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Abstract
The clinical trials investigative team faces a number of challenges during the execution of a chemoprevention protocol that often depend on the phase of the trial. Phase II chemoprevention trials test promising agents for biomarker modulation in cohorts of 30 to 200 participants at greater than average risk of the cancer being studied who meet strict eligibility criteria. By contrast, phase III trials test agents for their efficacy in cancer prevention in thousands of participants who are generally healthy or may be at slightly elevated risk. Consideration must be given to accruing a very large cohort or a smaller but relatively rare group of participants, and to maintaining vigilance over the toxicity profile of the agent, which may be taken for a lengthy period of time. Additional considerations include clear communication to the participants of the risks and benefits associated with participating on the trial, as well as the need for their long-term commitment. In light of the layer of complexities that chemoprevention research adds to clinical trials, one or more team members need a unique set of skills and knowledge, beyond understanding the scientific aspects of the trial.
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Affiliation(s)
- Ellen Richmond
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
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2
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Mehta RR, Hawthorne M, Peng X, Shilkaitis A, Mehta RG, Beattie CW, Das Gupta TK. A 28-Amino-Acid Peptide Fragment of the Cupredoxin Azurin Prevents Carcinogen-Induced Mouse Mammary Lesions. Cancer Prev Res (Phila) 2010; 3:1351-60. [DOI: 10.1158/1940-6207.capr-10-0024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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3
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Shin YG, Udeani GO, Kosmeder JW, Zhao G, Dagar S, Onyuksel H, Moriarty RM, Cordell GA, Moon RC, Kinghorn AD, Pezzuto JM. Identification of Degradation Product of Deguelin and Its Stability Using Liquid Chromatography and Electrospray/Mass Spectrometry. J LIQ CHROMATOGR R T 2007. [DOI: 10.1081/jlc-120030178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Young Geun Shin
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
- g Drug Metabolism and Pharmacokinetics , GlaxoSmithKline , Collegeville , PA , 19426 , USA
| | - George O. Udeani
- b Department of Pharmacy Practice, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Jerome W. Kosmeder
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Guo‐Min Zhao
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Sumeet Dagar
- c Department of Pharmaceutics and Pharmacodynamics, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Hayat Onyuksel
- c Department of Pharmaceutics and Pharmacodynamics, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Robert M. Moriarty
- e Department of Chemistry, College of Liberal Arts and Sciences , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Geoffrey A. Cordell
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
- d Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - Richard C. Moon
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - A. Douglas Kinghorn
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
- d Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
| | - John M. Pezzuto
- a Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
- d Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy , University of Illinois at Chicago , Chicago , Illinois , USA
- f Department of Surgical Oncology, College of Medicine , University of Illinois at Chicago , Chicago , Illinois , USA
- h School of Pharmacy and Pharmacal Sciences , Purdue University , West Lafayette , IN , 47907 , USA
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Greenwald P. Clinical trials in cancer prevention: current results and perspectives for the future. J Nutr 2004; 134:3507S-3512S. [PMID: 15570061 DOI: 10.1093/jn/134.12.3507s] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer prevention remains the ideal strategy for reducing the burden of cancer on society. Progress in cancer prevention has been accelerated as prevention clinical trials are completed and reported. A promising strategy is the identification of cancer risk factors through epidemiologic and experimental research with lifestyle and medical approaches that allow translation of clinical trial results to clinical practice. A major focus of cancer prevention clinical trials has been on modulation of hormones and nutritional modifications using natural or synthetic bioactive food components for breast and prostate cancer. Breast cancer prevention clinical trials have investigated the role of estrogen antagonists with agents such as tamoxifen, raloxifene, and newer agents such as aromatase inhibitors and bioactive food components. Among the promising bioactive food components being investigated at the National Cancer Institute in prevention clinical trials to reduce breast cancer risk are indole-3-carbinol, sulforaphanes, phytoestrogen isoflavones, perillyl alcohol, and green tea polyphenols. Prostate cancer prevention trials have focused on hormone modulation with the 5-alpha-reductase inhibitor finasteride and bioactive food components such as selenium and vitamin E. Soy isoflavones, green tea polyphenols, and doxercalciferol also are being investigated for prostate cancer prevention. Future prevention clinical trials will rely on multidisciplinary medical approaches that bring together expertise in many fields to address disease across the cancer spectrum. Nutritional science can play an important role in this effort through the use of new and emerging technologies to better understand the influence of bioactive food components on the genes, proteins, and cellular processes that are associated with cancer risk.
