E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Estrogen receptor positive metastatic breast cancer patients |
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E.1.1.1 | Medical condition in easily understood language |
Estrogen receptor positive metastatic breast cancer patients |
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E.1.1.2 | Therapeutic area | Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] - Diagnosis [E01] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To visualize and quantify androgen receptor and estrogen receptor expression by PET imaging with the tracers 18F-FDHT and 18F-FES respectively. |
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E.2.2 | Secondary objectives of the trial |
- To describe the number of lesions detected on PET imaging compared to standard staging with CT-scan and bone scintigraphy.
- To describe the inter- and intra-patient variation in tracer uptake.
- To evaluate the inter-observer variation in FES PET and FDHT PET results in two independent observers. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Metastatic breast cancer, with at least one known metastasis outside of the liver
2. Presence of a lesion that is safely accessible for tumor biopsy (may be liver lesion)
3. Postmenopausal status defined as one of the following:
a. age ≥60 years
b. previous bilateral oophorectomy
c. age <60 years and amenorrhea for >12 months in the absence of interfering hormonal therapies (such as LH-RH agonists and ER-antagonists)
d. patients age <60 years using an ER-antagonist should have amenorrhea for > 12 months and FSH >24 U/L and LH >14 U/L
e. patient age <60 years using LH-RH agonists should continue LH-RH-agonists until after the PET procedures
4. Initially ER-positive tumor histology.
5. ECOG performance status 0-2.
6. Signed written informed consent
7. Able to comply with the protocol |
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E.4 | Principal exclusion criteria |
1. Use of estrogen receptor ligands, including tamoxifen, fulvestrant or estrogens, or androgen receptor ligands, during the 6 weeks before entry into the study
2. Life-expectancy ≤ 3 months |
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E.5 End points |
E.5.1 | Primary end point(s) |
The sensitivity and specificity of qualitatively scored FDHT PET will be calculated using immunohistochemistry of a biopsied lesion as golden standard. Receiver operating characteristic (ROC) analysis will be used to determine the quantitative threshold (SUVmax/mean) that optimally differentiates between AR-positive and AR-negative lesions. For FES PET, a threshold of tumor SUVmax 1.5 has previously been proposed to optimally differentiate between ER-positive and negative (with regard to response to endocrine therapy). We will prospectively evaluate this threshold to dichotomize FES PET results, and also use ROC analysis to re-evaluate the most optimal threshold. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
All study procedures (2 PET scans and 1 biopsy) will be performed within an 8 week timeframe for each individual patient. |
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E.5.2 | Secondary end point(s) |
Heterogeneity of tumor 18F-FDHT- and 18F-FES-uptake will be described using CT and bone scan as golden standard for metastases. Inter- and intra-patient heterogeneity of 18F-FDHT- and 18F-FES-uptake will be described and coefficient of variance will be calculated. PET will qualitatively and quantitatively be analysed by two independent observers (one from UMCG and one from VUMC). Inter-observer variation for qualitative and quantitative PET results will be calculated. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
All study procedures (2 PET scans and 1 biopsy) will be performed within an 8 week timeframe for each individual patient. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Yes |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | No |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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last visit of the last subject undergoing the PET imaging procedures |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |