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Treatment With Ribavirin for Patients With Metastatic Breast Cancer

Primary Purpose

Metastatic Breast Cancer

Status
Terminated
Phase
Phase 1
Locations
Canada
Study Type
Interventional
Intervention
Ribavirin
Sponsored by
Jewish General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Breast Cancer focused on measuring metastatic breast cancer, ribavirin, eIF4E

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically or cytologically confirmed breast cancer at diagnosis, with metastatic disease at the time of screening, who have progressed on prior anthracycline and taxane-containing regimens.
  • Willing to have a screening biopsy performed from an easily accessible lesion (ex. skin, superficial lymph node), AND must have overexpression of eIF4E in the metastatic tissue.
  • Easily accessible lesion for serial biopsies (ex. skin, superficial lymph node, or other easily accessible site).
  • At least 1 unidimensionally measurable lesion (based on the RECIST criteria) outside the CNS.
  • ECOG 0, 1, or 2.
  • Adequate recovery (excluding alopecia) from previous surgery, radiation, and chemotherapy.
  • Adequate wash-out period from last therapy for breast cancer (at least 3 weeks).
  • Life expectancy ≥ 12 weeks.
  • Age is ≥ 18 years. There is no upper age limit since the drug can be administered orally and even considered in a palliative setting.
  • Female patients of childbearing potential must have a negative serum (beta-HCG) pregnancy test within 14 days of starting protocol and must not be breastfeeding. Men and women of childbearing potential must agree to use an effective means of contraception throughout the study and for at least 6 months after completion of protocol. Post-menopausal women (defined as 12 or more consecutive months of amenorrhea, or follicle stimulating hormone (FSH) in the post-menopausal range), or surgically sterile women, do not require methods of contraception.
  • Adequate renal and hepatic function: serum creatinine < 1.5 x ULN; AST or ALT < 2.5 x ULN (or < 5 x ULN if liver involvement with metastases); serum bilirubin < 1.5 x ULN.
  • Adequate hematopoietic function: neutrophils ≥1.0 x 10E9/L, platelets ≥ 100 x 10E9/L.
  • Provide written consent after the investigational nature, study design, risks and benefits of the study have been explained.
  • Accessible for treatment and follow up.

Exclusion Criteria:

  • Symptomatic brain metastases.
  • Active cardiovascular disease as defined by New York Heart Association (NYHA) class III-IV categorization.
  • Intercurrent illness or medical condition precluding safe administration of the planned protocol treatment or required follow-up.
  • Use of any investigational drug within 4 weeks before start of study treatment or inadequate recovery from any toxic effects of such therapy.
  • Female patients who are pregnant or breastfeeding.
  • Concurrent treatment with other anti-cancer therapy. Bisphosphonates are allowed as long as they were started prior to screening (at least 4 weeks before study entry) and the dose does not change during study participation.
  • Known infection with HIV.
  • History of other malignancy in the past 5 years. Subjects who have been disease-free for 1 year or subjects with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible.

Sites / Locations

  • Jewish General Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ribavirin

Arm Description

Outcomes

Primary Outcome Measures

Overall response rate to therapy with daily oral ribavirin

Secondary Outcome Measures

Time to and duration of response
Time to relapse
To determine the medical risk (safety and tolerability) that ribavirin may have on breast cancer patients as determined by laboratory tests, vital signs, and clinical adverse events.
Correlation between activity of eIF4E and response
Effect of ribavirin on the activity of eIF4E related pathways
Evaluate pharmacokinetic parameters of ribavirin
Correlate expression of eIF4E in fresh and archived tissue

Full Information

First Posted
January 25, 2010
Last Updated
November 3, 2015
Sponsor
Jewish General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01056757
Brief Title
Treatment With Ribavirin for Patients With Metastatic Breast Cancer
Official Title
A Phase I/II Exploratory Study of Ribavirin in Metastatic Breast Cancer Expressing Elevated eIF4E
Study Type
Interventional

2. Study Status

Record Verification Date
November 2015
Overall Recruitment Status
Terminated
Why Stopped
Study closed because of new overlapping study with ribavirin.
Study Start Date
December 2009 (undefined)
Primary Completion Date
November 2010 (Actual)
Study Completion Date
November 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Jewish General Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to learn whether oral Ribavirin is safe and effective in treating patients with metastatic breast cancer, that have high levels of eIF4E.
Detailed Description
Overexpression of eIF4E occurs in greater than 50% of BC, where it has been associated with clinical progression, angiogenesis and chemoresistance. eIF4E protein expression is not elevated in stroma or in benign tissue. A major focus in the future management of BC is to develop novel targeted therapeutics, with associated biomarkers of clinical value. It is possible that targeting a central regulator that can control multiple pathways might be more effective than targeting a single downstream molecule. In our preclinical studies, we have demonstrated that ribavirin inhibits proliferation of BC cell lines at clinically achievable concentrations by inhibiting its target, eIF4E. This trial addresses the important clinical issue of the lack of treatment for poor prognosis BC, characterized by overexpression of eIF4E. We will explore the use of eIF4E as therapeutic target and a predictive marker. We will determine whether targeting eIF4E with ribavirin, a commercially approved, inexpensive, oral therapeutic compound with a favourable toxicity profile, may present a novel treatment option for patients with aggressive, metastatic disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Breast Cancer
Keywords
metastatic breast cancer, ribavirin, eIF4E

