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Current Research Projects

Project Title Effects of Depo Provera on Breast Tissue Study

Researcher Karine Chung, MD, University of Southern California, Los Angeles, CA

Study Abstract Births, especially a first birth before the age of 30, provide lasting protection against breast cancer. An appealing chemopreventive strategy is mimicking this protective effect in young women. Progesterone is present at high levels during pregnancy and there is some evidence from epidemiological studies that treatment with this hormone at pregnancy levels may be associated with a reduced risk of breast cancer. We are proposing to reach out to women currently being treated with this hormone, perform a breast biopsy, and determine if this treatment induces the same gene expression changes brought about by a pregnancy.

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Project Title Phase Ib Trial of 2nd Generation Designer T Cells in Metastatic Breast Cancer

Researcher Richard Junghans, PhD, MD, Associate Professor of Medicine, Boston University School of Medicine, and Roger Williams Medical Center, Providence, Rhode Island

Study Abstract Hypotheses: that designer T cells offer an immune based alternative to cancer therapies that has the potential to cure metastatic breast cancers; that several components will potentially contribute to an optimal therapeutic anti-tumor agent; that CEA is the optimal platform for a rapid optimization that will allow generalizable lessons over the range of breast cancer antigens.

Specific Aims:
Clinical (existing products):
1. To test efficacy of 2nd gen designer T cells in metastatic breast cancer
2. To test ancillary procedures for improved persistence and activity of infused designer T cells
Advanced Research & Development:
3. To create and test other CIR designs with alternative co-stimulatory domains
4. To create and test CIR with to avoid need for IL2 supplementation in vivo to sustain T cell survival
Clinical (new products):
5. To conduct clinical trials with the new generation products.

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Project Title The Milk Study

Researcher Kathleen Arcaro, Ph.D., University of Massachusetts, Amherst, Amherst, MA

Study Abstract Accurate assessment of breast-cancer-risk will benefit most women and analysis of promoter hypermethylation in exfoliated epithelial cells in breast milk provides an ideal opportunity to assess breast-cancer-risk.

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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 Pregnancy and Breast Cancer Risk Study

Researcher Ana Soto, M.D., Tufts University, Boston, MA

Study Abstract The overarching goal of the proposed research is to reveal whether or not the protective role of pregnancy is mediated by the stroma, and if so, whether this effect is mediated through physical properties operating in it. A novel in vitro three-dimensional model of the normal and neoplastic breast will be used to study 1) the role of the parous stroma as mediator of the protective effect of pregnancy on breast carcinogenesis and 2) the contribution of the mechanical forces generated by stromal fibroblasts in this protective process. This research is not only relevant to improving our understanding of the role of the stroma, which has not been studied in detail in humans, but it will open up a new target for prevention and therapy, namely, how to modulate stromal function.

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Project Title Inflammation Changes Over Time In Obese, Overweight, and Normal Weight Women

Researcher Edward Sauter, MD, PhD, M.H.A., University of Texas Health Sciences Center in Tyler, Texas

Study Abstract Overview: Inflammation is present in both individuals with cancer and those who are obese. Inflammation is a process critical to the development and progression of breast cancer. Chronic inflammation is a hallmark sign of obesity. Ovarian hormones influence the expression of proteins involved in multiple pathways.

Hypothesis: Inflammation marker expression will be higher in breast fluid than in the circulating blood; that it will be higher in obese and overweight women compared with normal weight women; and will vary more through the menstrual cycle of premenopausal women compared to postmenopausal women over a 30 day period.

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Project Title Low Dose Tamoxifen Breast Cancer Prevention Study

Researcher Melanie Palomares, MD, MS, City of Hope; Sofia Merajver, MD, PhD, University of Michigan; Melissa Hudson, MD, St. Jude Children's Research Hospital; Ruth O'Regan, MD, Emory University; David Hodgson, Princess Margaret Hospital

Study Abstract The objective of this trial is to test whether a low dose of tamoxifen can have a beneficial effect on breast cancer risk biomarkers in women treated with chest radiotherapy for a prior diagnosis of cancer. Such women have a very high risk of developing breast cancer, approximately 55-times that of an average woman. The standard daily dose of 20mg of tamoxifen has been shown to decrease breast cancer risk by 50%. More recent data suggest that a lower dose of 5mg daily has a similar beneficial effect but with lower side effects. The Low Dose Tamoxifen Breast Cancer Risk Reduction Trial is a placebo-controlled randomized controlled trial of tamoxifen delivered at a reduced dose of 5mg daily for two years. The study is also measuring the safety and tolerability of tamoxifen at the lower dose.

