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Hormone Therapy in Preventing Endometrial Carcinogenesis (Cancer) in Women With a Genetic Risk For Hereditary Nonpolyposis Colon Cancer
This study is ongoing, but not recruiting participants.
Sponsors and Collaborators: M.D. Anderson Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00033358
  Purpose

RATIONALE: Hormone therapy may prevent the development of endometrial carcinogenesis (cancer) in women with a genetic risk for hereditary nonpolyposis colon cancer. It is not yet known which hormone therapy regimen is more effective in preventing endometrial cancer.

PURPOSE: Randomized phase II trial to compare two different hormone therapy regimens in preventing endometrial cancer in women who have a genetic risk for hereditary nonpolyposis colon cancer.


Condition Intervention Phase
Endometrial Cancer
Hereditary Non-Polyposis Colon Cancer (hmsh2, hmlh1, hpms1, hpms2)
Drug: ethinyl estradiol
Drug: medroxyprogesterone
Drug: norgestrel
Phase II

Genetics Home Reference related topics: Lynch syndrome
MedlinePlus related topics: Cancer
Drug Information available for: Depogen Estradiol Estradiol 3-benzoate Estradiol acetate Estradiol cypionate Estradiol dipropionate Estradiol valerate Polyestradiol phosphate Ethinyl estradiol Medroxyprogesterone Medroxyprogesterone 17-acetate Norgestrel
U.S. FDA Resources
Study Type: Interventional
Study Design: Prevention, Randomized, Active Control
Official Title: Modulation Of Putative Surrogate Endpoint Biomarkers In Endometrial Biopsies From Women With HNPCC

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Frequency of endometrial abnormalities by histology at baseline [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Changes in histology and ultrasound appearance at 3 months [ Designated as safety issue: No ]
  • Changes in surrogate endpoint biomarkers at 3 months [ Designated as safety issue: No ]

Estimated Enrollment: 44
Study Start Date: February 2002
Primary Completion Date: October 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm I: Experimental
Patients receive medroxyprogesterone intramuscularly once on day 1. Approximately 90 days after the injection, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.
Drug: medroxyprogesterone
Given by injection
Arm II: Experimental
Patients receive oral contraceptive pills (OCP) comprising ethinyl estradiol and norgestrel once daily on days 1-21. Treatment repeats every 28 days for 3-4 courses (3-4 packs of OCP) in the absence of unacceptable toxicity. Approximately 1 week after starting the fourth pack of OCP, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.
Drug: ethinyl estradiol
Given orally
Drug: norgestrel
Given orally

Detailed Description:

OBJECTIVES:

  • Compare the effect of medroxyprogesterone vs ethinyl estradiol and norgestrel on potential surrogate endpoint biomarkers relevant to endometrial carcinogenesis in women with a known hereditary non-polyposis colon cancer (HNPCC)-associated gene mutation or HNPCC-associated cancer(s).
  • Compare the 3-month changes in histology and ultrasound appearance of the endometrium in patients treated with these preventive regimens.

OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2 arms.

All patients undergo a baseline transvaginal ultrasound and endometrial biopsy.

  • Arm I: Patients receive medroxyprogesterone intramuscularly once on day 1. Approximately 90 days after the injection, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.
  • Arm II: Patients receive oral contraceptive pills (OCP) comprising ethinyl estradiol and norgestrel once daily on days 1-21. Treatment repeats every 28 days for 3-4 courses (3-4 packs of OCP) in the absence of unacceptable toxicity. Approximately 1 week after starting the fourth pack of OCP, patients undergo a repeat transvaginal ultrasound and endometrial biopsy.

Patients are followed at 6 weeks and are encouraged to return in 6 months to participate in continued endometrial screening.

PROJECTED ACCRUAL: A total of 44 patients (22 per arm) will be accrued for this study.

