Pilot Study of Anti-oxidant Supplementation With N-Acetyl Cysteine in Stage 0/I Breast Cancer

Study Overview
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Brief Summary
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NAC is the N-acetyl derivative of the naturally occurring amino acid, L-cysteine. It is a common over-the-counter supplement and also is available as an injectable pharmaceutical that protects the liver in cases of acetaminophen overdose. In the exercise physiology literature, both oral and injectable NAC have been shown to reduce fatigue and improve recovery from exertion which has interesting implications for exploring cancer-related fatigue. In terms of cancer cell biology, reactive oxygen species (ROS) may play an important role in the development and progression of breast cancer

Official Title
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Pilot Study of Anti-oxidant Supplementation With N-Acetyl Cysteine in Stage 0/I Breast Cancer

Conditions
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Stage 0/1 Breast Cancer, Post Biopsy, Pre-surgery

Intervention / Treatment
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* Drug: IV/oral n-acetylcysteine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Demographic • Females ≥18 years of age Disease related Stage 0/I breast cancer by biopsy (patients may be consented and screened with suspected breast cancer, but no treatment will occur until cancer is confirmed by their biopsy). Awaiting surgery which will consist of either lumpectomy or mastectomy. ECOG performance status 0-1 Laboratory Laboratory values that would not prevent the patient from receiving treatment as determined by the PI or study oncologist Serum creatinine ≤2.0 mg/dL Serum bilirubin ≤2.0 X ULN Serum HgB ≥8.0 mg/dL General Competent to comprehend, sign, and date an IRB-approved informed consent form Female subjects of childbearing potential have a negative pregnancy test Exclusion Criteria: Disease Related History or known presence of metastases History of another primary cancer, except: Curatively treated cervical carcinoma in situ, or Curatively resected non-melanomatous skin cancer, or Other primary solid tumor curatively treated with no known active disease present and no treatment administered for ≤ 3 years prior to enrollment Other concurrent anticancer chemotherapy within 4 weeks as determined by the PI Any co-morbid disease that would increase risk of toxicity as determined by PI Medications/Treatments Subjects requiring chronic use of immunosuppressive agents (eg, methotrexate, cyclosporine, corticosteroids) Recent infection requiring a course of systemic anti-infectives that was completed ≤ 14 days prior to enrollment (exception can be made at the judgment of the PI for oral treatment of an uncomplicated urinary tract infection ([UTI]) General History of any medical or psychiatric condition or addictive disorder, or laboratory abnormality that, in the opinion of the PI, may increase the risks associated with study participation or study drug administration or may interfere with the conduct of the study or interpretation of study requirements History of bronchospasm or severe asthma as determined by the PI Subject unwilling or unable to comply with study requirements Known positive test(s) for human immunodeficiency virus infection, hepatitis C virus, chronic active hepatitis B infection Documented history of alcohol, cocaine or intravenous drug abuse ≤ 6 months of enrollment

Ages Eligible for Study
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Minimum Age: 18 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: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: IV and oral n-acetylcysteine<br>50-150mg/kg of n-acetylcysteine intravenously once a week for at least two weeks. 600mg n-acetylcysteine orally twice daily except on day of infusion | Drug: IV/oral n-acetylcysteine<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Efficacy | To assess the feasibility of evaluating the effect of n-acetylcysteine on tumor cell metabolism by assessing the changes in expression of caveolin -1 and MCT4 in cancer associated fibroblasts in pre and post therapy breast tissue treated with NAC. | 2-4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety | To confirm the safety of combined oral and IV NAC in patients with breast cancer. This will be evaluated by the number of participants with adeverse events and Grade 3/4 toxicities according to CTCAE v3.0 | 2-4 weeks | 
| 2. To access the changes in HIF-1 alpha and p65 subunit of NFB in tumor stroma in pre and post therapy breast tissue treated with NAC | To access the changes in HIF-1 alpha and p65 subunit of NFB in tumor stroma in pre and post therapy breast tissue treated with NAC | 2-4 weeks | 
| To evaluate potential effects of NAC on quality of life and fatigue | To evaluate potential effects of NAC on quality of life and fatigue using the FACT-G, Brief Fatigue Inventory, and PROMIS quality assessment instruments. | 2-4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Integrative Medicine, Breast Cancer, Stage 0, Stage 1