FLT PET in Measuring Treatment Response in Patients With Newly Diagnosed Estrogen Receptor-Positive, HER2-Negative Stage I-III Breast Cancer

Imaging Early Response of ER+, HER2- Breast Cancer to Aromatase Inhibitor (AI) +/- Ovarian Suppression (OS) Therapy With [18F]Fluorothymidine (FLT) PET

This clinical trial studies fluorine F 18 fluorothymidine (FLT) positron emission tomography (PET) in measuring treatment response in patients with newly diagnosed estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative stage I-III breast cancer. Comparing results of diagnostic procedures done before and during hormone therapy may help doctors predict a patient's response to treatment and help plan the best treatment.

Study Overview

• Status: Completed
• Conditions: Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIC Breast Cancer; Estrogen Receptor Positive; HER2/Neu Negative; Male Breast Carcinoma
• Intervention / Treatment: Other: Laboratory Biomarker Analysis; Drug: Fluorothymidine F-18; Procedure: Positron Emission Tomography; Drug: Run-in (short pre-surgery course) of endocrine-targeted therapy

Detailed Description

PRIMARY OBJECTIVES:

I. Measure the effect of a short course of endocrine therapy on primary breast cancer metabolism and proliferation by measuring changes in serial FLT PET measures pre and post a short course of endocrine therapy.

SECONDARY OBJECTIVES:

I. Compare changes in imaging measures to tissue measures of response, in particular antigen identified by proliferation-related Ki-67 antigen (Ki-67), in the pre-therapy biopsy versus the post-therapy surgical specimen.

II. Correlate imaging measures to measures of gene expression from pre and post therapy assays to determine if there are molecular changes associated with early response to therapy.

OUTLINE:

Patients undergo FLT PET at baseline and 1-6 weeks after the start of treatment.

• Study Type: Interventional
• Enrollment (Actual): 28
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Washington
    • Seattle, Washington, United States, 98109
      • Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• A new diagnosis of invasive breast cancer > 1.0 cm in size, ER+ clinical stage I-III
• Patient must have surgical resection followed by systemic adjuvant therapy with an aromatase inhibitor (AIs) as part of planned treatment; any approved AI at standard clinical dosing may be used; in pre-menopausal patients, ovarian suppression with a gonadotropin-releasing hormone (GnRH) agonist will be started prior to initiation of the AI on a separate clinical trial in parallel with the imaging study
• Have tissue block available from core biopsy for correlative biomarkers and genomic assay

• Have menopausal status determined prior to study enrollment; for study purposes, postmenopausal is defined as

  • A prior documented bilateral oophorectomy, or
  • A history of at least 12 months without spontaneous menstrual bleeding, or
  • Age 60 or older with a prior hysterectomy without oophorectomy, or
  • Age less than 60 with a prior hysterectomy without oophorectomy (or in whom the status of the ovaries is unknown) with a documented follicle-stimulating hormone (FSH) level demonstrating confirmatory elevation in the postmenopausal range for the lab
• Negative pregnancy test within 7 days of baseline positron emission tomography (PET) scan for pre-menopausal patients
• Tumor HER2/neu expression must be determined (as part of standard clinical care) prior to study enrollment; HER2 may be tested by any Food and Drug Administration (FDA) approved HER2 testing method; if determination is intermediate by immunohistochemistry (IHC), fluorescent in situ hybridization (FISH) or another alternate HER2 test must be performed
• Be a candidate for [18F]FLT PET imaging
• Be informed of the investigational nature of this study and provide written informed consent in accordance with institutional and federal guidelines prior to study-specific screening procedures
• Be willing and able to comply with scheduled visits and other trial procedures

Exclusion Criteria:

• Current use of aromatase inhibitor as prevention or treatment for breast cancer
• Life expectancy of less than two months
• HER2/neu positive by IHC and/or another FDA approved HER2 testing method
• Inability to tolerate scanning (e.g. - claustrophobia, severe pain)
• Weight exceeding capacity of imaging table

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Diagnostic (FLT PET); Patients undergo FLT PET at baseline and 1-6 weeks after the start of treatment.

