyperplasia or Lobular Carcinoma In Situ
Study Type
Interventional
2. Study Status
Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 26, 2021 (Actual)
Primary Completion Date
December 31, 2026 (Anticipated)
Study Completion Date
December 31, 2026 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Amy C. Degnim
Collaborators
National Cancer Institute (NCI)
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.
Yes
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The investigators plan to prospectively study breast tissue changes after a short course of Tamoxifen (Tam).
Detailed Description
Women with atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) are at increased risk of breast cancer (BC) (~1-2 % per year). Over two decades ago, placebo-controlled randomized trials established that oral tamoxifen (20 mg/day) reduces breast cancer risk by 50% in generally defined high risk women, with ~70% reduction in women at high risk specifically due to atypical hyperplasia.[1] Years later, the side effects and toxicity of oral tamoxifen at 20 mg/day remain a significant barrier to its uptake and longterm compliance.[2, 3] To address the issue of toxicity, two main strategies have been pursued: 1) using a lower dose of oral tamoxifen, and 2) using a topical formulation of tamoxifen to avoid systemic side effects. The investigators will perform a prospective study of women with AH or LCIS who will take a short course of prevention therapy; breast tissue samples will be evaluated pre- and post-therapy to identify and evaluate very early biomarkers of response. The overall goal of the study is to evaluate short-term changes in background breast tissue induced by either low-dose oral tamoxifen or topical 4-OHT gel in women with AH or LCIS.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atypical Hyperplasia, Lobular Carcinoma in Situ
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Subjects will be randomized 2:2:1 with either Oral Tamoxifen 10 mg/day
gel placebo, Topical 4-OHT gel 4 mg/each breast/day
oral placebo, or Control Oral and gel placebo for 4 weeks of treatment.
Masking
Care ProviderInvestigator
Masking Description
Subjects with be randomized by MedidataRave and Pharmacy.
Allocation
Randomized
Enrollment
104 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Oral Tamoxifen 10 mg/day
Arm Type
Experimental
Arm Description
Oral Tamoxifen 10 mg/day
Arm Title
Topical 4-OHT (4-hydroxytamoxifen) gel 4 mg/each breast/day
Arm Type
Experimental
Arm Description
Topical 4-OHT (4-hydroxytamoxifen) gel 4 mg/each breast/day
+oral placebo
Arm Title
Control
Arm Type
Experimental
Arm Description
Oral and gel placebo
Intervention Type
Drug
Intervention Name(s)
Tamoxifen
Other Intervention Name(s)
Oral tamoxifen
Intervention Description
Oral Tamoxifen 10 mg/day
Intervention Type
Drug
Intervention Name(s)
Topical 4-OHT( 4-hydroxytamoxifen)gel 4 mg/each breast/day
Other Intervention Name(s)
Topical gel
Intervention Description
Topical 4-OHT (4-hydroxytamoxifen) gel 4 mg/each breast/day
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
placebo pill, placebo gel
Intervention Description
placebo pill or placebo gel
Primary Outcome Measure Information:
Title
The purpose of this research is to evaluate short-term changes in background breast tissue induced by oral tamoxifen or 4-OHT gel in women with atypical hyperplasia or lobular carcinoma in situ (LCIS).
Description
Treatment Evaluation/Measurement of Effect
Time Frame
48 months
10. Eligibility
Sex
Female
Gender Based
Yes
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Willing to return to enrolling institution for follow-up
Willing to complete required testing
Ability to complete questionnaire by themselves or with assistance
Female (sex that was assigned at birth)
Ipsilateral intact breast with histology confirmation of atypical ductal or lobular hyperplasia, or LCIS, within the last 5 years, whether surgically excised or not.
Eastern Cooperative Oncology Group (ECOG) performance status ≤1
Willingness to agree to use ONE effective form of birth control (abstinence is not an allowed method) prior to study entry and for the duration of study participation, and for 2 months following the last dose of study medications. Effective birth control methods are: copper IUD [intrauterine device], diaphragm/cervical cap/shield, spermicide, contraceptive sponge, condoms. Women of childbearing potential must have a negative pregnancy test within five days before starting study medications. Should a participant become pregnant or suspect she is pregnant while participating in this study; the participant should inform the study physician immediately.
Willingness to avoid exposing breast skin to natural or artificial sunlight (i.e. tanning beds) for the duration of the study.
Participants must have acceptable organ and marrow function as defined below within 30 days of randomization: judged by treating physician's evaluation of baseline laboratory data.
Negative urine pregnancy test, if of childbearing potential. and / or FSH to verify menopausal status.
Exclusion Criteria:
Clinically suspicious mass/lesions Breast cancer in the past 5 years.
Prior thromboembolism within last 5 years (history of varicose veins and superficial phlebitis is allowed) Current pregnancy or lactation History of other prior breast cancer-specific therapy within the previous 2 years (chemotherapy, anti-HER2 agents, endocrine agents, everolimus, CDK4-6 inhibitors).
Cytotoxic chemotherapy for any indication in last 2 years.
Prior use of SERMS or AIs including tamoxifen, raloxifene, anastrozole, letrozole, or exemestane for prevention or therapy within 5 years.
Exogenous sex steroid, including oral contraceptive pill use within 1 month prior to research core needle biopsy (CNB).
Use of vaginally administered estrogens and hormone coated IUD such as Mirena is permitted History of any prior ipsilateral breast radiotherapy. Previous unilateral radiation of the contralateral side is allowed.
Skin lesions on the breast that disrupt the stratum corneum (eg eczema, ulceration).
History of endometrial neoplasia
Current smoker. Cessation for at least 6 weeks
Current users of potent inhibitors of tamoxifen metabolism. The potent inhibitors of tamoxifen metabolism are: bupropion, cinacalcet, fluoxetine, paroxetine, quinidine.
Participants may not be receiving any other investigational agents within 90 days of enrollment or during this study.
History of allergic reactions to tamoxifen.
Uncontrolled intercurrent illness that in the judgement of the treating physician would make them unsuitable for study participation
Anticoagulation meds and clinical concern for discontinuing meds for study research biopsy.
Identification of a clinically suspicious mass on examination.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Denice Gehling, RN
Phone
507-538-1628
Email
gehling.denice@mayo.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Lisa R Seymour
Email
seymour.lisa@mayo.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amy Degnim, MD
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Northwestern University
City
Evanston
State/Province
Illinois
ZIP/Postal Code
60208
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Zachary Feldman
Phone
312-695-1476
Email
zachary.feldman@northwestern.edu
First Name & Middle Initial & Last Name & Degree
Seema Khan, M.D.
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Denice Gehling, RN
Phone
507-538-1628
Email
gehling.denice@mayo.edu
First Name & Middle Initial & Last Name & Degree
Lisa Seymour, B.S
Phone
5072727414
Email
seymour.lisa@mayo.edu
First Name & Middle Initial & Last Name & Degree
Amy Degnim, MD
12. IPD Sharing Statement
Plan to Share IPD
No
Links:
URL
https://www.mayo.edu/research/clinical-trials
Description
Mayo Clinic Clinical Trials
Learn more about this trial
Oral Tamoxifen vs. TamGel vs. Control in Women With Atypical Hyperplasia or Lobular Carcinoma In Situ
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