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Study of the Efficacy of Chloroquine in the Treatment of Ductal Carcinoma in Situ (The PINC Trial)

Primary Purpose

Carcinoma, Intraductal, Noninfiltrating, DCIS, Ductal Carcinoma In Situ

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Chloroquine Standard Dose (500mg/week)
Chloroquine Low Dose (250mg/week)
Breast Biopsy
Sponsored by
Inova Health Care Services
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Carcinoma, Intraductal, Noninfiltrating focused on measuring Carcinoma, Intraductal, Noninfiltrating, Ductal Carcinoma In Situ, DCIS, Carcinoma, Intraductal, Breast Cancer, Breast Tumors, chloroquine, autophagy, Autophagic Cell Death, Autophagocytosis, Programmed Cell Death, Type II, Autophagy, Cellular, Autophagic Programmed Cell Death

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have a tissue diagnosis of low, intermediate or high grade ductal carcinoma in situ or ductal carcinoma in situ with microinvasion.
  • Patients with ductal carcinoma in situ undergoing either lumpectomy/radiation or mastectomy.
  • Patients must be female at least 18 years of age.
  • Patients must have a signed tissue acquisition consent and have at minimum, adequate samples of primary fresh tissue or blood available for use in this study.
  • No history of a previous invasive cancer in the last five years with the exception of minimally invasive non-melanoma skin cancer.
  • Normal liver function based on Liver Function Tests (Total Bilirubin and Asparate transaminase (AST) <1.5 X Upper Limit of Normal).
  • Normal White Blood Count (WBC) (3.5-10.8 x 103µL), Platelet count (PLT) (140-400 x 103µL), and Hematocrit (HCT)(37-52%)
  • Potassium within the normal range of 3.5-5.3 mEq/L
  • Adequate renal sufficiency (serum creatinine <1.5 mg/dL).
  • Eastern Cooperative Oncology Group performance status 0-2.
  • Are able to swallow and retain oral medication.
  • No underlying ocular/retinal pathology.
  • No medically documented preexisting auditory damage.
  • Subjects should be willing to abstain from use of hormonal therapies (e.g. hormone replacement therapy, oral contraceptive pills, hormone-containing Intra Uterine Device (IUD)s, and E-string) and chronic non-steroidal anti-inflammatory (NSAID) s for the duration of the study (chronic use of NSAID's is defined as a frequency >3 times/week for more than two weeks per year and includes low dose aspirin).
  • Subjects with child-bearing potential must agree to use adequate contraception (total abstinence (no sexual intercourse), use of condom with spermicide or sterilization surgery, including tubal ligation (tubes tied) or hysterectomy (removal of the uterus or womb)) prior to study entry and for the duration of study treatment phase. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately.

If a subject is of child-bearing potential (women are considered not of child-bearing potential if they are at least one year postmenopausal and/or surgically sterile), she must have a documented negative serum or urine pregnancy test before starting treatment.

Exclusion Criteria:

  • Patients with a prior history of chemotherapy, hormonal ablation therapy and/or radiation therapy.
  • History of other invasive cancer in the previous 5 years other than minimally invasive non-melanoma skin cancer.
  • Patient desires not to participate in the study.
  • Inability to consent.
  • Current or recent pregnancy (within 12 months),
  • Current use of hormone-containing forms of birth control such as implants (i.e. Norplants, or injectables ( i.e. depo-provera)
  • Currently lactating.
  • Patients with history of renal or hepatic insufficiency.
  • Current diagnosis for depression, including treatment with an Selective Serotonin Reuptake Inhibitor (SSRI).
  • History of prior treatment with chloroquine for malaria within past 24 months.
  • History of allergic reactions to quinolones or chloroquine.
  • Active diagnosis of psoriasis or currently receiving treatment for psoriasis.
  • History of porphyria.
  • History of known Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency.
  • Alcoholism or hepatic disease.
  • History of epilepsy or seizures in the past 20 years.
  • History of deep vein thrombosis or pulmonary embolism.
  • History of human immunodeficiency virus (HIV) disease and/or treatment with anti-HIV agents.
  • Receiving concurrent treatment with prohibited medications (refer to Table 1 for details on prohibited medications); Examples include: ampicillin, antacids, cimetidine, cyclosporine, kaolin, magnesium trisilicate, coumarin-type anticoagulants, macrolide antibiotics (e.g., clarithromycin, isoniazid, and erythromycin), anti-HIV agents (e.g., ritonavir and delavirdine), antidepressants (e.g. fluoxetine and fluvoxamine), calcium channel blockers (e.g. verapamil and diltiazem), steroids and their modulators (e.g., gestodene, raloxifene, and mifepristone), and several herbal and dietary components (e.g. bergamottin and glabridin).
  • Used an investigational drug within 30 days or 5 half-lives, whichever is longer, preceding the first dose of study medication.

