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Current Research Projects

Project Title Breast Cancer Risk in Young Women Study

Researcher Paul Goodfellow, PhD, The Ohio State University College of Medicine, Columbus, OH, and Jennifer Ivanovich, MS, Washington University School of Medicine, St. Louis, MO

Study Abstract Breast cancer takes its greatest toll on young women. Young women frequently have biologically aggressive tumors. They often present with advanced disease and their tumors are frequently hormone non- responsive, thereby limiting treatment options. Young women suffer lower than average disease-free and overall survival. The work proposed is focused on discovery of the as yet unknown genetic risk factors that underlie development of early-onset breast cancer. These findings will pave the way for future studies to elucidate how genetic risk and environmental factors interact and account for the aggressive tumors and poor outcome young breast cancer patients experience. We hypothesize copy number variants (CNVs) play an important role in risk for development of early-onset breast cancer.

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Project Title Breast Cancer Microbiota Study

Researcher Ece Mutlu, MD, Rush University Medical Center, Chicago, Illinois

Study Abstract We intend to study the role of the gastrointestinal (GI) microbiota in the pathogenesis of breast cancer (BC) in women. Humans are super organisms that represent a fusion of eukaryotic cells of their own, as well as bacteria and archaea that reside in and over the body, primarily in the GI tract. Little is known about the GI microbiota, which represents the most dense and least diverse ecosystem known on earth. It is believed that GI microbiota is passed on from the mother to her infants and remains fairly stable through life. Bacterial cells in the GI tract outnumber human cells in the body by about 10 fold and carry thousands of additional genes which can rapidly evolve under the pressure of changing environmental factors. The GI tract microbiota approximately weighs about 1 kg in a human being and is estimated to have a metabolic activity comparable to the human liver. A recent metagenomic survey of this activity shows that the bacterial genes for xenobiotics (important in carcinogen and hormone metabolism) are enhanced in the human GI tract.

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Project Title Interpersonal Therapy for Depression in Breast Cancer Study

Researcher Carlos Blanco, MD, PhD, New York State Psychiatric Institute/Columbia University, New York, NY

Study Abstract Depressive disorders and symptoms are prevalent in patients with breast cancer, worsen over the course of cancer treatment, persist after cancer therapy, significantly impair quality of life, and decrease adherence to cancer therapy and survival. Yet, there are no established treatments for depression in breast cancer patients. As surviving cancer becomes increasingly common, there is an urgent need to develop an empirical basis to provide effective, evidence-based treatments to this population.

We are conducting a randomized clinical trial to compare the efficacy of Interpersonal Psychotherapy (IPT), Problem-Solving Therapy (PST), and Brief Supportive Psychotherapy (BSP) in alleviating depressive symptoms and improving quality of life for breast cancer patients with DSM-IV major depressive disorder (MDD). In addition to improvement in depressive symptoms, relationships between sociodemographic characteristics, clinical factors, depression treatment adherence, and outcomes care will be examined. Patients in each condition will receive 12 therapy sessions within a 16-week period, and will be followed for another 4 months to examine the stability of response.

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Project Title Genomic Analysis of Breast Cancer Risk

Researcher Harry Ostrer, MD, Albert Einstein College of Medicine, Bronx, New York

Study Abstract Genome wide association studies (GWAS) of breast cancer risk have provided clues for the identification of other risk genes. Single nucleotide polymorphisms (SNPs) in or near the FGFR2, TNRC9, MAP3K1, LSP1 and CASP genes, in addition to a presumed regulatory region upstream from the C-MYC gene on chromosome 8q24 and on 2q have been studied in several populations. An alternative approach would be to identify the rare but high-penetrant alleles that are not captured by GWAS. This approach has been successful when applied to studying the tails of the risk distribution for blood pressure and cardiac phenotypes. Recognizing the importance of this approach, the National Heart, Lung and Blood Institute established the Exome Sequencing Project (ESP) to study the tails of the distributions for diseases that fall within their mission. Exome sequencing offers the advantage of surveying key regions of the expressed regions, rather than the entire, genome, thus reducing complexity and cost. The ESP strategy can be applied by analyzing DNA for a well-defined high-risk phenotype (≥3 women affected with premenopausal breast cancer – likely to have a heritable mutation, or early onset breast cancer with no family history – likely to have a de novo mutation) and by studying well-defined populations that are likely to have common founder alleles.

