Abundant preclinical and epidemiologic data suggest that vitamin D possesses anti-neoplastic activity, and that individuals with higher plasma 25-hydroxyvitamin D [25(OH)D] levels have lower risk of colorectal cancer (CRC) and improved survival from CRC. Despite compelling evidence implicating vitamin D in CRC, critical questions remain about whether these findings reflect a true causal relationship, and what the biological mech- anisms of vitamin D activity are. Our central hypothesis is that vitamin D supplementation to achieve sufficient levels of 25(OH)D leads to improved survival in CRC patients and influences several neoplastic pathways that can be exploited as biomarkers of efficacy and targets for novel treatment strategies. We will test this hypothe- sis within two novel randomized clinical trials of vitamin D supplementation: a) a phase II double-blind random- ized trial of high- versus low-dose vitamin D3 in combination with chemotherapy in patients with metastatic CRC, and b) a randomized trial of preoperative high-dose vitamin D3 versus placebo in patients with resectable colon cancer for examination of vitamin D biology in fresh human tumor tissue. We will also lever- age a rich prospective cohort of metastatic CRC patients enrolled in a completed NCI-sponsored phase III trial of chemotherapy (CALGB/SWOG 80405) to further define and validate biomarkers of vitamin D action.
In Aim 1, we will determine the impact of supplemental vitamin D on survival of CRC patients, test distinct hypotheses about the vitamin D dose-response relationship, and explore biomarkers of vitamin D status, response, and efficacy. We will investigate whether circulating levels of vitamin D binding protein and tumoral expression of vitamin D receptor, 1?-hydroxylase, and 24-hydroxylase are associated with improved survival within our ran- domized trials, and whether these markers modify the relationship between vitamin D and patient outcome.
In Aim 2, we will conduct a precision medicine analysis of vitamin D to elucidate the mechanistic basis for its anti- tumor activity in CRC. We will explore the impact of vitamin D supplementation on tumoral markers of inflam- mation, lymphocytic infiltrates, and inflammatory gene signatures in surgical colectomy specimens from pa- tients treated with high-dose preoperative vitamin D3 versus placebo. We will also perform next generation se- quencing and Nanostring analysis of tumors from CRC patients with high- versus low vitamin D status to identi- fy unique genetic and transcriptional signatures associated with vitamin D-mediated carcinogenesis. In sum- mary, this translational proposal leverages innovative randomized trials of vitamin D to take the next critical steps in understanding vitamin D activity and biology in CRC. Our findings will confirm causality, provide new insights into biomarkers of vitamin D activity, and lead to potential inclusion of vitamin D into standard therapy ? including immunotherapy ? with the ultimate goal of improving the survival of patients with CRC.

Public Health Relevance

The proposed research is relevant to public health because colorectal cancer is the second leading cause of cancer death in the U.S., and may plausibly be linked to vitamin D deficiency. Abundant preclinical and epide- miologic data link lower levels of vitamin D to increased risk of and mortality from colorectal cancer; this is par- ticularly relevant given increasing rates of vitamin D deficiency in the U.S., as well as profound racial disparities in vitamin D status and colorectal cancer incidence and mortality. In an era of expensive and often toxic anti- neoplastic drugs, vitamin D therefore represents an attractive and accessible treatment option for patients of all races and sociodemographic groups with respect to both safety and cost.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA205406-04
Application #
9900749
Study Section
Chemo/Dietary Prevention Study Section (CDP)
Program Officer
Xi, Dan
Project Start
2017-03-15
Project End
2022-02-28
Budget Start
2020-03-01
Budget End
2021-02-28
Support Year
4
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Dana-Farber Cancer Institute
Department
Type
DUNS #
076580745
City
Boston
State
MA
Country
United States
Zip Code
02215
Yang, Wanshui; Liu, Li; Masugi, Yohei et al. (2018) Calcium intake and risk of colorectal cancer according to expression status of calcium-sensing receptor (CASR). Gut 67:1475-1483
Hamada, Tsuyoshi; Khalaf, Natalia; Yuan, Chen et al. (2018) Prediagnosis Use of Statins Associates With Increased Survival Times of Patients With Pancreatic Cancer. Clin Gastroenterol Hepatol 16:1300-1306.e3
Hamada, Tsuyoshi; Liu, Li; Nowak, Jonathan A et al. (2018) Vitamin D status after colorectal cancer diagnosis and patient survival according to immune response to tumour. Eur J Cancer 103:98-107
Liu, Po-Hong; Wu, Kana; Ng, Kimmie et al. (2018) Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women. JAMA Oncol :
Sineshaw, Helmneh M; Ng, Kimmie; Flanders, W Dana et al. (2018) Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer. Gastroenterology 154:906-915.e7
Lopes-Ramos, Camila M; Kuijjer, Marieke L; Ogino, Shuji et al. (2018) Gene Regulatory Network Analysis Identifies Sex-Linked Differences in Colon Cancer Drug Metabolism. Cancer Res 78:5538-5547
Khalaf, Natalia; Yuan, Chen; Hamada, Tsuyoshi et al. (2018) Regular Use of Aspirin or Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs Is Not Associated With Risk of Incident Pancreatic Cancer in Two Large Cohort Studies. Gastroenterology 154:1380-1390.e5
Momen-Heravi, Fatemeh; Masugi, Yohei; Qian, Zhi Rong et al. (2017) Tumor expression of calcium sensing receptor and colorectal cancer survival: Results from the nurses' health study and health professionals follow-up study. Int J Cancer 141:2471-2479
Bullman, Susan; Pedamallu, Chandra S; Sicinska, Ewa et al. (2017) Analysis of Fusobacterium persistence and antibiotic response in colorectal cancer. Science 358:1443-1448
Fuchs, M A; Yuan, C; Sato, K et al. (2017) Predicted vitamin D status and colon cancer recurrence and mortality in CALGB 89803 (Alliance). Ann Oncol 28:1359-1367

Showing the most recent 10 out of 12 publications