Comparative Analysis of Immunological Responses to Vitamin D Replacement Therapy in Black and West African Men Diagnosed With Prostate Cancer: Elucidating Differential Effects on Immune Function Between Patients With Localized Disease and Those With Metastatic Progression (iCCaRE)
This study is testing whether fixing vitamin D deficiency in Black/West African men with prostate cancer can strengthen their immune system, improve quality of life, and even slow cancer progression compared to those who remain deficient.
Key ideas being tested:
- More than half of Black/West African prostate cancer patients don't have enough vitamin D.
- Low vitamin D weakens immune cell function and affects quality of life, but these problems improve after 8 weeks of vitamin D supplements.
- Immune cell function differs between patients with advanced/recurrent prostate cancer and those with localized disease.
- Patients with advanced disease who show stronger immune responses after vitamin D correction may live longer without their PSA levels rising (a marker of cancer progression).
- Immune cell function in Black/West African patients is different from that in Black/African American patients, and this will be checked by comparing data with a parallel Mayo Clinic study.
Overall goals:
1 . Measure how widespread vitamin D deficiency is in Black/West African prostate cancer patients.
2. Understand how vitamin D levels affect immunity and quality of life. 3. Compare immune function between different groups (localized vs. advanced disease, West African vs. African American patients).
4 . See if vitamin D replacement improves both patient well-being and cancer outcomes.
Study Flow
1. Recruitment & Consent: Patients with prostate cancer (localized or advanced) are invited and give written consent.
2 . Initial Blood Test (10 mL): Check vitamin D and calcium levels. 3. Eligibility: If vitamin D is low (<30 ng/mL), patients join the treatment phase.
4. Baseline Testing (50 mL blood + QOL survey): Immune function measured; quality of life survey completed; virtual doctor consult.
5. Treatment (8 weeks): Daily vitamin D3 pills (2000 IU, free); patients keep a medication diary.
6. Midpoint Check (Week 4): Phone call to check side effects and compliance. 7 .End of Treatment (Week 8): Repeat blood tests (60 mL), second QOL survey, virtual consult.
8. Follow up (up to 3 years). Annual phone calls and medical record review to track progression-free survival.
In short, the study is trying to show that vitamin D deficiency is common in Black/West African prostate cancer patients, that it harms immune function and quality of life, and that correcting it could improve both health and cancer survival.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Principal Investigators:
University of Ilorin, Ilorin, Nigeria: Ademola Alabi Popoola, MBBCH; Joshua Abiodun, PhD; Collaborators: Mayo Clinic, Jacksonville, Florida, USA: Gerardo Colon-Otero, MD, Trevanne Matthews-Hew, MD, Kim Barbel-Johnson, MD, Sandra Casanova, Keith L. Knutson,n PhD, For research laboratory tests that will be performed at the Mayo Clinic and planned retrospective comparisons with a parallel Mayo Clinic.
This clinical trial, designed to explore the potential role of vitamin D supplementation in improving outcomes among West African men with advanced prostate cancer, is grounded in the following hypothesis.
Clinical Trial Hypotheses Prevalence of Vitamin D Insufficiency More than half of Black/West African prostate cancer patients are expected to have vitamin D insufficiency.
Impact on Immune Function & Quality of Life Vitamin D insufficiency is associated with altered immune cell function and reduced health-related quality of life. Both are expected to improve after 8 weeks of vitamin D replacement.
Disease Stage Differences Immune cell function differs significantly between patients with metastatic/locally recurrent prostate cancer and those with localized disease.
PSA Progression-Free Survival Patients with metastatic or recurrent disease who show an improved immune response after vitamin D correction will have better PSA progression-free survival than those without immune response changes.
Comparisons Across Populations Immune cell function in Black/West African prostate cancer patients differs from that in Black/African American patients. This will be tested by comparing data from this study with a parallel Mayo Clinic study, both partially funded by the U.S. Department of Defense.
Study Aims & Purpose
- Evaluate the prevalence of vitamin D insufficiency among Black/West African prostate cancer patients.
- Assess immune deficits linked to vitamin D insufficiency.
- Compare immune cell function between Black/West African and Black/African American patients (via Mayo Clinic parallel study).
- Examine differences in immune function between localized vs. metastatic/recurrent disease.
- Determine whether vitamin D replacement improves quality of life and PSA progression-free survival (PSA-PFS).
Specific Objectives
- Measure the prevalence of vitamin D insufficiency in Black/West African prostate cancer patients.
