Preoperative Radiotherapy + Mastectomy for Breast Cancer

Recruiting in Palo Alto (17 mi)

+6 other locations

Overseen by Audree Tadros, MD

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Recruiting

Sponsor: Memorial Sloan Kettering Cancer Center

Disqualifiers: Prior breast cancer, Pregnant, Stage IV, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial tests a new treatment for people with advanced breast cancer. It uses radiation to shrink the tumor before surgery and then rebuilds the breast using tissue from another part of the body. The goal is to see if this approach is safe and practical compared to standard treatments.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Preoperative Radiotherapy + Mastectomy for Breast Cancer?

Research suggests that preoperative radiotherapy, when combined with surgery, can help improve control and survival rates in breast cancer patients. Advances in radiotherapy techniques have made it more precise and effective, potentially increasing disease-free and overall survival rates when used before surgery. ^{1 2 3 4 5}

Is preoperative radiotherapy for breast cancer generally safe for humans?

Preoperative radiotherapy for breast cancer has been shown to be generally safe, with mild side effects that do not require stopping the treatment. However, some patients may experience wound problems, such as infections or fistulas (abnormal connections between organs), which may need antibiotics or additional surgery. ^{6 7 8 9 10}

How does the treatment of preoperative radiotherapy and mastectomy for breast cancer differ from other treatments?

This treatment is unique because it involves giving radiotherapy before surgery to shrink the tumor, potentially allowing for more effective surgery and better survival rates, unlike the traditional approach where radiotherapy is given after surgery. ^{2 11 12 13 14}

Research Team

Audree Tadros, MD

Principal Investigator

Memorial Sloan Kettering Cancer Center

Eligibility Criteria

This trial is for women over 18 with invasive breast cancer at a specific stage (cT3-4 cN0-3). They should have responded to initial chemotherapy, want reconstruction surgery using their own tissue, and be able to read English. It's not for those with unresectable disease, bilateral or previous same-side breast cancer, pregnancy, no change or worsening after chemo, prior chest radiotherapy, or BMI over 40.

Inclusion Criteria

I want and am deemed suitable for breast reconstruction using my own tissues.

My tumor is large or has spread to nearby tissues but not to distant parts of the body.

I am a woman over 18 with confirmed invasive breast cancer.

Exclusion Criteria

I have had radiation therapy to my chest area before.

You have a body mass index (BMI) higher than 40.

My breast cancer cannot be removed with surgery.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Neoadjuvant Chemotherapy

Participants receive standard neoadjuvant chemotherapy to assess response before proceeding to radiotherapy

8-12 weeks

Preoperative Radiotherapy

Participants receive radiotherapy before their mastectomy

4-6 weeks

Surgery and Immediate Reconstruction

Participants undergo mastectomy followed by immediate autologous reconstruction

1 week

Follow-up

Participants are monitored for safety and effectiveness after treatment, focusing on wound complications and surgical outcomes

5 years

Treatment Details

Interventions

• Neoadjuvant radiotherapy (Radiation)
• Pre-neoadjuvant radiotherapy (NART) biopsy (Radiation)
• Unilateral total mastectomy with axillary lymph node dissection (Surgery)

Trial Overview The study tests preoperative radiotherapy followed by mastectomy and immediate autologous reconstruction in T4 breast cancer patients. This means radiation treatment before surgery and using the patient's own tissue for breast reconstruction right after removing the cancer.

Participant Groups

Group I: Participants with clinical T4 biopsy-proven breast cancer Experimental Treatment 3 Interventions

Participants with clinical T4 biopsy-proven breast cancer with no evidence of distant metastases who demonstrate a complete or partial response to standard neoadjuvant chemotherapy/NAC and desire immediate autologous reconstruction/IR will be eligible to enroll.

Neoadjuvant radiotherapy is already approved in China for the following indications:

Approved in China as Neoadjuvant radiotherapy for:

• Locally advanced breast cancer (LABC)
• T4 breast cancer

Who Is Running the Clinical Trial?

Memorial Sloan Kettering Cancer Center

Lead Sponsor

Trials

1,998

Recruited

602,000+

Lisa M. DeAngelis

Memorial Sloan Kettering Cancer Center

Chief Medical Officer since 2021

MD from Columbia University

Selwyn M. Vickers

Memorial Sloan Kettering Cancer Center

Chief Executive Officer since 2022

MD from Johns Hopkins University

Findings from Research

The increasing use of neoadjuvant chemotherapy in breast cancer patients with node-positive disease raises questions about the necessity of complete axillary lymph node dissection (ALND) after achieving a complete clinical response, highlighting a need for individualized treatment approaches.

