Topical Sirolimus in Patients With Basal Cell Nevus Syndrome and in Healthy Participants

Study Overview
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Brief Summary
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RATIONALE: Studying samples of blood and tissue from patients with basal cell nevus syndrome and from healthy participants in the laboratory may help doctors learn more about changes that may occur in DNA and identify biomarkers related to basal cell nevus syndrome. Chemoprevention is the use of certain drugs to keep cancer from forming, growing, or coming back. The use of sirolimus may keep basal cell skin cancer from forming in patients with basal cell nevus syndrome. PURPOSE: This phase I trial is studying topical sirolimus in patients with basal cell nevus syndrome and in healthy participants.

Detailed Description
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OBJECTIVES: Primary Compare messenger RNA and protein expression patterns in patients with basal cell nevus syndrome (BCNS) vs in cultured cells of healthy participants (control) before treatment to identify a set of genes that are differentially expressed in BCNS. Assess the effects of topical sirolimus on gene expression (genes identified in the primary objective) in vivo using keratinocytes, fibroblasts, and lymphocytes from patients with BCNS and from healthy participants (controls) by targeted expression methods. OUTLINE: Patients and healthy participants receive topical sirolimus ointment twice daily for 12 weeks. Blood and skin biopsies are obtained at baseline and at week 12 for gene and protein expression studies. Alterations in RNA are measured by microarray analysis. Alterations in protein expression are measured by 2-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. After completion of study therapy, patients and healthy participants are followed at 4 weeks. PROJECTED ACCRUAL: A total of 16 patients and healthy participants will be accrued for this study.

Official Title
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In Vivo and In Vitro Pharmacology of Sirolimus in Subjects With Basal Cell Nevus Syndrome

Conditions
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Neoplastic Syndrome, Non-melanomatous Skin Cancer

Intervention / Treatment
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* Drug: sirolimus
* Genetic: comparative genomic hybridization
* Genetic: gene expression analysis
* Genetic: microarray analysis
* Genetic: protein expression analysis
* Genetic: proteomic profiling
* Other: laboratory biomarker analysis
* Other: mass spectrometry
* Procedure: biopsy


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Patient Confirmed diagnosis of basal cell nevus syndrome (BCNS) Known patched (PTCH) gene mutation Must have full sequence of coding exons with intron/exon junctions in the PTCH gene OR prior genetic testing confirming PTCH mutation by the Yale University DNA Diagnostics Laboratory Age- and sex-matched healthy participant (control) Unaffected relative of patient OR normal healthy volunteer with no family history of BCNS or features of BCNS No unrelated healthy participant meeting any of the following clinical criteria for BCNS: Lamellar calcification of the falx cerebri Prior odontogenic keratocyst or any jaw cyst for which a histopathologic diagnosis cannot be ascertained Palmar or plantar pits typical of BCNS More than 3 basal cell carcinomas (BCC) in a lifetime or 1 BCC under the age of 30 History of medulloblastoma No unrelated healthy participant with 2 or more of the following features: History of ovarian or cardiac fibroma Mesenteric or pleural cysts Polydactyly Macrocephaly determined after adjustment for height Craniofacial features of BCNS, including cleft palate, frontal bossing, hypertelorism, iris coloboma or other developmental defects of the eye, or coarse facies Vertebral anomalies, including spina bifida occulta outside the lumbar region Bifid or splayed ribs Other radiographic findings, including bridging of the sella turcica, nonlamellar calcification of the falx cerebri, or flame-shaped lucencies in the phalanges = 1-3 BCCs over the age of 30 PATIENT CHARACTERISTICS: WBC ≥ 4,000/mm³ Neutrophil count ≥ 2,000/mm³ Platelet count ≥ 150,000/mm³ Hemoglobin ≥ 11.5 g/dL Bilirubin 0.3-1.0 mg/dL AST 17-59 U/L PTT 10-13 seconds OR INR 1.0-1.4 Creatinine clearance > 50 mL/min Cholesterol < 350 mg/dL Triglycerides < 400 mg/dL Not pregnant or nursing Negative pregnancy test Fertile participants must use effective contraception for ≥ 1 month before, during, and for ≥ 12 weeks after study treatment No active infection No alcohol or drug abuse No psychiatric disorder or mental deficiency that would preclude study compliance No uncontrolled hypertension (i.e., blood pressure > 140/90 mm Hg on > 2 measurements) No chronic active infection requiring treatment No untreated reactive purified protein derivative of tuberculin (PPD) No HIV-1 infection No infection requiring antibiotics within the past 30 days No other skin disease affecting broad areas of the body, including the region to be treated and biopsied No known hepatitis B or C infection (detectable RNA off antiviral therapy) No immune deficiency disorder No known hypersensitivity to sirolimus or macrolide antibiotics (e.g., erythromycin, azithromycin, or clarithromycin) No cancer within the past 5 years except basal cell skin cancer PRIOR CONCURRENT THERAPY: At least 1 month since prior investigational drugs No concurrent dietary supplements, including Hypericum perforatum (St. John's wort) or megadose vitamins No other concurrent immunosuppressive medications, including corticosteroids No concurrent medications known to interfere with sirolimus metabolism No concurrent anticoagulants No concurrent acetylsalicyclic acid or other drugs affecting platelet function or number No routine (i.e., > 2 doses/week) use of nonsteroidal anti-inflammatory drugs No drugs or substances that would effect sirolimus blood concentrations, including any of the following: Nicardipine Verapamil Clotrimazole Fluconazole Itraconazole Troleandomycin Cisapride Metoclopramide Clarithromycin Erythromycin Bromocriptine Cimetidine Danazol HIV-protease inhibitors (e.g., ritonavir or indinavir) Phenobarbital Carbamazepine Phenytoin Rifabutin Rifapentine Grapefruit juice Vaccinations (especially live vaccines)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: sirolimus|nan|
|Genetic: comparative genomic hybridization|nan|
|Genetic: gene expression analysis|nan|
|Genetic: microarray analysis|nan|
|Genetic: protein expression analysis|nan|
|Genetic: proteomic profiling|nan|
|Other: laboratory biomarker analysis|nan|
|Other: mass spectrometry|nan|
|Procedure: biopsy|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alterations in RNA as measured by microarray analysis |  |  | 
| Alterations in protein expression as measured by 2-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight mass spectroscopy |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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basal cell carcinoma of the skin, nevoid basal cell carcinoma syndrome