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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 Sister Survivor: Improving the Survivorship Care of African-American Women with Breast Cancer

Researcher Kimlin Ashing-Giwa, PhD, City of Hope, and the African American Breast Cancer Coalition

Study Abstract The research team will implement and evaluate the impact of a multilevel peer navigator (PN) intervention for African-American breast cancer survivors (AABCS) on comprehension of and adherence to survivorship care plan (SCP).

25 PN will be trained to provide navigation to AABCS. 120 participants will be randomized to either PN intervention (n=60) or control (n=60) conditions. The peer navigation sessions will be delivered via face-to face or by telephone. The Peer Navigator trial is accomplished through 5 processes: 1) Information: PN provide education and resources about the effects of breast cancer and its treatments, care planning, physical functioning; 2) Patient activation: coaching in medical efficacy and communication; 3) Providing support: PN listen, share, and attend to the human side; 4) Access: facilitate utilization of healthcare resources/services, access to SCP; 5) Coordination: facilitate utilization of healthcare, adherence to SCP.

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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 Study of High-Dose Vitamin D Supplementation in Premenopausal Women at High Risk for Breast Cancer

Researcher Katherine Crew, MD, MS, Columbia University, New York, NY

Study Abstract The purpose of this trial is to evaluate the effect of vitamin D on mammographic density (MD) in premenopausal women at high risk of breast cancer, and secondarily to gain information concerning the ability of vitamin D to modulate the expression of breast tissue markers and serum markers. The study has an optional breast biopsy component built in to obtain healthy breast tissue from study participants to investigate the impact vitamin D may have on breast tissue biomarkers. The study uses a double-blind randomization to compare high-dose cholecalciferol of 20,000 IU weekly for one year versus placebo weekly for one year. The main outcome measure of this trial is change in mammographic breast density between mammograms pre-intervention and one-year post intervention.

Southwest Oncology Group (SWOG) is sponsoring the study. The investigators include: Katherine Crew, MD, MS, and Dawn Hershman, MD, MS, Columbia University, New York, NY; Powel Brown, MD, PhD, MD Anderson Cancer Center, Houston, TX; Gary Goodman, MD, SWOG Chemoprevention Subcommittee and Fred Hutchinson Cancer Research Center, Seattle, WA; Garnet Anderson, PhD, and Danika Lew, MS, SWOG Data Operations and Statistical Center, Seattle, WA; and all participating SWOG members, the Community Clinical Oncology Program (CCOP), and Affiliate Medical Oncologists and Surgeons.

SWOG is one of the five cooperative groups that together comprise the National Cancer Institute’s National Clinical Trials Network. SWOG designs and conducts multidisciplinary clinical trials to improve the practice of medicine in preventing, detecting, and treating cancer, and to enhance the quality of life for cancer survivors. Learn more about SWOG here: http://www.swog.org/Visitors/AboutUs.asp

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Project Title Breast Cancer Risk Assessment in Nursing Mothers

Researcher Edward Sauter, MD, PhD, M.H.A., University of Texas Health Sciences Center at Tyler (UTHSCT).

Study Abstract Early first full term pregnancy (FFTP) leads to permanent genetic changes in the breast that combat the tendency toward abnormal cell growth at the time of involution. Compared to nulliparous women, lifetime breast cancer risk is decreased in parous women whose FFTP occurs under age 26, and increased in those whose FFTP occurs after 35 years of age. The research team believes that breast cancer associated proteins can provide clues to how parity influence breast cancer risk. Demonstration that tumor promoting proteins are downregulated related to FH and age at FFTP would suggest these are important mechanisms. This study addresses an important research priority of the Avon Foundation, the understanding of how breastfeeding, parity, age and FH influence breast cancer risk.