- Analyze changes in immune cell function with insufficiency (<30 ng/ml) and after vitamin D replacement.
- Assess the acceptability of vitamin D replacement and its impact on health-related quality of life.
- Compare immune cell function between Black/West African vs. Black/African American patients, and between localized vs. advanced disease.
- Evaluate whether vitamin D replacement improves PSA-PFS in metastatic/recurrent patients who show immune response changes, compared to those without changes and historical controls.
Background Context
- Vitamin D insufficiency (hypovitaminosis D) is linked to increased risks of cardiovascular disease, cancer, infections, and overall mortality.
- Black populations are disproportionately affected due to melanin reducing skin vitamin D synthesis.
- Racial disparities in prostate cancer survival are influenced by socioeconomic, genetic, and health system factors.
- Vitamin D supplementation has been shown to reduce cancer mortality, improve progression-free survival in some cancers, and enhance quality of life.
- Immunological effects: Vitamin D modulates B-cells, T-cells, dendritic cells, and suppresses pro-tumor Th17 T cells, suggesting a role in cancer immunity.
Preliminary Data
- Mayo Clinic pilot study (Duval County, USA): 66% prevalence of hypovitaminosis D in African American participants.
- IRONMAN study (Nigeria): Over 150 men recruited, providing infrastructure for prostate cancer research.
- ICCARE Phase 1 Pilot Project 5: Serum vitamin D levels in 81 Nigerian prostate cancer patients vs. 71 controls showed significantly lower levels in cancer patients, especially advanced cases.
- These findings highlight the high prevalence of vitamin D insufficiency and its potential link to poor prostate cancer outcomes in Black/West African populations.
Study Design & Methods
- Type: Minimal-risk interventional clinical trial.
- Participants: Black/West African men with localized or metastatic/locally recurrent prostate cancer.
- Process:
Pre-screening: Serum vitamin D and calcium testing. Patients with vitamin D <30 ng/ml will be enrolled in the therapeutic arm. Intervention: Oral vitamin D3 (2000 IU daily, free of charge) for 8 weeks. Monitoring: Medication diary, 4-week phone check, baseline, and 8-week blood draws for immune function tests.
Quality of life: CDC HRQOL-4 survey at baseline and 8 weeks. Follow-up: Annual contact up to 3 years for PSA progression-free survival (PSA-PFS).
Study Aims (Detailed)
- Vitamin D Levels: Measure prevalence and mean/median serum 25OHD levels; assess immune regulation after supplementation.
- Immune Profiling: Phenotype immune cell populations (CD4, CD8, B cells, monocytes, dendritic cells, Tregs, NK cells).
- Cancer Antigen Immunity: Measure T-cell and antibody responses to prostate cancer antigens (PAP, PMSA, P53, MUC1).
- General Immunity: Assess responses to viral/bacterial antigens (e.g., tetanus, EBV, CMV).
- Clinical Outcomes: Evaluate PSA-PFS compared to historical controls and stratify by immune response changes after vitamin D replacement.
Target Accrual
- Pre-screening: 200 Nigerian men with localized prostate cancer and 200 with metastatic/locally recurrent disease.
- Intervention: ~100 localized and ~100 advanced cases (due to 60-70% prevalence of vitamin D insufficiency).
- Sample size: Adequate to evaluate effects of vitamin D insufficiency and replacement on immune profiles.
Subject Population
- Adults ≥18 years, Nigerians, with a history of prostate cancer (localized or advanced).
- Intervention group: 200 patients with low vitamin D (<30 ng/ml), treated with oral vitamin D3 (2000 IU daily for 8 weeks).
- Blood samples collected at UITH, Ilorin, Nigeria.
Specimen Handling
- Blood stored at -80°C freezers at the University of Ilorin.
- Shipped to Mayo Clinic Biobank and analyzed at Dr. Keith Knutson's lab (Florida).
- Retrospective comparison planned with Mayo Clinic parallel study (DoD-funded).
Data Analysis Plan
- Regression models controlling for age, BMI, smoking, and vitamin D receptor variants.
- Descriptive analysis of vitamin D supplement use (diagnosis, enrollment, follow-up).
- Frequency of vitamin D testing pre- and post-enrollment; chi-square and t-tests for group comparisons.
- Separate analyses for USA vs. Nigeria cohorts; centralized lab analysis at Mayo Clinic.
Endpoints
- Effects of vitamin D replacement on immune cell function.
- Differences in immune profiles:
- Black/African American vs. Black/West African patients.
- Localized vs. metastatic/recurrent disease.
