Mirena® IUD's Effect on Fallopian Tube Fimbriae and Ovarian Cortical Inclusion Cyst Cell Proliferation

Study Overview
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Brief Summary
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Combination-type oral contraceptives (COCs) have been shown to significantly reduce the risk of invasive epithelial ovarian cancer (IEOC); this protective effect may be achieved to a large extent through COCs ability to reduce cell proliferation in the fallopian tube fimbriae (FTF). The progestin-releasing Mirena® intra-uterine device (IUD) is an increasingly popular method of contraception, but it is not known if its use will reduce a woman's risk of IEOC. Mirena® use does not block ovulation in most women but it may release sufficient progestin to also reduce cell proliferation in the FTF. This study aims to evaluate the effects of the Mirena® IUD on cell proliferation in the FTF as a possible biomarker of protection against IEOC.

Official Title
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Mirena® IUD's Effect on Fallopian Tube Fimbriae and Ovarian Cortical Inclusion Cyst Cell Proliferation

Conditions
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Epithelial Ovarian Cancer

Intervention / Treatment
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* Device: Mirena® intra-uterine device (IUD)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women between 35 and 50 years of age (inclusive) Women who will be scheduled to undergo an RRSO or RRs Women who will have at least one fallopian tube removed for risk-reducing reasons (with or without removal of ovar(ies)) Women who are willing to have a Mirena® IUD inserted at least prior to risk-reducing surgery or who already have the Mirena® in place Women using non-hormonal forms of contraception (Note: If a copper IUD is being used, the IUD must be removed prior to or at time of Mirena insertion.) Exclusion Criteria: Any medical contraindication to use of a Mirena® IUD, including: Pregnancy (a pregnancy test is required prior to study entry) Known uterine anomaly that distorts the shape of the uterine cavity Acute pelvic inflammatory disease Postpartum endometritis or endometrial infection Known or suspected uterine or cervical neoplasia Known history or suspected breast cancer or other progestin-sensitive cancer Uterine bleeding of unknown etiology. Untreated acute cervicitis, vaginitis, or other lower genital tract infections Acute liver disease or liver tumor (benign or malignant) Use of tamoxifen, raloxifene, or chemotherapy within the previous 6 months Positive pregnancy test Breastfeeding Use of a copper IUD if the patient is not willing to have it removed prior to surgery and replaced with a Mirena® IUD

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mirena® IUD<br>This is a non-randomized study of the effect of Mirena® IUD use of at least 10 days before an RRSO or RRS on cell proliferation within the FTF and when available within ovarian CICs in women aged 35 through 50. The study will compare the results from 14 women using Mirena® with the results from 28 normally cycling women identified under MSK IRB Protocol #14-165 described above; all patients will be aged 35-50 years, and will have undergone the RRSO at MSK. To date we have identified approximately 100 suitable controls and are continuing to identify further suitable controls among women who have recently undergone RRSOs at MSK. The balancing/matching factors will be BRCA status (BRCA1/BRCA2/BRCA-ve), age (35-39/40-44/45-50), parity (nulliparous/parous), and BMI (<30/30+ kg/m^2). As each Mirena® patient completes the study and is deemed evaluable, she will be matched on each of these factors with 2 controls. | Device: Mirena® intra-uterine device (IUD)<br>* In this study, a Mirena® IUD will be inserted into volunteers scheduled for a risk-reducing salpingo-oophorectomy (RRSO) or risk-reducing salpingectomy (RRS) at Memorial Sloan Kettering Cancer Center (MSK). Alternatively, women with a Mirena® IUD already in place and who will be scheduled for an RRSO or RRS at MSK can also participate. We are seeking 14 evaluable participants. FTF tissue (and ovarian inclusion cyst tissue, when available) collected at the time of risk-reducing salpingectomy (RRS) will be tested by immunochemistry staining for Ki67 (a protein that is significantly increased when cells are preparing for division).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cell Proliferation in the Fallopian Tube Fimbriae as Measured by Ki-67%+ | Women will be deemed evaluable for this primary outcome if they successfully underwent placement of the Mirena® IUD, received a RRSO or RRS as planned, and had a P4 value ≤1 ng/ml. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mirena® IUD's, Women, risk-reducing salpingo-oophorectomy, risk-reducing salpingectomy