Losartan to Reduce Radiation Induced Fibrosis in Breast Cancer Patients

Trial Title: Losartan to Reduce Radiation Induced Fibrosis in Breast Cancer Patients

NCT ID: NCT05637216

Condition: Radiation Induced Fibrosis

Conditions: Official terms:
Radiation Pneumonitis
Fibrosis
Radiation Fibrosis Syndrome
Losartan

Conditions: Keywords:
losartan
radiation
fibrosis
cosmesis
reoperation
TGFB1
Transforming growth factor beta 1 (TGF-β1)
Angiotensin II Receptor Blockers
ace inhibitor
Angiotensin-converting enzyme (ACE) inhibitors
TGF-β1
antifibrotic
signaling pathway
breast cancer
TGF beta
radiation induced fibrosis
irradiation fibrosis
Radiation injury with fibrosis
Transforming growth factor beta 1
Inflammation
Biomarker
Suppressor of Mothers against Decapentaplegic (SMAD)

Study type: Interventional

Study phase: Phase 2

Overall status: Recruiting

Study design:

Allocation: Randomized

Intervention model: Parallel Assignment

Intervention model description: Participants will be blocked by surgical type (breast conservation surgery/mastectomy) and then randomized 1:1 in a parallel design into treatment and control arms. All participants will take an oral 25 milligram tablet once daily of either losartan or placebo. Assessments of fibrosis will include provider assessments and participant reported outcomes of fibrosis and cosmesis, the participant's decision for reoperation, laboratory assessments of inflammatory biomarkers, a CT scan and bilateral mammograms.

Primary purpose: Prevention

Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Masking description: Participants, research staff and clinicians will be blinded from study group assignment.

Intervention:

Intervention type: Drug
Intervention name: Losartan 25 milligram capsule
Description: Losartan 25 milligram oral capsule
Arm group label: Breast Conservation Surgery with Losartan
Arm group label: Mastectomy with Losartan

Other name: losartan potassium

Intervention type: Drug
Intervention name: Placebo
Description: Placebo 25 milligram oral capsule
Arm group label: Breast Conservation Surgery with Placebo
Arm group label: Mastectomy with Placebo

Summary: This study will evaluate the efficacy of losartan (LOS), an FDA-approved transforming growth factor beta-1 (TGF-β1) blocker, to decrease radiation induced fibrosis (RIF) in the breast and the lung of breast cancer patients, testing the hypothesis that Losartan will decrease RIF, TGF- β1 and cellular senescence/inflammation in the breast and the lung of irradiated breast cancer patients relative to placebo treatment and consequently improve clinical outcomes in breast cancer patients.

Detailed description: This single site study will be conducted at the Vail Health Shaw Cancer Center in Edwards, Colorado. A block, double-blinded, placebo-controlled, randomized phase II design will be utilized . Study participants will be blocked by surgical intervention (breast conserving surgery vs. mastectomy) and then randomized, 1:1, into the treatment and control arms for a total of four study arms. The research team and study participants will be blinded to the study arm and a placebo will be used to reduce detection bias in the reporting of outcomes. Selection bias will be minimized through the randomization of study arms. Study participants will be prescribed 25mg capsules of placebo or the investigational drug, Losartan, to be taken by mouth once daily. The treatment start date will be the day that subject begins radiation therapy. Radiation therapy will continue to be prescribed in accordance with local clinic procedures. Treatment with the study intervention will continue for one year upon completion of radiation therapy. All participants will be assessed for fibrosis, cosmetic outcomes, and incidence of reoperation for 18 months following the completion of radiation therapy.

Criteria for eligibility:
Criteria:
Inclusion Criteria - Diagnosed with clinical or pathologic stage 0-IV invasive breast cancer to include ductal carcinoma in situ (Tis), primary tumor cannot be assessed (TX) and all other primary tumor stage categories (T1-T4) - Has been treated with breast conserving surgery or mastectomy with reconstruction - Is a candidate for unilateral post-surgery radiation therapy per National Comprehensive Cancer Network (NCCN) guidelines - Age ≥ 18 - Female - Laboratory values - Aspartate Aminotransferase (AST) ≤ 2.5 x Upper Limit Normal (ULN) - Alanine Aminotransferase (ALT) ≤ 2.5 x ULN - Creatine ≤ 1.5 x ULN - Estimated Glomerular Filtration Rate (eGFR) ≥ 60 Inclusion of Women and Minorities - Women of any race/ethnicity are eligible for this trial. Exclusion Criteria - Recurrent breast cancer and history of prior breast radiation therapy - Breast cancer requiring bilateral breast/chest wall radiation therapy - Undergoing concurrent chemotherapy treatment - Documented fall risk - Active known diagnosis of a connective tissue disorder, rheumatoid arthritis, or systemic lupus erythematosus (SLE) - Any known uncontrolled intercurrent illness including, but not limited to: - Hyperkalemia - Impaired renal function - Symptomatic congestive heart failure - Unstable angina pectoris - Kidney disease - Uncontrolled diabetes - Cystic fibrosis - Fibromyalgia based on American College of Rheumatology criteria - Concomitant use of: - Losartan - Other renin-angiotensin system (RAS) agent - Agents to increase serum potassium - Lithium - Aliskiren for diabetes - Having a known allergy to any active or inactive ingredient in Losartan - Unable to tolerate oral medication - Pregnant or breast-feeding or planning pregnancy for the year following radiation - A medical history of interstitial lung disease or evidence of interstitial lung disease - Patients with any medical condition, including findings in laboratory or medical history or in the baseline assessments, that (in the opinion of the Principal Clinical Investigator or his/her designee), constitutes a risk or contraindication for participation in the study or that could interfere with the study conduct, endpoint evaluation or prevent the subject from fully participating in all aspects of the study - Individuals known to possess deoxyribonucleic acid (DNA) gene mutations including: - Ataxia-Telangiectasia Mutated (ATM) - Double-strand-break repair protein rad21 homolog (RAD21) - C-to-T single-nucleotide polymorphism (C-509T) in the Transforming growth factor β-1 gene

Gender: Female

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: Vail Health Shaw Cancer Center

Address:
City: Edwards
Zip: 81632
Country: United States

Status: Recruiting

Contact:
Last name: Katie Hess, BS

Phone: (970) 485-7874
Email: katherine.hess@vailhealth.org

Contact backup:
Last name: Paige Bordelon, BS, MPH

Phone: (970) 569-7608
Email: paige.bordelon@vailhealth.org

Contact backup:
Last name: Patricia H Hardenbergh, MD

Start date: August 17, 2023

Completion date: August 17, 2027

Lead sponsor:
Agency: Shaw Cancer Center
Agency class: Other

Collaborator:
Agency: Steadman Philippon Research Institute
Agency class: Other

Source: Shaw Cancer Center

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05637216
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