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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 Breast Density Patterns in African immigrant and African-American women

Researcher Tomi Akinyemiju, PhD, Columbia University, New York, NY

Study Abstract Mammographic breast density is one of the strongest and most consistent risk factors known for the development of breast cancer. Studies have reported a 2- to 4- fold increase in the risk of breast cancer among women with mostly dense breasts compared to women with less dense breasts. Several studies have observed racial/ethnic differences in the distribution of mammographic breast density across White, African-American and Asian women in the U.S. However, very little is known about the distribution of mammographic breast density among first- and second- generation African women residing in the US. This is a population of women that has been understudied as a separate racial/ethnic category, and often categorized together with African American women. There are important cultural and lifestyle differences that are relevant for breast cancer development that may be different between first- and second-generation African and African-American women. These are factors which, together with other biological and genetic features, may also significantly influence the patterns of mammographic density. In addition, despite a large body of cross-sectional studies of mammographic density, few studies have considered repeated measures of density, and the determinants of changes in breast density are not well understood. This study would add to the existing literature by examining breast density patterns among African immigrants and associated risk factors, and assess if these risk factors are associated with changes in breast density patterns over time.

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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 Asian American Community Health Initiative

Researcher Scarlett Lin Gomez, PhD, at the Cancer Prevention Institute of California; Asian & Pacific Islander American Health Forum; Asian Health Services; Asian Americans for Community Involvement

Study Abstract High and rapidly increasing incidence rates of breast cancer among California Asian Americans (AA) have been masked by rates that are traditionally reported for AAs as an aggregated group. Not only do rates vary considerably among AA ethnic subgroups, the research team recently showed that they are high among young US-born women, and rapidly increasing among some US-born and foreign-born groups; for some, rates were even higher than among non-Hispanic white women in California.

The research team will recruit AA controls from the same source population to form a population-based case-control study of breast cancer risk, thereby creating a unique multilevel dataset that will allow them to address the following specific aims: to determine, among controls, 1) the associations between perceived stress and the immigration experience and discrimination, and how these associations are modified by generational status, timing of immigration, and coping styles; 2) how other relevant breast cancer exposures, including age-specific markers of infectious disease exposures, physical activity and body size, and dietary intake and behaviors, vary with generational status and timing of immigration; 3) the extent to which the factors in Aims 1 and 2 vary according to family, social network, and neighborhood characteristics and relationships; and 4) among cases and controls, identify the associations between the factors in Aims 1 and 2 and breast cancer risk among AAs.

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Project Title Flaxseed Alters Markers of Breast Cancer Risk

Researcher Swati Kulkarni, M.D., University of Chicago, IL

Study Abstract Flaxseed is a natural food source containing lignan, a phytoestrogen, and alpha-linolenic acid, an omega-3 fatty acid. Flaxseed consumption has been reported in preclinical and clinical studies to decrease tumor growth through anti-estrogenic activity and estrogen-independent mechanisms in both estrogen receptor (ER) positive and ER negative breast cancers, and flaxseed has no known serious side effects. A pilot study is proposed to test the central hypothesis that flaxseed will be a safe and effective chemopreventive agent in healthy premenopausal women at high risk of breast cancer. The central hypothesis will be tested with the following specific aims: determine if the daily consumption of 25 grams of ground flaxseed 1) alters the proportion of breast epithelial cells expressing Ki-67 and caspase-3 (a measure of apoptosis) after six months in random periareolar fine needle aspiration (RPFNA) samples; 2)alters estrogen regulated genes, cyclin D1, survivin and vascular endothelial growth factor (VEGF) in RPFNA samples ; 3) alters serum levels of IGF-1 and IGFBP-3 after six months and 4) produces any significant side effects in premenopausal women who are at increased risk of developing of breast cancer based on elevated Gail and Claus scores, history of atypia on surgical biopsy,or history of unilateral breast cancer, and Ki-67 labeling index >1.5% on random periareolar fine needle aspiration samples (RPFNA).

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