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Affiliation(s)
- Peter Greenwald
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Wolff RA. Chemoprevention for pancreatic cancer. INTERNATIONAL JOURNAL OF GASTROINTESTINAL CANCER 2004; 33:27-41. [PMID: 12909736 DOI: 10.1385/ijgc:33:1:27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
For a number of solid tumors, including pancreatic cancer, efforts aimed at disease prevention may be more successful than currently available anticancer treatments. While specific interventions are emerging to prevent breast, prostate, lung, and colorectal cancer, no trials of chemoprevention are being conducted in pancreatic cancer. Importantly, there are significant obstacles to the conduct of such research. However, preclinical and epidemiologic studies suggest that several drugs may have chemopreventive potential in pancreatic cancer. These include aspirin and other non-steroidal antiinflammatory drugs (NSAIDs), selective cyclooxygenase inhibitors, somatostatin analogs, selective estrogen receptor modulators (SERMs), and anti-androgenic agents. As the oncology community evaluates some of these agents in large chemoprevention trials for breast, colon, and prostate cancer, it may be found that pancreatic cancer prevention occurs as an unintended, but desirable consequence. Moreover, other general societal trends, such as smoking cessation and the widespread use of cholesterol-lowering agents and aspirin, could have a role in reducing the risk of pancreatic cancer, and in the future, may lead to a decrease in its incidence.
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Affiliation(s)
- Robert A Wolff
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Abstract
Hodgkin's disease is one of the commoner malignancies presenting in adolescence and young adulthood and is curable in the majority of cases. A number of therapeutic regimens have been used successfully, often at the expense of the development of side-effects in later life, including second malignancies, infertility and cardiac disease. We discuss the challenge faced by paediatric oncologists today in finding the balance between maximising cure and minimising the late effects.
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Affiliation(s)
- A B Thomson
- Department of Haematology/Oncology, Royal Hospital for Sick Children, 17 Millerfield Place, EH9 1LW, Edinburgh, UK
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Cyrus-David MS, Strom SS. Chemoprevention of breast cancer with selective estrogen receptor modulators: views from broadly diverse focus groups of women with elevated risk for breast cancer. Psychooncology 2001; 10:521-33. [PMID: 11747064 DOI: 10.1002/pon.547] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Selective estrogen receptor modulators (SERMs) are anti-estrogens that selectively antagonize the proliferative effects of estrogens on breast cells, thereby inhibiting or reversing neoplastic progression to clinical breast cancer. The goal is to administer these agents to healthy women with an elevated risk for breast cancer. The study reported here assessed the knowledge and attitude of 26 broadly selected women with an elevated risk for breast cancer who participated in three focus groups (eight to ten per group) that discussed the use of SERMs, such as tamoxifen and raloxifen. Data were analyzed by cross-case procedure using variable-oriented strategies. Acceptance of breast cancer chemoprevention treatment with SERMs was found to be influenced by various factors, including a knowledge of breast cancer risk factors, the perception of personal risk for breast cancer, and the perception of barriers and benefits to receiving chemoprevention treatment. The issues involved in making the decision to accept treatment with SERMs are discussed. Most of the participants in the groups indicated they were unlikely to accept breast cancer chemoprevention treatment with SERMs.
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Affiliation(s)
- M S Cyrus-David
- Department of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
The continued widespread prevalence of breast cancer supports placing a high priority on research aimed at its primary prevention, particularly among women who are at increased risk for developing this disease. The suggestion of potential agents for the primary chemoprevention of breast cancer evolved out of the treatment setting. Extensive experience with tamoxifen, a first-generation selective estrogen receptor modulator (SERM) showing efficacy, first, in the treatment of advanced breast cancer and, subsequently, as adjuvant therapy for early stage disease established the safety of this agent. Cumulative data from multiple adjuvant studies documented the efficacy of tamoxifen in reducing second primary breast cancers in the contralateral breast, supporting its potential as a chemopreventive agent for breast cancer. The safety and second primary data on tamoxifen, together with extensive information on its pharmacokinetics, metabolism, and antitumor effects, as well as its potentially beneficial effects on lipid metabolism and osteoporosis, led the National Surgical Adjuvant Breast and Bowel Project (NSABP) to select tamoxifen for testing in the first prospective randomized phase III trial of the efficacy of a chemopreventive agent for preventing breast cancer in women at increased risk of the disease. Accordingly, in 1992 the NSABP started the Breast Cancer Prevention Trial (P-1) in which 13,388 women > or = 35 years of age who were at increased risk of breast cancer according to Gail model risk factors [family history, age, and personal history (i.e., age at first birth, age at menarche, previous breast biopsies)] were randomized to tamoxifen 20 mg/day or placebo for 5 years. Through 69 months of follow-up tamoxifen reduced the risk of invasive breast cancer, primarily estrogen receptor-positive tumors, by 49% (two-sided p < 0.00001). Tamoxifen reduced the risk of noninvasive breast cancer by 50% (two-sided p < 0.002). In addition, tamoxifen reduced fractures of the hip, radius, and spine, but it had no effect on the rate of ischemic heart disease. As previously shown, the rates of endometrial cancer and vascular events increased with tamoxifen. With the P-1 results establishing tamoxifen as the standard of care for the primary chemoprevention of breast cancer in high-risk women, concern over the side effects of tamoxifen has prompted a continuing search for an agent that displays a more desirable efficacy/toxicity profile. Raloxifene, a second-generation SERM approved for the prevention of osteoporosis in postmenopausal women, displays antiestrogenic properties in the breast and possibly the endometrium, and estrogenic effects in the bone and on the lipid profile, suggesting it as a candidate for comparison with the chemopreventive standard, tamoxifen. Raloxifene will be compared to tamoxifen in an equivalency trial, the Study of Tamoxifen and Raloxifene (STAR) NSABP P-2, which began in July 1999 at almost 500 centers in North America. The plan is to randomize 22,000 postmenopausal women > or = 35 years of age at increased risk of breast cancer by Gail criteria to tamoxifen 20 mg/day or raloxifene 60 mg/day for 5 years. Study endpoints include invasive and noninvasive breast cancer, cardiovascular disease, endometrial cancer, bone fractures, and vascular events.
