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Phase IIB Randomized Controlled Biomarker Modulation Study of Vitamin D in Premenopausal Women at High Risk for Breast Cancer


Phase 2
18 Years
50 Years
Open (Enrolling)
Female
brca1 Mutation Carrier, brca2 Mutation Carrier, Breast Cancer

Thank you

Trial Information

Phase IIB Randomized Controlled Biomarker Modulation Study of Vitamin D in Premenopausal Women at High Risk for Breast Cancer


OBJECTIVES:

- To assess whether mammographic density is reduced in premenopausal women at high risk
of breast cancer taking high-dose vitamin D3 (oral cholecalciferol 20,000 IU weekly) vs
placebo for 1 year.

- To assess whether proliferation as measured by Ki-67 staining of breast epithelial
cells is reduced in women receiving these treatments.

- To explore the difference in the expression of other biomarkers (including cleaved
caspase-3 [apoptosis marker], ER, vitamin D receptor [VDR], and 1α-hydroxylase) in
breast tissue obtained from these women.

- To assess whether parathyroid hormone, IGF-1, IGFBP-3, 25(OH)D, and 1,25(OH)D serum
levels are altered in these women at baseline and at 6 and 12 months.

- To explore whether a change in mammographic density correlates with polymorphisms in
the VDR gene.

- To assess other sources of vitamin D (sunlight exposure, diet) in these women using a
validated questionnaire administered at baseline and at 12 and 24 months.

- To collect and bank serum, plasma, and breast tissue from these women before and after
a 1-year intervention with vitamin D for future biomarker analysis.

- To assess the toxicity of high-dose cholecalciferol compared to placebo in this
setting.

OUTLINE: This is a multicenter study. Participants are stratified according to baseline
serum 25(OH)D level (< 20 ng/mL vs 20-32 ng/mL or < 50 nmol/L vs 50-80 nmol/L), baseline
mammographic density (11-50% vs > 50%), and designated biopsy site (yes vs no). Participants
are randomized to 1 of 2 treatment arms.

- Arm I: Participants receive oral cholecalciferol once weekly and oral vitamin D once
daily. Treatment repeats for 12 months in the absence of evidence of cancer or
unacceptable toxicity.

- Arm II: Participants receive oral placebo once weekly and oral vitamin D once daily.
Treatment repeats for 12 months in the absence of evidence of cancer or unacceptable
toxicity.

Blood samples are collected at baseline and periodically thereafter for biomarkers and
25(OH)D level. Participants undergo a mammogram at baseline and at 12 months. Participants
may also undergo random core-needle breast biopsy at baseline and at 12 months.

Participants complete a questionnaire at baseline and at 12 and 24 months.

After completion of study therapy, participants are followed up at 1 and 12 months.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- At an elevated risk of breast cancer by at least one of the following criteria:

- Diagnosis of ADH, ALH, lobular carcinoma in situ (LCIS) or resected ductal
carcinoma in situ (DCIS) or small invasive breast cancers (pTmi or pT1a N0) if
no pior RT, tamoxifen, or systemic breast cancer treatment within 28 days prior
to registration OR diagnosis of resected Stage I (T1b-c N0-N1mi) through Stage
II breast cancer for which the participant has been disease-free for at least 5
years and has completed all adjuvant treatment OR

- A known* deleterious mutation in BRCA1, BRCA2, PTEN, or TP53 NOTE: *The
participant must be a documented carrier to meet this criterion. If there is a
known mutation in a hereditary breast cancer susceptibility gene in a
participant's family member, the participant herself must have undergone genetic
testing as per NCCN clinical guidelines to be eligible per this criterion.

- Modified Gail Model/CARE model** risk at 5 years ≥ 1.67% or lifetime risk ≥ 20%
by Claus, BRCAPro, Tyrer-Cuzick or IBIS models OR

- Mammographic density ≥ 50% (heterogenously dense) NOTE: **Risk models are to be
used only if there is no known previous diagnosis of resected DCIS or LCIS and
there is no known deleterious mutation in BRCA1, BRCA2, PTEN, or TP53.

- At least one breast available for imaging and biopsy (a previously irradiated breast
[i.e., for resected DCIS] is not evaluable for breast imaging or biopsy)

- Baseline mammogram (performed within 10 days after starting their last menstrual
period on a digital mammography machine) that shows either normal or benign findings

- Baseline mammographic density > 10% based upon the classification system (2 =
11-50%, "scattered fibroglandular densities"; 3 = 51-75%, "heterogeneously
dense"; 4 = >75, "extremely dense". Women with a baseline mammographic density
of ≤ 10% (1 = ≤ 10% breasts are almost entirely fat)will not be eligible.