The article emphasizes the importance of ongoing clinical trials to gather more evidence on optimal locoregional management, encouraging patient participation in trials and supporting informed decision-making based on personal values.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Debating the Optimal Approach to Nodal Management After Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer. Carter, S., Neuman, H., Mamounas, EP., et al.[2019]

Recent advancements in breast cancer treatment are shifting towards administering systemic therapy before surgery, which can lead to more effective treatment outcomes and potentially higher rates of disease-free and overall survival.

The evolving approach to radiotherapy includes considering its use before surgery, supported by improved radiobiological knowledge and technology, allowing for safer and more effective combinations with other treatments like antitumor drugs or immunotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preoperative Radio(Chemo)Therapy in Breast Cancer: Time to Switch the Perspective? Montero, A., Ciérvide, R.[2023]

In a study of 176 node-positive, ER+, HER2- breast cancer patients treated with neoadjuvant therapy, the overall rate of axillary pathologic complete response (pCR) was 12.3%, with higher rates observed in patients diagnosed at clinical stage II (20%) compared to stage III (8.4%).

Neoadjuvant chemotherapy (NCT) was associated with a higher pCR rate (13.9%) compared to neoadjuvant endocrine therapy (NET) (7.3%), and most patients achieving pCR after NCT were able to avoid axillary dissection, highlighting the potential of NAT to reduce surgical interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Axillary Response to Neoadjuvant Therapy in Node-Positive, Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: Predictors and Oncologic Outcomes. Friedman-Eldar, O., Ozmen, T., El Haddi, SJ., et al.[2022]

In a study comparing three groups of breast cancer patients who underwent radical mastectomy, the ten-year survival rates were identical across all groups, indicating that the type of treatment (radical mastectomy alone, postoperative irradiation, or preoperative irradiation) did not significantly affect long-term survival.

The data showed that higher rates of positive axillary nodes were associated with lower survival rates, suggesting that irradiation (either pre- or post-surgery) may provide survival benefits, but there was no evidence that preoperative irradiation was more effective than postoperative irradiation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preoperative or postoperative irradiation as adjunctive treatment with radical mastectomy in breast cancer. Rodger, A., Montague, ED., Fletcher, G.[2019]

Modern neo-adjuvant therapies can effectively convert initially positive lymph nodes to negative in breast cancer patients, particularly those with HER2-positive disease, allowing for more accurate axillary staging.

Clinical trials are currently underway to identify which patients can safely forgo axillary dissection and/or radiation, potentially reducing the need for more invasive procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Management of the clinically positive axilla. Euhus, DM.[2020]

Neoadjuvant chemotherapy or hormonal therapy allows more patients with locally advanced breast cancer (T2 and T3) to undergo breast-conserving surgery without significantly increasing the risk of cancer recurrence in the same breast.

Induction chemotherapy can enhance cosmetic outcomes post-surgery, but it is crucial to ensure clear surgical margins and to plan surgeries carefully, particularly in onco-plastic contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Breast conservative surgery for operable invasive ductal carcinoma after neoadjuvant chemotherapy or hormonal therapy- a challenge for breast surgeon: a review based on literature and experience. Bobin, JY., Al-Khaledi, K., Ahmad, J.[2014]

Pre-operative 5-fraction breast radiotherapy followed by immediate breast-sparing surgery was feasible in 14 patients, but wound complications occurred in 5 patients, highlighting a significant risk of post-surgical issues.

The study emphasizes the importance of performing sentinel node procedures before pre-operative radiotherapy, as two patients had pathological lymph node involvement, which could affect treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pre-OPerative accelerated radiotherapy for early stage breast cancer patients (POPART): A feasibility study. Mulliez, T., Miedema, G., Van Parijs, H., et al.[2022]

In a clinical trial involving 250 patients per group, preoperative radiotherapy (RT) significantly reduced the incidence of locally recurrent breast cancer from 16% to 4% without affecting overall survival rates after two years.

The study found that preoperative RT did not increase mortality or metastasis, and the side effects were mild, suggesting that RT is a safe and effective option for reducing local recurrence in operable breast cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Preoperative radiotherapy in breast cancer. Description of a clinical trial record and first results]. de Schryver, A.[2009]

In a trial involving 67 breast cancer patients undergoing neo-adjuvant therapy, pre-operative chemotherapy showed low side effects, with 79% of patients experiencing no hair loss and 74% reporting no gastrointestinal issues, despite the use of five different cytotoxic agents.

