Low Dose Tamoxifen With or Without Omega-3 Fatty Acids for Breast Cancer Risk Reduction

• Status: Not yet recruiting
• Trial end date: 2027-01-01
• Target enrollment: 0
• Participant gender: Female

Summary

This phase II trial evaluates tamoxifen, with or without omega-3 fatty acids, for reducing risk of breast cancer among postmenopausal and overweight or obese women who are at increased risk of developing breast cancer. Tamoxifen is a selective estrogen receptor modulator. It works by blocking the effects of the hormone estrogen in the breast. Tamoxifen is approved by the Food and Drug Administration for prevention of breast cancer in women at increased risk. Omega-3 fatty acids have been shown to decrease the amount of fats made in the liver. Omega-3 fatty acids may work to prevent cancer in overweight or obese individuals. Tamoxifen with or without omega-3 fatty acids may be effective at reducing risk of breast cancer among women who are postmenopausal, overweight or obese, and at increased risk.

• Phase: Phase 2
• Accepts Healthy Volunteers?: Accepts Healthy Volunteers

Details

• Lead Sponsor: National Cancer Institute (NCI)
• Treatments: Tamoxifen

Criteria

Inclusion Criteria:

• Age 45 - 65

• Postmenopausal female

• Postmenopausal is defined as prior removal of the ovaries, or if ovaries intact amenorrhea for 12 months and not on any form of contraception, or amenorrhea for greater than 2 months with serum follicle-stimulating hormone (FSH) in postmenopausal range (>= 25 IU/L). Women with ovaries and a prior hysterectomy or endometrial ablation < age 55 must have a FSH within the postmenopausal range. Women may be on vaginal low dose estrogen preparations for vaginal dryness. Women over age 50 with a levonorgestrel intrauterine device in place for 2 or more years are also eligible if FSH is in the postmenopausal range and they are not planning removal for the next 6 months

• Note: FSH will be done at time of screening

• Women with intact ovaries and uterus < age 55 must have a negative pregnancy test prior to randomization

• Obese (body mass index [BMI] >= 30 kg/m^2) OR overweight (BMI 25 to < 30 kg/m^2) WITH at least two or more of the following elements of metabolic syndrome documented in the past 180 days prior to randomization:

• Waist circumference of >= 89 cm

• Blood pressure over 130/85 mmHg (or current treatment for hypertension)

• Fasting triglyceride (TG) level over 150 mg/dl

• Fasting high-density lipoprotein (HDL) < 50 mg/dl (or current statin treatment)

• Fasting glucose > 100 mg/dl

• Note: BMI must be calculated within 28 days of randomization

• Willing to undergo a fasting blood draw and non-fasting RPFNA with fixed and frozen aliquots sent to University of Kansas Medical Center (KUMC)

• At increased risk of breast cancer per at least one of the following:

• Personal medical history

• History of atypical hyperplasia or lobular carcinoma in situ (LCIS) found on breast biopsy

• History of unilateral ductal carcinoma in situ treated with unilateral mastectomy, lumpectomy, or local excision with or without radiation and this treatment was completed at least 3 months prior to the screening RPFNA

• High mammographic density determined by one of the following:

• Visual estimate of area of density (VAS) > 50%,

• Volpara (trademark) >= 15% dense volume (Volpara d)

• Breast Imaging Reporting and Data System (BIRADS) assessment = extremely dense (BIRADs D)

• Genetic test result

• Germline gene mutation in ATM, BARD1, CDH1, CHEK2, NF1, PTEN, RAD51C, RAD51D, or STK11

• Polygenic lifetime risk score >= 2x average or 25%

• Calculated risk based on standard models

• Five-year Breast Cancer Risk Assessment Tool (BCRAT) (version 2.0) >= 1.66% (https://dceg.cancer.gov/tools/risk-assessment/bcra)

• Ten-year IBIS (version 8) >= 3% (http://www.ems-trials.org/riskevaluator/)

• Ten-year relative risk IBIS (version 8) >= 2X that for age group

• Ten- year Breast Cancer Surveillance Consortium (version 2) >= 3% (https://tools.bcscscc.org/BC5yearRisk/calculator.htm)

