City of Hope’s Melanie Palomares, M.D., M.S., will lead a five-year, $3.3 million clinical research effort to decrease breast cancer risk among women treated for Hodgkin’s lymphoma in childhood, adolescence or early adulthood.
The five-year investigation funded by the National Cancer Institute (NCI) will evaluate whether taking a low dose of tamoxifen every day can reduce markers associated with breast cancer risk in this group of cancer survivors. The grant began July 1.
|Melanie Palomares (Photo by Markie Ramirez)|
“Hodgkin’s lymphoma patients frequently get high-dose radiation to the chest, which is critical to the cure of their cancer — but it also contributes to the development of breast cancer,” said Palomares, assistant professor in the departments of Population Sciences and Medical Oncology & Therapeutics Research.
“Young women treated for Hodgkin’s lymphoma have a 20 percent risk of developing breast cancer by age 45. By comparison, the average woman has a 10 percent risk of developing breast cancer by age 80. This represents up to a 55-fold increased risk in young Hodgkin’s lymphoma survivors.”
And the risk continues to grow as women age. National guidelines call for Hodgkin’s lymphoma survivors to receive regular breast cancer screenings, including mammograms and magnetic resonance imaging scans, starting in their mid-20s. City of Hope’s Smita Bhatia, M.D., M.P.H., Ruth Ziegler Chair in Population Sciences, and Wendy Landier, R.N., M.S.N., C.P.N.P., clinical director of the Center for Cancer Survivorship, helped author the guidelines.
Palomares and other researchers seek ways to reduce this risk, and tamoxifen may be a logical tool.
Tamoxifen interferes with estrogen in the body, and most breast cancers depend on estrogen to grow. Doctors already prescribe it to prevent breast cancer in other women at high risk, including women who are found to have precancerous lesions of the breast and those with breast cancer-related genetic mutations.
The study will involve 300 healthy, female Hodgkin’s lymphoma survivors at five institutions across the U.S. and Canada. Women must have received radiotherapy for lymphoma before age 30.
They will take 5 milligrams (mg) of tamoxifen a day or a placebo for two years. The tamoxifen dose is significantly lower than the daily 20 mg usually prescribed to breast cancer patients.
Italian researchers recently showed that this low daily dose of tamoxifen could lower proven markers of breast cancer risk — the density of a woman’s breast tissue as seen through mammography and levels of a hormone called insulin-like growth factor 1, or IGF-1, in her body.
The Italian study showed that low doses of tamoxifen resulted in markedly fewer side effects, such as hot flashes. Fewer side effects could mean that more women would tolerate the therapy and comply with treatment, Palomares said.
Palomares and her colleagues will monitor mammographic density and levels of IGF-1, as well as reported symptoms and measures of blood and bone health among women in their study. Women also may choose to undergo random fine-needle aspiration, a procedure that samples breast cells so that researchers may look for evidence of abnormalities that might lead to cancer.
Bhatia and Lennie Wong, Ph.D., associate research professor in the Department of Population Sciences, are co-investigators on the trial, and Laura Kruper, M.D., and Sean Lau, M.D., are clinical consultants.
Palomares noted that all participating institutions have a well-established record of long-term follow up of pediatric cancer patients and have built strong partnerships between adult and pediatric oncologists to take care of long-term survivors of childhood cancer. They include St. Jude’s Children’s Research Hospital in Tennessee, the Emory University School of Medicine in Georgia, University of Michigan’s C.S. Mott Children’s Hospital and Princess Margaret Hospital in Toronto.
For more information about the research, e-mail HLsurvivortrial@coh.org or call Palomares at ext. 61080. To learn more about breast cancer screening guidelines for pediatric and young adult cancer patients, visit www.survivorshipguidelines.org and select “Breast Cancer.”