title: Improving treatment for obese women with early stage cancer of the uterus: rationale and design of the levonorgestrel intrauterine device ± metformin ± weight loss in endometrial cancer (feMME) trial.
abstract: OBJECTIVE
  Endometrial adenocarcinoma (EC) is the most common gynaecologic cancer. Up to 90% of EC patients are obese which poses a health threat to patients post-treatment. Standard treatment for EC includes hysterectomy, although this has significant side effects for obese women at high risk of surgical complications and for women of childbearing age. This trial investigates the effectiveness of non-surgical or conservative treatment options for obese women with early stage EC. The primary aim is to determine the efficacy of: levonorgestrel intrauterine device (LNG-IUD); with or without metformin (an antidiabetic drug); and with or without a weight loss intervention to achieve a pathological complete response (pCR) in EC at six months from study treatment initiation. The secondary aim is to enhance understanding of the molecular processes and to predict a treatment response by investigating EC biomarkers.
  
  
  METHODS
  An open label, three-armed, randomised, phase-II, multi-centre trial of LNG-IUD ± metformin ± weight loss intervention. 165 participants from 28 centres are randomly assigned in a 3:3:5 ratio to the treatment arms. Clinical, quality of life and health behavioural data will be collected at baseline, six weeks, three and six months. EC biomarkers will be assessed at baseline, three and six months.
  
  
  CONCLUSIONS
  There is limited prospective evidence for conservative treatment for EC. Trial results could benefit patients and reduce health system costs through a reduction in hospitalisations and through lower incidence of adverse events currently observed with standard treatment.
authors.affiliation: School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Hawkes
authors.affiliation: Royal Women's Hospital Royal Women's Hospital, Melbourne, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Quinn
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Gebski
authors.affiliation: Pathology, Mater Adult Hospital, South Brisbane, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Armes
authors.affiliation: Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Brennan
authors.affiliation: School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Janda
authors.affiliation: School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy*; D014408:Biomarkers, Tumor; D004032:Diet; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D009367:Neoplasm Staging; D009765:Obesity / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012107:Research Design; D015431:Weight Loss
chemical_list: D014408:Biomarkers, Tumor; D016912:Levonorgestrel; D008687:Metformin
keywords: Endometrial cancer; Levonorgestrel intrauterine device; Metformin; Physical activity; Progestin/Progesterone; Weight loss