E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Breast tissue density in women with BI-RADS Breast Density Categories C to D |
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E.1.1.1 | Medical condition in easily understood language |
Breast tissue density in women identified as having dense breast tissue. |
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E.1.1.2 | Therapeutic area | Body processes [G] - Physiological processes [G07] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10065307 |
E.1.2 | Term | Breast density increased |
E.1.2 | System Organ Class | 100000004848 |
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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 determine the efficacy of 8 mg/day (4 mg/breast) of BHR-700 gel compared to placebo for reducing breast tissue density in women identified as having dense breast tissue upon analysis of screening mammography using the Food and Drug Administration (FDA)-cleared Cumulus 2D software. |
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E.2.2 | Secondary objectives of the trial |
Incidence and severity of adverse events (AEs) with special attention given to uterine abnormalities, cardiovascular events, thromboembolic events, and incidence of vasomotor symptoms (“hot flush”).
Change in serum concentration of sex hormone binding globulin (SHBG).
Change in serum concentration of: cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL).
Change in serum concentration of Protein C-activity, Protein Sactivity, Antithrombin 111 antigen, and Activated Protein C resistance (APCR).
Change in serum concentration of select bone biomarkers CTx and BSAP.
Plasma concentrations of the E and Z isomers of 4-OHT. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Healthy women age 35 – 75 years with either heterogeneously dense (C) or extremely dense (D), breast tissue on 2D mammography, based on American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS©) fifth edition classification) in either breast within 3 months prior to randomization. Mammogram with BI-RADS final assessment category 1 or 2 (negative or benign findings). 2. If the woman is of childbearing potential, she must have a documented negative urine pregnancy test at time of screening and randomization and no plans to become pregnant for the duration of study participation. 3. Ability to understand and the willingness to sign a written informed consent document. |
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E.4 | Principal exclusion criteria |
1. Participants may not be receiving treatment with any investigational drug or investigational biologic within 30 days of randomization or at any time during the study. 2. Women with a history of allergic reactions attributed to compounds of similar chemical or biologic composition to Tamoxifen. 3. Pregnant women are excluded from this study because the effects of 4-OHT gel on the developing human fetus at the recommended dose and route are unknown. 4. Pregnancy (independent of outcome) and/or lactation within 1 year prior to the screening mammogram. 5. Women with previous history of cancer (including invasive or intra-ductal breast cancer) except for non-melanoma skin cancer. 6. Women who have had a prior mastectomy (unilateral or bilateral), segmental mastectomy, reduction mammoplasty or breast augmentation including implants. 7. Women with surgical breast biopsy(s) performed within 3 years or core biopsy(s) performed within 1 year prior to randomization. 8. Women with an abnormal mammogram (BI-RADS final assessment category 3-probably benign, 4-suspicious, or 5- malignant findings). Women with BI-RADS 0 assessment (needs additional imaging evaluation) that are subsequently found to have negative (BI-RADS 1) or benign findings (BI-RADS 2), are NOT excluded. 9. Women with only synthetic 2D mammograms generated from 3D (tomosynthesis) are excluded as breast density measurements are not yet validated for synthetic mammograms. Women with combination 2D+3D mammograms are not excluded. 10. Women with active liver disease or thromboembolic disorder. 11. Women with skin conditions such as psoriasis, fungal infections, keloids etc., or tattoos and/or piercings, which in the opinion of the Investigator, would interfere with absorption of the IP. 12. Women who have had an abnormal gynecology exam within the last three years with clinically significant findings, such as secondary dysmenorrhea, polyps, or atypia, which in the opinion of the Investigator would interfere with the study. 13. Women who have received treatment with Selective Estrogen Receptor Modulators (SERMs) (e.g. tamoxifen, raloxifen) or aromatase inhibitors. 14. Women taking estrogen containing contraceptives or Hormone Replacement Therapy (HRT) must discontinue the treatment a minimum of 6 months prior to the screening mammogram. Progestin only contraceptives are permitted. 15. Women with a concurrent illness, disease or condition that, in the opinion of the Investigator, would limit their compliance with study requirements or place them at additional risk. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The percentage reduction of mammographic breast tissue density on a follow-up mammogram compared to the baseline mammogram after 52 weeks of treatment. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
#1 Incidence and severity of adverse events (AEs) with special attention given to uterine abnormalities, cardiovascular events, thromboembolic events, and incidence of vasomotor symptoms (“hot flush”).
#2 Change in serum concentration of sex hormone binding globulin (SHBG).
#3 Change in serum concentration of: cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL).
#4 Change in serum concentration of Protein C-activity, Protein Sactivity, Antithrombin 111 antigen, and Activated Protein C resistance (APCR).
#5 Change in serum concentration of select bone biomarkers CTx and BSAP.
#6 Plasma concentrations of the E and Z isomers of 4-OHT. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Secondary end point #1 Blinded Phase Week 13, Week 26, Week 39, Week 52 Open-Label Phase Week 13, Week 26, Week 39, Week 52
Secondary end point #2 Blinded Phase Week 52 Open-Label Phase Week 52
Secondary end point #3 Blinded Phase Week 26, Week 52 Open-Label Phase Week 26, Week 52
Secondary end point #4 Blinded Phase Week 26, Week 52 Open-Label Phase Week 26, Week 52
Secondary end point #5 Blinded Phase Week 52 Open-Label Phase Week 52
Secondary end point #6 Blinded Phase Week 13, Week 26, Week 52 Open-Label Phase Week 26, Week 52 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | Yes |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Open-label treatment phase (52 wks) after 52 wks randomized double-blind treatment phase (elective) |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 3 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Germany |
Spain |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
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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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 | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 0 |