Sites / Locations

  • Medical Oncology and Hematology Associates of Northern Virginia
  • Virginia Cancer Specialists, PC
  • Virginia Surgery Associates
  • Inova Fairfax Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Chloroquine Standard Dose (500mg/week)

Chloroquine Low Dose (250mg/week)

Arm Description

Patients with ER+ or ER- DCIS regardless of histologic grade will be randomly assigned to receive one month standard dose chloroquine (500 mg/week).

Patients with ER+ or ER- DCIS regardless of histologic grade will be randomly assigned to receive one month low dose chloroquine (250mg/week).

Outcomes

Primary Outcome Measures

Average Change in the Longest Diameter of the Breast MRI Target Lesion
One of the primary outcomes of this study was to measure the impact of weekly chloroquine on the amount of DCIS seen on MRI.The tumor response was evaluated by RECIST criteria. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR The longest diameter of the target lesion or primary area of non-mass enhancement was measured by digital calipers. For one patient, the longest diameter was difficult to measure due to the presence of a significant post biopsy resolving hematoma at the biopsy site. Further correlation was made based on the extent of the pre-treatment microcalcifications and post treatment areas of non-mass enhancement.

Secondary Outcome Measures

Total Number of Treatment-Related Adverse Events
One of the outcomes was to ensure the safety of weekly chloroquine. Patients were followed clinically during the treatment with chloroquine and during their surgery and postoperative period ( including radiation therapy). Patients were verbally assessed for additional symptoms or concerns. Patients were also examined by the provider during treatment and follow up visits to the surgeon.
Effect of Chloroquine on Proliferating Cell Nuclear Antigen (PCNA) Proliferation Index
We evaluated the effect of therapy on cellular proliferation as measured by the change in proliferating cell nuclear antigen (PCNA) proliferation index. PCNA , which is elevated during the G1/S phase of the cell cycle, may be used as a marker of cellular proliferation. The PCNA proliferation index was measured as the number of PCNA positive stained cells in the DCIS lesion/ total number of cells in the lesion. The change in the PCNA index is equal to the mean PCNA proliferation index pre-treatment minus the mean PCNA proliferation index post-treatment.
Impact of Chloroquine Treatment on the Cell Signaling Kinase Levels in DCIS Lesions.
The study evaluated the effect of chloroquine treatment on the proteomic signaling profiles of the DCIS lesions. Post treatment surgical specimens were evaluated by immunohistochemical staining to measure cell signaling kinase levels for CD68 and HMGB1. CD68 (Cluster Determinant 68) is a marker of macrophages/monocytes in the breast ducts. and HMGB1 (High Mobility Group Box 1) is involved in oxidative stress-mediated autophagy. HMGB1 is a non-histone DNA binding protein. The number of positive cells were quantified and recorded. .

Full Information

First Posted
December 1, 2009
Last Updated
June 8, 2021
Sponsor
Inova Health Care Services
Collaborators
George Mason University, University of Pittsburgh Medical Center, United States Department of Defense, U.S. Army Medical Research and Development Command
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1. Study Identification

Unique Protocol Identification Number
NCT01023477
Brief Title
Study of the Efficacy of Chloroquine in the Treatment of Ductal Carcinoma in Situ (The PINC Trial)
Official Title
Preventing Invasive Breast Neoplasia With Chloroquine (PINC) Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
December 2009 (undefined)
Primary Completion Date
October 2016 (Actual)
Study Completion Date
October 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Inova Health Care Services
Collaborators
George Mason University, University of Pittsburgh Medical Center, United States Department of Defense, U.S. Army Medical Research and Development Command

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to test the hypothesis that chloroquine will reduce the ability of ductal carcinoma in situ (DCIS) to survive and spread. Participants will receive either chloroquine standard dose (500mg/week) or chloroquine low dose (250mg/week) for 1 month prior to surgical removal of the tumor.
Detailed Description
The purpose of this study is to test the hypothesis that inhibiting the autophagy pathway in DCIS will reduce the capacity of DCIS to survive and invade. The study will examine the safety and effectiveness of neoadjuvant chloroquine administration for a one month period to patients with low, intermediate grade, or high grade DCIS. We will evaluate whether this treatment will reduce the capacity of DCIS neoplastic cells, existing within the duct, to survive, induce lesion regression, and kill the invasive DCIS progenitor cells.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Carcinoma, Intraductal, Noninfiltrating, DCIS, Ductal Carcinoma In Situ
Keywords
Carcinoma, Intraductal, Noninfiltrating, Ductal Carcinoma In Situ, DCIS, Carcinoma, Intraductal, Breast Cancer, Breast Tumors, chloroquine, autophagy, Autophagic Cell Death, Autophagocytosis, Programmed Cell Death, Type II, Autophagy, Cellular, Autophagic Programmed Cell Death