- Antigen-specific T-cell and antibody responses (baseline vs. 8 weeks).
- Prevalence of vitamin D insufficiency.
- Acceptability of vitamin D replacement therapy.
- PSA progression-free survival (PSA-PFS) outcomes. Safety & Monitoring
- Vitamin D dose (2000 IU daily) is safe and within recommended limits.
- Adverse events monitored via phone calls and physician consults.
- Oversight by Savante Consulting (CRO), site PIs, and NAFDAC compliance.
- Clinical Monitoring Plan ensures GCP adherence and regulatory compliance. Data Storage & Access
- Patient data limited to essentials, stored securely in REDCap®.
- Hard copies locked for 5 years, then shredded.
- De-identified data sent to Mayo Clinic biostatisticians for analysis. Funding
- Supported by U.S. Department of Defense (DoD) (Project ID: PC230672P11).
- Covers investigator salaries, coordinators, lab supplies, pharmacy costs, and specimen processing.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Ademola A Popoola, MD
- Telefonnummer: 000 +2348032224299
- E-mail: ademolapopoola@unilorin.edu.ng
Undersøgelse Kontakt Backup
- Navn: Remi S Solagbade, MD
- Telefonnummer: 000 +2347037779545
- E-mail: solagbaders@gmail.com
Studiesteder
-
-
Kwara State
-
Ilorin, Kwara State, Nigeria, 240001
- University of Ilorin Teaching Hospital
-
Kontakt:
- Remi S Solagbade, MD
- Telefonnummer: 000 +2347037779545
- E-mail: solagbaders@gmail.com
-
Kontakt:
- Abiodun L Azeez, MD
- Telefonnummer: 000 +2347065870498
- E-mail: azeezlateefabiodun@yahoo.com
-
Underforsker:
- Hannah O Olawumi, MD
-
Underforsker:
- Ismail Oseni, MD
-
Underforsker:
- Joshua Abiodun, PhD
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Self-identified Black/West African Males, Age ≥18 years
- Patients with a previous history of localized or metastatic or locally recurrent prostate cancer
- Willing to travel to the University of Ilorin Surgery Outpatient Department (SOPD UITH)for baseline and 8 weeks visit for blood collection, if eligible.
Exclusion Criteria:
- Known hypersensitivity to vitamin D.
- End-stage renal failure on dialysis
- Liver cirrhosis
- Currently taking a vitamin D or multivitamin supplement, which has more than 400 IU/10mcg of vitamin D daily for the past month.
- Legal inability or restricted legal ability, medical or psychological conditions not allowing proper study completion or informed consent signature.
- History of hypercalcemia
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Vitamin Deficiency patients who will have Vitamin D Supplements
2000 IU of Vitamin D supplement will be given to the patients with advanced prostate cancer who have Vitamin D levels less than 30 ng/ ml for 8 weeks
|
2000 IU of vitamin D will be given to the patients with prostate cancer with Serum low Vitamin D levels ( he Locally advanced Group and the group with metastasis).
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Proportion of Men with Advanced Prostate Cancer with Vitamin D Deficiency
Tidsramme: 48 months
|
The proportion of African men with advanced prostate cancer who have low vitamin D levels will be calculated as the number of men with vitamin D deficiency divided by the total number of men diagnosed with advanced prostate cancer.
|
48 months
|
|
Serum levels of Vitamin D in African Men with Advanced Prostate Cancer .
Tidsramme: The test will be done at the time of recruitment and at 8 weeks after the supplementation
|
The serum 25(OH)D levels will be measured using Enzyme Linked Immunosorbent Assay (ELISA) (target: 30-50 ng/mL).
|
The test will be done at the time of recruitment and at 8 weeks after the supplementation
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Tolerability of eight weeks of Vitamin D supplementation in African men with Advanced Prostate Cancer who have low levels of Vitamin D
Tidsramme: Tolerability will be monitored during the 8-week supplementation period and for an additional 8 weeks thereafter, covering a total duration of 16 weeks.
|
The participants' tolerance of vitamin D supplementation will be measured by the following: Symptoms of vitamin D intolerance will be documented by looking at the proportion of men with the following symptoms. These include the following: Gastrointestinal (nausea, vomiting, constipation, abdominal pain, and loss of appetite); Neuromuscular (weakness, fatigue, muscle aches, and confusion); bone pain; dehydration; and blood pressure changes. |
Tolerability will be monitored during the 8-week supplementation period and for an additional 8 weeks thereafter, covering a total duration of 16 weeks.
|
|
Vitamin D supplementation and PSA levels in advanced prostate cancer.
