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Trial record 1 of 1 for:    NCT05568472
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Monitoring Symptoms to Help Young Women Take Hormone Therapy for Stage I-III Breast Cancer, ASPEN Study

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ClinicalTrials.gov Identifier: NCT05568472
Recruitment Status : Recruiting
First Posted : October 5, 2022
Last Update Posted : November 13, 2023
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
SWOG Cancer Research Network

Study Description
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Brief Summary:
This phase III trial compares the effect of active symptom monitoring and patient education to patient education alone in helping young women with stage I-III breast cancer stay on their hormone therapy medicines. The patient education tool contains interactive weblinks which provide patients with education material about breast cancer and side effects of therapy. Symptom monitoring is a weblink via email or text message with questions asking about symptoms. Hormone therapy for breast cancer can cause side effects, and may cause some women to stop treatment early. Asking about symptoms more often may help women keep taking hormone therapy medicines.

Condition or disease Intervention/treatment Phase
Anatomic Stage I Breast Cancer AJCC v8 Anatomic Stage II Breast Cancer AJCC v8 Anatomic Stage III Breast Cancer AJCC v8 Hormone Receptor-Positive Breast Carcinoma Other: Best Practice Procedure: Biospecimen Collection Procedure: Endocrine Drug Therapy Behavioral: Health Education Other: Questionnaire Administration Other: Symptom Specific Assessment Tool Not Applicable

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Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 540 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: A Randomized Phase III Trial Comparing Active Symptom Monitoring Plus Patient Education Versus Patient Education Alone to Improve Persistence With Endocrine Therapy in Young Women With Stage I-III Breast Cancer (ASPEN)
Actual Study Start Date : March 29, 2023
Estimated Primary Completion Date : May 1, 2027
Estimated Study Completion Date : May 1, 2028

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: ARM I (ET, health education, symptom assessment)
Patients receive ET and standard of care clinic visits with a cancer provider at 12, 24, 36, 48, 60, and 72 weeks, and phone visit at 80 weeks to access ongoing use ET medication. Patients are asked 6 brief questions about symptoms weekly by email, text, or phone call for the first 6 months, then every 4 weeks for 12 months. Patients also receive a list of websites with information about breast cancer, side effects of breast cancer medicines, and ways to help with heart health. Patients have the option to submit blood specimen collection at baseline, 3, 12, and 18 months.
 Other: Best Practice
Standard of care hormone therapy and standard visit with clinician
Other Names:
  • standard of care
  • standard therapy

Procedure: Biospecimen Collection
Undergo correlative studies
Other Names:
  • Biological Sample Collection
  • Biospecimen Collected
  • Specimen Collection

Procedure: Endocrine Drug Therapy
Undergo endocrine therapy

Behavioral: Health Education
Receive list of websites

Other: Questionnaire Administration
Ancillary studies

Other: Symptom Specific Assessment Tool
Receive a weblink via email or text message and asked 6 brief questions about symptoms
Other Names:
  • Symptom Assessment Tool
  • Symptom-Specific Assessment Tool
Active Comparator: ARM II (ET, health education)
Patients receive ET and standard of care clinic visits with a cancer provider at 12, 24, 36, 48, 60, and 72 weeks, and phone visit at 80 weeks to access ongoing use ET medication. Patients also receive a list of websites with information about breast cancer, side effects of breast cancer medicines, and ways to help with heart health. Patients have the option to submit blood specimen collection at 3, 12, and 18 months.
 Other: Best Practice
Standard of care hormone therapy and standard visit with clinician
Other Names:
  • standard of care
  • standard therapy

Procedure: Biospecimen Collection
Undergo correlative studies
Other Names:
  • Biological Sample Collection
  • Biospecimen Collected
  • Specimen Collection

Procedure: Endocrine Drug Therapy
Undergo endocrine therapy

Behavioral: Health Education
Receive list of websites

Other: Questionnaire Administration
Ancillary studies


Outcome Measures
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Primary Outcome Measures :
  1. Persistence with initially prescribed oral estrogen (ET) medication [ Time Frame: From randomization to discontinuation of the initially prescribed ET for more than 60 days or switching to a new oral ET medication, assessed up to 72 weeks ]
    Will be assessed by the treating provider at each study visit every 12 weeks and prospectively documented on the S2010 treatment log, including any switch from the initially prescribed oral ET. Persistence with initially prescribed oral ET by intervention arm out to 72 weeks will be described using Kaplan-Meier plots. Potential differences by arm will be tested using multivariable Cox regression. Persistence with any oral ET (aromatase inhibitor [AI] and/or tamoxifen) at 72 weeks by arm will be examined in a consistent manner. The study stratification variables (age [< 45 vs >= 45], chemotherapy [yes/no], and ET [AI vs tamoxifen]), as well as race, ethnicity, and disease stage, will be included as covariates in the regression models. In the timeframe of evaluation, censored events (newly diagnosed cancer, cancer recurrence, or death) are anticipated to be low.