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Affiliation(s)
- B K Dunn
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
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Affiliation(s)
- Carol Fabian
- University of Kansas Medical Center; Kansas City, Kansas
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Abstract
Chemoprevention is the use of natural or synthetic compounds to block, reverse, or prevent the development of invasive cancers. Cellular carcinogenesis forms the biologic basis for the identification of chemopreventives, assessment of their activity, and ultimately the success or failure of a chemopreventive. Chemopreventive agents undergo multistep evaluations to assess efficacy that are similar in concept but vastly different in practice to standard ablative oncologic therapeutics. In vitro assessments of potential anticarcinogenesis efficacy include measurements of an agent's antioxidant activity, induction of phase II metabolizing enzymes and effects upon cellular proliferation and apoptotic control pathways. In vivo efficacy is assessed primarily in rodent models of carcinogenesis that are specific for a given organ target. The role of genetically modified animal models in the in vivo assessment of chemoprevention agents remains unclear. Clinical assessment of chemopreventive agent efficacy consists of a multistep process of identification of an optimal chemopreventive agent (phase 1), demonstration of efficacy in humans through the modulation of reversal of a tissue, biochemical, and molecular surrogates for neoplastic transformation and invasion (phase 2) and cancer risk reduction in large cohort trials (phase 3). Opportunities and future needs include the development of reliable, predictive in vivo models of carcinogenesis, careful exploration of the preventive pharmacology of therapeutic agents being used for non-cancer prevention indications, and the incorporation of genetic risk cohorts to define cancer chemopreventive efficacy.
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Affiliation(s)
- I Shureiqi
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0934, USA
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11
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Abstract
With the advent of screening and the increased incidence of breast cancer, concern for the prevention of breast cancer has become forefront in today's society. Determining individual risk is the key to prescribing prevention. Prevention of breast cancer is still under clinical investigation with only one drug, tamoxifen, showing benefit in high risk patients. This paper reviews the possible sites for prevention of neoplastic transformation via biomarkers in a breast cell as well as the investigational drugs and their potential use in the chemoprevention of breast cancer.
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Affiliation(s)
- K A Carolin
- University of Michigan, 3303 CGC, Ann Arbor 48109-0932, USA
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Fabian CJ, Kimler BF, Elledge RM, Grizzle WE, Beenken SW, Ward JH. Models for early chemoprevention trials in breast cancer. Hematol Oncol Clin North Am 1998; 12:993-1017. [PMID: 9888018 DOI: 10.1016/s0889-8588(05)70038-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several models are being explored for use in the phase I and phase II evaluation of breast cancer chemoprevention agents. The short-term DCIS/small invasive cancer model is probably best used in late phase I trials in conjunction with agents likely to have activity in the progression phase of neoplastic development in addition to activity in earlier phases. The core biopsy or FNA hyperplasia models may be best used with drugs that are likely to have activity primarily in the promotion phase of neoplastic development and that are suitable for longer duration trials lasting several months to years. Morphology currently is the key surrogate endpoint biomarker for assessing efficacy in phase II trials. Other biomarkers that may undergo modulation will have to be validated, in that modulation will have to be shown to be directly related to decreased cancer risk in subsequent phase III trials. Only then can they be considered as validated surrogate endpoint biomarkers and used as stand-alone efficacy markers in phase II trials. Despite accrual challenges and technologic hurdles, interest in phase I and phase II chemoprevention trials is high.
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Affiliation(s)
- C J Fabian
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, USA
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