A Pilot Trial of Tamoxifen and 4-HPR (4-N-Hydroxyphenyl Retinamide) in Persons at High Risk for Developing Breast Cancer

Inclusion Criteria

POPULATION CHARACTERISTICS:

Women and men at increased risk for the development of breast cancer by at least one of
the following criteria:

Histologically documented ductal carcinoma in situ (DCIS), including DCIS with minimal
invasion or microinvasion.

Histologically documented lobular neoplasia, including lobular hyperplasia and lobular
carcinoma in situ (LCIS).

Histologically documented atypical ductal hyperplasia in postmenopausal women.

Histologically documented atypical ductal hyperplasia in premenopausal women with 1
first-degree relative (mother or sister) diagnosed with breast cancer.

Histologically documented atypical ductal hyperplasia in premenopausal women with 3 or
more relatives diagnosed with breast cancer provided at least 1 is a second-degree
relative.

3 or more first- or second-degree relatives diagnosed with breast or ovarian cancer with
at least 1 diagnosed with breast cancer.

2 or more premenopausal (under age 50) first-degree relatives diagnosed with breast
cancer.

1 or more first-degree relatives diagnosed with breast cancer if at least 1 relative in
the extended pedigree had ovarian cancer.

3 or more relatives with breast cancer with at least 1 first-degree relative diagnosed
with premenopausal breast cancer.

Previously diagnosed Stage I breast cancer with surgery and/or radiotherapy only (without
prior adjuvant chemo- or hormonal therapy).

Positive for the BRCA1/BRCA2 gene.

No history of other invasive breast cancer.

No evidence of malignancy on breast and gynecologic exams.

Participants with a family history of breast cancer will be seen in consultation by the
Family Studies Branch, NCI.

PRIOR/CONCURRENT THERAPY:

Mastectomy or lumpectomy plus radiotherapy required prior to entry for patients with DCIS.
Patients with DCIS who have participated in protocol NCI-MB-348 eligible.

No participation in any other breast cancer prevention study involving pharmacologic
intervention.

No prior chemotherapy or hormonal therapy for invasive breast cancer.

At least 3 months since estrogen or progesterone replacement therapy or hormonal
contraceptives.

PATIENT CHARACTERISTICS:

Age: 35 and over.

Performance status: Ambulatory.

Life expectancy: At least 10 years.

Hematopoietic: Complete blood count normal.

Hepatic:

Bilirubin normal.

Alkaline phosphate normal.

AST normal.

PT, PTT normal.

No history of bleeding disorder.

No history of chronic hepatitis or cirrhosis.

Renal:Creatinine less than 1.5 mg/dL.

Cardiovascular:

No history of deep venous thrombosis.

No history of pulmonary embolus.

Other:

No allergy to any study medication.

Capable of tolerating multiple diagnostic procedures.

No history of abnormal vaginal bleeding. Hysterectomy for vaginal bleeding of benign
etiology allowed.

No history of retinal disease, macular degeneration, or night blindness.

No medical or psychiatric risk due to nonmalignant systemic disease that would preclude
study participation.

No history of malignancy except: Curatively treated nonmelanomatous skin cancer.
Curatively treated in situ cervical carcinoma. Hodgkin's disease treated more than 5
years ago.

No pregnant women.

Adequate contraception required of fertile patients during and for 12 months after
fenretinide and for 2 months after tamoxifen.