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High-doses of Vitamin D (VD) may be used as targeted therapy against breast cancer. The investigators will assess the effect of high dose VD on the following biomarkers in the breast cancer cells: VDR, estrogen receptor (ER), progesterone receptor (PR), epidermal growth factor receptor 2 (Her2/neu), androgen receptor (AR), as well as epidermal growth factor receptor 1 (EGFR) and Ki-67, as markers of proliferation, and E-cadherin, a marker of invasion and metastasis.
This is a phase I/II open-label, non-randomized study. In phase I, a fixed weekly course of oral high-dose Vitamin D (VD) is planned for either 3, 4 or 5 weeks; patients will be sequentially enrolled into 3 groups (A, B or C respectively) in a manner such that no more than two patients may have treatment-limiting toxicities (TLTs).
After the group with the optimal duration of VD therapy to achieve a "favorable response" is determined, phase II will begin enrollment.
Patients must be scheduled to have surgery performed within 2- weeks of the last dose of VD.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Phase 1 - Group A - VD 3 Weeks | Experimental | Weekly oral dose of 50,000 IU Vitamin D3 (VD) for 3 weeks. |
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| Phase 1 - Group B - VD 4 Weeks | Active Comparator | Weekly oral dose of 50,000 IU Vitamin D3 (VD) for 4 weeks |
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| Phase 1 - Group C - VD 5 Weeks | Active Comparator | Weekly oral dose of 50,000 IU Vitamin D3 (VD) for 5 weeks. |
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| Phase 2 - VD | Experimental | Weekly oral dose of 50,000 IU Vitamin D3 (VD) therapy for the duration selected from the phase I part of the study. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Vitamin D3 | Drug | Weekly oral dose of Vitamin D3 per protocol. |
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| Measure | Description | Time Frame |
|---|---|---|
| Phase 1 - Rate of Treatment-Related Toxicity in Subjects | Rate of treatment-related adverse events and other toxicities in subjects. | From Baseline to 30 days (+ 5 days) After Last Dose of Protocol Therapy, About 3 Months |
| Phase 2 - Rate of Favorable Treatment Response in Subjects Receiving Protocol Therapy Given Within the Optimal Duration Determined in Phase 1. | Rate of subjects achieving a "favorable treatment response" to protocol therapy given within the optimal duration determined in Phase 1. The effect of VD therapy will be assessed in terms of change in expression of VDR, ER, PR, HER2/neu, AR, Ki-67, E-cadherin and EGFR comparing surgical specimen (post-VD treatment) and baseline biopsy specimen (pre-VD treatment). The effect of VD will be described as increased expression, decreased expression or no change in expression of each marker/receptor measured. The expression of nuclear receptors/proteins (VDR, Ki-67, ER, PR, AR,) will be scored based on the percentage of positively staining nuclei as follows:
A decrease in the expression of Ki-67 by ≥+1 after treatment is considered a "favorable treatment response". | Up to 7 Weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Phase 1 - Optimal Duration of Once-Weekly Protocol Therapy | The determination of the optimal duration of once-weekly protocol therapy, 3, 4 or 5 weeks, as preoperative treatment to achieve a "favorable" treatment response in subjects with the study disease. The effect of VD therapy will be assessed in terms of change in expression of VDR, ER, PR, HER2/neu, AR, Ki-67, E-cadherin and EGFR comparing surgical specimen (post-VD treatment) and baseline biopsy specimen (pre-VD treatment). The effect of VD will be described as increased expression, decreased expression or no change in expression of each marker/receptor measured. The expression of nuclear receptors/proteins (VDR, Ki-67, ER, PR, AR,) will be scored based on the percentage of positively staining nuclei as follows:
A decrease in the expression of Ki-67 by ≥+1 after treatment is considered a "favorable treatment response". |
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Inclusion Criteria:
Patients must have histologically confirmed invasive breast carcinoma (IBC) or high grade (DIN3) Ductal Carcinoma in-situ (DCIS) and be scheduled for primary surgery.
Patients must be recommended/scheduled for primary surgery.
Female patients 18 years of age or older.
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.
Patients must have normal organ function as defined below:
Women of childbearing potential (WoCBP) must have a negative (serum or urine) pregnancy test and agree to use barrier contraception while on treatment and for 30-days thereafter.
Ability to understand and the willingness to sign a written informed consent document by patient or their legal representatives.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Eli Avisar, MD | University of Miami | Principal Investigator |
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| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D002285 | Carcinoma, Intraductal, Noninfiltrating |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
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| ID | Term |
|---|---|
| D002762 | Cholecalciferol |
| ID | Term |
|---|---|
| D002782 | Cholestenes |
| D002776 | Cholestanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
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|
| Up to 7 Weeks |
| Phase 2 - Rate of Treatment-Related Toxicity in Subjects | Rate of treatment-related adverse events and other toxicities in subjects. | From Baseline to 30 days (+ 5 days) After Last Dose of Protocol Therapy, About 3 Months |
| D017437 |
| Skin and Connective Tissue Diseases |
| D000230 | Adenocarcinoma |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
| D000071960 | Breast Carcinoma In Situ |
| D002278 | Carcinoma in Situ |
| D018299 | Neoplasms, Ductal, Lobular, and Medullary |
| D011083 |
| Polycyclic Compounds |
| D013261 | Sterols |
| D014807 | Vitamin D |
| D012632 | Secosteroids |
| D008563 | Membrane Lipids |
| D008055 | Lipids |