Selenium for Prevention of Adenomatous Colorectal Polyps

• ClinicalTrials.gov Identifier: NCT00078897
• Recruitment Status: Terminated
• First Posted: March 9, 2004
• Results First Posted: September 24, 2019
• Last Update Posted: September 24, 2019
• Sponsor: University of Arizona
• Collaborator: National Cancer Institute (NCI)
• Information provided by (Responsible Party): University of Arizona

Study Description

Brief Summary:

RATIONALE: Chemoprevention therapy is the use of certain drugs to try to prevent the development or recurrence of cancer. Selenium may be effective in preventing the recurrence of adenomatous colorectal polyps.

PURPOSE: This randomized phase III trial is studying selenium to see how well it works in preventing the recurrence of polyps in patients with adenomatous colorectal polyps.

Condition or disease	Intervention/treatment	Phase
Colorectal Cancer; Adenomatous Colorectal Polyps; Precancerous Condition	Drug: Selenium	Phase 3

Detailed Description:

OBJECTIVES:

Primary

• Compare the effects of selenium vs placebo on the recurrence of adenomatous colorectal polyps, in terms of histologic type, degree of dysplasia, number, size, and location, in patients with adenomatous colorectal polyps.
• Compare the type, incidence, and outcome of side effects in patients treated with these regimens.
• Determine patient adherence to long-term treatment with these regimens.

Secondary

• Determine the effects of regimen modification by baseline blood selenium level, low-dose aspirin, selenoprotein genetic marker polymorphisms (e.g., GPx-1, GPx-2, and SEP15)
• Determine the effects of low-dose aspirin (81 mg/day) modification by ornithine decarboxylase promoter genotype, and toxicity by slow-metabolizer genotypes of the cytochrome p450 2C9 and UT1A6 loci in these patients.

OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to use of low-dose (≤ 81 mg/day) aspirin (yes vs no). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients receive oral selenium once daily.
• Arm II: Patients receive oral placebo once daily. In both arms, treatment continues for up to 5 years* in the absence of disease progression or unacceptable toxicity.

Patients undergo follow-up colonoscopy approximately 5 years* after baseline colonoscopy.

NOTE: Some patients will continue participation for up to 7 and a half years

PROJECTED ACCRUAL: A total of 1,600 patients with an adenoma will be randomized to this study, followed by a second group of randomization of 200 patients with at least one advanced adenoma (at baseline) for a substudy. Total planned randomizations = 1,800 participants.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 1621 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Prevention
• Official Title: Phase III Study of the Effects of Selenium on Adenomatous Polyp Recurrence
• Actual Study Start Date: January 20, 2005
• Actual Primary Completion Date: January 7, 2014
• Actual Study Completion Date: May 17, 2018

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Selenium; Participants receive oral selenium 200 mcg once daily.	Drug: Selenium; Participants will be randomized either to selenium or placebo, taking the randomized intervention for 3 to 5 years, depending on when their recommended follow up colonoscopy is scheduled.; Other Name: SelenoExcell
Placebo Comparator: Placebo; Participants receive oral placebo once daily.	Drug: Selenium; Participants will be randomized either to selenium or placebo, taking the randomized intervention for 3 to 5 years, depending on when their recommended follow up colonoscopy is scheduled.; Other Name: SelenoExcell

Outcome Measures

Primary Outcome Measures :

1. Number of Recurrent Adenomas at Surveillance Colonoscopy [ Time Frame: 3 to 5 years after baseline colonoscopy ]
   Detection of metachronous colorectal adenomas during follow-up, by treatment, in the original cohort. Surveillance colonoscopy is recommended 3 to 5 years after removal of colorectal adenoma(s). Participants will remain on the study intervention until their surveillance colonoscopy. Surveillance colonoscopy is determined by participants' GI physician.
2. Median Selenium Blood Levels at One Year. [ Time Frame: One year ]
   Adequate adherence to long-term selenium treatment as measured by blood selenium levels (ng/mL) at one year.

Eligibility Criteria

• Ages Eligible for Study: 40 Years to 80 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed colorectal adenomatous polyps

• Meets the following criteria by colonoscopy (performed within the past 6 months):

  • Cecum was totally visualized or reached
  • At least 90% visualization of colon surface area
  • Removed at least 1 adenomatous polyp of at least 3 mm in size during procedure (For the Advanced Adenoma Sub-study: Removal of at least 1 advanced colorectal adenomatous polyp during procedure. An adenoma is considered advanced if it is 10 mm or greater in size, and/or has villous histology and/or shows high grade dysplasia)
  • Removed no more than 10 adenomatous polyps of any size by endoscopy
  • All other neoplastic and non-neoplastic colon polyps must have been completely removed (except for diminutive [less than 3 mm] sessile rectal polyps)
  • For the sub-study, at least 1 advanced adenomatous polyp defined as 10 mm or greater in size and/or has villous histology and/or shows high grade dysplasia

• No prior diagnosis of any of the following:

  • Colorectal cancer
  • Familial adenomatous polyposis
  • Ulcerative colitis
  • Crohn's disease

  • Hereditary non-polyposis colon cancer (HNPCC), defined as:

    • Histologically confirmed colorectal cancer in at least 3 relatives, 1 of whom is a first-degree relative of the other 2
    • Disease occurrence in at least 2 consecutive generations

    • Colorectal cancer diagnosis in at least 1 family member who is less than 50 years of age

      • Patients with a family history of colorectal cancer but who are not diagnosed with HNPCC are allowed
• No more than 1 prior segmental colon resection

PATIENT CHARACTERISTICS:

