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Ductal Breast Carcinoma in SituNCT01293032

Hormone Therapy Or Chemotherapy Before Surgery Based on Gene Expression Analysis in Treating Patients With Breast Cancer

A study testing Neoadjuvant Therapy, Therapeutic Conventional Surgery and Laboratory Biomarker Analysis in people with Ductal Breast Carcinoma in Situ and Lobular Breast Carcinoma in Situ, run by Virginia Commonwealth University at 8 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This randomized pilot clinical trial studied whether the Oncotype DX gene expression "Recurrence Score" (RS) would be useful for helping make a decision about which type of pre-operative treatment, hormone therapy or chemotherapy would be a better for patients with hormone responsive cancers that were not suitable for… Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Neoadjuvant Therapy, Therapeutic Conventional Surgery and Laboratory Biomarker Analysis
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
59 participants
Where
8 sitesin 2 countries
Study dates
Apr 2011to Mar 2016
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • The treating surgeon must determine that breast conservation therapy (BCT) would be made more feasible by reducing tumor size using neoadjuvant systemic therapy
  • The patient must have signed and dated an institutional review board (IRB) approved consent form that conforms to federal and institutional guidelines
  • The patient must be female
  • The patient must be greater than or equal to 18 years old
  • The patient must have an Eastern Cooperative Oncology Group Score (ECOG) performance status of 0 or 1
  • The diagnosis of invasive carcinoma of the breast must have been made by core needle biopsy
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  • The primary breast tumor must be >= 2 cm by physical exam or imaging
  • Ipsilateral axillary lymph nodes must be evaluated by imaging (MRI or ultrasound) within 6 weeks prior to randomization; If indicated for abnormal lymph nodes, fine needle aspirate (FNA) or core biopsy must be performed.
  • The tumor must have been determined to be HER2-negative as follows:
  • Fluorescent in situ hybridization (FISH)-negative (defined by ratio of HER2 to Chromosome 17 centromere (CEP17) must be < 2.2) or, if a ratio was not performed, the HER2 gene copy number must be < 4 per nucleus; or
  • Chromogenic in situ hybridization (CISH) is performed, the result must indicate a HER2 gene copy number of < 6 per nucleus; or
  • Immunohistochemistry (IHC) 0-1+; or
  • IHC 2+ and FISH-negative or CISH-negative
  • The tumor must have been determined to be ER+ and/or progesterone positive (PgR+) defined as > 10% tumor staining by immunohistochemistry
  • The patient must have been evaluated by a treating physician, reviewed and discussed by the multi-disciplinary breast team, and considered to be a candidate for chemotherapy

Who cannot join

  • FNA alone to diagnose the primary tumor
  • Excisional biopsy or lumpectomy performed prior to randomization
  • Surgical axillary staging procedure or sentinel node (SN) biopsy performed prior to registration
  • Tumors clinically staged as including inflammatory breast cancer
  • Ipsilateral cN2b or cN3 disease (patients with cN1 or cN2a disease are eligible)
  • Definitive clinical or radiologic evidence of metastatic disease (Note: chest imaging [mandatory for all patients] and other imaging [if required] must have been performed within 6 weeks prior to randomization)
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  • Synchronous or metachronous contralateral invasive breast cancer; (patients with synchronous and/or metachronous contralateral ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) are eligible)
  • HER2 test result of IHC 3+, regardless of FISH results, if performed
  • Any history of ipsilateral invasive breast cancer or ipsilateral DCIS if treated with radiation therapy (RT); (patients with synchronous or metachronous ipsilateral LCIS are eligible)
  • History of non-breast malignancies, except for in situ cancers treated only by local excision and basal cell and squamous cell carcinomas of the skin, within 5 years prior to randomization
  • Treatment including RT, chemotherapy, and/or targeted therapy for the currently diagnosed breast cancer prior to registration
  • Cardiac disease (history of and/or active disease) that would preclude the use of chemotherapy
  • Pregnancy or lactation at the time of randomization; (Note: pregnancy testing must be performed within 2 weeks prior to randomization for women of childbearing potential)
  • Other non-malignant systemic disease that would preclude the patient from receiving study treatment or would prevent required follow-up
  • Psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements
  • Use of any investigational product within 30 days prior to registration

Trial locations and contacts

8 sites in 2 countries.

