Thompson Cancer Survival Center Participates in Major Breast Cancer Prevention Trial
 he Study of Tamoxifen and Raloxifene, or STAR, one of the largest breast cancer prevention studies ever, is now recruiting volunteers at more than 400 centers across the United States, Canada, and Puerto Rico. Thompson Cancer Survival Center is one of these sites.
 "We are excited about bringing this important study to the Knoxville area," said Timothy J. Panella, M.D., principal investigator for the STAR study. "Women everywhere are at risk for breast cancer, and we are pleased that Knoxville women will have the chance to participate in this important study."
Jamie Rodgers, R.N. and coordinator of the breast cancer prevention trial, adds, "Over 80 women from the Knoxville area participated in the original breast cancer prevention trial. We are looking forward to expanding our role in the new study and actively enrolling participants." Rodgers has just returned from a STAR kickoff meeting in Toronto, Canada, and is very excited about being able to provide this opportunity to the women of Knoxville and surrounding counties.
The trial will include 22,000 postmenopausal women at increased risk of breast cancer to determine whether the osteoporosis prevention drug raloxifene (Evista) is as effective in reducing the chance of developing breast cancer as tamoxifen (Nolvadex) has proven to be. There will be no placebo involved in this study. All participants will receive an active drug shown to prevent breast cancer.
The Thompson Center is part of the National Surgical Adjuvant Breast and Bowel Project (NSABP), the network of research professionals that will conduct STAR, which is supported by the National Cancer Institute (NCI). NSABP chairman Norman Wolmark, M.D., noted that "studies of raloxifene suggest it has the potential to prevent breast cancer. The only way to prove that potential is to do a clinical trial in which the risks and benefits are directly compared with the risks and benefits of tamoxifen."
Tamoxifen was shown to reduce the chance of developing breast cancer by about half in the Breast Cancer Prevention Trial (BCPT), a study of over 13,000 postmenopausal and premenopausal women at high risk for breast cancer. Results of this trial were announced in April 1998 and published in the Journal of the National Cancer Institute on Sept. 16, 1998. In the BCPT, half of the women took tamoxifen and half took a placebo (an inactive pill that looked like tamoxifen). Participants taking tamoxifen had fewer fractures of the hip, wrist, and spine than women taking the placebo.
The drug, however, increased the women's chances of developing four potentially life-threatening health problems: endometrial cancer (cancer of the uterine lining), deep vein thrombosis (blood clots in large veins), pulmonary embolism (blood clot in the lung), and possibly stroke. The U.S. Food and Drug Administration (FDA) approved the use of tamoxifen to reduce the incidence of breast cancer in women at increased risk of the disease in October 1998.
Leslie Ford, M.D., associate director for clinical research at NCI's Division of Cancer Prevention, noted that "tamoxifen is a medically proven intervention, but it is not perfect. Women who are at increased risk for breast cancer need options for preventing this disease with a minimum of side effects, and STAR is a concerted effort to find one." Ford is responsible for all aspects of NCI's involvement in STAR.
Information about the safety of raloxifene is limited compared to the data available on tamoxifen. Raloxifene was approved in December 1997 by the FDA to prevent osteoporosis and has been in clinical trials for about five years. Tamoxifen has been approved by the FDA to treat women with breast cancer for more than 20 years and has been in clinical trials for about 30 years.
Women taking raloxifene in studies of osteoporosis have had an increased chance of developing deep vein thrombosis or pulmonary embolism similar to the risks seen with tamoxifen. In these studies, however, raloxifene did not increase the risk of endometrial cancer. An important part of STAR will be to compare the long-term safety of raloxifene and tamoxifen in women at increased risk for breast cancer.
Women who participate in STAR must be postmenopausal, at least age 35, and have increased risks of breast cancer as determined by their age, family history of breast cancer, personal medical history, age at first menstrual period, and age at first live birth.
They will also go through a process known as informed consent, during which they will learn about the potential benefits and risks of tamoxifen and raloxifene before deciding whether to participate in STAR. Once a woman chooses to participate, she will be randomly assigned to receive either 20 mg tamoxifen or 60 mg raloxifene daily for five years and will have regular follow-up examinations, including mammograms and gynecologic exams.
The makers of tamoxifen, Zeneca Pharmaceuticals in Wilmington, Del., and the maker of raloxifene, Eli Lilly and Company in Indianapolis, Ind., are providing their drugs for the trial without charge.
For more information about STAR or for a free risk assessment, call Jamie Rodgers, R.N. at the Thompson Cancer Survival Center's clinical trials department at (865) 541-1812.
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