Response rates to pre-operative chemotherapy included 4% complete remission and 38% partial remission, indicating that while the treatment was generally well-tolerated, the effectiveness varied, and the study aims to identify which patients would benefit most from subsequent post-operative treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective randomized clinical trial: protoadjuvant chemotherapy vs. protoadjuvant radiotherapy in breast cancer stages T3/4, N+/-, M0. Rainer, H.[2007]

Postmastectomy radiotherapy (PMRT) significantly reduces the risks of locoregional failure, recurrence, and breast cancer mortality in patients with T1-2 breast cancer who have one to three positive axillary nodes, based on a systematic review of recent literature.

The decision to use PMRT should be individualized, considering the patient's specific risk factors and potential toxicities, as some patients may have a low risk of locoregional failure that does not justify the treatment's risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. Recht, A., Comen, EA., Fine, RE., et al.[2022]

In a review of 100 patients with locally advanced breast cancer treated with preoperative radiotherapy, significant local postoperative complications were observed, including a 25% incidence of local wound infections and 63% seroma formation.

The study suggests that preoperative chemotherapy may be a better option than radiotherapy for these patients, as it could reduce local postoperative morbidity and improve their quality of life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Morbidity of surgical treatment for advanced cancer of the breast after irradiation]. Guenier, C., Coibion, M., Badr el Din, A., et al.[2009]

Breast conservation surgery followed by radiation therapy is as effective as mastectomy for early-stage breast cancer, providing comparable local control and survival rates, based on various studies.

With proper patient selection and surgical techniques, 80-90% of patients achieve good to excellent cosmetic outcomes, which may encourage more women to seek early detection of breast cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Primary radiation therapy as an alternative to mastectomy for early-stage breast cancer. Ratanatharathorn, V., Powers, WE.[2006]

Preoperative radiotherapy for mastocarcinoma can effectively reduce tumor size, allowing for radical surgery, and is preferred over postoperative radiotherapy due to anatomical and radiobiological advantages.

The local control rate of the treatment is impressively high at 90-100%, and the cosmetic outcomes are generally excellent, making it a viable alternative to mastectomy for certain tumor sizes and conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Preoperative radiotherapy and curative radiotherapy without mastectomy in carcinoma of the breast (author's transl)]. Sauer, R.[2006]

Recent interest in preoperative breast radiation therapy (RT) is growing due to advancements in modern techniques, which may improve its effectiveness compared to older studies that did not change clinical practice.

Current clinical trials are exploring the combination of preoperative RT with novel drugs, aiming to enhance treatment outcomes and optimize translational research in breast cancer therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preoperative breast radiation therapy: Indications and perspectives. Lightowlers, SV., Boersma, LJ., Fourquet, A., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Debating the Optimal Approach to Nodal Management After Pathologic Complete Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer. [2019]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Preoperative Radio(Chemo)Therapy in Breast Cancer: Time to Switch the Perspective? [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Axillary Response to Neoadjuvant Therapy in Node-Positive, Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: Predictors and Oncologic Outcomes. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Preoperative or postoperative irradiation as adjunctive treatment with radical mastectomy in breast cancer. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Management of the clinically positive axilla. [2020]

6. Kuwait pubmed.ncbi.nlm.nih.gov

Breast conservative surgery for operable invasive ductal carcinoma after neoadjuvant chemotherapy or hormonal therapy- a challenge for breast surgeon: a review based on literature and experience. [2014]

7. Ireland pubmed.ncbi.nlm.nih.gov

Pre-OPerative accelerated radiotherapy for early stage breast cancer patients (POPART): A feasibility study. [2022]

8. France pubmed.ncbi.nlm.nih.gov

[Preoperative radiotherapy in breast cancer. Description of a clinical trial record and first results]. [2009]

9. Austria pubmed.ncbi.nlm.nih.gov

Prospective randomized clinical trial: protoadjuvant chemotherapy vs. protoadjuvant radiotherapy in breast cancer stages T3/4, N+/-, M0. [2007]

10. United States pubmed.ncbi.nlm.nih.gov

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update. [2022]

11. France pubmed.ncbi.nlm.nih.gov

[Morbidity of surgical treatment for advanced cancer of the breast after irradiation]. [2009]

12. United States pubmed.ncbi.nlm.nih.gov

Primary radiation therapy as an alternative to mastectomy for early-stage breast cancer. [2006]

13. Germany pubmed.ncbi.nlm.nih.gov

[Preoperative radiotherapy and curative radiotherapy without mastectomy in carcinoma of the breast (author's transl)]. [2006]

14. England pubmed.ncbi.nlm.nih.gov

Preoperative breast radiation therapy: Indications and perspectives. [2021]