8 sites in 2 countries

United States7 sites
  • Carolinas Medical Center

    Charlotte, North Carolina, 28203

  • Forsyth Regional Cancer Center

    Charlotte, North Carolina, 28204

  • Cone Health Cancer Center

    Greensboro, North Carolina, 27403

  • Methodist Cancer Center

    Houston, Texas, 77030

  • Lynchburg Hematology Oncology Clinic, Inc

    Lynchburg, Virginia, 24501

  • Virginia Commonwealth University

    Richmond, Virginia, 23298

  • Washington Cancer Institute

    Washington D.C., District of Columbia, 20010

Other trials in United States

Canada1 site
  • Centre Hospitalier de l'Université de Montréal , Hôtel-Dieu Hospital

    Montreal, Quebec, H2W 1T8

Other trials in Canada

About this study

Official title: Choosing Neoadjuvant Chemotherapy Versus Hormonal Therapy for Breast Cancer Based on Gene Expression Profile

This randomized pilot clinical trial studied whether the Oncotype DX gene expression "Recurrence Score" (RS) would be useful for helping make a decision about which type of pre-operative treatment, hormone therapy or chemotherapy would be a better for patients with hormone responsive cancers that were not suitable for breast conserving surgery. The RS is currently used to predict the risk of distant recurrence and the benefit of the addition of chemotherapy to hormonal therapy in the adjuvant setting.

Read the detailed description

Assessed the feasibility of carrying out a large-scale multi-center trial in which recurrence score (RS) was used to select treatment type in the neoadjuvant setting. Whether patients with intermediate RS were willing to be randomized between hormonal and chemotherapy.

The treatment received was not experimental and considered standard treatment for the type of cancer the participants had. What was experimental included the way in which they were assigned to a type of treatment. The design of this study was used to help determine if RS can be used to predict which type of treatment women with breast cancer are most likely to benefit from.

OUTLINE: Patients are assigned to 1 of 3 groups based on RS following Oncotype Dx gene expression profiling.

  • GROUP 1 (RS < 11): Patients receive neoadjuvant hormonal therapy comprising tamoxifen (pre-menopausal women) or an aromatase inhibitor (post-menopausal women) for 4-6 months in the absence of disease progression or unacceptable toxicity.
  • GROUP 2 (RS 11-25): Patients are randomized to 1 of 2 treatment arms:
  • ARM 1: Patients receive neoadjuvant hormonal therapy as in group I.
  • ARM 2: Patients receive 6-8 courses of neoadjuvant chemotherapy comprising an anthracycline/taxane based regimen over 4-6 months in the absence of disease progression or unacceptable toxicity.
  • GROUP 3 (RS > 25): Patients receive neoadjuvant chemotherapy as in group 2 arm 2.

All patients undergo surgery and receive hormonal therapy for at least 5 years.

After completion of study treatment, patients are followed up periodically.

Being tested
Neoadjuvant Therapy, Therapeutic Conventional Surgery, Laboratory Biomarker Analysis, Gene Expression Analysis, Systemic Chemotherapy
Keywords
Estrogen Receptor Positive, Progesterone Receptor Positive, HER2/Neu Negative, Breast Cancer
Medical subject headings
Carcinoma, Intraductal, Noninfiltrating, Breast Carcinoma In Situ, Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Neoadjuvant TherapyProcedure or surgery

    Also called Induction Therapy, Neoadjuvant, Preoperative Therapy

    Undergo neoadjuvant therapy

  • Therapeutic Conventional SurgeryProcedure or surgery

    Undergo therapeutic conventional surgery

  • Laboratory Biomarker AnalysisOther

    Also called Correlative studies

    Correlative studies

  • Gene Expression AnalysisGenetic

    Undergo Oncotype Dx gene expression profiling. The Oncotype DX gene expression profiling system will be used to calculate a "Recurrence Score" (RS).

  • Systemic ChemotherapyDrug

    Undergo chemotherapy

  • Tamoxifen CitrateDrug

    Also called Nolvadex, TAM, tamoxifen, TMX

    Undergo hormonal therapy

  • Aromatase Inhibition TherapyDrug

    Also called Inhibition therapy, aromatase, Aromatase Inhibition, hormonal therapy