Other: Laboratory Biomarker Analysis; Correlative studies; Drug: Fluorothymidine F-18; Undergo FLT PET; Other Names: 18F-FLT; 3'-deoxy-3'-[18F]fluorothymidine; Procedure: Positron Emission Tomography; Undergo FLT PET; Other Names: Medical Imaging, Positron Emission Tomography; PET; PET Scan; Positron Emission Tomography Scan; Drug: Run-in (short pre-surgery course) of endocrine-targeted therapy; Patients undergo run-in (short pre-surgery course) of endocrine-targeted therapy with aromatase inhibitor between the two (baseline and repeat) FLT PET scans. This is not an experimental therapy. This is a standard of care therapy that patients will continue after surgery, when the study is completed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent Change in Net Influx Constant (Ki) by FLT PET	Percent change between pre-treatment (baseline) and post-therapy PET measurements in breast tumors will be computed. Association between Ki-67 and Ki by FLT (KFLT) decline will be analyzed using the mid-P adjustment to Fisher's exact test to evaluate the potential clinical utility of change in FLT as a biomarker for early response, using Ki-67 as the standard for early response.	Baseline to up to 6 weeks
Percent Change in SUV by FLT PET	Percent change between pre-treatment (baseline) and post-therapy measurements of FLT standardized uptake value (SUV) in breast tumors will be computed.	Baseline to up to 6 weeks
Percentage of Ki-67 Positive Tumor Cells in Surgical (Post-therapy) Sample	Surgically removed breast tumor tissue is stained using immuno-histochemistry techniques to visualize dividing cells expressing the Ki-67 protein, which is a cellular marker for proliferation.	1 to 6 weeks post-therapy start
Percentage Change in Ki-67 Positive Cells Between Pre-therapy and Post-therapy Tumor Specimens	Tumor tissue samples from pre-treatment (baseline) biopsy and post-treatment surgery are stained using immuno-histochemistry techniques to visualize dividing cells expressing the Ki-67 protein, which is a cellular marker for proliferation. The % values of positive cells from the baseline and post-treatment samples are then compared for each individual patient. Association between Ki-67 and KFLT decline will be analyzed to evaluate the potential clinical utility of change in FLT as a biomarker for early response, using Ki-67 as the standard for early response.	Baseline to up to 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change in K1 (Blood Flow Parameter) by FLT PET	Percent change between pre-treatment (baseline) and post-therapy PET measurements in breast tumors will be computed.	Baseline to up to 6 weeks
Baseline Ki (Flux Constant) Values by FLT PET	Ki (flux constant) in breast tumor tissue as determined by the pre-therapy (baseline) FLT PET scan	Baseline
Baseline FLT Transport (K1) Values by FLT PET	K1 (blood flow measure) in breast tumor tissue as determined by the pre-therapy (baseline) FLT PET	Baseline
Baseline Standardized Uptake Values (SUV) by FLT PET	FLT SUV in breast tumor tissue as determined by the pre-therapy (baseline) FLT PET	Baseline
Post-therapy Ki (Flux Constant) Values by FLT PET	Ki (flux constant) in breast tumor tissue as determined by the post-therapy FLT PET	1 to 6 weeks post-therapy start
Post-treatment FLT Transport (K1) Values by FLT PET	K1 (blood flow measure) in breast tumor tissue as determined by the post-therapy FLT PET	1 to 6 weeks post-therapy start
Post-treatment Standardized Uptake Values (SUV) by FLT PET	FLT SUV in breast tumor tissue as determined by the post-treatment FLT PET	1 to 6 weeks post-therapy start

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-treatment Gene Expression Levels	Analyzed using BeadStudio software. Four clustering metrics for calculating dissimilarities (correlation, absolute correlation, Euclidean, and Manhattan) are available in BeadStudio and will be applied using standard analysis methods and diagnostics in BioConductor. To focus the analysis, proposed gene sets will be examined based on biological pathways and molecular signatures.	1 to 6 weeks post-therapy start
Pre-treatment Gene Expression Levels	Analyzed using BeadStudio software. Four clustering metrics for calculating dissimilarities (correlation, absolute correlation, Euclidean, and Manhattan) are available in BeadStudio and will be applied using standard analysis methods and diagnostics in BioConductor. To focus the analysis, proposed gene sets will be examined based on biological pathways and molecular signatures.	Baseline

Collaborators and Investigators

• Sponsor: University of Washington
• Collaborators: National Cancer Institute (NCI)

Study record dates

Study Major Dates

• Study Start: September 1, 2011
• Primary Completion (Actual): July 20, 2015
• Study Completion (Actual): July 20, 2015

Study Registration Dates

• First Submitted: August 20, 2013
• First Submitted That Met QC Criteria: August 20, 2013
• First Posted (Estimate): August 23, 2013

Study Record Updates

• Last Update Posted (Actual): May 15, 2018
• Last Update Submitted That Met QC Criteria: April 13, 2018
• Last Verified: April 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Breast Neoplasms, Male; Anti-Infective Agents; Antiviral Agents; Alovudine
• Other Study ID Numbers: 7536 (Other Identifier: Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium); P30CA015704 (U.S. NIH Grant/Contract); NCI-2013-01380 (Registry Identifier: CTRP (Clinical Trial Reporting Program)); RC1CA146456 (U.S. NIH Grant/Contract)