BRE-06: Study to Increase Tolerance to Aromatase Inhibitors for Patients With Early-Stage Hormone Receptor Positive Breast Cancer Who Developed Hypoactive Sexual Desire Disorder

Phase 2Not Yet RecruitingNCT07596212

University of Illinois at Chicago100 enrolled

Overview

This study is open to women who have early-stage breast cancer and are on aromatase inhibitor (AI) therapy, and who have hypoactive sexual desire disorder (HSDD). HSDD is a persistent lack of physical desire for sex and a lack of sexual activity, or even sexual thoughts or fantasies, that causes you distress. The researchers want to determine if sexual functioning, as measured by responses on a sexual functioning questionnaire, is improved by adding Bupropion Extended Release (XL) to the AI treatment regimen. Bupropion XL is an FDA-approved medication for the treatment of major depressive disorder, seasonal affective disorder, and nicotine dependence. It has been studied in HSDD in pre- and post-menopausal healthy women, and has been demonstrated to be effective, but it has not been thoroughly studied in women with early-stage breast cancer on AI therapy.

Patients diagnosed with HSDD (defined as Female Sexual Function Index, or FSFI, score ≤ 26) will discontinue their current AI therapy and will be randomized to treatment with a different AI (non-steroidal AI to steroidal AI, or vice versa) plus bupropion 150 mg orally twice a day versus single-agent AI. All patients diagnosed with HSDD will be referred to counseling services and pelvic floor therapy. In addition, patients will be offered access to the Rosy App. FSFI will be administered at months 1, 3, 6, and during the year 3 visit.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

100

Conditions

Early-stage Breast Cancer

Interventions

Aromatase InhibitorsDRUG

An aromatase inhibitor will be given at a duration, frequency, and dose per standard of care.

BupropionDRUG

Bupropion will be taken twice a day by mouth at 150 mg with the option to change to 300 mg daily for those with ongoing HSDD symptoms

GnRH agonistDRUG

A GnRH agonist will be administered for a duration and dose per standard of care as part of ovarian suppression therapy for those who are pre-menopausal. These will be administered subcutaneously every 28 days.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Females 18 or older * Histologically-proven, resected, hormone receptor-positive (defined as estrogen receptor ≥1% and/or progesterone receptor (PgR)≥1% by immunohistochemistry at local institutions) early invasive breast cancer, stage I-III per American Joint Committee of Cancer (AJCC) 8th edition, regardless of Human Epidermal growth factor Receptor 2 (HER2) status * Completion of the following planned cancer treatments prior to registration: * Surgical resection of breast and nodal surgery; (NOTE: Reconstructive surgery does not have to be completed) * Adjuvant radiation therapy, if needed * Neoadjuvant and/or adjuvant chemotherapy if needed * Treatment with anti-HER2 agents is allowed * Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2. * Ability to swallow oral medication. * Provide written informed consent and fill out questionnaires * Willing to return to the enrolling institution for follow-up * Women of childbearing potential must not be pregnant or breastfeeding. A negative serum or urine pregnancy test is required per institutional practice guidelines. Women of childbearing potential will be required to use effective contraception from the time of consent until 30 days after the last dose of bupropion. Acceptable methods include hormonal contraception, intrauterine device, barrier methods with spermicide, or sterilization Exclusion Criteria: * Previous bilateral oophorectomy or ovarian irradiation; pregnant or lactating at the time of randomization or desiring pregnancy within 5 years. * History of psychiatric illnesses on active treatment * History or active suicidal thoughts or behaviors * Currently taking anti-depressants, anti-anxiety, or anti-psychotic medications. History of seizure disorder * History of bulimia or anorexia nervosa * Inhibitors or inducers of CYP2B6 * Drugs metabolized by CYP2D6 * Use of monoamine oxidase inhibitors (MAOI) * History of hypertension, regardless of control status. * History of angle closure glaucoma * Subjects taking levodopa, amantadine, methylene blue, and linezolid * Those with a hypersensitivity to bupropion, anastrozole, letrozole, exemestane, goserelin, or leuprolide. Currently receiving any of the following cancer-directed therapies: * Radiation therapy * Systemic therapy such as chemotherapy (standard or investigational) * Anti-HER2 agents are allowed

Outcomes

Primary Outcomes

Tolerance of study drugs in patients with early stage breast cancer and Hypoactive Sexual Desire Disorder

To compare the tolerance of aromatase inhibitor (+/- ovarian suppression therapy) in comparison to aromatase inhibitor (+/- ovarian suppression therapy) plus bupropion. This is assessed by the proportion of patients no longer meeting HSDD criteria as reflected by FSFI \> 26 at three months post-randomization.

Time frame: Until 3 months post-study enrollment

Secondary Outcomes

Disease free-survival in patients with early stage breast cancer and Hypoactive Sexual Desire Disorder

To compare the disease free survival rate of patients taking aromatase inhibitor (+/- ovarian suppression therapy) to those taking aromatase inhibitor therapy (+/- ovarian suppression therapy) plus bupropion. This is assessed by the time since treatment end to the date of disease progression, death, or least contact, whichever comes first

Time frame: Until 3 years post-study enrollment

Overall survival in patients with early stage breast cancer and Hypoactive Sexual Desire Disorder

To compare the overall survival rate of patients taking aromatase inhibitor (+/- ovarian suppression therapy) to those taking aromatase inhibitor therapy (+/- ovarian suppression therapy) plus bupropion. This is defined as the time of treatment randomization to death or last contact in study participants.

Time frame: Until 3 years post-study enrollment

Safety and tolerability of study drugs in patients with early stage breast cancer and Hypoactive Sexual Desire Disorder

To determine the safety and tolerability of aromatase inhibitor (+/- ovarian suppression therapy) versus aromatase inhibitor (+/- ovarian suppression therapy) and bupropion as defined by the number of adverse events using NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.

Time frame: Until 6 months post-study enrollment

Medication adherence of study drugs in patients with early stage breast cancer and Hypoactive Sexual Desire Disorder

To determine the rate of medication adherence for patients taking aromatase inhibitor (+/- ovarian suppression therapy) versus aromatase inhibitor (+/- ovarian suppression therapy) and bupropion. This is defined as the number of medication diary entries and physician queries to treatment.

Time frame: Until 3 years post-treatment start