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Chloroquine Standard Dose (500mg/week)
Arm Type
Experimental
Arm Description
Patients with ER+ or ER- DCIS regardless of histologic grade will be randomly assigned to receive one month standard dose chloroquine (500 mg/week).
Arm Title
Chloroquine Low Dose (250mg/week)
Arm Type
Experimental
Arm Description
Patients with ER+ or ER- DCIS regardless of histologic grade will be randomly assigned to receive one month low dose chloroquine (250mg/week).
Intervention Type
Drug
Intervention Name(s)
Chloroquine Standard Dose (500mg/week)
Other Intervention Name(s)
Aralen
Intervention Description
Patients will receive chloroquine (500 mg/once a week) for 1 month prior to surgical removal of the DCIS lesion.
Intervention Type
Drug
Intervention Name(s)
Chloroquine Low Dose (250mg/week)
Other Intervention Name(s)
Aralen
Intervention Description
Patients will receive chloroquine (250 mg/once a week) for 1 month prior to surgical removal of the DCIS lesion.
Intervention Type
Procedure
Intervention Name(s)
Breast Biopsy
Other Intervention Name(s)
Biopsy, DCIS, Ductal Carcinoma in Situ
Intervention Description
Patients diagnosed with DCIS will undergo a breast biopsy prior to the start of study treatment. This biopsy is entirely voluntary and is not required to remain in the study. The biopsy will allow researchers to study the tissue for biomarkers and to determine how the DCIS tissue changes during treatment. Additional samples of the DCIS tissue will be collected at the time of surgery.
Primary Outcome Measure Information:
Title
Average Change in the Longest Diameter of the Breast MRI Target Lesion
Description
One of the primary outcomes of this study was to measure the impact of weekly chloroquine on the amount of DCIS seen on MRI.The tumor response was evaluated by RECIST criteria. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR The longest diameter of the target lesion or primary area of non-mass enhancement was measured by digital calipers. For one patient, the longest diameter was difficult to measure due to the presence of a significant post biopsy resolving hematoma at the biopsy site. Further correlation was made based on the extent of the pre-treatment microcalcifications and post treatment areas of non-mass enhancement.
Time Frame
Immediately preceding study drug treatment and again after treatment prior to surgery. The total time interval was up to 8 weeks
Secondary Outcome Measure Information:
Title
Total Number of Treatment-Related Adverse Events
Description
One of the outcomes was to ensure the safety of weekly chloroquine. Patients were followed clinically during the treatment with chloroquine and during their surgery and postoperative period ( including radiation therapy). Patients were verbally assessed for additional symptoms or concerns. Patients were also examined by the provider during treatment and follow up visits to the surgeon.
Time Frame
The patients were monitored from the time of diagnosis through 6 months of surgical follow up.
Title
Effect of Chloroquine on Proliferating Cell Nuclear Antigen (PCNA) Proliferation Index
Description
We evaluated the effect of therapy on cellular proliferation as measured by the change in proliferating cell nuclear antigen (PCNA) proliferation index. PCNA , which is elevated during the G1/S phase of the cell cycle, may be used as a marker of cellular proliferation. The PCNA proliferation index was measured as the number of PCNA positive stained cells in the DCIS lesion/ total number of cells in the lesion. The change in the PCNA index is equal to the mean PCNA proliferation index pre-treatment minus the mean PCNA proliferation index post-treatment.
Time Frame
At the time of breast biopsy and again at time of surgery.
Title
Impact of Chloroquine Treatment on the Cell Signaling Kinase Levels in DCIS Lesions.
Description
The study evaluated the effect of chloroquine treatment on the proteomic signaling profiles of the DCIS lesions. Post treatment surgical specimens were evaluated by immunohistochemical staining to measure cell signaling kinase levels for CD68 and HMGB1. CD68 (Cluster Determinant 68) is a marker of macrophages/monocytes in the breast ducts. and HMGB1 (High Mobility Group Box 1) is involved in oxidative stress-mediated autophagy. HMGB1 is a non-histone DNA binding protein. The number of positive cells were quantified and recorded. .
Time Frame
At the time of surgery

