Typhoid Vaccine in Testing Response to Immune Stress in Patients With Stage I-IIIA Breast Cancer

Study Overview
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Brief Summary
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This randomized clinical trial uses an inactive typhoid vaccine to briefly stimulate an immune response in patients with stage I-IIIA breast cancer who received primary cancer treatment and studies whether patients' fitness levels affect how their bodies handle a challenge to their immune system. A vaccine is a substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms such as bacteria or viruses. Immune responses may cause excess inflammation in the body and behavioral changes, such as depression, fatigue, pain, and problems with thinking and reasoning. Studying immune responses in patients with breast cancer who have undergone primary cancer treatment may help doctors learn whether physical fitness can protect the body from effects of immune system stress and whether it may be able to reduce health problems in patients with breast cancer.

Detailed Description
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PRIMARY OBJECTIVES: I. To evaluate the relationships between cardiorespiratory fitness and inflammatory and behavioral responses (negative mood, fatigue, pain, and cognitive problems) to typhoid vaccine in breast cancer survivors. II. To determine the effects of age and depressive symptoms on inflammatory and behavioral responses to typhoid vaccine and placebo. III. To assess the ability of cardiorespiratory fitness to moderate age- and depression-related responses to typhoid vaccine. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive inactive typhoid vaccine intramuscularly (IM) at visit 1 followed by placebo IM 30 days later at visit 2. ARM II: Patients receive placebo IM at visit 1 followed by inactive typhoid vaccine IM 30 days later at visit 2. There is an initial screening visit where patients in both arms complete an audio-recorded interview that includes questions about changes in mood and emotion throughout their lives, body measurements, a finger stick to assess for anemia and diabetes markers. During visit 1 and 2, patients in both arms will have blood drawn periodically and complete sets of questionnaires that assess feelings, health behaviors, and personality. Patients also complete cognitive tasks and a temperature sensitivity task at 3-4.5 hours post-injection.

Official Title
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The IMPACT Study: Inflammatory Responses, Mood and Physical Fitness After Cancer Treatment

Conditions
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Cognitive Side Effects of Cancer Therapy, Depression, Recurrent Breast Carcinoma, Stage IA Breast Cancer, Stage IB Breast Cancer, Stage IIA Breast Cancer, Stage IIB Breast Cancer, Stage IIIA Breast Cancer

Intervention / Treatment
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* Biological: typhoid vaccine
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women who have been diagnosed with stage I-IIIA breast cancer will be recruited 1-10 years after the completion of all primary cancer treatment except for longer-term hormonal therapies (tamoxifen, aromatase inhibitors) All women will be postmenopausal Exclusion Criteria: A prior history of any other malignancy except basal or squamous cell skin cancers, strokes, diabetes, current heart disease or uncontrolled hypertension, peripheral vascular disease, liver disease, autoimmune and/or inflammatory diseases including rheumatoid arthritis and ulcerative colitis, and other medical conditions that would limit participation in the assessments (e.g., pulmonary disease, orthopedic problems, major psychiatric illness, major cognitive dysfunction, or an acute medical problem) Anemia Alcohol or drug abuse Smoking Medication exclusions will include steroids as well as statins and other medications with anti-inflammatory actions Women who have received a typhoid vaccine within the last three years

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm I (inactive typhoid vaccine, placebo)<br>Patients receive inactive typhoid vaccine IM at visit 1 followed by placebo IM 30 days later at visit 2. | Biological: typhoid vaccine<br>* Given IM<br>Other: Placebo<br>* Given IM<br>* Other names: PLCB;|
| Placebo Comparator: Arm II (placebo, inactive typhoid vaccine)<br>Patients receive placebo IM at visit 1 followed by inactive typhoid vaccine IM 30 days later at visit 2. | Biological: typhoid vaccine<br>* Given IM<br>Other: Placebo<br>* Given IM<br>* Other names: PLCB;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in level of IL-6 | Blood will be drawn for IL-6 in serum samples measured using an electrochemiluminescence method with Meso Scale Discovery kits at the fasting baseline and then every 90 minutes post-inoculation for 7.5 hours. | At baseline prior to vaccine or placebo administration, and then every 90 minutes post-inoculation for 7.5 hours. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pain | Self-reported intensity of pain on 0-9 scale (0 = no pain; 9 = pain as bad as you can imagine) at baseline prior to vaccine or placebo administration, and then every 90 minutes post-inoculation for the next 7.5 hours | At baseline prior to vaccine or placebo administration, and then every 90 minutes post-inoculation for 7.5 hours. | 
| Change in fatigue | Self-reported intensity of fatigue on 0-9 scales (0 = no fatigue; 9 = fatigue as bad as you can imagine) at baseline prior to vaccine or placebo administration, and then every 90 minutes post-inoculation for the next 7.5 hours | At baseline prior to vaccine or placebo administration, and then every 90 minutes post-inoculation for 7.5 hours. |