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Project Title Genomics and Breast Cancer Risk in Hispanic Women Study

Researcher Susan Neuhausen, PhD, City of Hope, Duarte, CA

Study Abstract In this proposal, we will focus on breast cancer in Hispanic women. Although Hispanics represent the fastest growing ethnic population in the U.S., they have been largely understudied in terms of genetic susceptibility to cancer even though breast cancer is the most common cancer and causes the most cancer deaths in Hispanic women. The overall long-term goal of this project is the development of a comprehensive clinical genetic test that provides a set of susceptibility genes for inherited breast cancer and can be readily integrated into clinical practice. Specific Aim 1 is to identify variants in 605 genes involved in DNA damage response pathways using next-generation sequencing. We will use DNA from 1000 Latina breast cancer patients and 1000 healthy Latina controls. Specific Aim 2 is to identify the set of variants of biological significance through in silico analyses. Specific Aim 3 is to perform gene-based association tests of the genes and risk to develop breast cancer. We will utilize Hispanic breast cancer cases already participating in Dr. Jeffrey Weitzel’s study. We will recruit Hispanic controls from the Army of Women, focusing on women from California and the Southwest United States. We expect that the results will reveal which genes are important for susceptibility to breast cancer and can be used for possible risk prediction, and provide a number of specific targets for developing therapeutics

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Project Title A Pilot Study of the Flaxseed Effects on Hormones and Lignans: Role of Race, Genes, and Gut Microbiome

Researcher Susan McCann, PhD, Roswell Park Cancer Institute

Study Abstract The objective of this study is to determine how variation in gut microbial
community composition and in steroid hormone and xenobiotic metabolizing genes affects the metabolism of mammalian lignans and steroid hormones at baseline and after exposure to a lignan-rich food (flaxseed), and how these associations differ for African American and Caucasian women. Humans are, in fact, superorganisms with a diverse genetic background that is augmented by diverse and metabolically active bacterial communities, the composition of which can be modified by specific dietary exposures. The central hypothesis is that the metabolic response to a dietary component results from the combined effects of an individual’s genetic makeup and the particular composition of that individual’s gut bacterial communities. Elucidation of interactions between the gut microbiome, host genetics, and diet will have a positive impact on development of improved targeted dietary interventions to reduce cancer risk.

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Project Title Acupuncture for Joint Symptoms in Women with Early Stage Breast Cancer

Researcher Southwest Oncology Group, (SWOG)

Study Abstract The primary objective of this study is to determine whether true acupuncture administered twice weekly for 6 weeks (8-12 sessions) compared to sham acupuncture and waitlist control causes a significant reduction in joint pain/stiffness related to aromatase inhibitors (AIs) in women with early stage breast cancer as measured by the Brief Pain Inventory-Short Form (BPI-SF) worst pain score at 6 weeks.

Secondary objectives are to investigate the effects of true acupuncture administered twice weekly for 6 weeks (8-12 sessions) followed by 6 weekly treatments (4-6 sessions) of maintenance (12-18 sessions total over 12 weeks) compared to sham acupuncture and waitlist control in this study population. The evaluations at 12 and 24 weeks are to determine the benefit of additional 6 weekly acupuncture treatments for maintenance and to determine the durability of response after stopping acupuncture, respectively. The evaluation at 52 weeks is to determine the long-term effects of acupuncture and adherence to AIs.

