- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00090857
Letrozole in Preventing Breast Cancer in Postmenopausal Women (WISE)
A Pilot Study of Aromatase Inhibitors for Women at Increased Risk of Breast Cancer Based on Estradiol Levels
RATIONALE: Chemoprevention therapy is the use of certain drugs to try to prevent the development or recurrence of cancer. Letrozole may be effective in preventing the development or recurrence of breast cancer in postmenopausal women who are at increased risk of developing breast cancer because of elevated estradiol levels.
PURPOSE: This randomized phase II trial is studying how well letrozole works in preventing breast cancer in postmenopausal women with elevated estradiol levels.
Study Overview
Detailed Description
OBJECTIVES:
Primary
- The primary outcome of the study is the change in bone mineral density following a year on letrozole vs. a year on placebo.
Secondary
- Compare the safety, acceptability, and adherence to letrozole vs placebo in postmenopausal women at increased risk for the development or recurrence of breast cancer based on elevated plasma estradiol levels through evaluation of menopausal symptoms (including hot flushes, weight changes, sexual functioning, and genitourinary effects), blood lipid levels, markers of bone turnover, and multidimensional quality of life.
- Determine the effect of letrozole-induced reduction of plasma estradiol levels on mammographic percent breast density.
- Obtain background information for a future large chemoprevention trial to address the question of whether a reduction in plasma estradiol levels can reduce the risk of breast cancer in postmenopausal women.
OUTLINE: This is a pilot, randomized, double-blind, placebo-controlled, multicenter study. Patients are randomized to 2:1 (experimental treatment: placebo arms).
PROJECTED ACCRUAL: A total of 110 patients (73 for arm I and 37 for arm II) will be accrued for this study.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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Massachusetts
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Boston, Massachusetts, United States, 02215
- Beth Israel Deaconess Medical Center
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Boston, Massachusetts, United States, 02114
- Massachusetts General Hospital
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Boston, Massachusetts, United States, 02115
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104-4283
- Abramson Cancer Center of the University of Pennsylvania
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Texas
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Houston, Texas, United States, 77030
- Dan L. Duncan Cancer Center at Baylor College of Medicine
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
DISEASE CHARACTERISTICS:
- At increased risk for the development or recurrence of breast cancer, defined as an estradiol level ≥ 9 pg/mL
No evidence of suspicious or malignant disease, based on the following examinations:
- Clinical bilateral breast examination within the past 6 months
- Bilateral* mammogram within 3 months before randomization OR within 30 days after randomization
- Pelvic exam normal within the past 5 years
- General physical exam within the past 6 months NOTE: *Unilateral mammogram of the uninvolved breast for patients with prior invasive breast cancer or ductal carcinoma in situ (DCIS)
Bone density scan within 2 standard deviations from normal within the past 30 days
- Bone density scan ≥ 2 standard deviations below normal allowed if approved by the study physician
- At least 1 breast that has not been previously treated with radiotherapy or surgery (for patients with prior invasive breast cancer or DCIS)
Hormone receptor status:
- Not specified
PATIENT CHARACTERISTICS:
Age
- 35 and over
Sex
- Female
Menopausal status
Postmenopausal, defined by any of the following criteria:
- At least 12 months without spontaneous menstrual bleeding
- Prior hysterectomy and bilateral salpingo-oophorectomy
- ≥ 55 years of age with a prior hysterectomy with or without oophorectomy
- < 55 years of age with a prior hysterectomy without oophorectomy OR the status of the ovaries is unknown AND follicle-stimulating hormone (FSH) level is in the postmenopausal range
Performance status
- Normal activity must not be restricted for a significant portion of the day
Life expectancy
- At least 10 years
Hematopoietic
Complete blood count with differential normal
- Prior benign neutropenia allowed provided the granulocyte count is ≥ 1,500/mm^3
Hepatic
- Bilirubin normal
- Alkaline phosphatase normal
- SGOT and SGPT normal
Renal
- Creatinine normal
Cardiovascular
- No uncontrolled cardiovascular disease
Other
- Not pregnant
- No other malignancy within the past 5 years except basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
- No osteoporosis
- No hyperlipidemia
- No mental health status resulting in cognitive or emotional impairment that would preclude study participation
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- Not specified
Endocrine therapy
More than 30 days since prior AND no concurrent use of any of the following hormonal agents:
- Estrogen or progesterone replacement therapy
- Oral contraceptives
- Raloxifene or other plasma estrogen receptor modulators (SERMs)
- Androgens (e.g., danazol)
- Luteinizing hormone-releasing hormone (LHRH) analogs (e.g., goserelin or leuprolide)
- Prolactin inhibitors (e.g., bromocriptine)
- Antiandrogens (e.g., cyproterone)
- More than 60 days since prior AND no concurrent tamoxifen
- No prior aromatase inhibitors (for patients with prior invasive breast cancer or DCIS)
No concurrent phytoestrogenic dietary supplements (e.g., soy, ginseng, or other natural products)
- Dietary soy allowed
Radiotherapy
- See Disease Characteristics
Surgery
- See Disease Characteristics
- No prior bilateral mastectomy
Other
- More than 60 days since prior treatment for invasive breast cancer or DCIS
- More than 30 days since prior bisphosphonates or calcitonin
- No prior or concurrent participation on a treatment study for invasive breast cancer or DCIS
- No concurrent participation in any other cancer prevention study or osteoporosis prevention study involving pharmacologic agents
- No concurrent calcitonin
- No concurrent bisphosphonate therapy
- Concurrent cholecalciferol (vitamin D) and calcium to augment bone mineral density allowed
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Letrozole
Participants in this arm received 2.5 mg of letrozole per day for a duration of 12 months; followed by an optional 4 years.
