Phase II A Trial of Curcumin Among Patients With Prevalent Subclinical Neoplastic Lesions (Aberrant Crypt Foci)

National Cancer Institute (NCI)44 enrolled

Overview

Chemoprevention is the use of certain substances to keep cancer from forming, growing, or coming back. Curcumin is a compound found in plants that may prevent colon cancer from forming. This phase II trial is studying how well curcumin works in preventing colon cancer in smokers with aberrant crypt foci.

PRIMARY OBJECTIVES: I. To determine mean percentage change from baseline in prostaglandin E2 (PGE2) within ACF pre and post 30 days of curcumin administration at a specified dose. SECONDARY OBJECTIVS: I. To determine mean percentage change from baseline in 5-hydroxy-eicosatetraenoic acid (5-HETE) within ACF pre and post 30 days of curcumin administration at a specified dose. II. To determine mean percentage change from baseline in PGE2 and 5-HETE within comparison normal mucosa pre and post 30 days of curcumin administration at a specified dose. III. To quantify corresponding enzyme changes in the cyclooxygenases (COX-1, COX-2,) and lipoxygenase (5-LOX) protein abundance. Semi-quantitative changes in these proteins will be measured by western blotting and correlated with changes in prostaglandins and leukotrienes respectively. IV. Document changes in total ACF number. V. Determine proliferation by Ki-67 IHC in rectal mucosa pre and post therapy and correlate with changes in ACF number and size. VI. Determine curcumin concentration in rectal mucosa after 30 days therapy and correlate with PGE2 and 5-HETE changes described above. VII. Measure glutathione peroxidase (GPx) activity within the colon pre and post therapy as an indirect marker of reduced oxidative stress within the colonic epithelium. VIII. Ensure safety of all participants during course of study investigation. IX. Determine the curcumin concentration in plasma before and after treatment. OUTLINE: This is a multicenter, nonrandomized, uncontrolled study. Patients receive 1 of 2 doses of oral curcumin once daily. Treatment continues for 30 days in the absence of unacceptable toxicity or disease progression. Blood and tissue biopsies are obtained by sigmoidoscopy or colonoscopy at baseline and at day 30 for correlative biomarker studies. The change in prostaglandin E\_2 (PGE\_2) is assessed by enzyme immunoassay, 5-hydroxy-eicosatetraenoic acid (5-HETE) by high-performance liquid chromatography, cyclooxygenases (COX-1 and COX-2) and 5-lipoxygenase (5-LOX) by western blotting, Ki-67 by immunohistochemistry, and glutathione peroxidase (GPx) by spectrophotometric assay. After completion of study therapy, patients are followed at 1 week. PROJECTED ACCRUAL: A total of 48 patients will be accrued for this study.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

Conditions

Healthy, no Evidence of Disease Tobacco Use Disorder

Interventions

laboratory biomarker analysisOTHER

Correlative studies

pharmacological studyOTHER

Correlative studies

curcuminDRUG

Given orally

Eligibility

Sex: ALLMin age: 40 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Current smoker with \> 3 pack-year total smoking history * Subjects taking NSAIDS or ASA \< 10 days month are eligible but must undergo 14 day washout and refrain from use during the study * Subjects who are: * Having a clinically indicated screening/surveillance colonoscopy (e.g. due to risk factors, personal history, or symptoms) OR * Not having a colonoscopy but are otherwise eligible. These subjects would undergo a flexible sigmoidoscopy. * ECOG performance status 0-2 (Karnofsky \> 60%) * No severe organ dysfunction which might increase bleeding risk: * Demonstrated by: Normal hematologic status (WBC \> 3,000/mm\^3, hemoglobin \> 10.0 gm/dl, and platelet-count \>100,000/mm\^3), normal hepatic function (bilirubin \< 1.5 mg/dl, transaminases \< 1.5x institutional norms), and normal renal function (serum creatinine \< 2.0 mg/dl, documented in clinical chart 28 days prior to enrollment * Healthy current smokers (1 cigarette in previous yr) with \> 3-pack year of cigarette smoking and able to provide written informed consent; there are no gender restrictions * The effects of curcumin on the developing human fetus at the recommended therapeutic dose are unknown; for this reason women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately * Ability to understand and the willingness to sign a written informed consent document Exclusion Criteria: * NSAID or ASA use \> 10 days /month; any current glucocorticoid use or omega 3-fatty acid supplement use * Evidence of the following chronic medical conditions such as: * Pregnant or lactating women and/or women who are contemplating pregnancy during the duration of the protocol * History of chronic inflammatory bowel disease or prior pelvic irradiation * History of peptic ulcer disease (PUD) endoscopically confirmed \< 5 yrs from enrollment date * Newly diagnosed colorectal cancer or advanced adenoma \< 1 yr from enrollment * Unspecified history of bleeding or coagulation disorder reported by patient or in medical history * Hereditary Colon Cancer syndromes (FAP or HNPCC) * Participants may not be receiving any other investigational agents * History of contact dermatitis from turmeric * Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Pregnant women are excluded from this study because curcumin is an agent with the potential for teratogenic or abortifacient effects; because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with curcumin, breastfeeding should be discontinued if the mother is treated with curcumin

Locations (1)

