Description:
Rationale: The purpose is to evaluate whether non-invasive in vivo imaging of androgen
receptor (AR) presence in metastatic breast cancer patients by means of
18F-fluoro-dihydrotestosterone positron emission tomography (FDHT-PET) can be used to predict
(early) treatment response to, and optimal dosing of, the anti androgen bicalutamide. The
ultimate goal is to contribute to optimal selection of breast cancer patients for anti
androgen treatment. Objective: Feasibility to detect a diffrence in uptake on 18F-FDHT scan
after 6 weeks of treatment with bicalutamide in metastatic breast cancer patients. Secondary
Objectives: to describe whether changes in 18F-FDHT tracer uptake after six weeks associates
with response to bicalutamide, to describe whether changes in AR availability are different
for breast cancer subgroups during treatment with bicalutamide and to describe whether
18F-FDHT tracer uptake is influenced by the amount of AR tumor expression. Study design: This
is a single arm, one stage feasibility study, which will be executed in the University
Medical Center Groningen, The Netherlands. The primary endpoint of the study is to evaluate
the difference in 18F-FDHT uptake in tumor lesions after 6 weeks of bicalutamide treatment in
patients with AR-positive metastatic breast cancer. Patients will be treated with
bicalutamide until progression or unacceptable toxicity is encountered. Study population: The
investigators will include 20 postmenopausal metastatic breast cancer patients with an AR
positive, HER2 negative tumor. Patients should be restaged clinically with bone scintigraphy
and CT scan within a 6 week timeframe of the PET examinations. Intervention: All patients
will receive a baseline FDHT-PET scan and start with bicalutamide treatment 150mg daily.
During follow-up patients will receive one FDHT-PET scan after 6 weeks. Treatment with
bicalutamide will continue until progression or unacceptable toxicity is encountered. Main
study endpoint: The percent difference in 18F-FDHT uptake in tumor lesions after 6 weeks of
monotherapy bicalutamide. A minimum decrease of 20% in 18F-FDHT uptake after 6 weeks compared
to baseline uptake with an α of 0.05 and a power of 80%, is considered clinical significant.
Title
- Brief Title: FDHT PET and Bicalutamide in Metastatic Breast Cancer
- Official Title: FDHT-PET to Visualize the Effect on the Androgen Receptor Level by Bicalutamide
Clinical Trial IDs
- ORG STUDY ID:
NL2015.0704
- NCT ID:
NCT02697032
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Bicalutamide | casodex | Patients |
Purpose
Rationale: The purpose is to evaluate whether non-invasive in vivo imaging of androgen
receptor (AR) presence in metastatic breast cancer patients by means of
18F-fluoro-dihydrotestosterone positron emission tomography (FDHT-PET) can be used to predict
(early) treatment response to, and optimal dosing of, the anti androgen bicalutamide. The
ultimate goal is to contribute to optimal selection of breast cancer patients for anti
androgen treatment. Objective: Feasibility to detect a diffrence in uptake on 18F-FDHT scan
after 6 weeks of treatment with bicalutamide in metastatic breast cancer patients. Secondary
Objectives: to describe whether changes in 18F-FDHT tracer uptake after six weeks associates
with response to bicalutamide, to describe whether changes in AR availability are different
for breast cancer subgroups during treatment with bicalutamide and to describe whether
18F-FDHT tracer uptake is influenced by the amount of AR tumor expression. Study design: This
is a single arm, one stage feasibility study, which will be executed in the University
Medical Center Groningen, The Netherlands. The primary endpoint of the study is to evaluate
the difference in 18F-FDHT uptake in tumor lesions after 6 weeks of bicalutamide treatment in
patients with AR-positive metastatic breast cancer. Patients will be treated with
bicalutamide until progression or unacceptable toxicity is encountered. Study population: The
investigators will include 20 postmenopausal metastatic breast cancer patients with an AR
positive, HER2 negative tumor. Patients should be restaged clinically with bone scintigraphy
and CT scan within a 6 week timeframe of the PET examinations. Intervention: All patients
will receive a baseline FDHT-PET scan and start with bicalutamide treatment 150mg daily.
