Modulation of Breast Cancer Risk Biomarkers by High Dose Vitamin D

The overall goal of this project is to determine if high dose vitamin D3 given to premenopausal women at high risk for development of breast cancer, who initially have insufficient levels of 25-hydroxy vitamin D (<30 ng/ml), will raise 25(OH)D levels above 50 ng/ml. If so, will certain risk biomarkers for development of breast cancer be reliably and favorably modulated?

Study Overview

• Status: Completed
• Conditions: Breast Cancer
• Intervention / Treatment: Drug: vitamin D3

Detailed Description

Protocol Objectives:

To determine if high dose vitamin D3 given to premenopausal women who initially have insufficient levels of 25-hydroxy vitamin D (<30 ng/ml) will raise 25(OH)D levels above the 50 ng/ml level considered to be required for breast health. If so, will certain risk biomarkers for development of breast cancer be reliably and favorably modulated? The primary endpoint will be a decrease in mammographic breast density (percent area considered at increased density). Change in proliferation (a decrease as assessed by Ki-67) will also be examined. Modulate of expression of genes important in breast cancer risk or reflective of vitamin D's mechanism of action will be studied using quantitative real time polymerase chain reaction (qRT-PCR).

Study Design:

The study is a single-arm open label clinical trial. Women who are high risk for development of breast cancer on the basis of family or personal history will undergo random periareolar fine needle aspiration (RPFNA) to acquire breast cells for assessment of gene expression by qRT-PCR. Women with mammographic density >10% will be eligible for enrollment. All subjects will receive high dose vitamin D3 (3 capsules of 10,000 IU of vitamin D3 every week for 6-8 months). At that time, a repeat RPFNA and mammogram will be performed. Measurement of serum levels of 25(OH)D will be performed at baseline, 3 months, and 6 months.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • University of Kansas Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 55 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Subjects must be premenopausal women age 55 or younger, and actively menstruating with 4 or more periods per year.
• Subjects may be using barrier contraceptive, an intrauterine device, a Nuvaring, or similar non-oral contraceptive; or oral contraceptives.

• Subjects must be at increased risk for breast cancer on the basis of at least one of the following criteria:

  • five-year Gail risk of 3X the average risk of the age group;
  • a first degree relative with breast cancer under the age of 60 or multiple second degree relatives with breast cancer;
  • prior biopsy exhibiting atypical hyperplasia (AH), LCIS, DCIS, RPFNA evidence of hyperplasia with atypia within the last three years;
  • Chest or neck radiation before age 30;
  • Breast density equals or exceeds 50 percent.
• If previously on a chemoprevention agent or prevention trial, subjects must have completed study participation at least 6 months prior to baseline biomarker assessment.
• If subject has a history of AH, LCIS, or ER-positive DCIS by diagnostic biopsy, must have been counseled about appropriate standard prevention therapies such as tamoxifen and is either not eligible or is not interested in standard prevention therapies. Women with DCIS must have had appropriate local therapy (lumpectomy plus radiation or mastectomy).
• Subject must have had a mammogram performed at the University of Kansas Breast Imaging Center with estimated visual breast density of greater than 10 percent.
• Subject must have had within six months prior to entering the study, an RPFNA during the follicular portion (day 1-10) of the menstrual cycle with material for cytomorphology, Ki-67 and qRT-PCR; in addition to serum obtained and banked.
• Subjects must have 25(OH)D level < 30 ng/ml as measured within 8 weeks of starting intervention. Subjects may have been identified as having low vitamin D levels through participation in HSC 11313, Osteopenia/Osteoporosis in Pre-menopausal Women at High Risk for Development of Breast Cancer, but low level must be confirmed within 8 weeks prior to starting study agent Subject must be willing to continue the same hormonal milieu present at baseline throughout trial.
• Subjects must be willing to undergo measurement of height, weight, and BMI at initiation of intervention.
• Subjects must have participated in HSC 11313, and have had a DEXA scan for bone density and body fat analysis on the GE Lunar Prodigy Advance research unit in the Breast Cancer Survivorship Center.
• Subjects must be willing to sign an informed consent for the entire study and separate consent for repeat RPFNA.

Exclusion Criteria:

• Women that have had a metastatic malignancy of any kind.
• Women that have had prior invasive breast cancer If subject has had a DCIS, at least two months must have elapsed from surgery and/or radiation therapy to the involved breast. Only the contra-lateral (uninvolved breast) will be studied by FNA. The subject may not have had any radiation therapy to the contra-lateral breast to be studied.
• Women who are pregnant or nursing.
• Women who have taken a SERM, aromatase inhibitor or participated in a chemoprevention or other investigational drug study within six months prior to baseline FNA.
• Women who have used fertility drugs within six months prior to baseline aspiration.
• Women with a history of sarcoidosis, hypercalcemia, hyperparathyroidism, or renal stones.
• Women who are receiving treatment for rheumatoid arthritis or other connective tissue diseases.
• Women who have an elevated blood calcium level at baseline; defined as any elevation above the institutional normal range.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: high dose vitamin D3 (10,000 IU weekly); Group/Cohort Label vitamin D3	Drug: vitamin D3; oral capsules, 10,000 IU per week for 6 months; Other Names: Maximum D3

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Mammographic Breast Density Over Course of Study	Change in the percent of the breast area that is considered to be at higher density on mammogram.	baseline and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Proliferation (as Assessed by Ki-67) Examined in Breast Epithelial Cells.	Change in percent of cells expressing staining for Ki-67 antibody in breast epithelial cell specimens acquird by Random Periareolar Fine Needle Aspiration.	baseline and 6 months
OH Vitamin D Levels in Serum	Assessment of 25(OH)D levels as a measure of circulating vitamin D.	baseline and 6 months

Collaborators and Investigators

• Sponsor: Carol Fabian, MD
• Collaborators: BTR Group
• Investigators: Principal Investigator: Carol Fabian, MD, University of Kansas Medical Center

Study record dates

Study Major Dates

• Study Start: May 1, 2009
• Primary Completion (Actual): June 1, 2011
• Study Completion (Actual): June 1, 2011

Study Registration Dates

• First Submitted: July 16, 2010
• First Submitted That Met QC Criteria: July 19, 2010
• First Posted (Estimate): July 21, 2010

Study Record Updates

• Last Update Posted (Estimate): July 18, 2016
• Last Update Submitted That Met QC Criteria: June 16, 2016
• Last Verified: June 1, 2016

More Information

Terms related to this study

• Keywords: Additional relevant MeSH terms:; Pathologic Processes; Neoplasms; vitamin D3; Breast Neoplasms; Physiological Effects of Drugs; Pharmacologic Actions; Hyperplasia; chemoprevention; high risk for breast cancer; Neoplasms by Site; Breast Diseases; breast atypia; breast epithelial hyperplasia; Molecular Mechanisms of Pharmacological Action; random periareolar fine needle aspiration; RPFNA; ki-67; high risk for development of breast cancer; Antirheumatic Agents
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Physiological Effects of Drugs; Micronutrients; Vitamins; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Vitamin D; Cholecalciferol
• Other Study ID Numbers: 11657 (Registry Identifier: DAIDS ES Registry Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: Global results only will be published.