Chao Family Comprehensive Cancer Center

Orange, California, United States

Outcomes

Primary Outcomes

Baseline in Prostaglandin E2 (PGE2) Within Aberrant Crypt Foci (ACF)

Baseline prostaglandin E2 (PGE2) values found in rectal aberrant crypt foci (ACF) tissue

Time frame: Baseline

Post-treatment in Prostaglandin E2 (PGE2) Within Aberrant Crypt Foci (ACF)

Post-treatment prostaglandin E2 (PGE2) values found in rectal aberrant crypt foci (ACF) tissue

Time frame: At 30 day

Secondary Outcomes

Baseline in 5-hydroxy-eicosatetraenoic Acid (5-HETE) Within Aberrant Crypt Foci (ACF)

Baseline 5-hydroxy-eicosatetraenoic acid (5-HETE) values found in rectal aberrant crypt foci (ACF) tissue

Time frame: Baseline

Post-treatment in 5-hydroxy-eicosatetraenoic Acid (5-HETE) Within Aberrant Crypt Foci (ACF)

Post-treatment 5-hydroxy-eicosatetraenoic acid (5-HETE) values found in rectal aberrant crypt foci (ACF) tissue

Time frame: At 30 Day

Baseline in Prostaglandin E2 (PGE2) Level in Normal Mucosa

Baseline prostaglandin E2 (PGE2) values found in normal mucosa rectal tissue

Time frame: Baseline

Post-treatment in Prostaglandin E2 (PGE2) Level in Normal Mucosa

Post-treatment prostaglandin E2 (PGE2) values found in normal mucosa rectal tissue

Time frame: At 30 day

Baseline in 5-hydroxy-eicosatetraenoic Acid (5-HETE) Level in Normal Mucosa

Baseline 5-hydroxy-eicosatetraenoic acid (5-HETE) values found in normal mucosa rectal tissue

Data from ClinicalTrials.gov

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Time frame: Baseline

Post-treatment in 5-hydroxy-eicosatetraenoic Acid (5-HETE) Level in Normal Mucosa

Post-treatment 5-hydroxy-eicosatetraenoic acid (5-HETE) values found in normal mucosa rectal tissue

Time frame: At 30 day

Change in Cyclooxygenases (COX-1, COX-2), and Lipoxygenase (5-LOX) Protein Abundance

The protein levels for each enzyme will be expressed as an absolute change from baseline and graphed against % change of its enzyme product in the same individual. The degree of correlation between these parameters will be assessed by either Pearson's correlation coefficient or Spearman's rank order correlation coefficient.

Time frame: Baseline to 30 days

Changes in Total Aberrant Crypt Foci (ACF) Number

Changes in total aberrant crypt foci (ACF) number = Number of ACF at pre-treatment - Number of ACF at post-treatment

Time frame: Baseline to 30 days

Proliferation by Ki-67 Immunohistochemical Assay (IHC) in Normal Mucosa - Proximal Third

Time frame: Baseline

Proliferation by Ki-67 Immunohistochemical Assay (IHC) in Normal Mucosa - Proximal Third

Time frame: At 30 day

Proliferation by Ki-67 Immunohistochemical Assay (IHC) in Normal Mucosa - Middle Third

Time frame: Baseline

Proliferation by Ki-67 Immunohistochemical Assay (IHC) in Normal Mucosa - Middle Third

Time frame: At 30 day

Proliferation by Ki-67 Immunohistochemical Assay (IHC) in Normal Mucosa - Distal Third

Time frame: Baseline

Proliferation by Ki-67 Immunohistochemical Assay (IHC) in Normal Mucosa - Distal Third

Time frame: At 30 day

Baseline Curcumin Concentration in Rectal Mucosa

If detectable in the rectal mucosa, it is predicted that curcumin concentrations and potentially curcumin conjugate concentrations will be associated with reduction in PGE2 and 5-HETE measured from colorectal mucosal biopsies. Pearson correlation coefficients between changes in baseline levels in these 2 parameters and curcumin concentration in rectal mucosa will be calculated. Endpoints may be log transformed as appropriate prior to analysis.

Time frame: Baseline

Post-treatment Curcumin Concentration in Rectal Mucosa

Time frame: At 30 day

Baseline Curcumin Plasma Concentrations

Baseline curcumin conjugate concentrations will be measured directly from the subject's plasma and then the change in concentrations after the last dose of study drug will be measured. Concentrations will be measured and statistically evaluated by paired t-test or Wilcoxon matched-pairs signed-ranks test, as appropriate.

Time frame: Baseline

Post-treatment Curcumin Plasma Concentrations

Time frame: At 30 day

Baseline Curcumin Conjugates Concentration in Rectal Mucosa

Time frame: Baseline

Post-treatment Curcumin Conjugates Concentration in Rectal Mucosa

Time frame: At 30 day

Baseline Curcumin Conjugates Plasma Concentrations

Time frame: Baseline

Post-treatment Curcumin Conjugates Plasma Concentrations

Post-treatment curcumin conjugate concentrations will be measured directly from the subject's plasma and then the change in concentrations after the last dose of study drug will be measured. Concentrations will be measured and statistically evaluated by paired t-test or Wilcoxon matched-pairs signed-ranks test, as appropriate.

Time frame: At 30 day

Number of Participants at Each Adverse Event Grade Level

Time frame: Baseline to 30 days