Cryoablation vs Lumpectomy for Early Stage Breast Cancer

(COOL-IT Trial)

Overseen by Heather Garrett, M.D.

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Washington University School of Medicine

Disqualifiers: BRCA mutation, Prior breast cancer, Pregnant, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial studies the safety and effectiveness of cryoablation, a method that freezes and kills cancer cells, in patients with low risk, early stage breast cancer. It aims to see if cryoablation can be a better alternative to the usual surgery. Cryoablation has been successfully used to treat various types of solid tumors, including breast carcinomas, and is considered a less invasive alternative to surgical treatment.

Do I need to stop my current medications for the trial?

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 Cryoablation vs Lumpectomy for Early Stage Breast Cancer?

Research shows that cryoablation, a treatment that uses extreme cold to destroy cancer cells, is safe and effective for small breast tumors, with studies noting complete local tumor control in 73% of patients. It is also considered more patient-friendly due to its natural pain-relieving effects and satisfactory cosmetic outcomes. ^{1 2 3 4 5}

Is cryoablation safe for treating breast cancer?

Research shows that cryoablation is generally safe for treating breast cancer, with no major complications reported and only minor issues observed. Improvements in techniques and equipment have enhanced its safety profile. ^{2 5 6 7 8}

How does cryoablation differ from lumpectomy for early-stage breast cancer?

Cryoablation is a minimally invasive treatment that uses extreme cold to destroy cancer cells, often performed with local anesthesia and guided by imaging, making it potentially more patient-friendly and cost-effective compared to traditional surgery like lumpectomy, which involves removing the tumor surgically. ^{1 2 3 5 8}

Research Team

Heather Garrett, M.D.

Principal Investigator

Washington University School of Medicine

Eligibility Criteria

This trial is for women over 50 with early-stage, low-risk breast cancer (T1N0M0, Luminal A type, ER/PR positive, Her-2 negative) that's visible on ultrasound and not too close to the skin or chest muscles. Participants must have a specific Oncotype score if applicable and can't be pregnant or breastfeeding. They should not have had breast cancer before, no BRCA mutations, no electrical implants incompatible with MRI, and no allergy to local anesthetics.

Inclusion Criteria

My breast cancer has an Oncotype score below 26.

My breast cancer is early stage, hormone receptor positive, HER2 negative, and not aggressive.

My tumor can be seen on an ultrasound and is not too close to my skin or chest muscles.

Exclusion Criteria

My cancer has spread to the lymph nodes in my armpit.

I have a BRCA 1 or BRCA 2 gene mutation.

I have had breast cancer before.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Safety Lead-In

Initial safety assessment of cryoablation procedure

31 days

1 visit (in-person)

Treatment

Participants receive either cryoablation or lumpectomy

Varies based on procedure

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 years

6 month MRI and yearly MRI/mammography

Treatment Details

Interventions

• Endocare SlimLine Cryoprobe (Cryoablation)
• Lumpectomy (Surgery)

Trial Overview The study compares cryoablation—a technique of freezing tumors—with lumpectomy—the standard surgical removal of tumors—in treating T1 stage breast cancer. It aims to assess which method offers better disease control and quality of life while monitoring safety and complication rates.

Participant Groups

Group I: Rescue Arm: Lumpectomy Experimental Treatment 1 Intervention

If there is evidence of residual or recurrent tumor on follow-up imaging evaluation (6 month MRI (if can tolerate) and yearly MRI/mammography), patients in the cryoablation safety lead-in and who were randomized to receive cryoablation only will be crossed over to receive a rescue lumpectomy followed by adjuvant treatment based on standard of care.

Group II: Cryoablation - Safety Lead In Experimental Treatment 1 Intervention

Patients will be treated with cryoablation (Day 1) using the Endocare SlimLine Cyroprobe followed by adjuvant treatment.

Group III: Cryoablation Experimental Treatment 1 Intervention

Patients will be treated with cryoablation using the Endocare SlimLine Cyroprobe under real time ultrasound guidance and local anesthesia. The cryoablation consists of a 10 minute freeze phase followed by a 10 minute passive thaw, and ends with a second 10 minute freeze cycle. The freeze-thaw-freeze times may be adjusted at the physician's discretion depending on tumor size.

Group IV: Lumpectomy Active Control 1 Intervention

Lumpectomy will be performed under general anesthesia as per standard operative procedures at Washington University and Siteman Cancer Center.

Who Is Running the Clinical Trial?

Washington University School of Medicine

Lead Sponsor

Trials

2,027

Recruited

2,353,000+

David H. Perlmutter

Washington University School of Medicine

Chief Executive Officer since 2015

MD from Washington University School of Medicine

Paul Scheel

Washington University School of Medicine

Chief Medical Officer since 2022

MD from Washington University School of Medicine

The Foundation for Barnes-Jewish Hospital

Collaborator

Trials

43

Recruited

6,600+

Varian Medical Systems

Industry Sponsor

Trials

63

Recruited

3,700+

Dow R. Wilson

Varian Medical Systems

Chief Executive Officer since 2012

MBA from Dartmouth's Amos Tuck School of Business, BA from Brigham Young University

Dr. Deepak Khuntia

Varian Medical Systems

Chief Medical Officer since 2020

MD from the University of Cambridge, PhD from the University of Leicester

Findings from Research

Cryoablation is a safe and effective treatment for early-stage breast cancer, particularly for tumors smaller than 1.5 cm, with successful destruction rates for cancers under 1.0 cm.