• Family History

• Breast cancer in a first or second degree relative (female or male) with onset under age 50. (First degree relative = parent, sibling, or child. Second degree relative = grandparent, uncle, aunt, nephew, niece, half-sibling, grandchild or first cousin)

• Breast cancer in two or more first or second-degree relatives from either the maternal or paternal linage without regard to age

• Bilateral breast cancer or breast and ovarian cancer in the same first or second degree relative without regard to age

• Primary source documentation of risk is required and must be submitted to the lead academic organization (LAO) for review along with the eligibility checklist

• Risk factor: Atypical hyperplasia or LCIS; Primary source document: Copy of pathology report or clinical note confirming the diagnosis

• Risk factor: Ductal carcinoma in situ (DCIS) and treatment history; Primary source document: Copies of pathology report or clinic notes confirming the diagnosis, treatment plan and treatment end date(s)

• Risk factor: Mammographic density; Primary source document: Copy of clinic note or mammogram report

• Risk factor: Genetic; Primary source document: Copy of genetic test report

• Risk factor: Calculated based on standard models; Primary source document:

Copy of the calculation result

• Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)

• Note: Higher total bilirubin levels (=< 3 mg/dL) can be allowed if due to known benign liver condition, i.e., Gilbert's syndrome

• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) =< 3.0 x institutional upper limit of normal

• Alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3.0 x institutional upper limit of normal

• Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial

• For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated

• Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load

• Patients on chronic suppressive antiviral therapy for herpes simplex virus (HSV) are eligible

• Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)

• Women must have at least 1 unaffected untreated breast for fine needle aspiration. Women may have had prior unilateral breast radiation or mastectomy for DCIS

• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

• Exclusions based on current or past conditions:

• Bilateral breast implants (danger of implant puncture with RPFNA)

• Prior invasive breast cancer

• Prior invasive uterine cancer

• Other prior invasive cancer and haven't completed cancer related therapy or with evidence of disease (other than non-melanoma skin cancer) within the past 2 years

• Currently breastfeeding (concern that tamoxifen may be in breast milk) or nursing within past 12 months (concern about milk fistula with RPFNA)

• Type I or type II diabetes mellitus requiring current pharmacologic treatment (including metformin, glucagon-like peptide 1 agonists, insulin, sulfonylurea)

• Prior deep vein thrombosis, pulmonary embolus, or stroke

• Prior gastric bypass surgery

• History of chronic liver disease including NASH (nonalcoholic steatohepatitis) or cirrhosis

• Planned initiation of a structured weight loss intervention

• Current or plans to initiate a glucagon-like peptide 1 agonist within the next 6 months

• Exclusions based on medications:

• Current use of prescription anticoagulants such as Coumadin (warfarin), direct-acting oral anticoagulants such as Xarelto (rivaroxaban) or Eliquis (apixaban) or heparin

• Women who would not be able to or do not wish to discontinue daily use of aspirin (81mg or higher) and aspirin containing products (81 mg or higher) at least 3 weeks prior to each RPFNA

• Note: Women may resume daily use of aspirin and aspirin containing products 3 days after each RPFNA procedure

• Planned removal of hormone intrauterine device within the next 6 months

• Current use of hormone therapy (oral, transdermal, or injectable)

• Note: Vaginal estrogen is allowed

• Prior treatment with tamoxifen, aromatase inhibitor or selective estrogen receptor degrader for more than 2 months

• Note: Women with < 2 months of these drugs must be off for at least 6 months before they may begin biomarker screening tests

• Greater than 1 gram daily of omega-3 fatty acid supplement within the last 6 months

• Current use of prescription immunosuppressive drugs

• Participants may not be receiving any other investigational agents

• History of allergic reactions attributed to compounds of similar chemical or biologic composition to tamoxifen or omega-3 fatty acid or generic Lovaza or compounds of similar chemical composition

• Uncontrolled intercurrent illness or psychiatric illness/social situations that would limit compliance with study requirements