PT  - JOURNAL ARTICLE
AU  - Aideen M Campbell
AU  - Melanie Morris
AU  - Rebecca Gallagher
AU  - Ruth Boyd
AU  - Hazel Carson
AU  - D Paul Harkin
AU  - Ewa Wielogorska
AU  - Christopher Elliott
AU  - Kienan I Savage
AU  - Stuart A McIntosh
TI  - Chemoprevention in BRCA1 mutation carriers (CIBRAC): protocol for an open allocation crossover feasibility trial assessing mechanisms of chemoprevention with goserelin and anastrozole versus tamoxifen and acceptability of treatment
AID  - 10.1136/bmjopen-2018-023115
DP  - 2018 Dec 01
TA  - BMJ Open
PG  - e023115
VI  - 8
IP  - 12
4099  - http://bmjopen.bmj.com/content/8/12/e023115.short
4100  - http://bmjopen.bmj.com/content/8/12/e023115.full
SO  - BMJ Open2018 Dec 01; 8
AB  - Introduction BRCA1 mutation carriers have a significant lifetime risk of breast cancer, with their primary risk-reduction option being bilateral mastectomy. Preclinical work from our laboratory demonstrated that in BRCA1-deficient breast cells, oestrogen and its metabolites are capable of driving DNA damage and subsequent genomic instability, which are well-defined early events in BRCA1-related cancers. Based on this, we hypothesise that a chemopreventive approach which reduces circulating oestrogen levels may reduce DNA damage and genomic instability, thereby providing an alternative to risk-reducing surgery.Methods and analysis 12 premenopausal women with pathogenic BRCA1 mutations and no previous risk-reducing surgery will be recruited from family history clinics. Participants will be allocated 1:1 to two arms. All will undergo baseline breast biopsies, blood and urine sampling, and quality of life questionnaires. Group A will receive goserelin 3.6 mg/28 days by subcutaneous injection, plus oral anastrozole 1 mg/day, for 12 weeks. Group B will receive oral tamoxifen 20 mg/day for 12 weeks. Following treatment, both groups will provide repeat biopsies, blood and urine samples, and questionnaires. Following a 1-month washout period, the groups will cross over, group A receiving tamoxifen and group B goserelin and anastrozole for a further 12 weeks. After treatment, biopsies, blood and urine samples, and questionnaires will be repeated. DNA damage will be assessed in core biopsies, while blood and urine samples will be used to measure oestrogen metabolite and DNA adduct levels.Ethics and dissemination This study has ethical approval from the Office for Research Ethics Committees Northern Ireland (16/NI/0055) and the Medicines and Healthcare products Regulatory Agency (MHRA) (reference: 32485/0032/001–0001). The investigational medicinal products used in this trial are licensed and in common use, with well-documented safety information. Dissemination of results will be via high-impact journals and relevant national/international conferences. A copy of the results will be offered to the participants and be made available to patient support groups.Trial registration number EudraCT: 2016-001087-11; Pre-results.