Overview

Phase IIB Trial of Bazedoxifene Plus Conjugated Estrogens

Status:
Not yet recruiting
Trial end date:
2026-12-01
Target enrollment:
0
Participant gender:
Female
Summary
Women at risk for development of breast cancer and experiencing vasomotor menopausal symptoms (hot flashes) will be randomized to bazedoxifene (BZA) plus conjugated estrogens (CE) for 6 months versus a wait list control. Two risk factors for development of breast cancer will be studied pre-study and after 6 months: fibroglandular volume (FGV) on mammogram as assessed by Volpara software and proliferation by Ki-67 immunocytochemistry in benign breast tissue acquired by random periareolar fine needle aspiration (RPFNA). Change in biomarkers will be compared between groups.
Phase:
Phase 2
Accepts Healthy Volunteers?
Accepts Healthy Volunteers
Details
Lead Sponsor:
University of Kansas Medical Center
Collaborator:
National Cancer Institute (NCI)
Treatments:
Bazedoxifene
Estrogens
Estrogens, Conjugated (USP)
Criteria
Inclusion Criteria for Baseline Mammogram and RPFNA

Inclusion Criteria:

- Current vasomotor symptoms (hot-flashes, night sweats or both). These do not need to
be frequent or severe, but should occur at least once a week. Women who feel that they
would likely need a supplement or be at high risk of withdrawal if they were
randomized to waitlist because of vasomotor symptoms are not good candidates for this
trial.

- Menopause status: late menopause transition (have missed 2 periods within past 12
months) or postmenopausal (no periods for 12 months or more) with an intact functional
uterus.

- Intact Functional Uterus: have missed at least 2 periods in the past 12 months in the
absence of a Mirena IUD or oral contraceptives which suppress menses.

- Prior hysterectomy or prior endometrial ablation:

- Age 45-49, vasomotor symptoms and a FSH ≥ 25 mIU/ml or FSH in the postmenopausal
range specified by the local institutional laboratory.

- Age ≥ 50, vasomotor symptoms only (no requirement for FSH)

- Must have at least one ovary.

- BMI: ≤ 35 kg/m2

- Two breasts without prior therapeutic radiation

- Chemistry profile showing reasonably normal renal and hepatic function: creatinine
<2.0 mg/dL, bilirubin < 2.5 mg/dL, and albumin > 3.4 g/dL within the past 12 months
(determination is made at local site).

- Risk Factors/Level. Moderate risk of developing breast cancer based on having at least
one of following:

- First or second degree relative with breast cancer age 60 or younger;

- A prior breast biopsy showing proliferative breast disease, including
hyperplasia, atypical hyperplasia, or changes designated as lobular carcinoma in
situ without evidence of pleomorphism

- 2 or more prior biopsies regardless of benign histology

- Women with known gene mutations associated with an increased risk for breast
cancer such as ATM, CDH1, CHEK2, NBN, NF1, PALB2, PTEN, STK11, P53, PTEN (Note:
BRCA1/2 are excluded as women 45 and over should have undergone risk-reducing
bilateral salpingo-oophorectomy).

- 10-year relative risk of ≥2X that for the average population for age group as
calculated by IBIS Breast Cancer Risk Evaluation Tool version 8 (Tyrer-Cuzick)
(http://www.ems-trials.org/riskevaluator/); or a 5-year Gail Model Risk of ≥2X
the average risk woman for age group (as calculated by the NCI Breast Cancer Risk
Assessment Tool, http://www.cancer.gov/bcrisktoolmobile). Average risk for women
in the same age-group is based on the Surveillance, Epidemiology, and End Results
(SEER) Program provided by the NCI (http://srab.cancer.gov/devcan/).

- Vaginal Hormones: Low dose vaginal hormones, such as Estring(®, Vagifem®, or 0.5 gram
or less of conjugated estrogen vaginal cream twice weekly or less often, for vaginal
dryness and dyspareunia may be continued at the same dose.

- Systemic Hormones: If previously on oral contraceptives or hormone replacement, women
must be off for 8 weeks or more prior to baseline mammogram and RPFNA.

Exclusion Criteria:

- Have a predisposition to or prior history of thromboembolism, deep venous thrombosis,
pulmonary embolism, stroke, or myocardial infarction

- Prior bilateral oophorectomy

- BRCA1/2 deleterious mutation (these women should have both of their ovaries and
fallopian tubes removed)

- Pleomorphic LCIS, DCIS, prior invasive breast, uterine or ovarian cancer (estrogen
dependent neoplasia)

- Current renal or liver disease or clinically significant abnormalities of liver and
renal function tests.

- Women are sufficiently distressed by their vasomotor symptoms, such that they do not
believe they would be able to remain on study for 6 months without additional
medications if their hot flashes were not relieved.

- Any other condition or intercurrent illness that in the opinion of the investigator
makes the woman a poor candidate for RPFNA or treatment with BZA+CE.

- Current anticoagulant use (must have discontinued for 3 weeks prior to FNA)

- Taking oral or transdermal systemic hormones within two months (eight weeks) prior to
baseline blood, imaging studies or RPFNA.

- Taken tamoxifen, raloxifene, or an aromatase inhibitor within 6 months of baseline
blood imaging or RPFNA

Inclusion Criteria for Intervention Phase:

- BIRADs Class I-III mammogram suitable for assessment by Volpara® software, and
retention of raw imaging file. This must be performed within 3 months prior to RPFNA.
Mammograms read out as Class 0 or IV must be resolved with additional procedures prior
to RPFNA or entry on intervention phase.

- For women with very large breasts: the entire breast must be able to be captured in
one view. Women whose breast size require mosaic views will not be eligible.

- Volpara® determined breast fibroglandular volume as read at site or KUMC must be
evaluable on both breasts and total at least 80 cm3

- Sites with Volpara® assessment capability: If the criteria above are met, the Volpara®
clinical report is sent to KUMC (pdf format is acceptable) and the investigator may
proceed with RPFNA and additional screening. However, the raw imaging file (DICOM
format) must still be received in KUMC central repository prior to stratification and
randomization.

- Sites without Volpara® assessment capability: The raw imaging file (DICOM format) is
sent to the KUMC central repository and KUMC notified. KUMC will confirm within 24
hours that the file has been received and whether screening with RPFNA may proceed.

- RPFNA specimen must be received at KUMC in good condition and cellular enough to
provide a minimum of 500 epithelial cells on slide(s); but there is no requirement for
a specific value for Ki-67 or cytomorphology.

- Willing to comply with study procedures.

- Willing to have fasting blood drawn at baseline and 6 months.

- Willing to have dual energy x-ray absorptiometry (iDXA) at baseline at KUMC. DXA is
optional at other sites.

- Willing to have a repeat mammogram and RPFNA at 6 months following initiation of study
drug. (12-month mammogram for waitlist control only is optional)

- Willing to provide personal health history, family history of breast and ovarian
cancer

- Willing to undergo a physical exam including weight, height, and waist measurement at
baseline and 6-month visit

- Willing to complete Menopause Quality of Life (MEN-QOL) questionnaire and a hot flash
assessment at baseline and 6-month visits

- Able to understand and willing to sign consent for study participation

- If less than age 55, and uterus is functionally intact, and menstrual period in past
12 months and husband/partner has not had vasectomy, must be willing to use
non-hormonal contraceptive precautions.

Exclusion Criteria for Study Intervention (Randomization)

• Medical: Intercurrent illness which makes potential participant unsuitable for study;
development of clinically significant abnormalities of liver or renal functions; or started
hormone replacement therapy between mammogram/RPFNA and enrollment on study.