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
4 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ribavirin
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Ribavirin
Intervention Description
1000 mg bid, po, q28days
Primary Outcome Measure Information:
Title
Overall response rate to therapy with daily oral ribavirin
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Time to and duration of response
Time Frame
1-5years
Title
Time to relapse
Time Frame
1-5 years
Title
To determine the medical risk (safety and tolerability) that ribavirin may have on breast cancer patients as determined by laboratory tests, vital signs, and clinical adverse events.
Time Frame
1-2 years
Title
Correlation between activity of eIF4E and response
Time Frame
1-2 years
Title
Effect of ribavirin on the activity of eIF4E related pathways
Time Frame
1-2 years
Title
Evaluate pharmacokinetic parameters of ribavirin
Time Frame
1-2 years
Title
Correlate expression of eIF4E in fresh and archived tissue
Time Frame
1-2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed breast cancer at diagnosis, with metastatic disease at the time of screening, who have progressed on prior anthracycline and taxane-containing regimens. Willing to have a screening biopsy performed from an easily accessible lesion (ex. skin, superficial lymph node), AND must have overexpression of eIF4E in the metastatic tissue. Easily accessible lesion for serial biopsies (ex. skin, superficial lymph node, or other easily accessible site). At least 1 unidimensionally measurable lesion (based on the RECIST criteria) outside the CNS. ECOG 0, 1, or 2. Adequate recovery (excluding alopecia) from previous surgery, radiation, and chemotherapy. Adequate wash-out period from last therapy for breast cancer (at least 3 weeks). Life expectancy ≥ 12 weeks. Age is ≥ 18 years. There is no upper age limit since the drug can be administered orally and even considered in a palliative setting. Female patients of childbearing potential must have a negative serum (beta-HCG) pregnancy test within 14 days of starting protocol and must not be breastfeeding. Men and women of childbearing potential must agree to use an effective means of contraception throughout the study and for at least 6 months after completion of protocol. Post-menopausal women (defined as 12 or more consecutive months of amenorrhea, or follicle stimulating hormone (FSH) in the post-menopausal range), or surgically sterile women, do not require methods of contraception. Adequate renal and hepatic function: serum creatinine < 1.5 x ULN; AST or ALT < 2.5 x ULN (or < 5 x ULN if liver involvement with metastases); serum bilirubin < 1.5 x ULN. Adequate hematopoietic function: neutrophils ≥1.0 x 10E9/L, platelets ≥ 100 x 10E9/L. Provide written consent after the investigational nature, study design, risks and benefits of the study have been explained. Accessible for treatment and follow up. Exclusion Criteria: Symptomatic brain metastases. Active cardiovascular disease as defined by New York Heart Association (NYHA) class III-IV categorization. Intercurrent illness or medical condition precluding safe administration of the planned protocol treatment or required follow-up. Use of any investigational drug within 4 weeks before start of study treatment or inadequate recovery from any toxic effects of such therapy. Female patients who are pregnant or breastfeeding. Concurrent treatment with other anti-cancer therapy. Bisphosphonates are allowed as long as they were started prior to screening (at least 4 weeks before study entry) and the dose does not change during study participation. Known infection with HIV. History of other malignancy in the past 5 years. Subjects who have been disease-free for 1 year or subjects with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wilson Miller, MD, PhD
Organizational Affiliation
Jewish General Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Katherine Borden, PhD
Organizational Affiliation
Université de Montréal
Official's Role
Study Director
Facility Information:
Facility Name
Jewish General Hospital
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3T 1E2
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
15601771
Citation
Kentsis A, Topisirovic I, Culjkovic B, Shao L, Borden KL. Ribavirin suppresses eIF4E-mediated oncogenic transformation by physical mimicry of the 7-methyl guanosine mRNA cap. Proc Natl Acad Sci U S A. 2004 Dec 28;101(52):18105-10. doi: 10.1073/pnas.0406927102. Epub 2004 Dec 15.
Results Reference
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PubMed Identifier
19433856
Citation
Assouline S, Culjkovic B, Cocolakis E, Rousseau C, Beslu N, Amri A, Caplan S, Leber B, Roy DC, Miller WH Jr, Borden KL. Molecular targeting of the oncogene eIF4E in acute myeloid leukemia (AML): a proof-of-principle clinical trial with ribavirin. Blood. 2009 Jul 9;114(2):257-60. doi: 10.1182/blood-2009-02-205153. Epub 2009 May 11.
Results Reference
background
PubMed Identifier
19367274
Citation
Coleman LJ, Peter MB, Teall TJ, Brannan RA, Hanby AM, Honarpisheh H, Shaaban AM, Smith L, Speirs V, Verghese ET, McElwaine JN, Hughes TA. Combined analysis of eIF4E and 4E-binding protein expression predicts breast cancer survival and estimates eIF4E activity. Br J Cancer. 2009 May 5;100(9):1393-9. doi: 10.1038/sj.bjc.6605044. Epub 2009 Apr 14.
Results Reference
background
PubMed Identifier
18719964
Citation
Holm N, Byrnes K, Johnson L, Abreo F, Sehon K, Alley J, Meschonat C, Md QC, Li BD. A prospective trial on initiation factor 4E (eIF4E) overexpression and cancer recurrence in node-negative breast cancer. Ann Surg Oncol. 2008 Nov;15(11):3207-15. doi: 10.1245/s10434-008-0086-9. Epub 2008 Aug 22.
Results Reference
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Treatment With Ribavirin for Patients With Metastatic Breast Cancer

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