POSNOC - A Trial Looking at Axillary Treatment in Early Breast Cancer

NCT ID: NCT02401685

Last Updated: 2025-07-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

1900 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-08-01

Study Completion Date

2026-12-31

Brief Summary

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POSNOC is a pragmatic, randomised, multicentre, non-inferiority trial.

Aim For women with early stage breast cancer and one or two sentinel node macrometastases, to assess whether adjuvant therapy alone is no worse than adjuvant therapy plus axillary treatment, in terms of axillary recurrence within 5 years.

Stratification: Institution, Age (\<50, ≥50), Breast-conserving surgery (BCS) or mastectomy, Estrogen receptor (ER) status (positive, negative), Number of positive nodes (1, 2), Intra-operative sentinel assessment using OSNA (yes, no).

Interventions The study will compare adjuvant therapy alone with adjuvant therapy plus axillary treatment (axillary node clearance (ANC) or axillary radiotherapy (ART)).

Sample Size: 1900 participants

Follow-up: Participants will be followed up for 5 years.

Adjuvant Therapy: All participants will receive adjuvant systemic therapy (chemotherapy and/or endocrine therapy). All participants may receive breast/chest wall radiotherapy. Axillary and supraclavicular fossa radiotherapy is not allowed when randomised to adjuvant therapy alone.

Detailed Description

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Conditions

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Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Adjuvant therapy alone

Women in this arm will have adjuvant therapy but no treatment to their armpit after surgery. Axillary and supraclavicular fossa radiotherapy is not allowed when randomised to this arm.

Group Type EXPERIMENTAL

Adjuvant therapy

Intervention Type OTHER

Adjuvant therapy will include chemotherapy and/or endocrine therapy for all women, and radiotherapy to breast or chest wall if indicated. Human epidermal growth factor receptor 2 (HER2) targeted treatment may also be administered when indicated.

Adjuvant therapy plus axillary treatment

Women in this arm will have adjuvant therapy plus treatment to their armpit after surgery. Axillary treatment can be axillary node clearance or axillary radiotherapy as per local guidelines.

Group Type ACTIVE_COMPARATOR

Adjuvant therapy

Intervention Type OTHER

Adjuvant therapy will include chemotherapy and/or endocrine therapy for all women, and radiotherapy to breast or chest wall if indicated. Human epidermal growth factor receptor 2 (HER2) targeted treatment may also be administered when indicated.

Axillary treatment

Intervention Type PROCEDURE

Axillary treatment can be axillary node clearance or axillary radiotherapy as per local guidelines.

Interventions

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Adjuvant therapy

Adjuvant therapy will include chemotherapy and/or endocrine therapy for all women, and radiotherapy to breast or chest wall if indicated. Human epidermal growth factor receptor 2 (HER2) targeted treatment may also be administered when indicated.

Intervention Type OTHER

Axillary treatment

Axillary treatment can be axillary node clearance or axillary radiotherapy as per local guidelines.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Unifocal or multi-focal invasive tumour with lesion ≤5 cm in its largest dimension, measured pathologically or largest invasive tumour diameter on radiology should be used for women who are randomised intra-operatively or undergo sentinel node biopsy before neoadjuvant therapy (tumour size should be based only on the single largest tumour; do not add the sizes together from the multiple foci)
* At sentinel node biopsy have 1 or 2 nodes with macrometastases (tumour deposit \>2.0mm in largest dimension or defined as macrometastasis on molecular assay)
* Fit for axillary treatment and adjuvant therapy
* Have given written informed consent

Exclusion Criteria

* bilateral invasive breast cancer
* more than 2 nodes with macrometastases
* neoadjuvant therapy for breast cancer except:

* if sentinel node biopsy performed prior to neoadjuvant chemotherapy in women with early breast cancer
* short duration of neoadjuvant endocrine therapy is acceptable (up to 3 months)
* previous axillary surgery on the same body side as the scheduled sentinel node biopsy
* not receiving adjuvant systemic therapy
* previous cancer less than 5 years previously or concomitant malignancy except:

* basal or squamous cell carcinoma of the skin
* in situ carcinoma of the cervix
* in situ melanoma
* contra- or ipsilateral in situ breast cancer
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Nottingham

OTHER

Sponsor Role collaborator

Sussex Health Outcomes Research & Education in Cancer (SHORE-C)

UNKNOWN

Sponsor Role collaborator

NCRI Radiotherapy Trials QA Group (RTTQA)

UNKNOWN

Sponsor Role collaborator

Breast Cancer Trials, Australia and New Zealand

OTHER

Sponsor Role collaborator

University Hospitals of Derby and Burton NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Dr Amit Goyal

Consultant Oncoplastic Breast Surgeon & Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Amit Goyal