The presence of noncalcified ductal carcinoma-in-situ (DCIS) can lead to treatment failures, so cryoablation is recommended only for invasive ductal carcinoma with less than 25% DCIS in the biopsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cryosurgery of breast cancer. Niu, L., Zhou, L., Xu, K.[2022]

Percutaneous breast cancer cryoablation demonstrated a complete local tumor control rate of 73% over an average follow-up period of 8 months, indicating its efficacy, especially for small ductal tumors under 15 mm.

The procedure was found to be safe, with no major complications reported and satisfactory cosmetic outcomes, suggesting it is a viable option for breast cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Percutaneous Image-Guided Cryoablation of Breast Cancer: A Systematic Review. Lanza, E., Palussiere, J., Buy, X., et al.[2022]

Cryoablation is a safe and effective primary therapy for breast fibroadenoma, providing durable results that can be replicated in community practices, making it a patient-friendly alternative to traditional heat-based treatments.

Cryolocalization, a new application of cryotechnology, helps create a clear frozen boundary around tumors, which may reduce the chances of leaving cancerous tissue behind during lumpectomy procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cryoablation and cryolocalization in the management of breast disease. Whitworth, PW., Rewcastle, JC.[2007]

Cryoablation was successfully used to treat two nonpalpable breast cancers in an 85-year-old woman, demonstrating its potential as a treatment option for breast tumors.

The patient was monitored for 18 months using mammograms, ultrasounds, and histological evaluations, indicating that cryoablation can be safely followed by long-term observation without immediate need for tumor resection.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Unresected Breast Cancer: Evolution of Imaging Findings Following Cryoablation. Bergin, JT., Sisney, GA., Lee, FT., et al.[2020]

In a phase II trial involving 99 patients with early-stage breast cancer, cryoablation successfully ablated 75.9% of tumors, indicating its potential as an effective non-surgical treatment option.

The study also found that magnetic resonance imaging (MRI) had a negative predictive value of 81.2% for detecting residual cancer, suggesting it could be a useful tool in assessing treatment success after cryoablation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Phase II Trial Exploring the Success of Cryoablation Therapy in the Treatment of Invasive Breast Carcinoma: Results from ACOSOG (Alliance) Z1072. Simmons, RM., Ballman, KV., Cox, C., et al.[2022]

In a study involving 102 patients and 124 lesions across 12 centers, the Tailored Freeze technique for cryoablation showed a median tumor volume reduction of 91% after 12 months, with 73% of tumors becoming nonpalpable.

The safety profile of cryoablation was excellent, with only minor complications reported, and 92% of patients expressed good to excellent satisfaction with the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cryoablation of benign breast tumors: evolution of technique and technology. Caleffi, M., Filho, DD., Borghetti, K., et al.[2006]

Percutaneous cryoablation of breast tumors in 17 patients with metastatic breast cancer was technically successful and resulted in complete regression of the primary lesions in 15 patients, demonstrating its efficacy for local control of tumors.

The procedure was well-tolerated with low complication rates, providing immediate and long-term pain relief for patients, making it a viable option for palliative care in those with limited treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Percutaneous cryoablation of breast tumours in patients with stable metastatic breast cancer: safety, feasibility and efficacy. Beji, H., Pilleul, F., Picard, R., et al.[2019]

Cryoablation is a minimally invasive technique for treating breast cancer that allows for breast conservation and is well-visualized during the procedure due to ice formation.

This case study highlights the potential of CT-guided cryoablation to treat breast cancer with lymph node metastasis effectively, using only local anesthesia and/or mild sedation, making it a cost-effective outpatient option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CT-guided cryoablation of both breast cancer and lymph node axillary metastasis. Pusceddu, C., Capobianco, G., Meloni, F., et al.[2020]

References

1. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

Cryosurgery of breast cancer. [2022]

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

Percutaneous Image-Guided Cryoablation of Breast Cancer: A Systematic Review. [2022]

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

Cryoablation and cryolocalization in the management of breast disease. [2007]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Unresected Breast Cancer: Evolution of Imaging Findings Following Cryoablation. [2020]

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

A Phase II Trial Exploring the Success of Cryoablation Therapy in the Treatment of Invasive Breast Carcinoma: Results from ACOSOG (Alliance) Z1072. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Cryoablation of benign breast tumors: evolution of technique and technology. [2006]

7. England pubmed.ncbi.nlm.nih.gov

Percutaneous cryoablation of breast tumours in patients with stable metastatic breast cancer: safety, feasibility and efficacy. [2019]

8. Singapore pubmed.ncbi.nlm.nih.gov

CT-guided cryoablation of both breast cancer and lymph node axillary metastasis. [2020]