    Undergo hormonal therapy

Study groups in NCT01293032
Study groupRoleWhat they receive
Group 1 (RS < 11)ExperimentalPatients with a Recurrence Score (RS) less than 11 (RS <11) are assigned to Group 1, neoadjuvant hormonal therapy either tamoxifen (pre-menopausal women) or an aromatase inhibitor (post-menopausal women) for 4-6 months in the absence of disease progression or unacceptable toxicity. Treatment: * Neoadjuvant therapy * Therapeutic conventional surgery * Laboratory biomarker analysis/Correlative studies * Gene Expression Analysis/ Oncotype DX Gene Expression Profiling System * Hormonal therapy: * Tamoxifen Citrate (pre-menopausal women) OR * Aromatase Inhibition Therapy (post-menopausal women)
Receives: Procedure: Neoadjuvant Therapy; Procedure: Therapeutic Conventional Surgery; Other: Laboratory Biomarker Analysis; Genetic: Gene Expression Analysis; Drug: Tamoxifen Citrate; Drug: Aromatase Inhibition Therapy
Group 2 Arm 1 (RS 11-25)ExperimentalPatients with an intermediate RS (11-25) assigned to Group 2. Randomized to Arm 1, neoadjuvant hormonal therapy as in Group 1. Treatment: * Neoadjuvant therapy * Therapeutic conventional surgery * Laboratory biomarker analysis/Correlative studies * Gene Expression Analysis/ Oncotype DX Gene Expression Profiling System * Hormonal therapy: * Tamoxifen Citrate (pre-menopausal women) OR * Aromatase Inhibition Therapy (post-menopausal women)
Receives: Procedure: Neoadjuvant Therapy; Procedure: Therapeutic Conventional Surgery; Other: Laboratory Biomarker Analysis; Genetic: Gene Expression Analysis; Drug: Tamoxifen Citrate; Drug: Aromatase Inhibition Therapy
Group 2 Arm 2 (RS 11-25)ExperimentalPatients with an intermediate RS(11-25) assigned to Group 2. Randomized to Arm 2, neoadjuvant chemotherapy 6-8 courses of anthracycline/taxane based regimen over 4-6 months in the absence of disease progression or unacceptable toxicity. Treatment: * Neoadjuvant therapy * Therapeutic conventional surgery * Laboratory biomarker analysis/Correlative studies * Gene Expression Analysis/Oncotype DX Gene Expression Profiling System * Systemic chemotherapy
Receives: Procedure: Neoadjuvant Therapy; Procedure: Therapeutic Conventional Surgery; Other: Laboratory Biomarker Analysis; Genetic: Gene Expression Analysis; Drug: Systemic Chemotherapy
Group 3 (RS > 25)ExperimentalPatients with a high RS (> 25) assigned to Group 3, neoadjuvant chemotherapy as in Group 2 Arm 2. Treatment: * Neoadjuvant therapy * Therapeutic conventional surgery * Laboratory biomarker analysis/Correlative studies * Gene Expression Analysis/Oncotype DX Gene Expression Profiling System * Systemic chemotherapy
Receives: Procedure: Neoadjuvant Therapy; Procedure: Therapeutic Conventional Surgery; Other: Laboratory Biomarker Analysis; Genetic: Gene Expression Analysis; Drug: Systemic Chemotherapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The Proportion of Patients With RS 11-25 Who Refused the Assigned Treatment

    The primary purpose of this trial is to determine the feasibility of carrying out a large multi-center trial with a similar design. Feasibility, in terms of less than 1/3 of patients with intermediate (11-25) Recurrence Score (RS) who refused the assigned treatment (Group 2) or refused randomization between hormonal (Arm 1) or chemotherapy (Arm 2). The confidence interval will be 95%. The proportion (and 95% confidence interval) of patients with RS 11-25 who refuse the assigned treatment will be calculated.

    Measured: Up to 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Feb 2011 (estimated)
  2. Study startApr 2011
  3. Primary completionMay 2015
  4. Study completionMar 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
59 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01293032
Sponsor's protocol ID
MCC-13311
Other IDs
NCI-2010-02342, P30CA016059
Status last verified
Jun 2016
First submitted
7 Feb 2011
Last updated
12 Jul 2016
Data monitoring committee
Yes
Individual data sharing
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Neoadjuvant Therapy, Therapeutic Conventional Surgery and Laboratory Biomarker Analysis in people with Ductal Breast Carcinoma in Situ and Lobular Breast Carcinoma in Situ, run by Virginia Commonwealth University at 8 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Jul 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 12 Jul 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The Proportion of Patients With RS 11-25 Who Refused the Assigned Treatment (time frame: Up to 2 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jul 2016; AzTrials last refreshed its copy on 30 Oct 2026.

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