Secondary Outcome Measures :
  1. Occurrence of any non-adherence [ Time Frame: Up to 18 months ]
    Will be assessed using the Voils validated adherence tool that both determines the extent of nonadherence as well as reasons for non-adherence. Kaplan Meier plots will be used to describe patterns of non-adherence between arms. Multivariable Cox regression will be used to assess this secondary endpoint.

  2. Worst pain [ Time Frame: Up to 12 weeks ]
    Will be measured using the Brief Pain Inventory - Short Form (BPI-SF) "worst pain" question ("Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours") in the subset of patients planning to receive AI treatment. Worst pain is measured on an 11-point scale of 0 ("no pain") to 10 ("pain as bad as you can imagine"). Linear regression will be used, adjusting for the stratification factors and the baseline score.

  3. Incidence of hot flashes [ Time Frame: Up to 12 weeks ]
    Will be assessed using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) "I have hot flashes/hot flushes" (ES1) question in the subset of patients planning to receive tamoxifen therapy. Hot flashes/hot flushes are measured on a scale of 0 ("not at all") to 4 ("very much"), with higher values indicating increased concern over the past 7 days. Linear regression will be used to compare scores between arms, adjusting for the stratification factors and the baseline score.


Other Outcome Measures:
  1. Symptom bother [ Time Frame: Up to 18 months ]
    Assessed using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) "I am bothered by side effects of treatment" (GP5) question. This is rated on a scale of 0 ("not at all") to 4 ("very much") with higher values indicating worse physical well-being over the past 7 days.

  2. Symptom burden: average pain [ Time Frame: Up to 18 months ]
    Will be measured using the Brief Pain Inventory - Short Form (BPI-SF) average pain question "Please rate your pain by marking the box beside the number that best describes your pain on the average", range 0 to 10, with 0 representing "no pain" and 10 representing "pain as bad as you can imagine."

  3. Symptom burden: pain interference [ Time Frame: Up to 18 months ]
    Will be measured using the Brief Pain Inventory - Short Form (BPI-SF) pain interference scale, range 0 to 10, with lower values representing "no interference" and 10 signifying "complete interference."

  4. Symptom burden: overall health profile [ Time Frame: Up to 18 months ]
    Will be measured using the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) profile subscales: fatigue (33-76), sleep disturbance (32-74), physical function (22-57), depression (41-80), anxiety (40-82), and ability to participate in social roles and activities (27-65). Raw scores (range 4-20 for all subscales) are converted to T scores (approximate ranges shown next to subscale), with mean 50 and standard deviation 10. The T score conversion is handled programmatically by Health Measures and depends upon the number of questions answered, minimums and maximums may differ from those shown here. Higher T scores represent more of the characteristic being measured (e.g., higher T score on fatigue score represents more fatigue, but higher T score on physical function represents better physical function).

  5. Symptom burden: cognitive function [ Time Frame: Up to 18 months ]
    Will be measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function 4a. Raw scores (range 4 to 20) are converted to a T score with mean 50, and standard deviation 10. The approximate minimum and maximum T scores for this scale are 24 and 62 respectively, with higher T scores representing better cognitive function. T score conversion is handled programmatically by Health Measures and depends upon the number of questions answered; actual minimums and maximums may differ depending upon the number of questions answered.

  6. Symptom burden: endocrine symptoms [ Time Frame: Up to 18 months ]
    Will be measured using the Functional Assessment of Cancer Therapy - Endocrine Symptoms (FACT-ES) Endocrine Symptoms Scale. This is a 19-item subscale with range 0 to 76, with higher values representing better quality of life.

  7. Estradiol concentration [ Time Frame: Up to 18 months ]
    Plasma concentrations of estradiol will be quantitated centrally using a tandem mass spectroscopy-based ultrasensitive estradiol assay

  8. Adherence to medications based on plasma concentrations [ Time Frame: Up to 18 months ]
    Objectively assessed biochemically by quantitating tamoxifen and AI drug and metabolite plasma concentrations as previously described.