PATIENT CHARACTERISTICS:

- Premenopausal, defined as ≥ 1 of the following criteria:

- Less than 6 months since the last menstrual period, no prior bilateral
oophorectomy, and no use of hormone-replacement therapy

- Has undergone a prior hysterectomy but no prior bilateral oophorectomy AND
follicle-stimulating hormone values measured within the past 28 days are
consistent with the normal values for the premenopausal state

- Zubrod performance status 0-1

- Serum creatinine ≤ upper limit of normal (ULN)

- Serum calcium or corrected calcium ≤ ULN

- Spot urine calcium:creatinine ratio < 0.37 mg/dL

- INR ≤ 1.5 times ULN+

- PT and PTT ≤ ULN*

- Baseline serum 25(OH)D level ≤ 32 ng/mL (or 80 nmol/L)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No other prior malignancy except for the following:

- Adequately treated basal cell or squamous cell skin cancer

- In situ cervical cancer

- Adequately treated stage I or II (including resected Stage I, T1b-c N0-N1mi
through Stage II breast cancer) from which the participant is currently in
complete remission

- Any other cancer (including contralateral breast) for which the participant has
been disease-free for ≥ 5 years

- No history of kidney stones

- No medical conditions requiring calcium or vitamin D supplementation (i.e.,
osteoporosis)

- No known hypersensitivity to vitamin D

- No known allergy to soy NOTE: +For patients undergoing breast biopsy.

PRIOR CONCURRENT THERAPY:

- Prior breast reduction surgery allowed

- No bilateral breast implants

- More than 1 month since prior surgery or radiotherapy to the breast for resected DCIS

- At least 28 days since prior tamoxifen

- Prior anticoagulant therapy allowed provided it is discontinued ≥ 7 days before
breast biopsy

- No concurrent calcium or additional vitamin D supplements

- Concurrent multivitamins allowed provided that the dose of vitamin D in the
multivitamin does not exceed 400 IU daily

- No concurrent participation in any other clinical trial for the treatment or
prevention of cancer unless the participant is no longer receiving the intervention
and is in the follow-up phase only (participants must not join such a trial while
participating in this study)

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Prevention

Outcome Measure:

Change in mammographic density at 12 months compared to baseline

Outcome Time Frame:

12 months

Safety Issue:

No

Principal Investigator

Laurence H. Baker, DO, FACOI

Investigator Role:

Principal Investigator

Investigator Affiliation:

Southwest Oncology Group - Group Chair's Office

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000668698

NCT ID:

NCT01097278

Start Date:

November 2011

Completion Date:

July 2015

Related Keywords:

  • brca1 Mutation Carrier
  • brca2 Mutation Carrier
  • Breast Cancer
  • breast cancer
  • ductal breast carcinoma in situ
  • lobular breast carcinoma in situ
  • BRCA1 mutation carrier
  • BRCA2 mutation carrier
  • Breast Neoplasms

