Breast Cancer
Conditions
Keywords
neoadjuvant endocrine
Brief summary
The purpose of this study is to monitor the change in cancer size in women with breast cancer on anti-hormone treatment using different types of assessment including ultrasound scan (US), shearwave elastography (SWE) and magnetic resonance imaging (MRI), and assess how this corresponds to the changes in the cancer biology.
Detailed description
Background Endocrine resistance is a significant problem in the management of breast cancer, with increasing evidence that the tumour microenvironment is influential on tumour growth and disease resistance. The neoadjuvant setting provides an excellent opportunity to observe tumour response to treatment in vivo, allowing development of methods for monitoring and predicting response to treatment. Aims To assess potential radiological and biological tumoural and peri-tumoural biomarkers in patients before and during neoadjuvant endocrine treatment. Our hypothesis is that there will be less response in women with abnormal peri-tumoural stroma, and that tumours with high monocarboxyl transporter (MCT4) and loss of caveolin-1 in stroma are resistant to endocrine treatment. Techniques and Methodology Patients with primary breast cancer receiving neoadjuvant letrozole will undergo radiological assessment with digital mammogram, US including SWE, and MRI. Core biopsies will be taken at diagnosis and at surgery from tumour and peri-tumoural stroma, and assessed for biomarkers lysyl oxidase (LOX), fibronectin, collagen, proliferation, MCT4 and caveolin-1. All data will be correlated to peri-tumoural abnormalities on MRI and SWE. Impact on breast cancer research This study will provide information on the ability of SWE and MRI to predict and detect endocrine resistance, correlated with biological markers that are associated with endocrine resistance. Identifying resistant tumours can prevent unnecessary treatment and reduce risks of recurrence as alternative or additional therapies can be utilised.
Interventions
Patients with primary breast cancer receiving neoadjuvant letrozole will undergo radiological assessment with digital mammogram, ultrasound (US) including shearwave elastography (SWE). These will be performed at 3 monthly intervals until surgical intervention is considered feasible.
DRUGLetrozole
Patients will be receiving neoadjuvant letrozole as standard therapy for breast cancer
PROCEDUREBreast core biopsy
Core biopsies will be taken at diagnosis, and at the time of surgery to allow biological assessment of changes in tumour
OTHERMagnetic Resonance Imaging
Breast MRI scans will be performed at time of diagnosis and prior to surgery to allow comparison of MRI change and response to treatment
Sponsors
NHS Tayside
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Postmenopausal women: Defined as \>12 months amenorrhoea in absence of medical therapy known to induce this; or bilateral oophorectomy; or if last menses \<12 months before starting treatment, FSH \>35 IU/L and LH \>40 IU/L. * ER positive (Allred score \>3) invasive breast cancer * Staging as T1-4, N0-2, M0 * Patient agreed to neoadjuvant endocrine therapy as recommended by MDT * Fresh tissue stored at time of diagnostic core biopsy * Suitable for, and tolerant of MRI scan * Fit for surgical intervention at time of entry into study
Exclusion criteria
* Premenopausal or unable to determine menopausal status * Not fit for surgical intervention due to co-morbidities * Contraindication for MRI (including severe claustrophobia) * Current use of HRT, or HRT use at time of diagnostic core biopsy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Proliferative response | At surgery, min 3 months max 24 months | Pathological response to treatment by proliferation (Ki67) (%) |
| Change in Pathological response | At surgery, min 3 months max 24 months | Residual cancer burden score |
| Change in Shearwave stiffness | 0,3,6, up to 24 months | shearwave stiffness (kPa) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| lysyl oxidase | 0 months and at time of surgery (min 3 months, max 24 months) | peri-tumoural immunohistochemical analysis |
| Change in peritumoural imaging on MRI | 0 months and surgery (min 3 months, max 24 months) | MRI - digital contrast enhanced (DCE) and diffusion weighted imaging (DWI) |
| collagen | 0 months and at time of surgery (min 3 months, max 24 months) | peri-tumoural immunohistochemical analysis |
| fibronectin | 0 months and at time of surgery (min 3 months, max 24 months) | peri-tumoural immunohistochemical analysis |
| caveolin-1 | 0 months and at time of surgery (min 3 months, max 24 months) | peri-tumoural immunohistochemical analysis |
| Monocarboxyl transport 4 | 0 months and at time of surgery (min 3 months, max 24 months) | peri-tumoural immunohistochemical analysis |
Countries
United Kingdom
Outcome results
None listed