An Exploratory Evaluation of Biomarkers in Blister Fluid in Healthy Volunteers and Irradiated Skin

BACKGROUND

Blister fluid has been used to measure cytokine expression, proteomic profiles, and pharmacokinetics in a variety of disease states.

Blister fluid inside radiation treatment fields has been shown to have altered expression of cytokines and products of collagen metabolism.

Evaluation of blister fluid in normal skin inside and outside the radiation field may allow the development of a minimally invasive marker of radiation exposure or damage induced by radiation in irradiated skin.

OBJECTIVES

This protocol will evaluate the ability to determine a cytokine pattern and global changes at the protein level measured in blister fluid that correlates with radiation exposure, absorbed skin dose, or skin toxicity from patients receiving radiation.

ELIGIBILITY

Patients in whom radiotherapy is required for standard management of theirbreast or prostate cancer.

Healthy volunteers with no history of cutaneous inflammatory condition of the skin such as eczema, or psoriasis.

DESIGN

This protocol is designed to evaluate blister fluid in and out of the radiation field in patients that are receiving radiation therapy and in healthy volunteers.

Patients will undergo blister induction and blister fluid collection prior to treatment outside of the radiation field, and after completion of radiation within the radiation field.

Blisters will be induced in a non-sun exposed area and if possible in matched sites (i.e. left and right).

• ELIGIBILITY CRITERIA

ELIGIBILITY CRITERIA FOR PATIENTS RECEIVING RADIOTHERAPY:

Inclusion criteria

• Histological diagnosis: Pathologically confirmed diagnosis of 1) invasive breast cancer, 2) ductal carcinoma in situ, or 3) adenocarcinoma of the prostate.
• Patients in whom the management of the histologic diagnosis will include radiation treatment as part of standard clinical management.
• Patients in whom the extent of disease is considered local or locoregional (i.e. requiring definitive radiotherapy to the breast or prostate).
• Patients must be older than 18 years of age.
• Patients must have a primary medical or surgical oncologist in the community or at NCI who is willing to collaborate with the ROB staff in the clinical management of the patient.
• Patients of childbearing or child- fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while they are being treated with radiotherapy on this study.
• Patients must have an ECOG performance status of 0-2 and a life expectancy greater than 12 months.

Exclusion criteria

• Patients with a history of chronic skin disease such as psoriasis, eczema, or history of keloid formation.
• Patients requiring concurrent use of topical steroids
• Patients requiring concurrent use of glucocorticoid therapy.
• Patients who have received topical or systemic chemotherapy within 4 weeks of enrollment (not including hormonal agents such as antiandrogens, GnRH agonists, aromatase inhibitors, tamoxifen, and similar agents) are excluded.
• Patients requiring concurrent chemotherapy with radiotherapy except as noted in (Protocol section 2.3.1) are excluded.
• Patients with a history of lupus erythematosis, scleroderma, ataxia telengiectasia or other known hypersensitivity to therapeutic radiation.
• Patients with prior radiotherapy to the site which would be used for blister induction.
• Patients who are pregnant because of the potential mutagenic effects of radiation on a developing fetus or newborn.
• Patients with unrelated systemic illness which in the judgment of the Principal Investigator (PI) would compromise the patient s ability to tolerate this therapy or are likely to interfere with the study procedures or results.
• Patients who are in the estimation of the PI, deemed unable or unlikely to adhere to protocol treatment.
• Patients with significant skin atrophy that would interfere with blister formation.
• Breast cancer patients in whom the site of radiotherapy includes a myocutaneous flap or skin graft.

ELIGIBILITY CRITERIA FOR HEALTHY VOLUNTEERS:

Inclusion criteria

• Healthy volunteers older than 18 years of age.
• Ability to provide informed consent.

Exclusion criteria

• History of chronic skin disease such as psoriasis, eczema, or history of keloid formation.
• Concurrent use of glucocorticoid therapy.
• History of lupus erythematosis, scleroderma, ataxia telengiectasia or other known hypersensitivity to therapeutic radiation.
• Prior radiotherapy to the site which would be used for blister induction (for benign or malignant causes).
• Unrelated systemic illness which in the judgment of the Principal Investigator (PI) would compromise the patient s ability to tolerate blister induction or are likely to interfere with blister healing, the study procedures, or the study results.
• Darkly pigmented skin in whom pigmentation changes are a likely complication
• Significant skin atrophy that would interfere with blister formation.