  Eligibility

Ages Eligible for Study:   25 Years to 50 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Meets criteria for 1 of the following:

    • Known hereditary non-polyposis colon cancer (HNPCC)-associated mutation of MLH1, MSH2, MSH3, MSH6, PMS1, or PMS2 identified by gene sequencing
    • Fulfills Amsterdam criteria with 1 or more HNPCC-associated cancers
  • No known or suspected malignancy of the breast or endometrium

    • Must have had a screening mammogram within the past 12 months if age 40 or over

PATIENT CHARACTERISTICS:

Age:

  • 25 to 50

Sex:

  • Female

Menopausal status:

  • No postmenopausal patients with amenorrhea for more than 1 year

Performance status:

  • Not specified

Life expectancy:

  • Not specified

Hematopoietic:

  • Not specified

Hepatic:

  • No liver dysfunction or disease (e.g., hepatic adenomas or carcinoma)
  • Liver function tests normal

Renal:

  • Not specified

Cardiovascular:

  • No active thrombophlebitis
  • No prior or concurrent thromboembolic disorders or cerebrovascular disease
  • No concurrent hypertension that is not well controlled
  • No coronary artery disease

Other:

  • Not pregnant
  • Negative pregnancy test
  • Fertile patients must use effective barrier contraception during the first month of study therapy
  • No undiagnosed vaginal bleeding
  • No gallbladder disease
  • No hypersensitivity to medroxyprogesterone contraceptive injection
  • No concurrent uncontrolled depression
  • No prior or concurrent epilepsy
  • No prior or concurrent diabetes
  • No tobacco smoking for patients age 35 to 50
  • No alcohol dependence or illicit drug use
  • No other significant medical history or psychiatric problems that would preclude study participation
  • Fasting triglycerides no greater than 400 mg/dL
  • Cholesterol no greater than 240 mg/dL
  • Low-density lipoprotein (LDL) no greater than 160 mg/dL
  • High-density lipoprotein (HDL) at least 35 mg/dL

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • Not specified

Chemotherapy:

  • At least 2 years since prior chemotherapy

Endocrine therapy:

  • At least 4 months since prior oral contraceptives, medroxyprogesterone, or other hormonal exposure (e.g., hormonal intrauterine device, tamoxifen, raloxifene, or other selective estrogen receptor modulators)
  • At least 4 months since prior systemic steroids (e.g., prednisone)
  • No concurrent systemic steroids (e.g., prednisone)

Radiotherapy:

  • No prior pelvic irradiation

Surgery:

  • At least 3 months since prior endometrial biopsy, hysteroscopy, dilation and curettage, or placement of an intrauterine device
  • No prior hysterectomy (patients may be scheduled for a prophylactic hysterectomy)
  • No prior bilateral oophorectomy

Other:

  • No other concurrent participation in a protocol with pharmacological intervention
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00033358

Locations
United States, California
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California, United States, 94115
United States, Nebraska
Creighton University Medical Center
Omaha, Nebraska, United States, 68131-2197
United States, Texas
M. D. Anderson Cancer Center at University of Texas
Houston, Texas, United States, 77030-4009
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Study Chair: Karen H. Lu, MD M.D. Anderson Cancer Center
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Responsible Party: M. D. Anderson Cancer Center at University of Texas ( Karen H. Lu )
Study ID Numbers: CDR0000069277, MDA-ID-01340, NCI-P02-0218
Study First Received: April 9, 2002
Last Updated: November 25, 2008
ClinicalTrials.gov Identifier: NCT00033358  
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
endometrial cancer
hereditary non-polyposis colon cancer (hMSH2, hMLH1, hPMS1, hPMS2)

Study placed in the following topic categories:
Medroxyprogesterone 17-Acetate
Gastrointestinal Diseases
Colonic Diseases
Estradiol valerate
Urogenital Neoplasms
Hereditary nonpolyposis colon cancer
Estradiol 17 beta-cypionate
Genital Diseases, Female
Endometrial Neoplasms
Estradiol 3-benzoate
Uterine Neoplasms
Endometrial cancer
Polyestradiol phosphate
Digestive System Neoplasms
Metabolic Diseases
Genital Neoplasms, Female
Ethinyl Estradiol
Uterine Diseases
Intestinal Diseases
Estradiol
Intestinal Neoplasms
Norgestrel
Neoplastic Syndromes, Hereditary
Digestive System Diseases
Genetic Diseases, Inborn
Colorectal Neoplasms, Hereditary Nonpolyposis
Gastrointestinal Neoplasms
Medroxyprogesterone
Metabolic disorder
Colonic Neoplasms

Additional relevant MeSH terms:
Estrogens
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Contraceptive Agents
DNA Repair-Deficiency Disorders
Physiological Effects of Drugs
Contraceptives, Oral
Hormones, Hormone Substitutes, and Hormone Antagonists
Contraceptive Agents, Female
Reproductive Control Agents
Contraceptive Agents, Male
Hormones
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Contraceptives, Oral, Synthetic

ClinicalTrials.gov processed this record on January 16, 2009