Overview

This trial is active, not recruiting.

Condition breast cancer
Treatments ritonavir, therapeutic conventional surgery
Phase phase 1/phase 2
Sponsor Masonic Cancer Center, University of Minnesota
Collaborator Susan G. Komen Breast Cancer Foundation
Start date May 2010
End date July 2014
Trial size 52 participants
Trial identifier NCT01009437, 2008NTLS083, UMN-0809M45461

Summary

RATIONALE: Ritonavir may stop the growth of tumor cells by blocking some of the enzymes needed for cancer cell growth. Studying samples of blood and tissue from patients with breast cancer in the laboratory may help doctors learn more about the effects of ritonavir on biomarkers involved in breast cancer growth.

PURPOSE: This phase I/II trial is studying the best dose of ritonavir and its effects on biomarkers in women undergoing surgery for newly diagnosed breast cancer.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation non-randomized
Endpoint classification safety/efficacy study
Intervention model single group assignment
Masking open label
Primary purpose diagnostic
Arm
(Active Comparator)
Five ER+, HER2- breast cancer patients meeting all study eligibility will be enrolled prior to the start of phase I recruitment to act as controls (no ritonavir will be given-will receive therapeutic conventional surgery) to confirm that anesthesia does not affect EET levels. Core biopsies, surgical tumor/normal tissue and pre- and post- surgery blood samples will be collected for comparison with the treatment group.
therapeutic conventional surgery Surgery
Tissue collection is from all patients, including the control, phase I and phase II patients.
(Experimental)
Standard phase I dose escalation (with therapeutic conventional surgery) will be used with 3 levels of ritonavir given - 200 mg bid, 400 mg bid, and 600 mg bid for the following groups: ER+, HER2- ER+, HER2+ ER-, HER2+ ER-, PR+, HER2- ER-, PR-, HER2-
ritonavir NORVIR® tablets
Phase I: Dose escalation will be used with 3 levels of ritonavir given - 200 mg twice a day (bid), 400 mg bid, and 600 mg bid. Phase II: Dose will be maximum tolerated dose from Phase I.
therapeutic conventional surgery Surgery
Tissue collection is from all patients, including the control, phase I and phase II patients.
(Experimental)
Phase II: Once the maximum tolerated dose (MTD) of ritonavir is established, 19 ER+, HER2- patients will be enrolled at MTD during the phase II component along with therapeutic conventional surgery.
ritonavir NORVIR® tablets
Phase I: Dose escalation will be used with 3 levels of ritonavir given - 200 mg twice a day (bid), 400 mg bid, and 600 mg bid. Phase II: Dose will be maximum tolerated dose from Phase I.
therapeutic conventional surgery Surgery
Tissue collection is from all patients, including the control, phase I and phase II patients.

Primary Outcomes

Measure
Inhibition of breast cancer by targeting Hsp90-Akt pathway
time frame: Pre and Post Treatment

Secondary Outcomes

Measure
Activation of apoptosis markers
time frame: Pre and Post Treatment
Modulation of autophagy markers
time frame: Pre and Post Treatment
Alteration of plasma levels of eicosanoids
time frame: Pre Treatment and 3 Hours Post Treatment
Induction of Hsp70 in peripheral blood mononuclear cells
time frame: Pre Treatment and 3 Hours Post Treatment
Reduction of ERα in ERα+ tumors
time frame: Pre and Post Treatment
Changes in TNF-α and IL-6 levels as well as reduction in intratumoral nuclear NF-kB and phospho-Stat3
time frame: Pre and Post Treatment
Alteration of urine eicosanoid levels
time frame: Pre and Post Treatment
Alteration of plasma and urine eicosanoid levels resulting from tumor resection.
time frame: Pre and Post Treatment
Induction of the unfolded protein response (UPR) assayed by grp78 or related markers (phospho-PERK, ATF-4, and CHOP)
time frame: pre- and post-surgery
inhibition of tumor growth markers (Ki67 LI, Hsp90, phosphorylated AKT)
time frame: pre- and post-surgery

Eligibility Criteria

Female participants at least 18 years old.

