Pilot Clinical-pathological and Molecular Analysis of Atypical Nevi in Response to BSE-L-Sulforaphane Abstract Melanoma is an epidemic solid tumor that has eluded systemic therapy in the setting of advanced disease. In the adjuvant setting, only high-dose IFN alfa-2b has shown reproducible benefit in relapse-free survival, and two trials demonstrating overall survival benefit. Despite regulatory approval worldwide, the toxicity of IFN has limited its adoption for adjuvant therapy, and precludes its consideration for prevention. Atypical nevi are non- obligate precursors and risk markers of melanoma, in which the presence of progression markers such as mutation of the BRAF gene, and the constitutive expression of STAT3 have been documented. We have demonstrated STAT3 expression and its correlation with the degree of atypia in atypical nevi of patients with a personal history of melanoma. The natural broccoli sprout extract enriched in sulforaphane (BSE-SFN) has shown promise as a chemopreventive agent in several solid tumors;preclinical studies demonstrate its inhibition of STAT3, as well as the induction of pro-apoptotic and growth-inhibitory activity against melanoma. We propose a pilot evaluation of three dosages of oral BSE-SFN (50, 100, and 200 ?mol per day, assigned at random in groups of 6 patients per dosage). Candidates for this pilot trial will have multiple atypical nevi and a history of prior melanoma, and be evaluated in Specific Aim 1 for tolerance and clinical-pathological effects of oral BSE-SFN Atypical nevi will be documented by photograph and biopsy, prior to and following 28 daily oral doses of BSE-SFN. BSE-SFN localization to the skin and modulation of STAT3 signaling in atypical nevi will also be evaluated in Specific Aim 2. The pilot trial of the multidisciplinary Melanoma Program of the UPCI will allow us to select a dosage for Phase II evaluation in larger numbers of subjects with melanoma and atypical nevi, in the cooperative group setting, either in ECOG or in the Melanoma Prevention Working Group.
This pilot project will develop the broccoli sprout extract enriched in sulforaphane (BSE-SFN) as a non-toxic natural chemopreventive agent for melanoma for patients who have multiple atypical nevi and a prior history of cutaneous melanoma. The pilot studies proposed in this application will assess the effects of 28 days of oral BSE-SFN at one of three dosages upon the clinical and pathological features, as well as STAT3 signaling which is constitutively activated in atypical nevi, which are established risk markers and non-obligate precursors of melanoma, and improve our scientific understanding of the clinical and molecular effects of BSE- SFN in relation to atypical nevi as surrogates for melanoma. The methods and technologies we develop in the context of this study will drive further studies of BSE-SFN in the context of the Melanoma and Skin Cancer Program of the University of Pittsburgh Cancer Institute, as well as the Melanoma Prevention Working Group we have formed amongst ECOG, SWOG, NCCTG and CALGB.