Name

Location

Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
Tripler Army Medical Center Honolulu, Hawaii  96859-5000
CCOP - Wichita Wichita, Kansas  67214-3882
Hurley Medical Center Flint, Michigan  48503
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
CCOP - Cancer Research for the Ozarks Springfield, Missouri  65807
CCOP - Montana Cancer Consortium Billings, Montana  59101
CCOP - Columbus Columbus, Ohio  43206
CCOP - Greenville Greenville, South Carolina  29615
CCOP - Columbia River Oncology Program Portland, Oregon  97225
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
CCOP - St. Louis-Cape Girardeau Saint Louis, Missouri  63141
City of Hope Comprehensive Cancer Center Duarte, California  91010
Arizona Cancer Center at University of Arizona Health Sciences Center Tucson, Arizona  85724
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
Winthrop University Hospital Mineola, New York  11501
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
Central Baptist Hospital Lexington, Kentucky  40503
Via Christi Cancer Center at Via Christi Regional Medical Center Wichita, Kansas  67214
Lahey Clinic Medical Center - Burlington Burlington, Massachusetts  01805
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
Alaska Regional Hospital Cancer Center Anchorage, Alaska  99508
Good Samaritan Regional Health Center Mt. Vernon, Illinois  62864
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
Hematology-Oncology Centers of the Northern Rockies - Billings Billings, Montana  59101
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Glacier Oncology, PLLC Kalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Montana Cancer Specialists at Montana Cancer Center Missoula, Montana  59802
Adena Regional Medical Center Chillicothe, Ohio  54601
Doctors Hospital at Ohio Health Columbus, Ohio  43228
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Strecker Cancer Center at Marietta Memorial Hospital Marietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial Hospital Newark, Ohio  43055
Community Hospital of Springfield and Clark County Springfield, Ohio  45505
Genesis - Good Samaritan Hospital Zanesville, Ohio  43701
Mountain States Tumor Institute at St. Luke's Regional Medical Center Boise, Idaho  83712-6297
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center New York, New York  10032
Legacy Emanuel Hospital and Health Center and Children's Hospital Portland, Oregon  97227
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Chao Family Comprehensive Cancer Center at University of California Irvine Medical Center Orange, California  92868
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Mount Carmel Health - West Hospital Columbus, Ohio  43222
Front Range Cancer Specialists Fort Collins, Colorado  80528
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Poudre Valley Hospital Fort Collins, Colorado  80524
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Cancer Center of Kansas, PA - Dodge City Dodge City, Kansas  67801
Feist-Weiller Cancer Center at Louisiana State University Health Sciences Shreveport, Louisiana  71130-3932
Saint Francis Medical Center Cape Girardeau, Missouri  63701
Highland Hospital of Rochester Rochester, New York  14620
Legacy Mount Hood Medical Center Gresham, Oregon  97030
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical Center Portland, Oregon  97213-2967
Providence St. Vincent Medical Center Portland, Oregon  97225
Legacy Meridian Park Hospital Tualatin, Oregon  97062
Bon Secours St. Francis Health System Greenville, South Carolina  29601
Southwest Washington Medical Center Cancer Center Vancouver, Washington  98668
Highland General Hospital Oakland, California  94602
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Cancer Center of Kansas, PA - Chanute Chanute, Kansas  66720
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Cancer Center of Kansas, PA - Kingman Kingman, Kansas  67068
Lawrence Memorial Hospital Lawrence, Kansas  66044
Cancer Center of Kansas, PA - Liberal Liberal, Kansas  67905
Cancer Center of Kansas, PA - Newton Newton, Kansas  67114
Cancer Center of Kansas, PA - Parsons Parsons, Kansas  67357
Cancer Center of Kansas, PA - Pratt Pratt, Kansas  67124
Cancer Center of Kansas, PA - Salina Salina, Kansas  67401
Cancer Center of Kansas, PA - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, PA - Wichita Wichita, Kansas  67214
Associates in Womens Health, PA - North Review Wichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas, PA - Winfield Winfield, Kansas  67156
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy Hospital Port Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
Billings Clinic - Downtown Billings, Montana  59107-7000
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
Great Falls Clinic - Main Facility Great Falls, Montana  59405
Sletten Cancer Institute at Benefis Healthcare Great Falls, Montana  59405
Grant Medical Center Cancer Care Columbus, Ohio  43215
Knox Community Hospital Mount Vernon, Ohio  43050
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Portland, Oregon  97210
Legacy Salmon Creek Medical Center Vancouver, Washington  98686
Rocky Mountain Oncology Casper, Wyoming  82609
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Methodist Hospital Houston, Texas  77030
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris Road Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical Oncology Greer, South Carolina  29650
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Phelps County Regional Medical Center Rolla, Missouri  65401
Cancer Centers of the Carolinas - Eastside Greenville, South Carolina  29601
Mid-Illinois Hematology-Oncology Associates at Community Cancer Center Normal, Illinois  61761
Rockwood Clinic Cancer Treatment Center Spokane, Washington  99204-2967
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
Midwest Hematology Oncology Group, Incorporated Saint Louis, Missouri  63109
Contra Costa Regional Medical Center Martinez, California  94553-3156
El Camino Hospital Cancer Center Mountain View, California  94040
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
OnCare Hawaii, Incorporated - Kuakini Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Lusitana Honolulu, Hawaii  96813
Caritas St. Elizabeth's Medical Center Brighton, Massachusetts  02135-2997
AnMed Cancer Center Anderson, South Carolina  29621
Lovelace Medical Center - Downtown Albuquerque, New Mexico  87102
Regional Medical Center Anniston, Alabama  36202
Cancer Centers of the Carolinas - Easley Easley, South Carolina  29640
Self Regional Cancer Center at Self Regional Medical Center Greenwood, South Carolina  29646
Cancer Centers of the Carolinas - Greer Radiation Oncology Greer, South Carolina  29650
Falck Cancer Center at Arnot Ogden Medical Center Elmira, New York  14905
Castle Medical Center Kailua, Hawaii  96734
Kauai Medical Clinic Lihue, Hawaii  96766
Central Dupage Cancer Center Warrenville, Illinois  60555
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Providence Newberg Medical Center Newberg, Oregon  97132
Willamette Falls Hospital Oregon City, Oregon  97045
Southern Ohio Medical Center Cancer Center Portsmouth, Ohio  45662
Arizona Cancer Center at University Medical Center North Tucson, Arizona  85719
Kuakini Medical Center Honolulu, Hawaii  96817
Mountain States Tumor Institute - Meridian Meridian, Idaho  83642
Mountain States Tumor Institute at St. Luke's Twin Falls, Idaho  83301
Central Care Cancer Center at Carrie J. Babb Cancer Center Bolivar, Missouri  65613
Carolina Blood and Cancer Care Rock Hill, South Carolina  29732
Mercy Clinic Cancer and Hematology - Rolla Rolla, Missouri  65401
Oncare Hawaii, Incorporated - Pali Momi Aiea, Hawaii  96701
Epic Care - Oakland Oakland, California  94612
Delnor Hospital - Geneva Geneva, Illinois  60134