A phase II non randomized study evaluating the role of Androgen Receptors as Targets for therapy of pre-treated postmenopausal patients with ER/PgR-negative/AR-positive or ER and/or PgR-positive/AR-positive metastatic breast cancer. Study Design: Multicentric, Open-label not randomized trial. Description of Study Treatment: Daily oral administration of DHEA (Dehydroepiandrosterone) at the dosage of 100 mg/die in combination with a daily oral administration of anastrozole at dosage of 1 mg/die or letrozole at the dosage of 2.5 mg/die or exemestane at the dosage of 25 mg/die without interruption until discontinuation for progression of disease, unacceptable toxicity or discontinuation/withdrawal of participants from study treatment. Number of Subjects: 12 patients per group in the first step; if the number of responders is greater or equal to 2, recruitment will continue up to a total of 35 patients (per group). For the biological part, we will evaluate: 1. Correlation between AR expression and clinical and biological features (tumor size, nodal status, histotype, grading, proliferative index, ER, PgR, HER2) 2. Evaluation of AR expression on primitive and/or metastatic site in the two distinct populations of patients: ER/PgR- negative/ARpositive and ER-positive and/or PgR-positive/AR-positive 3. Evaluation of ER, PgR, HER2 expression on tumor cells of metastatic site (when it is possible) and comparison with the same features of primitive tumor. 4. CTCs analysis in term of molecular characteristics (gene expression and mutations) and functionality (vitality and tumorigenicity). 5. Prognostic and predictive role of Circulating Tumor Cells (CTC) evaluated at baseline before study treatment and at the moment of discontinuation of treatment.
A phase II non randomized study evaluating the role of Androgen Receptors as Targets for therapy of pre-treated postmenopausal patients with ER/PgR-negative/AR-positive or ER and/or PgR-positive/AR-positive metastatic breast cancer. Study Design: Multicentric, Open-label not randomized trial. Description of Study Treatment: Daily oral administration of DHEA (Dehydroepiandrosterone) at the dosage of 100 mg/die in combination with a daily oral administration of anastrozole at dosage of 1 mg/die or letrozole at the dosage of 2.5 mg/die or exemestane at the dosage of 25 mg/die without interruption until discontinuation for progression of disease, unacceptable toxicity or discontinuation/withdrawal of participants from study treatment. Number of Subjects: 12 patients per group in the first step; if the number of responders is greater or equal to 2, recruitment will continue up to a total of 35 patients (per group). For the biological part, we will evaluate: 1. Correlation between AR expression and clinical and biological features (tumor size, nodal status, histotype, grading, proliferative index, ER, PgR, HER2) 2. Evaluation of AR expression on primitive and/or metastatic site in the two distinct populations of patients: ER/PgR- negative/ARpositive and ER-positive and/or PgR-positive/AR-positive 3. Evaluation of ER, PgR, HER2 expression on tumor cells of metastatic site (when it is possible) and comparison with the same features of primitive tumor. 4. CTCs analysis in term of molecular characteristics (gene expression and mutations) and functionality (vitality and tumorigenicity). 5. Prognostic and predictive role of Circulating Tumor Cells (CTC) evaluated at baseline before study treatment and at the moment of discontinuation of treatment. Statistical Considerations: The sample size required for each treatment arm will be predicted using a SIMON two-stage design with a 10 percent alpha and beta error. Assuming an acceptable minimum clinical benefit P0 equal to 10 percent and an auspicious clinical benefit P1 equal to 30 percent, we plan to recruit 12 patients per group in the first step. If the number of responders is greater or equal to 2, recruitment will continue up to a total of 35 patients (per group). If the number of responders is greater or equal to 6, the combination will be considered active and worthy of further evaluation. If a subgroup population is discontinued at the end of the first step, the study will be continued with the other subgroup.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
DHEA: Daily oral administration of DHEA(Dehydroepiandrosterone) at the dosage of 100 mg/die in combination with a daily oral administration of anastrozole at dosage of 1 mg/die or letrozole at the dosage of 2.5 mg/die or exemestane at the dosage of 25 mg/die without interruption.
Irccs Irst
Meldola, FC, Italy
Oncologia medica , PO FAENZA, Ausl della Romagna
Faenza, RA, Italy
Oncologia Medica PO Lugo, AUSL della Romagna
Lugo, RA, Italy
Oncologia medica PO Ravenna AUSL della Romagna
Ravenna, RA, Italy
Oncologia Medica PO Cattolica AUSL della Romagna
Cattolica, Italy
Oncologia Medica,E.O. Ospedali Galliera
Genova, Italy
Oncologia Medica AOU Policlinico di Modena
Modena, Italy
Oncologia medica PO Rimini AUSL della Romagna
Rimini, Italy
Clinical benefit rate (CB)
the proportion of patients with stability, partial response and complete response of the disease after 4 months of therapy.
Time frame: 36 months
Time to tumor progression (TTP)
It is defined as the time from randomization until objective tumor progression NOT including death.
Time frame: 36 months
Duration of response (DOR)
The time from the date of response documentation to the date of disease progression documentation.
Time frame: 36 months
Overall survival (OS)
The time from the date of randomization to date of death from any cause.
Time frame: 36 months
Quality of life Quality of life Quality of life Quality of life
FACT ( Functional Assessment of Cancer Therapy ) -B : a 36-item compilation, subdivided into four primary QOL (Quality of life) domains and a disease specific domain - additional concerns for breast cancer.
Time frame: 36 months
Correlation between AR expression and clinical and biological features
Immunohistochemistry for steroid receptors. Antigen expression is evaluated at light microscope (x 200) by two independent observers. The positivity is expressed as the percentage ratio between immunoreactive and total number of tumor cells. The cut off value \> 10%for AR will be adopted.
Time frame: 36 months
Evaluation of AR expression on primitive and/or metastatic site in the two distinct populations of patients ( ER/PgR- negative/ARpositive and ER-positive and/or PgR-positive/AR-positive)
Immunohistochemistry for steroid receptors. Antigen expression is evaluated at light microscope (x 200) by two independent observers. The positivity is expressed as the percentage ratio between immunoreactive and total number of tumor cells. The cut off value \> 10%for AR will be adopted.
Time frame: 36 months
Evaluation of ER, PgR, HER2 expression on tumor cells of metastatic sites (when it is possible) and comparison with the same features of the the primary site.
Immunohistochemistry for steroid receptors. Antigen expression is evaluated at light microscope (x 200) by two independent observers. The positivity is expressed as the percentage ratio between immunoreactive and total number of tumor cells. The cut off value \> 10%for AR will be adopted.
Time frame: 36 months
Circulating Tumor Cells (CTCs) analysis [Optionally, only for patients enrolled at IRCCS IRST of Meldola and who signed additional informed consent ]
Analyzing 15-20 ml peripheral blood (PB). The blood collection will be taken before starting treatment at baseline and at the end of treatment.
Time frame: 36 months
Safety
Assessed by collecting adverse events (AE) and serious adverse events (SAE) during the course of the study.
Time frame: 36 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.