  9. Genotyping [ Time Frame: Up to 18 months ]
    Germline deoxyribonucleic acid (DNA) will be genotyped by the University of Michigan Advanced Genomics Core using technology available at the time the analysis is performed


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Participants must be female and have Stage I, II, or III hormone receptor positive breast cancer based on clinical or pathologic evaluation

  • Participants must have been pre- or peri-menopausal at the time of breast cancer diagnosis by satisfying one of the following:

    • had a menstrual period (by self-report) within the 12 months before breast cancer diagnosis, or
    • had a serum or plasma estradiol and/or follicle stimulating hormone (FSH) concentration consistent with premenopausal status (based on institutional standards) within the 12 months before breast cancer diagnosis or when checked after breast cancer diagnosis
  • Participants must have started initial treatment with standard of care oral endocrine therapy (ET) (i.e., tamoxifen, anastrozole, exemestane, or letrozole; within 14 days prior to randomization or be planning to start initial treatment with standard of care oral ET within 14 days after randomization
  • Participants who currently have ovarian function (estradiol above the postmenopausal range) must be planning to undergo ovarian suppression or ablation concomitantly with oral ET medication, starting before or at the same time as oral ET initiation. Participants with chemotherapy-induced amenorrhea or ovarian failure at time of registration must be planning to start ovarian suppression or ablation if they have recurrence of ovarian function during study participation (circulating estradiol concentration in the premenopausal range or recurrence of menses)
  • Participants must have completed surgery for treatment of breast cancer at least 14 days prior to randomization NOTE: Concomitant radiotherapy at the time of randomization and/or during study participation is allowed
  • Participants who received chemotherapy must have finished it at least 14 days prior to randomization NOTE: Concomitant maintenance targeted or biologic therapy (e.g., human epidermal growth factor receptor 2 [anti-HER2] therapy, poly-ADP ribose polymerase [PARP] inhibitor therapy, CDK4/6 inhibitor therapy, osteoclast inhibitor therapy) at the time of randomization and/or during study participation is allowed
  • Participants must be >= 18 years of age
  • Participants must have a complete medical history within 60 days prior to randomization
  • Participants must be able to complete Patient-Reported Outcome (PRO) instruments in English or Spanish

Participants must:

  • agree to complete PROs at all scheduled assessments and

  • complete the pre-registration (baseline) PRO forms within 14 days prior to randomization

    • Participants must be able to complete symptom questions on a web browser (on a smartphone, tablet, or computer) or respond via voice on a telephone in English or Spanish. Participants must agree to complete symptom questions at all scheduled assessments NOTE: Participants who do not have access to the internet and who cannot receive telephone calls for interactive voice response system (IVRS) assessments are not eligible
    • Participants must be offered the opportunity to participate in specimen banking for translational medicine. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) specimen tracking system
    • Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines

Exclusion Criteria:

  • Participants must not have distant metastatic breast cancer
  • Participants who have started or plan to start treatment with tamoxifen during study participation must not have received prior tamoxifen for treatment or prevention of breast cancer
  • Participants who have started or plan to start treatment with an aromatase inhibitor during study participation must not have received prior aromatase inhibitor therapy for treatment or prevention of breast cancer
  • Participants must not be taking or planning to take oral estrogen-or progesterone-containing treatments during study participation

NOTES:

  • Participants who start or plan to start treatment with an aromatase inhibitor may have previously received tamoxifen for prevention of breast cancer or treatment of a prior cancer
  • Participants may have received prior treatment with an aromatase inhibitor for infertility treatment

  • Participants must not be planning to become pregnant during the 80 weeks of study participation

    • Participants must not receive additional anti-cancer treatments (i.e., experimental therapy, immunotherapy, biologics, etc.) as part of another clinical trial
    • Participants must not have a non-breast malignancy for which they are currently receiving treatment
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05568472


Locations
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Sponsors and Collaborators
SWOG Cancer Research Network
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Norah L Henry SWOG Cancer Research Network
More Information
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Responsible Party: SWOG Cancer Research Network
ClinicalTrials.gov Identifier: NCT05568472    
Other Study ID Numbers: S2010
NCI-2022-06902 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
S2010 ( Other Identifier: SWOG )
SWOG-S2010 ( Other Identifier: DCP )
S2010 ( Other Identifier: CTEP )
R01CA266012 ( U.S. NIH Grant/Contract )
UG1CA189974 ( U.S. NIH Grant/Contract )
First Posted: October 5, 2022    Key Record Dates
Last Update Posted: November 13, 2023
Last Verified: November 2023

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms by Site
Neoplasms
Breast Diseases
Skin Diseases