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Project Title A Study to Identify Predictors of Response to Duloxetine in Breast Cancer Patients with Chronic Pain (HUM00075181)

Researcher Norah Henry, University of Michigan, MD, PhD

Study Abstract The overall goal of this study is to learn more about why some breast cancer survivors develop chronic pain following treatment, in order to better manage their symptoms and improve their quality of life. In this proposal, the research team will investigate if some breast cancer survivors who develop chronic pain have centralized pain, since this could potentially influence treatment recommendations. This question will be addressed in two ways: 1) questionnaires to learn more about the symptoms the patients are experiencing, especially pain, fatigue, sleep disturbances, and memory problems, and 2) pain testing to determine each patient’s pain sensitivity. The research team will then treat the patients on a randomized, blinded clinical trial with duloxetine followed by placebo, or vice versa, in order to identify factors that predict which patients are more likely to benefit from duloxetine therapy. Patients will be assessed before and after each treatment using the methods described above. The hypothesis is that the patients with a greater degree of centralized pain will benefit more from treatment with duloxetine.

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Project Title A Phase II Study of Neratinib in Metastatic HER2 Non-amplified but HER2 Mutant Breast Cancer

Researcher Cynthia Ma, M.D., Ph.D., Washington University, St Louis, MO

Study Abstract The research team proposes to conduct a single arm 2-stage Phase 2 trial of neratinib in metastatic but HER2 non-amplified but HER2 mutant breast cancer. Pre-registration is required for tumor HER2 sequencing. The primary objective is clinical benefit rate (CBR: rate of complete response plus partial response and stable disease > 6 months). With an 80% power and a 1-sided 0.05 significance level, the first stage of 10 patients and the 2nd stage of 19 patients are planned to test an anticipated CBR of 20% versus the null hypothesis of 5%. Secondary endpoints include progression free survival and the molecular epidemiology of HER2 mutation. Exploratory endpoints include mechanisms of treatment resistance and other somatic mutations in HER2 negative disease. Because the mutation frequency is approximately 2%, they anticipate screening of 1500 patients to identify the 29 patients with the HER2 mutation and eligible for study drug therapy. The success of this trial could establish a new treatment option for a subset of patients with HER2 non-amplified tumors.

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Project Title BEAT Cancer Study

Researcher Edward McAuley, PhD, University of Illinois at Urbana Champaign and Laura Rogers, MD, MPH, at the University of Alabama at Birmingham

Study Abstract The research team's piloted physical activity behavior change intervention for breast cancer survivors significantly improved physical activity and health outcomes post-intervention. Testing in additional sites with longer follow-up is warranted to confirm program effectiveness short and longer term. Importantly, the pilot intervention resulted in changes in physical activity and social cognitive theory constructs, enhancing the team's potential for testing mechanisms mediating physical activity behavior change. The team's current multi-center, randomized controlled trial will enroll 356 breast cancer survivors. The primary study aim is to compare the effects of the BEAT Cancer physical activity behavior change intervention to usual care on short and longer term physical activity adherence among breast cancer survivors.

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Project Title Characteristics of Chemotherapy-Induced Neuropathy

Researcher Christine Miaskowski, PhD, University of California, San Francisco

Study Abstract Cancer chemotherapy-induced peripheral neuropathy (CIN) is the most common and serious neurologic complication of cancer treatment. CIN can occur with the most commonly used chemotherapy (CTX) drugs including platinum compounds; taxanes; plant alkaloids; antiangiogenesis agents; and proteasome inhibitors. CIN can result in treatment delays or cessation of treatment which may lead to disease progression and decreased survival. The specific aims of this study in oncology patients with and without CIN who have completed CTX are to: evaluate for differences in sensory and motor characteristics of patients with and without CIN, evaluate for differences in mood, concurrent symptoms, balance, and quality of life in patients with and without CIN, and evaluate for genetic differences, in patients with and without CIN.

