Vitamin D Supplementation in Breast Cancer Patients

The Effect of Vitamin D Supplementation in Breast Cancer Patients Receiving Taxane-based Chemotherapy

It is a randomized clinical trial aimed at exploring the neuroprotective effect of vitamin D3 (Cholecalciferol) supplementation in conjunction with paclitaxel-based chemotherapy among breast cancer patients with vitamin D insufficiency or deficiency.

Study Overview

• Status: Not yet recruiting
• Conditions: Peripheral Neuropathic Pain
• Intervention / Treatment: Drug: Vitamin D (Cholecalciferol )

Detailed Description

This study is a two-arm randomized controlled trial with 132 participants, evenly randomized into an intervention group and a control group. Both groups are scheduled to receive Adriamycin-Cyclophosphamide followed by paclitaxel (AC-T) chemotherapy protocol. The intervention group will undergo paclitaxel-based chemotherapy, along with vitamin D replacement therapy. Conversely, the control group will follow the AC-T protocol without the addition of vitamin D replacement therapy.

• Study Type: Interventional
• Enrollment (Estimated): 132
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Abdelrahman Mahmoud Dosoky, Dr; Phone Number: 0020 1148534951; Email: abdalrahman.mahmoud@pharma.cu.edu.eg

Study Locations

• Egypt
  • Cairo, Egypt
    • Ain Shams University (El-Demerdash) Hospital
    • Contact: Abdelrahman Mahmoud Dosoky, Dr; Phone Number: +201148534951; Email: abdalrahman.mahmoud@pharma.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Female aged 18 to 65 years old.
2. Histologically confirmed breast cancer.
3. Eastern Cooperative Oncology Group (ECOG) performance status of less than or equal to 2 [21] [22].
4. All patients should fulfill the criteria of the initiation of taxane-based chemotherapy such as absolute neutrophil count (ANC) > 1,500/mcL, platelets > 100,000/mcL, hemoglobin ≥ 9 g/mL, Aspartate Aminotransferase (AST) (Serum Glutamic-Oxaloacetic Transaminase) (SGOT) to Alanine Aminotransferase (ALT), (Serum Glutamic-Pyruvic Transaminase) (SGPY) ratio (AST (SGOT)/ALT (SGPT)) < 2.5 x institutional upper limit of normal (ULN), total bilirubin less than or equal to 1.5 x institutional ULN, serum creatinine < 1.5 x institutional ULN.
5. Stage I-III breast cancer scheduled to undergo adjuvant or neoadjuvant paclitaxel-based chemotherapy for breast cancer using doxorubicin 60 mg/m² and cyclophosphamide 600 mg/m² followed by paclitaxel 80 mg/m² weekly for 12 weeks protocol code BRAJACTW [23].
6. Vitamin D insufficiency defined as serum level < 30 ng/ml.
7. Ability to give informed consent as per the legal requirement.

Exclusion Criteria:

1. Prior neurotoxic chemotherapy including paclitaxel.
2. Metastatic carcinoma.
3. History of any other malignancy except malignancy that was treated with curative intent and for which there has been no known active disease for more than 3 years prior to randomization, curatively treated non-melanoma skin malignancy, cervical cancer in situ, in situ ductal carcinoma, or breast in situ lobular carcinoma.
4. Grade II neuropathy or higher based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0. neurosensory or neuromotor neuropathy, regardless of causality.
5. Patients who are scheduled to receive any neurotoxic chemotherapeutic agents such as platinum compounds (carboplatin, cisplatin), vinorelbine, eribulin, and ixabepilone.
6. Diabetes mellitus
7. Psychiatric disorders that limit ability to comply with study protocol i.e., history of regular exacerbation of major psychosis (schizophrenia, bipolar disorder) in last 2 years.
8. Known Fibromyalgia
9. Gastric bypass surgery.
10. Patients with chronic granuloma forming disorders (sarcoidosis or tuberculosis TB).
11. Known hyperparathyroidism.
12. Known thyroid dysfunction.
13. Known positive test for human immunodeficiency virus (HIV), hepatitis C virus, or acute or chronic hepatitis B infection.
14. Pregnancy and lactation.
15. Hypercalcemia (corrected blood calcium > 10.5 mg/dl or > 2.6 mmol/L)[24]
16. Hyperphosphatemia, serum phosphate concentration > 4.5 mg/dL [25]
17. History of symptomatic genitourinary stones within the past year.
18. Allergy to any cholecalciferol dosage form component.
19. Alcohol consumption.
20. Regular use of vitamin D > 2000 IU daily over the past year.
21. Inability to swallow pills.
22. Medications that may interfere with vitamin D metabolism, including enzyme inducing anticonvulsants, lithium, phenytoin, verapamil, orlistat, tuberculosis medications as isoniazid, and/or rifampin and estrogen-containing medications.
23. Patients receiving any of the following medications used to prevent CIPN: vitamin E, glutamine, nortriptyline, amitriptyline, tricyclic antidepressants, pregabalin, and duloxetine and other nutritional supplements as vitamin B during taxane administration.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Intervention group; In conjunction with the AC-T chemotherapy protocol, individuals in the intervention group who have a vitamin D deficiency will receive vitamin D replacement therapy.	Drug: Vitamin D (Cholecalciferol ); In conjunction with the AC-T chemotherapy protocol, individuals in the intervention group who have a vitamin D deficiency will receive an oral loading dose of 50,000 IU weekly for eight weeks. Subsequently, they will be given 100,000 IU monthly until the completion of their chemotherapy treatment.
No Intervention: The control group; only the standard of care will be administered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The cumulative incidence and grading of paclitaxel-induced peripheral neuropathy (PIPN)	The incidence and grading of paclitaxel-induced peripheral neuropathy (PIPN) will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0.	PIPN will be assessed throughout the 12-weeks paclitaxel administration phase.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The modified total neuropathy score mTNS.	The Modified Total Neuropathy Score (mTNS) is a tool including six items that evaluate peripheral neuropathy symptoms by their presence, location, and characteristics, including sensory and motor symptoms, response to pinprick, vibration sensitivity, muscle strength, and deep tendon reflexes. Each item is scored on a scale from 0 to 4, with the total possible score ranging from 0 to 24. The sum of these scores yields a total score, with higher scores indicating more severe neuropathy.	The change in mTNS will be compared at weeks 18 and 24 relative to baseline.
EORTC QLQ-CIPN20	The assessment of taxane-induced peripheral neuropathy will be carried out through interviews utilizing the Arabic version of the EORTC QLQ-CIPN20. This 20-item questionnaire, which includes sensory, motor, and autonomic subscales, will be employed for evaluations.	Taxane-induced peripheral neuropathy using (EORTC QLQ-CIPN20) at weeks 13, 15,18, 21 and 24.
Quality of life	Quality of life (QOL) assessments will be conducted through interviews utilizing the Arabic version of the Functional Assessment of Cancer Therapy Breast Symptom Index (FBSI).	Quality of life (QOL) assessed at the first week, then at weeks 13 and 24.

Collaborators and Investigators

• Sponsor: Abdelrahman Mahmoud

Study record dates

Study Major Dates

• Study Start (Estimated): October 15, 2024
• Primary Completion (Estimated): November 30, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: September 11, 2024
• First Submitted That Met QC Criteria: September 11, 2024
• First Posted (Estimated): September 19, 2024

Study Record Updates

• Last Update Posted (Estimated): September 19, 2024
• Last Update Submitted That Met QC Criteria: September 11, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Keywords: Breast cancer; Neuropathic pain; Vitamin D3; Paclitaxel; Cholecalciferol; Taxane
• Additional Relevant MeSH Terms: Nervous System Diseases; Pain; Neurologic Manifestations; Neuromuscular Diseases; Peripheral Nervous System Diseases; Neuralgia; Physiological Effects of Drugs; Micronutrients; Vitamins; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Vitamin D; Cholecalciferol
• Other Study ID Numbers: Vitamin D in cancer patients

Drug and device information, study documents

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