During follow-up patients will receive one FDHT-PET scan after 6 weeks. Treatment with
bicalutamide will continue until progression or unacceptable toxicity is encountered. Main
study endpoint: The percent difference in 18F-FDHT uptake in tumor lesions after 6 weeks of
monotherapy bicalutamide. A minimum decrease of 20% in 18F-FDHT uptake after 6 weeks compared
to baseline uptake with an α of 0.05 and a power of 80%, is considered clinical significant.
Trial Arms
Name | Type | Description | Interventions |
---|
Patients | Experimental | At day 0 before start with bicalutamide, a FDHT-PET/CT will be performed, and one after 6 weeks (i.e. 2 weeks after steady-state). The second FDHT-PET will be performed to determine if this scan can be used as a biomarker for early response. Patients will be treated with bicalutamide until progression or unacceptable toxicity is encountered. | |
Eligibility Criteria
Inclusion Criteria:
1. A history of histological proven AR-positive (i.e. >10% staining), HER2-negative
metastatic breast cancer (preferably assessment on fresh metastasis biopsy,
alternatively archival metastasis biopsy)
2. Tumor progression after at least one line of systemic treatment
3. Measurable disease according to RECIST 1.1; or evaluable disease
4. Age ≥ 18 years
5. Postmenopausal status defined as one of the following:
- Age ≥60 years
- Previous bilateral oophorectomy
- Age <60 years and amenorrhea for >12 months in the absence of interfering
hormonal therapies (such as LH-RH agonists and ER-antagonists
- Age <60 years using ER antagonists should have amenorrhea for >12 months and FSH
>24U/L and LH>14U/L
6. Adequate hematological, renal and liver function as follows:
- Absolute neutrophil count > 1.5 x 109/L
- Platelet count >100 x 109/L
- White blood cell count >3 x 109/L
- AST and ALT <3.0 x upper limit of normal (ULN)
- Alkaline phosphatase <2.5 x ULN
- Creatinine clearance >50mL/min
- Lipase/amylase <1/5 x ULN
- Protrombin time, partial tromboplastin time and INR <1.5 x ULN
7. Written informed consent
Exclusion Criteria:
1. Unable to comply with the protocol
2. Evidence of central nervous metastases
3. Presence of life-threatening visceral metastases
4. Corrected QT interval (QTc) >500millliseconds at screening
5. Recent history of cardiac disease, including myocardial infarction, unstable angina
pectoris or uncontrolled arrhythmia within 6 months prior to screening; or evidence of
severe congestive heart failure with New York Heart Association severity
classification > class I.
6. Recent history of trombo-embolic events within 6 months prior to screening
7. Hepatic impairment (Child-Pugh Class B or C)
8. Severe concurrent disease, infection, co morbid condition that, in the judgment of the
investigator would make the patient inappropriate for enrollment
9. The concomitant use of strong CYP3A4 inhibitors (see table 1)
10. Previous anti-androgen treatment
11. Concurrent use of ER-directed anti hormonal therapies
12. Radiotherapy or major surgery within 4 weeks before baseline PET scanning
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | quantify residual AR binding sites in metastatic breast cancer |
Time Frame: | 6 weeks |
Safety Issue: | |
Description: | To quantify residual AR binding sites in metastatic breast cancer after 6 weeks of treatment with bicalutamide. |
Secondary Outcome Measures
Measure: | determine whether changes in 18F-FDHT uptake |
Time Frame: | 6 weeks |
Safety Issue: | |
Description: | To determine whether changes in 18F-FDHT uptake after 6 weeks associates with response to bicalutamide. |
Measure: | Influence amount of AR tumor expression |
Time Frame: | 6 weeks |
Safety Issue: | |
Description: | To determine whether 18F-FDHT tracer uptake is influenced by the amount of AR tumor expression. |
Measure: | Difference in changes in AR availability |
Time Frame: | 6 weeks |
Safety Issue: | |
Description: | To determine whether changes in AR availability are different for breast cancer subgroups during treatment with bicalutamide |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | University Medical Center Groningen |
Trial Keywords
- FDHT
- PET
- Breast cancer
- Bicalutamide
Last Updated
November 27, 2019