Age

• 40 to 80

Performance status

• SWOG 0-1

Life expectancy

• Not specified

Hematopoietic

• Hemoglobin > 11 g/dL
• WBC 3,000 - 11,000/mm^3

Hepatic

• AST and ALT < 2 times upper limit of normal
• Bilirubin < 2.0 mg/dL

Renal

• Creatinine < 1.9 mg/dL

Cardiovascular

• No unstable* cardiac disease despite medication (e.g., diuretics or digitalis)
• No uncontrolled hypertension (i.e., systolic blood pressure ≥ 170 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg) despite medication NOTE: *Unstable defined as unable to walk across the room without chest pain or shortness of breath

Other

• Not pregnant or nursing
• Fertile patients must use effective contraception for at least 2 months before and during study treatment
• Resident of a clinical center metropolitan area or obtaining regular health care in a clinical metropolitan area for at least 6 months out of the year
• Must be able to swallow pills
• No unexpected weight loss of 10% or more within the past 6 months
• No prior rheumatoid arthritis

• No poorly controlled diabetes mellitus despite medication, defined as:

  • Blood sugar level ≥ 200 mg/dL on more than half of the readings taken within the past month
• No invasive malignancy within the past 5 years that required medical excision, radiotherapy, or chemotherapy except basal cell or squamous cell carcinoma

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No concurrent drugs that regulate the immune system

Chemotherapy

• No concurrent chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• No concurrent radiotherapy

Surgery

• See Disease Characteristics

Other

• Prior enrollment in another adenoma prevention study allowed
• Concurrent routine aspirin (≤ 81 mg/day) allowed
• No regular use of non-steroidal anti-inflammatory drugs (NSAIDs)
• No concurrent enrollment in another research study using pharmacological cancer drugs, a cyclo-oxygenase-2 inhibitor, or selenium
• No other concurrent selenium unless dosage is ≤ 50 µg/day

Contacts and Locations

Locations

United States, Arizona

Veterans Affairs Medical Center - Phoenix

Phoenix, Arizona, United States, 85012

Virginia G. Piper Cancer Center at Scottsdale Healthcare - Shea

Scottsdale, Arizona, United States, 85258-4512

Mayo Clinic Scottsdale

Scottsdale, Arizona, United States, 85259-5499

Arizona Cancer Center - Tucson Clinic

Tucson, Arizona, United States, 85724-5024

United States, Colorado

University of Colorado Cancer Center at UC Health Sciences Center

Denver, Colorado, United States, 80220

United States, New York

Endoscopy Center of Western New York

Williamsville, New York, United States, 14221

United States, Texas

Baylor University Medical Center - Dallas

Dallas, Texas, United States, 75246

Sponsors and Collaborators

University of Arizona

National Cancer Institute (NCI)

Investigators

• Principal Investigator: M. Peter Lance, MD; University of Arizona

More Information

Additional Information:

Journal Article 

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Trejo MJ, Batai K, Chen Y, Brezina S, Chow HS, Ellis N, Lance P, Hsu CH, Pogreba-Brown K, Bishop M, Gsur A, Jacobs ET. Genome-Wide Association Study of Metachronous Colorectal Adenoma Risk among Participants in the Selenium Trial. Nutr Cancer. 2023;75(1):143-153. doi: 10.1080/01635581.2022.2096910. Epub 2022 Jul 9.

Jacobs ET, Lance P, Mandarino LJ, Ellis NA, Chow HS, Foote J, Martinez JA, Hsu CP, Batai K, Saboda K, Thompson PA. Selenium supplementation and insulin resistance in a randomized, clinical trial. BMJ Open Diabetes Res Care. 2019 Feb 7;7(1):e000613. doi: 10.1136/bmjdrc-2018-000613. eCollection 2019.

Thompson P, Roe DJ, Fales L, Buckmeier J, Wang F, Hamilton SR, Bhattacharyya A, Green S, Hsu CH, Chow HH, Ahnen DJ, Boland CR, Heigh RI, Fay DE, Martinez ME, Jacobs E, Ashbeck EL, Alberts DS, Lance P. Design and baseline characteristics of participants in a phase III randomized trial of celecoxib and selenium for colorectal adenoma prevention. Cancer Prev Res (Phila). 2012 Dec;5(12):1381-93. doi: 10.1158/1940-6207.CAPR-12-0204. Epub 2012 Oct 11.

Solomon SD, Wittes J, Finn PV, Fowler R, Viner J, Bertagnolli MM, Arber N, Levin B, Meinert CL, Martin B, Pater JL, Goss PE, Lance P, Obara S, Chew EY, Kim J, Arndt G, Hawk E; Cross Trial Safety Assessment Group. Cardiovascular risk of celecoxib in 6 randomized placebo-controlled trials: the cross trial safety analysis. Circulation. 2008 Apr 22;117(16):2104-13. doi: 10.1161/CIRCULATIONAHA.108.764530. Epub 2008 Mar 31.

• Responsible Party: University of Arizona
• ClinicalTrials.gov Identifier: NCT00078897
• Other Study ID Numbers: CDR0000353185; P30CA023074 ( U.S. NIH Grant/Contract ); P01CA041108 ( U.S. NIH Grant/Contract )
• First Posted: March 9, 2004
• Results First Posted: September 24, 2019
• Last Update Posted: September 24, 2019
• Last Verified: September 2019

Keywords provided by University of Arizona:

colon cancer; rectal cancer; colorectal cancer; adenomatous polyp

Additional relevant MeSH terms:

Colorectal Neoplasms; Precancerous Conditions; Adenomatous Polyps; Polyps; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases; Pathological Conditions, Anatomical; Adenoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Selenium; Antioxidants; Molecular Mechanisms of Pharmacological Action; Protective Agents; Physiological Effects of Drugs; Trace Elements; Micronutrients