Inclusion criteria: - Newly diagnosed biopsy proven breast cancer for which a lumpectomy or mastectomy is planned. - Control Selection - ER+, HER2-: estrogen receptor positive (ER+) and human epidermal growth factor receptor 2 negative (HER2 -) as defined according to institutional standards. - Phase I Selection - ER+, HER2- - ER+, HER2+ - ER-, HER2+ - ER-, PR+, HER2- - ER-, PR-, HER2- - Phase II Selection - ER+HER2-: as defined for controls Menstrual status will be noted as either pre- or postmenopausal. For the purpose of this study, postmenopausal is defined as no menstrual period for 12 months or longer or bilateral oophorectomy - Sufficient tumor tissue from the diagnostic core biopsy, either as a block or a minimum of 5 slides - Tumor must be greater than 1 centimeter as measured by clinical exam, mammogram, ultrasound or MRI. - No prior treatment for breast cancer in the affected breast. - Karnofsky performance status >70% - No prior treatment for breast cancer in the affected breast - Adequate organ function for receiving study drug within 14 days 1st dose of study drug - Women of childbearing potential are required to use an effective method of contraception - Voluntary written consent Exclusion criteria: - Pregnant or lactating. - Known positive HIV status or on medications for HIV - Diagnosis of diabetes due to potential problems with insulin resistance and hyperglycemia - Any pre-existing gastrointestinal complaints including nausea, abdominal pain and/or diarrhea - Known hypersensitivity to ritonavir or any of the tablet ingredients - Co-administration of ritonavir is contraindicated with any of the drugs - Contraindicated Drugs because competition for primarily CYP3A by ritonavir could result in inhibition of the metabolism of these drugs and create the potential for serious and/or life-threatening reactions such as cardiac arrhythmias, prolonged or increased sedation, and respiratory depression. Voriconazole is an exception in that co-administration of ritonavir and voriconazole results in a significant decrease in plasma concentrations of voriconazole. If the patient cannot discontinue a contraindicated drug, she is not eligible for the trial. - Incompatible Drugs

Additional Information

Official title A Phase I/II Trial of Short Course Pre-Operative Ritonavir To Determine Akt Inhibition in Breast Cancer
Principal investigator David A. Potter, M.D., Ph.D.
Description OBJECTIVES: - Determine the effects of ritonavir on Akt activity, UPR, Ki67 LI, and ROS in a triple-negative breast cancer model. - Determine the maximum tolerated dose of ritonavir in women with newly diagnosed breast cancer. (Phase I - enrollment complete) OUTLINE: This is a multicenter, phase I dose-escalation study followed by a phase II study. Control Group - Five patients with estrogen receptor positive (ER+) and human epidermal growth factor 2 negative (HER2-) breast cancer are enrolled before the start of phase I recruitment. Phase I Group - Twelve breast cancer patients with either 1)ER+, HER2-, or 2)ER+, HER2+, or 3) ER-, HER2+, or 4) ER-, PR+, HER2-, or 5) ER-, PR-, HER2- will be enrolled for dose escalation study. Phase II Group - Nineteen ER+, HER2- patients will be enrolled for ritonavir pharmacokinetic study after maximum tolerated dose (MTD) is established. - Control: Patients do not receive ritonavir. - Phases I and II: Patients receive oral ritonavir twice daily for 5 days in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery as deemed appropriate by the surgeon and based on patient preference (mastectomy or lumpectomy with sentinel node procedure and/or axillary node dissection). All patients undergo blood and tissue sample collection periodically for biomarker research studies. Samples from patients enrolled in the control group are compared with the samples from patients enrolled in phase I and II.
Trial information was received from ClinicalTrials.gov and was last updated in January 2016.
Information provided to ClinicalTrials.gov by Masonic Cancer Center, University of Minnesota.