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Project Title Women’s Quality of Life and Satisfaction with Breasts: Developing Normative Data for the BREAST-Q

Researcher Carolyn L. Kerrigan, MD, MHCDS, Dartmouth College, New Hampshire

Study Abstract In order to generate normative data on women’s satisfaction and health-related quality of life related to breasts the research team will have women without a history of breast cancer or breast surgery complete the pre-operative modules of the BREAST-Q. The BREAST-Q is one of the most widely used and rigorously designed instruments to assess patient-reported outcomes in breast surgery. There are five separate modules of the BREAST-Q, each one designed for one of the following patient groups: women with breast cancer undergoing 1) mastectomy, 2) breast-conserving therapy, and 3) breast reconstruction, as well as women undergoing breast symmetrizing procedures 4) breast reduction and 5) breast augmentation. There are three common pre-operative questionnaires (breast cancer, breast reduction and breast augmentation), each of which is completed in approximately 10 minutes. The study will be completed in three phases, with each phase dedicated to a separate pre-operative questionnaire, with a goal of 500 surveys completed in each phase. In addition, demographic information and questions regarding body and breast size will be requested from each participant. Participants will be recruited using Army of Women and will complete the BREAST-Q survey online, where it will be uploaded using Qualtrics. Survey responses will be exported to Excel and then scored using Q-Score – a scoring algorithm specific to the BREAST-Q. Scoring data will be analyzed and reported in aggregate.

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Project Title Relationship among Cognitive Function, Lifestyle, and Exercise after Cancer Treatment (ReFLECT)

Researcher Edward McAuley, PhD, University of Illinois Urbana-Champaign

Study Abstract Objective/Hypothesis: Effective treatments of age-related cognitive decline may have potential in breast cancer patients and survivors. Our preliminary research has provided strong evidence of physical activity’s role in improving cognitive function and quality of life in older adults. However, few studies have tested this relationship in cancer populations. We propose to examine the relationship between physical activity and cognitive function in breast cancer patients and survivors.

Specific Aims: (1) Determine the effects of physical activity across time (6 months) on three domains of cognitive function known to be affected by cancer: executive function, working memory, and speed of processing; and (2) identify moderators of the proposed relationship.

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Project Title ALIVE Lifestyle Intervention Study

Researcher Raheem Paxton, MS, PhD, University of North Texas - Health Science Center

Study Abstract In this study, the research team will evaluate the effectiveness of a 3-month lifestyle (diet, physical activity, and sedentary behavior) intervention trial among 300 female breast cancer survivors. Participants will be randomized to 1 of 3 study conditions: diet only; exercise only; and a condition where the survivor can choose between diet and exercise. The specific aims of the study are to determine the rates of recruitment, retention, attendance, satisfaction, adverse events, and barriers to participation in the proposed intervention. Secondary aims of the study are to determine whether a home-based intervention is associated with improvements in mean minutes of moderate to vigorous physical activity, diet quality, body size, constructs of Social Cognitive Theory, and health-related quality of life.

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Project Title Mapping the Breast Ducts Study

Researcher Susan Love, MD, Dr. Susan Love Research Foundation, Santa Monica, CA

Study Abstract Breast cancer is thought to begin in the lining of the breast ducts with an increase in the lining cells termed intraductal carcinoma in situ or ductal carcinoma in situ (DCIS). Sometimes these cells will necrose and calcify manifesting on a mammogram as microcalfications. Unfortunately, these specs of calcium do not demarcate the extent of the disease. This along with the fact that we don’t know the basic anatomical patterns of the breast ducts means that surgeons are blindly removing tissue in an inefficient effort to remove the pathology, more often than not leading to mastectomy in an attempt to eliminate a disease which is not life threatening nor even cancer by most definitions.

An understanding of the usual distribution of the milk ducts in the breast along with common variations has the potential to put the surgery of the breast on anatomical footing. It would also set the stage for further exploration of non-invasive ways to address the premalignant condition of DCIS through ductoscopy, local therapy, or watchful waiting.

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