The Effect of Simvastatin on Breast Cancer Cell Growth in Women With Stage I-II Breast Cancer

The Effect of Statins on Markers of Breast Cancer Proliferation and Apoptosis in Women With Early Stage Breast Cancer

The purpose of this pilot phase II trial is to identify the molecular and genetic mechanisms by which statins influence breast cancer cell proliferation. Simvastatin may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and reduce the aggressiveness of breast cancer cells.

Study Overview

• Status: Completed
• Conditions: Invasive Breast Carcinoma; Stage I Breast Cancer AJCC v7; Stage IA Breast Cancer AJCC v7; Stage IB Breast Cancer AJCC v7; Stage II Breast Cancer AJCC v6 and v7; Stage IIA Breast Cancer AJCC v6 and v7; Stage IIB Breast Cancer AJCC v6 and v7
• Intervention / Treatment: Other: Laboratory Biomarker Analysis; Drug: Simvastatin

Detailed Description

PRIMARY OBJECTIVES:

I. Evaluate the relationship between short-term use of oral simvastatin on change in expression of Ki-67 as a candidate biomarker of breast tumor proliferation among women with clinical stage 1 or 2- primary invasive breast cancer.

II. Evaluate the relationship between short-term use of oral simvastatin on changes in other candidate predictive markers of breast tumor proliferation (cyclin D1 and P27), changes in a marker of apoptosis (cleaved caspase-3 [CC3]), changes in a marker of inflammation (c-reactive protein [CRP]) and as novel additional biomarkers changes in the composition of the plasma membrane (lipid rafts) and changes in activation of signaling markers (phosphorylation [p]Akt, pMAPK, pEGFR, PHER2).

III. To conduct exploratory analyses comparing the effect of statins on breast tumor proliferation and apoptosis in groups defined by tumor expression of hydroxymethylglutaryl co-enzyme A (CoA) reductase (HMG-CoA), estrogen receptor (ER)/progesterone receptor (PR) status, HER2neu, and tumor grade.

OUTLINE:

Patients receive simvastatin orally (PO) daily for 2-4 weeks in the absence of disease progression or unacceptable toxicity.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Detroit, Michigan, United States, 48201
      • Wayne State University/Karmanos Cancer Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Provision of informed consent prior to any study specific procedures
• Histologic confirmation of invasive breast cancer with any measures of ER, PR and HER2neu
• Clinical stage I or II breast cancer for which there will be at least a 2 week period of time between diagnosis and definitive surgery
• Performance status (Eastern Cooperative Oncology Group [ECOG] 0-1)
• Not currently pregnant during the study; participants will be informed that the use of contraceptive pills is contraindicated because it may interfere with the study drug and it may be harmful to the woman who has been diagnosed with breast cancer

Exclusion Criteria:

• Plans for administration of neoadjuvant chemotherapy or hormonal therapy
• Insufficient tissue on diagnostic core breast biopsy for analysis
• Previous or concurrent malignancy (with the exception of non-melanomatous skin cancer)
• Severe gastrointestinal disorder
• Current use of statins or fibrates for any time during the 3 months prior to the study
• Proven hypersensitivity to statins
• White blood cell (WBC) < 3,500/mm^3
• Platelet (Plt) < 120,000/mm^3
• Hemoglobin (HgB) < 10 g/dL
• Aspartate aminotransferase (AST) > 45 U/L
• Alanine aminotransferase (ALT) > 45 U/L
• Creatinine > 1.5 mg/dL
• Bilirubin > 1.15 mg/dL
• Creatine kinase measurement (CPK) > or = 250 mg/dL
• Central nervous system (CNS) diseases and major psychiatric diseases or inability to comply to the protocol procedures
• Active infections
• Cardiac failure, class I-IV
• Current anticoagulant or antiplatelet aggregation therapy
• Mitral and/or tricuspid valvopathy or valvular prosthesis; angina; severe arterial hypertension; chronic and/or paroxysmal atrial fibrillation; previous myocardial infarction
• Current lactation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• 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: Treatment (simvastatin); Patients receive simvastatin PO daily for 2-4 weeks in the absence of disease progression or unacceptable toxicity.	Other: Laboratory Biomarker Analysis; Correlative studies; Drug: Simvastatin; Given PO; Other Names: Zocor; MK 733; Synvinolin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Ki-67 Expression Assessed in Tumor Tissue by Immunohistochemistry	Differences in % positive cells pre and post treatment along with 95% confidence interval	Baseline up to 4 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Percentage of Cells P27+ From Pre-treatment to Post-treatment	The difference in percentage of cells P27+ from pre-treatment to post-treatment	Baseline up to 4 weeks
Cleaved Caspase-3 (CC3) as a Marker of Apoptosis	The difference in (percentage of cells cleaved caspase-3 (CC3)+) from pre-treatment to post-treatment	Baseline up to 4 weeks
C-reactive Protein (CRP) as a Marker of Inflammation	c-reactive protein (CRP) as a marker of inflammation.	Baseline up to 4 weeks
Change in (% Intracellular p27 +) From Pre-treatment to Post-treatment	the difference in (% intracellular p27 +) from pre-treatment to post-treatment	Baseline up to 4 weeks
Changes in p27 Cytoplasmic Intensity	the difference in (p27 cytoplasmic intensity) from pre-treatment to post-treatment	Baseline up to 4 weeks
Changes in Cyclin D1	the difference in % cyclin D1+ stained out of total cells from pre-treatment to post-treatment;	Baseline up to 4 weeks

Collaborators and Investigators

• Sponsor: Michael Simon
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Michael Simon, Barbara Ann Karmanos Cancer Institute

Publications and helpful links

General Publications

• Asari K, Sun WT, Kok ZH, Lam YH, Ng BL, Saunders V, White DL, Chuah C, Xiang W. Simvastatin enhances the efficacy of nilotinib in chronic myeloid leukaemia by post-translational modification and drug transporter modulation. Anticancer Drugs. 2021 Jun 1;32(5):526-536. doi: 10.1097/CAD.0000000000001028.

Study record dates

Study Major Dates

• Study Start (Actual): March 9, 2018
• Primary Completion (Actual): October 6, 2021
• Study Completion (Actual): October 6, 2021

Study Registration Dates

• First Submitted: February 22, 2018
• First Submitted That Met QC Criteria: March 2, 2018
• First Posted (Actual): March 6, 2018

Study Record Updates

• Last Update Posted (Actual): August 1, 2023
• Last Update Submitted That Met QC Criteria: July 27, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antimetabolites; Anticholesteremic Agents; Hypolipidemic Agents; Lipid Regulating Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Simvastatin
• Other Study ID Numbers: 2017-073 (Other Identifier: Wayne State University/Karmanos Cancer Institute); P30CA022453 (U.S. NIH Grant/Contract); NCI-2018-00044 (Registry Identifier: CTRP (Clinical Trial Reporting Program))

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No