Trial of Oral Hyaluronic Acid for the Prevention of Aromatase Inhibitor-Associated Arthralgias

Primary Objective To determine whether oral HA will prevent AI-induced arthralgias and
preserve physical function.

Secondary Objectives

1. To explore whether oral HA will have an acceptable safety and tolerability profile.

2. To determine whether oral HA will prevent other AI associated symptoms as assessed by
patient reported outcomes (PRO's).

3. To assess how many of the subjects are 90% compliant with taking the HA as directed.

Exploratory Objective To determine if mi486, (a microRNA enriched in skeletal muscle) and
other biomarkers associated with AIMSS (TNF, IL-6, IL-17) vary with the administration of HA.

Study Population ER/PR-Positive Breast Cancer Subjects whose AIMSS resolved with cessation
of their AI and are candidates for switching to a different AI and who meet the inclusion
and exclusion criteria will be eligible for participation in this study.

Inclusion Criteria

1. Age ≥ 18 years old.

2. Had been taking anastrazole or letrozole, and discontinued it within the past 90 days
due to pain and/or stiffness. The AI-related pain/stiffness must have resolved.

3. Prior tamoxifen use is allowed.

4. A prior switch from exemestane is allowed.

5. Women who have undergone a total mastectomy or breast conserving surgery for Stage 0-3
breast cancer +/- chemotherapy, +/- antiHer2Neu therapy, +/- radiotherapy.

6. Must have ER and/or PR positive tumors.

7. Women who are postmenopausal by the presence of natural amenorrhea ≥ 12 months or by
ovarian ablation (bilateral oophorectomy, radiation, or administration of a
gonadotropin-releasing hormone agonist).

8. Eastern Cooperative Oncology Group Performance Score (ECOG PS) 0-3 (Appendix II).

9. Patients may or may not be taking non-opioid analgesics.

10. Adequate renal and hepatic function:

i) Include only subjects with AST and ALT < 2.0 × ULN; AP < 1.5 × ULN; total bilirubin
< 1.2 × ULN ii) Include only subjects with as calculated creatinine clearance (CrCl) >
60 mL/min determined by the central laboratory using the modified Cockcroft-Gault
equation; blood urea nitrogen (BUN) < 1.5 × upper limit of normal (ULN)

11. Written informed consent from subject and ability for subject to comply with the
requirements of the study.

Exclusion Criteria

1. Presence of residual or recurrent cancer.

2. Presence of a condition or abnormality that in the opinion of the Investigator would
compromise the safety of the patient or the quality of the data.

3. Consumption of HA-containing supplements in the four weeks prior to study.

4. Known allergy to microcrystalline cellulose or HA. Any questionable reaction to
injected HA will be thoroughly investigated.

5. Prolonged systemic corticosteroid treatment, except for topical applications (e.g.,
for rash), inhaled sprays (e.g., for obstructive airway diseases), eye drops or local
insertion (i.e., intra-articular). A short duration of systemic corticosteroids is
allowed but not within 30 days prior to registration.

6. Self-reported compliance issues and lack of regular prescription filling.

7. Previous diagnosis of fibromyalgia and/or rheumatoid arthritis.