Tidsramme: The PSA will be measured every three months for each patient 36 months
|
This study aims to evaluate whether vitamin D supplementation in patients with advanced prostate cancer alters serum prostate-specific antigen (PSA) levels, a validated surrogate marker of disease progression.
PSA concentrations are reported in nanograms per milliliter (ng/mL).
|
The PSA will be measured every three months for each patient 36 months
|
|
Vitamin D supplementation and immune cell activity in advanced prostate cancer.
Tidsramme: The immune cell counts will be measured at the recruitment after 8 weeks
|
This trial investigates whether vitamin D supplementation influences immune activity.
Immune cell counts are reported in cells per microliter (cells/µL).
|
The immune cell counts will be measured at the recruitment after 8 weeks
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Ademola A Popoola, MBBS,MD, FWACS, FMCS, Department of Surgery, University of Ilorin Teaching Hospital / University of Ilorin
- Studieleder: Remi S Solagbade, MBBS, Department of Surgery , University of Ilorin Teaching Hospital
Publikationer og nyttige links
Generelle publikationer
- Aranow C. Vitamin D and the immune system. J Investig Med. 2011 Aug;59(6):881-6. doi: 10.2310/JIM.0b013e31821b8755.
- Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 2008 May;65(5):508-12. doi: 10.1001/archpsyc.65.5.508.
- Nelson SM, Batai K, Ahaghotu C, Agurs-Collins T, Kittles RA. Association between Serum 25-Hydroxy-Vitamin D and Aggressive Prostate Cancer in African American Men. Nutrients. 2016 Dec 28;9(1):12. doi: 10.3390/nu9010012.
- Song ZY, Yao Q, Zhuo Z, Ma Z, Chen G. Circulating vitamin D level and mortality in prostate cancer patients: a dose-response meta-analysis. Endocr Connect. 2018 Dec 1;7(12):R294-R303. doi: 10.1530/EC-18-0283.
- Andersen MR, Sweet E, Hager S, Gaul M, Dowd F, Standish LJ. Effects of Vitamin D Use on Health-Related Quality of Life of Breast Cancer Patients in Early Survivorship. Integr Cancer Ther. 2019 Jan-Dec;18:1534735418822056. doi: 10.1177/1534735418822056. Epub 2019 Jan 7.
- Grant WB, Peiris AN. Differences in vitamin D status may account for unexplained disparities in cancer survival rates between African and white Americans. Dermatoendocrinol. 2012 Apr 1;4(2):85-94. doi: 10.4161/derm.19667.
- Kanno K, Akutsu T, Ohdaira H, Suzuki Y, Urashima M. Effect of Vitamin D Supplements on Relapse or Death in a p53-Immunoreactive Subgroup With Digestive Tract Cancer: Post Hoc Analysis of the AMATERASU Randomized Clinical Trial. JAMA Netw Open. 2023 Aug 1;6(8):e2328886. doi: 10.1001/jamanetworkopen.2023.28886.
- Zhang Y, Fang F, Tang J, Jia L, Feng Y, Xu P, Faramand A. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ. 2019 Aug 12;366:l4673. doi: 10.1136/bmj.l4673.
- Peng X, Vaishnav A, Murillo G, Alimirah F, Torres KE, Mehta RG. Protection against cellular stress by 25-hydroxyvitamin D3 in breast epithelial cells. J Cell Biochem. 2010 Aug 15;110(6):1324-33. doi: 10.1002/jcb.22646.
- Stechschulte SA, Kirsner RS, Federman DG. Vitamin D: bone and beyond, rationale and recommendations for supplementation. Am J Med. 2009 Sep;122(9):793-802. doi: 10.1016/j.amjmed.2009.02.029.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Genitale sygdomme
- Genitale neoplasmer, mandlige
- Urogenitale neoplasmer
- Neoplasmer efter sted
- Neoplasmer
- Kønssygdomme, mandlige
- Prostatasygdomme
- Mandlige urogenitale sygdomme
- Neoplasmer efter histologisk type
- Neoplasmer, kirtel og epitel
- Karcinom
- Prostatiske neoplasmer
- Adenocarcinom
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- UIlorinTeachingH
- UNI-351872 (Andet bevillings-/finansieringsnummer: US DoD)
Plan for individuelle deltagerdata (IPD)
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IPD-planbeskrivelse
IPD-delingstidsramme
IPD-delingsadgangskriterier
IPD-deling Understøttende informationstype
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
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