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have a tissue diagnosis of low, intermediate or high grade ductal carcinoma in situ or ductal carcinoma in situ with microinvasion. Patients with ductal carcinoma in situ undergoing either lumpectomy/radiation or mastectomy. Patients must be female at least 18 years of age. Patients must have a signed tissue acquisition consent and have at minimum, adequate samples of primary fresh tissue or blood available for use in this study. No history of a previous invasive cancer in the last five years with the exception of minimally invasive non-melanoma skin cancer. Normal liver function based on Liver Function Tests (Total Bilirubin and Asparate transaminase (AST) <1.5 X Upper Limit of Normal). Normal White Blood Count (WBC) (3.5-10.8 x 103µL), Platelet count (PLT) (140-400 x 103µL), and Hematocrit (HCT)(37-52%) Potassium within the normal range of 3.5-5.3 mEq/L Adequate renal sufficiency (serum creatinine <1.5 mg/dL). Eastern Cooperative Oncology Group performance status 0-2. Are able to swallow and retain oral medication. No underlying ocular/retinal pathology. No medically documented preexisting auditory damage. Subjects should be willing to abstain from use of hormonal therapies (e.g. hormone replacement therapy, oral contraceptive pills, hormone-containing Intra Uterine Device (IUD)s, and E-string) and chronic non-steroidal anti-inflammatory (NSAID) s for the duration of the study (chronic use of NSAID's is defined as a frequency >3 times/week for more than two weeks per year and includes low dose aspirin). Subjects with child-bearing potential must agree to use adequate contraception (total abstinence (no sexual intercourse), use of condom with spermicide or sterilization surgery, including tubal ligation (tubes tied) or hysterectomy (removal of the uterus or womb)) prior to study entry and for the duration of study treatment phase. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately. If a subject is of child-bearing potential (women are considered not of child-bearing potential if they are at least one year postmenopausal and/or surgically sterile), she must have a documented negative serum or urine pregnancy test before starting treatment. Exclusion Criteria: Patients with a prior history of chemotherapy, hormonal ablation therapy and/or radiation therapy. History of other invasive cancer in the previous 5 years other than minimally invasive non-melanoma skin cancer. Patient desires not to participate in the study. Inability to consent. Current or recent pregnancy (within 12 months), Current use of hormone-containing forms of birth control such as implants (i.e. Norplants, or injectables ( i.e. depo-provera) Currently lactating. Patients with history of renal or hepatic insufficiency. Current diagnosis for depression, including treatment with an Selective Serotonin Reuptake Inhibitor (SSRI). History of prior treatment with chloroquine for malaria within past 24 months. History of allergic reactions to quinolones or chloroquine. Active diagnosis of psoriasis or currently receiving treatment for psoriasis. History of porphyria. History of known Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency. Alcoholism or hepatic disease. History of epilepsy or seizures in the past 20 years. History of deep vein thrombosis or pulmonary embolism. History of human immunodeficiency virus (HIV) disease and/or treatment with anti-HIV agents. Receiving concurrent treatment with prohibited medications (refer to Table 1 for details on prohibited medications); Examples include: ampicillin, antacids, cimetidine, cyclosporine, kaolin, magnesium trisilicate, coumarin-type anticoagulants, macrolide antibiotics (e.g., clarithromycin, isoniazid, and erythromycin), anti-HIV agents (e.g., ritonavir and delavirdine), antidepressants (e.g. fluoxetine and fluvoxamine), calcium channel blockers (e.g. verapamil and diltiazem), steroids and their modulators (e.g., gestodene, raloxifene, and mifepristone), and several herbal and dietary components (e.g. bergamottin and glabridin). Used an investigational drug within 30 days or 5 half-lives, whichever is longer, preceding the first dose of study medication.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kirsten H Edmiston, MD, FACS
Organizational Affiliation
Inova Fairfax Hospital Cancer Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Priscilla McAuliffe, MD, PhD
Organizational Affiliation
Magee-Women's Hospital of UPMC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medical Oncology and Hematology Associates of Northern Virginia
City
Fairfax
State/Province
Virginia
ZIP/Postal Code
22031
Country
United States
Facility Name
Virginia Cancer Specialists, PC
City
Fairfax
State/Province
Virginia
ZIP/Postal Code
22031
Country
United States
Facility Name
Virginia Surgery Associates
City
Fairfax
State/Province
Virginia
ZIP/Postal Code
22033
Country
United States
Facility Name
Inova Fairfax Hospital
City
Falls Church
State/Province
Virginia
ZIP/Postal Code
22042
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20562526
Citation
Martinez-Outschoorn UE, Pavlides S, Whitaker-Menezes D, Daumer KM, Milliman JN, Chiavarina B, Migneco G, Witkiewicz AK, Martinez-Cantarin MP, Flomenberg N, Howell A, Pestell RG, Lisanti MP, Sotgia F. Tumor cells induce the cancer associated fibroblast phenotype via caveolin-1 degradation: implications for breast cancer and DCIS therapy with autophagy inhibitors. Cell Cycle. 2010 Jun 15;9(12):2423-33. doi: 10.4161/cc.9.12.12048. Epub 2010 Jun 15.
Results Reference
derived

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Study of the Efficacy of Chloroquine in the Treatment of Ductal Carcinoma in Situ (The PINC Trial)

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