Treatment continued in the absence of unacceptable toxicity or diagnosis of invasive breast cancer, ductal carcinoma in situ, or any non-breast primary cancer.
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Other Names:
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Placebo Comparator: Placebo
Participants in this arm received 1 tablet per day which contained the inert ingredients from the letrozole tablet, for a duration of 12 months; followed by an optional 5 years of letrozole.Treatment continued in the absence of unacceptable toxicity or diagnosis of invasive breast cancer, ductal carcinoma in situ, or any non-breast primary cancer.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Lumbar Density From Baseline to 12 Months
Time Frame: Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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The bone mineral density (BMD) test was comprised of the following 4 measurements [total density (g/cm^2)]: lumbar, femoral neck, trochanter, hip.
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Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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Change in Femoral Neck Density From Baseline to 12 Months
Time Frame: Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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The bone mineral density (BMD) test was comprised of the following 4 measurements [total density (g/cm^2)]: lumbar, femoral neck, trochanter, hip.
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Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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Change in Trochanter Density From Baseline to 12 Months
Time Frame: Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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The bone mineral density (BMD) test was comprised of the following 4 measurements [total density (g/cm^2)]: lumbar, femoral neck, trochanter, hip.
|
Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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Change in Hip Density From Baseline to 12 Months
Time Frame: Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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The bone mineral density (BMD) test was comprised of the following 4 measurements [total density (g/cm^2)]: lumbar, femoral neck, trochanter, hip.
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Evaluation occurred at treatment initiation (BL) and after 12-months of treatment.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Worst Grade Hot Flashes
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade hot flashes: 01: mild (<1qd) or 02: moderate (>1qd) during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Muscle Aches/Pains
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade muscle aches/pains defined as grade 01: mild, 02: moderate, 03: severe (CTCAEv3) or 04: disabling (CTCAEv3) during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Nausea
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade nausea grade 01: able to eat, 02: oral intake significantly decreased, 03: no significant intake, requiring IV fluids during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Vomiting
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade vomiting grade 01: 1x in 24 hours, 02: 2-5x in 24 hours, 03: >/= 6x in 24 hours, grade 04: requiring parenteral nutrition/intensive care during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Abdominal Pain
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade abdominal pain: 01: mild, 02: moderate, 03: severe (CTCAEv3), 04: disabling (CTCAEv3) during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Bone Pain
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade bone pain: 01: mild, 02: moderate, 03: severe (CTCAEv3), 04: disabling (CTCAEv3) during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Headache
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade headache: 01: mild, 02: moderate, 03: severe (CTCAEv3), 04: disabling (CTCAEv3) during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Worst Grade Fatigue
Time Frame: Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Participants reported worst grade fatigue: 01: mild, 02: moderate, 03: severe (CTCAEv3), 04: disabling (CTCAEv3) during 12 months of treatment.
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Heath assessments during treatment were administered at 3- and 9-months by telephone contact and during clinic visits at 6- and12-months.
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Judy Garber, MD, Dana-Farber Cancer Institute
- Principal Investigator: Patricia A. Ganz, MD, Jonsson Comprehensive Cancer Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Skin Diseases
- Neoplasms
- Neoplasms by Site
- Breast Diseases
- Breast Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Hormone Antagonists
- Aromatase Inhibitors
- Steroid Synthesis Inhibitors
- Estrogen Antagonists
- Letrozole
Other Study ID Numbers
- DFCI-00024
- P50CA089393 (U.S. NIH Grant/Contract)
- P30CA006516 (U.S. NIH Grant/Contract)
- UCLA-0210012-02
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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