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Topical Sirolimus in Patients With Basal Cell Nevus Syndrome and in Healthy Participants

This study has been completed.
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Yale University Identifier:
First received: February 8, 2007
Last updated: September 21, 2016
Last verified: September 2016

RATIONALE: Studying samples of blood and tissue from patients with basal cell nevus syndrome and from healthy participants in the laboratory may help doctors learn more about changes that may occur in DNA and identify biomarkers related to basal cell nevus syndrome. Chemoprevention is the use of certain drugs to keep cancer from forming, growing, or coming back. The use of sirolimus may keep basal cell skin cancer from forming in patients with basal cell nevus syndrome.

PURPOSE: This phase I trial is studying topical sirolimus in patients with basal cell nevus syndrome and in healthy participants.

Condition Intervention Phase
Neoplastic Syndrome
Non-melanomatous Skin Cancer
Drug: sirolimus
Genetic: comparative genomic hybridization
Genetic: gene expression analysis
Genetic: microarray analysis
Genetic: protein expression analysis
Genetic: proteomic profiling
Other: laboratory biomarker analysis
Other: mass spectrometry
Procedure: biopsy
Phase 1

Study Type: Interventional
Study Design: Masking: Open Label
Primary Purpose: Prevention
Official Title: In Vivo and In Vitro Pharmacology of Sirolimus in Subjects With Basal Cell Nevus Syndrome

Resource links provided by NLM:

Further study details as provided by Yale University:

Primary Outcome Measures:
  • Alterations in RNA as measured by microarray analysis [ Designated as safety issue: No ]
  • Alterations in protein expression as measured by 2-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight mass spectroscopy [ Designated as safety issue: No ]

Estimated Enrollment: 16
Study Completion Date: March 2008
Primary Completion Date: March 2008 (Final data collection date for primary outcome measure)
Detailed Description:



  • Compare messenger RNA and protein expression patterns in patients with basal cell nevus syndrome (BCNS) vs in cultured cells of healthy participants (control) before treatment to identify a set of genes that are differentially expressed in BCNS.
  • Assess the effects of topical sirolimus on gene expression (genes identified in the primary objective) in vivo using keratinocytes, fibroblasts, and lymphocytes from patients with BCNS and from healthy participants (controls) by targeted expression methods.

OUTLINE: Patients and healthy participants receive topical sirolimus ointment twice daily for 12 weeks.

Blood and skin biopsies are obtained at baseline and at week 12 for gene and protein expression studies. Alterations in RNA are measured by microarray analysis. Alterations in protein expression are measured by 2-dimensional gel electrophoresis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

After completion of study therapy, patients and healthy participants are followed at 4 weeks.

PROJECTED ACCRUAL: A total of 16 patients and healthy participants will be accrued for this study.


Ages Eligible for Study:   18 Years to 120 Years   (Adult, Senior)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes


  • Patient

    • Confirmed diagnosis of basal cell nevus syndrome (BCNS)
    • Known patched (PTCH) gene mutation

      • Must have full sequence of coding exons with intron/exon junctions in the PTCH gene OR prior genetic testing confirming PTCH mutation by the Yale University DNA Diagnostics Laboratory
  • Age- and sex-matched healthy participant (control)

    • Unaffected relative of patient OR normal healthy volunteer with no family history of BCNS or features of BCNS

      • No unrelated healthy participant meeting any of the following clinical criteria for BCNS:

        • Lamellar calcification of the falx cerebri
        • Prior odontogenic keratocyst or any jaw cyst for which a histopathologic diagnosis cannot be ascertained
        • Palmar or plantar pits typical of BCNS
        • More than 3 basal cell carcinomas (BCC) in a lifetime or 1 BCC under the age of 30
        • History of medulloblastoma
      • No unrelated healthy participant with 2 or more of the following features:

        • History of ovarian or cardiac fibroma
        • Mesenteric or pleural cysts
        • Polydactyly
        • Macrocephaly determined after adjustment for height
        • Craniofacial features of BCNS, including cleft palate, frontal bossing, hypertelorism, iris coloboma or other developmental defects of the eye, or coarse facies
        • Vertebral anomalies, including spina bifida occulta outside the lumbar region
        • Bifid or splayed ribs
        • Other radiographic findings, including bridging of the sella turcica, nonlamellar calcification of the falx cerebri, or flame-shaped lucencies in the phalanges = 1-3 BCCs over the age of 30


  • WBC ≥ 4,000/mm³
  • Neutrophil count ≥ 2,000/mm³
  • Platelet count ≥ 150,000/mm³
  • Hemoglobin ≥ 11.5 g/dL
  • Bilirubin 0.3-1.0 mg/dL
  • AST 17-59 U/L
  • PTT 10-13 seconds OR INR 1.0-1.4
  • Creatinine clearance > 50 mL/min
  • Cholesterol < 350 mg/dL
  • Triglycerides < 400 mg/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile participants must use effective contraception for ≥ 1 month before, during, and for ≥ 12 weeks after study treatment
  • No active infection
  • No alcohol or drug abuse
  • No psychiatric disorder or mental deficiency that would preclude study compliance
  • No uncontrolled hypertension (i.e., blood pressure > 140/90 mm Hg on > 2 measurements)
  • No chronic active infection requiring treatment
  • No untreated reactive purified protein derivative of tuberculin (PPD)
  • No HIV-1 infection
  • No infection requiring antibiotics within the past 30 days
  • No other skin disease affecting broad areas of the body, including the region to be treated and biopsied
  • No known hepatitis B or C infection (detectable RNA off antiviral therapy)
  • No immune deficiency disorder
  • No known hypersensitivity to sirolimus or macrolide antibiotics (e.g., erythromycin, azithromycin, or clarithromycin)
  • No cancer within the past 5 years except basal cell skin cancer


  • At least 1 month since prior investigational drugs
  • No concurrent dietary supplements, including Hypericum perforatum (St. John's wort) or megadose vitamins
  • No other concurrent immunosuppressive medications, including corticosteroids
  • No concurrent medications known to interfere with sirolimus metabolism
  • No concurrent anticoagulants
  • No concurrent acetylsalicyclic acid or other drugs affecting platelet function or number
  • No routine (i.e., > 2 doses/week) use of nonsteroidal anti-inflammatory drugs
  • No drugs or substances that would effect sirolimus blood concentrations, including any of the following:

    • Nicardipine
    • Verapamil
    • Clotrimazole
    • Fluconazole
    • Itraconazole
    • Troleandomycin
    • Cisapride
    • Metoclopramide
    • Clarithromycin
    • Erythromycin
    • Bromocriptine
    • Cimetidine
    • Danazol
    • HIV-protease inhibitors (e.g., ritonavir or indinavir)
    • Phenobarbital
    • Carbamazepine
    • Phenytoin
    • Rifabutin
    • Rifapentine
    • Grapefruit juice
    • Vaccinations (especially live vaccines)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00433485

Sponsors and Collaborators
Yale University
National Cancer Institute (NCI)
Principal Investigator: Allen E. Bale, MD Yale University
  More Information

Responsible Party: Yale University Identifier: NCT00433485     History of Changes
Other Study ID Numbers: CDR0000522464  YALE-HIC-26866 
Study First Received: February 8, 2007
Last Updated: September 21, 2016
Health Authority: United States: Federal Government

Keywords provided by Yale University:
basal cell carcinoma of the skin
nevoid basal cell carcinoma syndrome

Additional relevant MeSH terms:
Skin Neoplasms
Basal Cell Nevus Syndrome
Pathologic Processes
Neoplasms by Site
Skin Diseases
Odontogenic Cysts
Jaw Cysts
Bone Cysts
Carcinoma, Basal Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms, Basal Cell
Neoplastic Syndromes, Hereditary
Bone Diseases, Developmental
Bone Diseases
Musculoskeletal Diseases
Jaw Diseases
Stomatognathic Diseases
Abnormalities, Multiple
Congenital Abnormalities
Genetic Diseases, Inborn
Anti-Bacterial Agents
Anti-Infective Agents processed this record on October 21, 2016