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Vaginal Testosterone Cream For Atrophic Vaginitis in Women Taking Aromatase Inhibitors for Breast Cancer.

Information source: University of Vermont
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Vaginitis; Dyspareunia; Breast Neoplasms

Intervention: Testosterone propionate (Drug)

Phase: Phase 1/Phase 2

Status: Suspended

Sponsored by: University of Vermont

Official(s) and/or principal investigator(s):
Sabrina M Witherby, MD, Principal Investigator, Affiliation: Memorial Hospital of Rhode Island, Warren Alpert School od Medicine at Brown University
Hyman Muss, MD, Principal Investigator, Affiliation: University of North Carolina
Marie Wood, MD, Principal Investigator, Affiliation: University of Vermont

Summary

Atrophic vaginitis is a condition in which the skin lining of the vagina and labia becomes thin and symptoms develop including vaginal itching, vaginal discomfort and dyspareunia. These can significantly affect women's comfort, sexuality and quality of life. Treatment for this condition includes estrogen given in pill form, commonly known as hormone replacement therapy and local estrogen treatments, such as vaginal estrogen creams and topical vaginal lubricants. Unfortunately, systemic estrogen is contraindicated in many women with breast cancer. Some providers also feel that women who are taking aromatase inhibitors for their breast cancer should also not use local estrogens as several small studies suggest that these treatments might effect estrogen levels and thus might change how effective the aromatase inhibitors are. If these women choose not to use any form of estrogen therapy there symptoms may not be well controlled with other treatments. The investigators hypothesize that a vaginal testosterone cream might be a safe and effective alternative treatment for these women. This small study is intended to test the hypothesis that testosterone cream will not increase estrogen (estradiol) levels and that it will improve the symptoms of atrophic vaginitis including vaginal dryness, vaginal itching and pain with intercourse. The investigators will enroll women in the trial who are taking an aromatase inhibitor and have the symptoms mentioned above. They will receive a testosterone cream which will be applied vaginally once a day for 28 days. If good results are found with a prespecified dose of testosterone, a lower dose will be tested in the next group of women enrolled.

Clinical Details

Official title: Vaginal Testosterone Cream For Atrophic Vaginitis in Women Taking Aromatase Inhibitors for Breast Cancer.

Study design: Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Serum estradiol levels

Secondary outcome:

Symptoms of vaginal atrophy

Clinical signs of vaginal atrophy.

pathologic measures of atrophic vaginitis

Detailed description: Atrophic vaginitis is a condition in which the skin lining of the vagina and labia becomes

thin, usually due to a decreased estrogen state - such as menopause. Symptoms of atrophic

vaginitis include vaginal itching, vaginal discomfort and dyspareunia and can significantly affect women's comfort, sexuality and quality of life. Treatment for this condition includes estrogen given in pill form, commonly known as hormone replacement therapy and local estrogen treatments, such as vaginal estrogen creams and topical vaginal lubricants. Unfortunately, systemic estrogen is contraindicated in many women with breast cancer. Some providers also feel that women who are taking aromatase inhibitors for their breast cancer should also not use local estrogens as several small studies suggest that these treatments might effect estrogen levels and thus might change how effective the aromatase inhibitors are. If these women choose not to use any form of estrogen therapy there symptoms may not be well controlled with other treatments. The investigators hypothesize that a vaginal testosterone cream might be a safe and effective alternative treatment for these women. This small study is intended to test the hypothesis that testosterone cream will not increase estrogen (estradiol) levels and that it will improve the symptoms of atrophic vaginitis including vaginal dryness, vaginal itching and pain with intercourse. The investigators will enroll women in the trial who are taking an aromatase inhibitor and have the symptoms mentioned above. They will receive a testosterone cream which will be applied vaginally once a day for 28 days. If good results are found with a prespecified dose of testosterone, a lower dose will be tested in the next group of women enrolled. Objectives: PRIMARY OBJECTIVE: 1. 1. Does topical testosterone cream affect serum estradiol levels in women taking aromatase inhibitors for breast cancer? SECONDARY OBJECTIVES: 1. 2. Can atrophic vaginitis and resultant symptoms of vaginal dryness, itching and dyspareunia in women taking aromatase inhibitors for the treatment of breast cancer be improved with a topical testosterone cream? 1. 3. Does topical testosterone cream affect physical findings, pH and cytologic changes in atrophic vaginitis? Schema:

Intervention - Subjects will apply a testosterone cream to the vaginal area daily for one

month (28 days).

Evaluation - Before and after the study intervention participants will have testosterone and

high-sensitivity estradiol tested. They will complete a questionnaire on symptoms of atrophic vaginitis and have a gynecologic examination (with visual, speculum, pH and sample of vaginal epithelial cells.)

Endpoints - Serum estradiol levels Improvement in symptoms of atrophic vaginitis, as

measured by questionnaire. Atrophic vaginitis as measured by gynecological examination (including pH and cytology to assess maturation index).

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Female.

Criteria:

Inclusion Criteria:

- Histologically or cytologically confirmed breast cancer (any stage).

- Currently be using an aromatase inhibitor (anastrazole, exemestane or letrozole) for

primary or adjuvant breast cancer treatment.

- Must have complaints of vaginal itching, vaginal dryness and/or dyspareunia.

- Not undergoing active chemotherapeutic or radiotherapeutic treatment

- Age >18 years

- Life expectancy of greater than 2 months.

- CALGB (ZUBROD) performance status <3.

- Post-menopausal - defined by absence of menses for at least 12 months and/or an FSH

>25. Not post-menopausal as a function of medications intended to suppress ovarian function, such as gonadotropin releasing hormone agonists. Surgically post-menopausal subject eligible.

- The effects of topical testosterone cream on the developing human fetus at the

recommended therapeutic dose are unknown. For this study only post-menopausal women are included and all women of child-bearing potential are excluded. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Exclusion Criteria:

- Patients who have not recovered from adverse events due to chemotherapeutic agents

administered more than 4 weeks earlier.

- History of allergic reactions attributed to compounds of similar chemical or biologic

composition to testosterone or the emollient delivery cream used in the study.

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active

infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.

- Pregnant women and women who are breast-feeding are excluded from this study because

it is limited to post-menopausal women.

Locations and Contacts

Memorial Hospital of Rhode Island,, Pawtucket, Rhode Island 02860, United States

Fletcher Allen Health Care, University of Vermont, Burlington, Vermont 05401, United States

Additional Information

Starting date: December 2006
Last updated: May 12, 2010

Page last updated: August 23, 2015

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