Breast Cancer
Conditions
Brief summary
Four in 10 women diagnosed with breast cancer undergo mastectomy with or without breast reconstruction and less than half are satisfied with how they look unclothed. Breast conservation (removing the area with the lump only) can offer less extensive surgery and improved breast appearance, which can therefore increase well-being. Intensity-modulated radiotherapy (IMRT) closely shapes the radiation beam to the cancer and is currently given after breast surgery. A new combination of IMRT followed by hormone treatment given before surgery, may increase the possibility of breast conservation.
Interventions
Simultaneous integrated boost technique using IMRT: 48 Gray (Gy) and 40 Gy will treat tumour and breast tissue respectively, in 15 fractions over 3 weeks.
DRUGEndocrine therapy
Endocrine therapy will commence following completion of radiotherapy, and will continue for 20 weeks.
PROCEDUREBreast conserving surgery
Surgery carried out using local protocol following completion of endocrine therapy.
Sponsors
Breast Cancer Now
CRUK Cambridge Institute
CCTU- Cancer Theme
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Written informed consent to participate * Female * Aged 18 years and older * ECOG performance status 0-2 * Histology confirmed invasive breast cancer * ER positive (Allred score 6-8) * HER2 negative * Palpable size ≥20mm * Grade I-II (or grade III if considered not suitable for neo-adjuvant chemotherapy) * Considered that radiotherapy will make breast conserving surgery easier * No evidence of non-breast malignancy if treated with curative intent unless the patient has been disease free ≥5 years * Unifocal or multifocal disease, i.e. tumour in the same quadrant and breast conserving surgery still feasible
Exclusion criteria
* Contraindications to breast radiotherapy or neo-adjuvant endocrine therapy * Bilateral breast cancer * Metastatic cancer * Multicentric disease * Concomitant medical/psychiatric problems preventing completion of study treatment or follow-up * Pregnancy * Breast feeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The proportion of patients successfully completing neo-adjuvant IMRT and endocrine treatment followed by beast surgery, as per study protocol. | 6 months | Successful completion of IMRT is defined as: * Treatment received was either 48 Gy/15# or 40 Gy/15# with sequential boost * Treatment received was 'other', but the reason for different schedule was not due to toxicity related from the radiotherapy * Radiotherapy treatment was not delayed by 5 days or more * Radiotherapy treatment was delayed by 5 days or more, but the reason was not due to toxicity related from the radiotherapy Successful completion of endocrine treatment is defined as: * Patient received at least 80% of endocrine treatment received * Patient did not receive 80% of endocrine treatment, but the reason was not due to toxicity or toxicity related from radiotherapy or endocrine Successful surgery is defined as: * Planned date of surgery is not delayed * Planned date of surgery is delayed, but the reason was not due to toxicity or toxicity related to radiotherapy or endocrine treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Acute radiotherapy toxicity following IMRT, assessed by CTCAE v4.03 | 3 weeks | Acute radiotherapy toxicity following IMRT, assessed by CTCAE v4.03 |
| Mastectomy rate | 6 months | Analysis will be descriptive, and in accordance to the statistical analysis plan. |
| Peri/post operative complications | 9 months | Including: * Length of stay * Unplanned return to theatre (and reason) * Use of antibiotics for wound related issues * Number of clinic attendances for wound related problems |
| Late normal tissue toxicity, as assessed by: 1) clinicians | Annually for 5 years | Clinician - post-radiotherapy questionnaire (with permission from IMPORT Trial Management Group and Dr Penny Hopwood) |
| Late normal tissue toxicity, as assessed by: 2) Patient Reported Outcome Measurements (PROMs) | Annually for 5 years | Patient Reported Outcome Measure - Validated Breast-Q questionnaire |
| Volume of residual tumour and response to treatment | 6 months | There will be a central review (2 readers) of all primary surgery histopathology reports for the secondary endpoint of pathological complete response (pCR). The histopathology slides from the surgical resection will be requested for central assessment of residual disease for all cases where there has not been a pCR. The variables that will be recorded include residual invasive tumour size in two dimensions, residual invasive tumour cellularity, number of lymph node metastases and size of the largest metastasis. A representative tumour tissue block will be selected and requested from the laboratory. Sections from the block will be taken for staining with ER and Ki67 to allow calculation of the histological assessment of residual tumour burden, and cores taken as per the protocol. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Exploratory research will be carried out to identify possible molecular and radiological biomarkers of response | 6 months post last patient recruited | Exploratory investigation of potential biomarkers include: * ctDNA, * PBMCs, * Tumour molecular profiles, * Immunohistochemical/immunofluorescence markers of: Immune response (TILs) Tumour proliferation (Ki67, Geminin) DNA damage response and cell cycle checkpoint activation (including 53BP1, RAD51, ATM1, BRCA1, p53, p21 and p-chk-1) Tumour microenvironment (hypoxia) \- Multiplexed single cell proteomics of both cellular suspensions (including whole blood) and intact tissues, to investigate the immune response and other novel markers Since the identification of new biomarkers correlating with disease activity and the efficacy or safety of treatment is rapidly evolving, the definitive list of biomarkers remains to be determined. However they will be detailed in an appropriate analysis plan prior to undertaking any sample analysis. |
Countries
United Kingdom
Contacts
Primary ContactVictoria Ingleson, BSc
Backup ContactAnne-Laure Vallier
Outcome results
None listed