Randomized Phase II Biomarker Pilot Trial of Fluvastatin Use in Women With Ductal Carcinoma in Situ (DCIS) or Stage I Breast Cancer
- Determine differences between measures of cell proliferation (Ki-67) in women with
ductal carcinoma in situ (DCIS) or stage I breast cancer receiving neoadjuvant
- Determine whether statin use differentially affects specific types of DCIS/early-stage
breast cancer (comedo, estrogen receptor [ER]-positive, ER-negative).
- Compare differences between tissue staining of CD68, circulating macrophages, and
regulatory T cells in these patients.
- Assess the feasibility of using inherent susceptibility (mRNA polymerase chain reaction
testing) to predict response to statins in these patients.
OUTLINE: This is a randomized, controlled, single-blind, multicenter, pilot study. Patients
are randomized to 1 of 2 treatment arms (arms I or II). Patients accrued as control
participants are assigned to arm III.
- Arm I: Patients receive oral fluvastatin sodium once daily for 3-6 weeks in the absence
of disease progression or unacceptable toxicity.
- Arm II: Patients receive oral fluvastatin sodium as in arm I at a higher dose.
- Arm III (control): Patients do not receive fluvastatin sodium. All patients then
undergo definitive surgery.
Patients in arms I and II undergo blood collection at baseline and at the time of surgery
for biomarker analysis. Patients in arm III undergo blood collection at baseline and then
approximately 1 month later. Tissue is collected from patients in all arms at the time of
surgery. Blood and tissue samples are examined for biological markers, including Ki-67,
C-reactive protein, cleaved caspase 3, HER2, CD68 gene, and estrogen and progesterone
receptors by immunohistochemistry. Markers of inflammation (e.g., comedo necrosis
macrophages and CD25-positive T cells), low-density lipoprotein, and cholesterol are also
analyzed. Serum mRNA is measured by polymerase chain reaction.
PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
Change in proliferation after statin exposure, as measured by Ki-67 level
up to 6 weeks
Laura J. Esserman, MD, MBA
University of California, San Francisco
United States: Food and Drug Administration
|Memorial Sloan-Kettering Cancer Center||New York, New York 10021|
|University of Chicago Cancer Research Center||Chicago, Illinois 60637|
|UCSF Helen Diller Family Comprehensive Cancer Center||San Francisco, California 94115|
|Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute||Boston, Massachusetts 02115|