Information and Resources from the U-M Comprehensive Cancer Center

Research Roundup

Depression Drug May Relieve Pain From Breast Cancer Treatment, Study Finds

A drug commonly used to treat depression and anxiety disorder was effective at reducing joint and muscle pain associated with a breast cancer treatment, according to a study from the University of Michigan Comprehensive Cancer Center. The study was presented recently at the 33rd Annual San Antonio Breast Cancer Symposium.

The women in the study were taking aromatase inhibitors, a type of drug designed to block the production of estrogen, which fuels some breast cancers. About half of women taking these drugs experience aches and pains in their joints and muscles that cannot be adequately relieved by over-the-counter painkillers. Up to 20% of these women will stop taking an aromatase inhibitor because of this pain.

"Since women typically take these drugs for five years, it is important that the side effects not interfere too much with their quality of life, or they will be less likely to continue taking the medicine, which may lead to a greater chance of their breast cancer returning," said study author N. Lynn Henry, M.D., Ph.D., assistant professor of internal medicine at the U-M Medical School.

The study looked at the drug duloxetine, or Cymbalta, which is used to treat depression and generalized anxiety disorder. It's also been shown to work for other chronic pain conditions, such as fibromyalgia and osteoarthritis. It is believed to decrease pain through its actions on the central nervous system.

Of 29 patients evaluated, nearly three-quarters reported that their pain had decreased by at least 30%. On average, after eight weeks of treatment, pain scores declined 61 percent. Only one in five patients stopped taking duloxetine because of side effects.

"Duloxetine appears to be effective at reducing the muscle and joint pain many women experience from aromatase inhibitors, with only mild additional side effects," Henry said.

The researchers are planning a randomized, controlled trial comparing duloxetine to placebo. Henry is also doing research looking at the effect of aromatase inhibitors on pain perception to better understand why women develop pain.

U-M Study Links Vitamin D to Lung Cancer Survival

Recent research suggests vitamin D may be able to stop or prevent cancer. Now, a new study finds that an enzyme that plays a role in metabolizing vitamin D can predict lung cancer survival. The study, published by University of Michigan Comprehensive Cancer Center researchers in the journal Clinical Cancer Research, suggests that this enzyme stops the anti-cancer effects of vitamin D.

Levels of the enzyme, called CYP24A1, were elevated as much as 50 times in lung adenocarcinoma compared with normal lung tissue. The higher the level of CYP24A1, the more likely tumors were to be aggressive. About a third of lung cancer patients had high levels of the enzyme. After five years, those patients had nearly half the survival rate as patients with low levels of the enzyme.

Researchers then linked this to how CYP24A1 interacts with calcitriol, the active form of vitamin D. CYP24A1 breaks down calcitriol, which has a normal and crucial role when kept in check. But when levels of CYP24A1 climb, the enzyme begins to hinder the positive anticancer effects of vitamin D.

Previous studies have linked low levels of vitamin D to a higher incidence of cancer and worse survival. Researchers are looking at using vitamin D to help prevent lung cancer from returning and spreading after surgery. This new study suggests the possibility of using CYP24A1 levels to personalize this approach to those likely to benefit most.

"Half of lung cancers will recur after surgery, so it's important to find a way to prevent or delay this recurrence. A natural compound like vitamin D is attractive because it has few side effects, but it's even better if we can determine exactly who would benefit from receiving vitamin D," says study author Nithya Ramnath, M.D., associate professor of internal medicine at the U-M Medical School.

Researchers also are working to identify drugs that block CYP24A1. Blocking the enzyme would reinstate the positive anti-cancer effects of vitamin D, suggesting that this inhibitor could potentially be combined with vitamin D treatments.

Vitamin D research continues, but in the meantime, Cancer Center care providers do not recommend exceeding the current recommended dose of 600-800 IU of vitamin D daily.

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