Role: PRINCIPAL_INVESTIGATOR

University Hospitals of Derby and Burton NHS Foundation Trust

Locations

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Royal Adelaide Hospital

Adelaide, , Australia

Site Status

Bankstown-Lidcocombe Hospital

Bankstown, , Australia

Site Status

Maeter Hospital

Brisbane, , Australia

Site Status

Coffs Harbour Health Campus

Coffs Harbour, , Australia

Site Status

Monash Cancer Centre

Melbourne, , Australia

Site Status

Royal Melbourne and Royal Women's Hospital

Melbourne, , Australia

Site Status

Sir Charles Gairdner Hospital

Perth, , Australia

Site Status

Riverina Cancer Care Centre

Wagga Wagga, , Australia

Site Status

Waikato Hospital

Hamilton, , New Zealand

Site Status

Rotorua Hospital

Rotorua, , New Zealand

Site Status

Ashford and St Peter's Hospitals NHS Foundation Trust

Ashford, , United Kingdom

Site Status

Barnsley Hospital

Barnsley, , United Kingdom

Site Status

Belfast City Hospital

Belfast, , United Kingdom

Site Status

City Hospital

Birmingham, , United Kingdom

Site Status

Queen Elizabeth Hospital

Birmingham, , United Kingdom

Site Status

Royal Bolton Hospital

Bolton, , United Kingdom

Site Status

Bradford Royal Infirmary

Bradford, , United Kingdom

Site Status

Princess of Wales Hospital

Bridgend, , United Kingdom

Site Status

Addenbrooke's Hospital

Cambridge, , United Kingdom

Site Status

University Hospital Llandough

Cardiff, , United Kingdom

Site Status

Darrent Valley Hospital

Dartford, , United Kingdom

Site Status

Royal Derby Hospital

Derby, , United Kingdom

Site Status

Eastbourne District General Hospital

Eastbourne, , United Kingdom

Site Status

Western General Hospital

Edinburgh, , United Kingdom

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Medway Maritime Hospital

Gillingham, , United Kingdom

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Western Infirmary

Glasgow, , United Kingdom

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Inverclyde Royal Hospital

Greenock, , United Kingdom

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Harrogate District Hospital

Harrogate, , United Kingdom

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University Hospital Crosshouse

Kilmarnock, , United Kingdom

Site Status

Forth Valley Hospital

Larbert, , United Kingdom

Site Status

St James's University Hospital

Leeds, , United Kingdom

Site Status

University Hospitals of Leicester NHS Trust

Leicester, , United Kingdom

Site Status

Guy's and St Thomas' NHS Foundation Trust

London, , United Kingdom

Site Status

Royal Marsden Hospital

London, , United Kingdom

Site Status

Luton and Dunstable University Hospital

Luton, , United Kingdom

Site Status

Macclesfield District General Hospital

Macclesfield, , United Kingdom

Site Status

Maidstone Hospital

Maidstone, , United Kingdom

Site Status

North Manchester General Hospital

Manchester, , United Kingdom

Site Status

Wythenshawe Hospital

Manchester, , United Kingdom

Site Status

Royal Victoria Infirmary

Newcastle upon Tyne, , United Kingdom

Site Status

Royal Gwent Hospital

Newport, , United Kingdom

Site Status

The Norfolk and Norwich University Hospital

Norwich, , United Kingdom

Site Status

Oxford University Hospitals

Oxford, , United Kingdom

Site Status

Peterborough City Hospital

Peterborough, , United Kingdom

Site Status

Derriford Hospital

Plymouth, , United Kingdom

Site Status

Rotherham General Hospital

Rotherham, , United Kingdom

Site Status

Royal Stoke University Hospital

Stoke-on-Trent, , United Kingdom

Site Status

Royal Cornwall Hospital

Truro, , United Kingdom

Site Status

Wishaw General Hospital

Wishaw, , United Kingdom

Site Status

New Cross Hospital

Wolverhampton, , United Kingdom

Site Status

Countries

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Australia New Zealand United Kingdom

References

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Goyal A, Dodwell D. POSNOC: A Randomised Trial Looking at Axillary Treatment in Women with One or Two Sentinel Nodes with Macrometastases. Clin Oncol (R Coll Radiol). 2015 Dec;27(12):692-5. doi: 10.1016/j.clon.2015.07.005. Epub 2015 Aug 5. No abstract available.

Reference Type BACKGROUND
PMID: 26254841 (View on PubMed)

Dodwell D, Goyal A. Axillary conservation in early breast cancer. Br J Surg. 2015 Oct;102(11):1297-9. doi: 10.1002/bjs.9881. Epub 2015 Jul 7. No abstract available.

Reference Type BACKGROUND
PMID: 26148870 (View on PubMed)

Goyal A, Dodwell D, Reed MW, Coleman RE. Axillary treatment in women with one or two sentinel nodes with macrometastases: more evidence is needed to inform practice. J Clin Oncol. 2014 Dec 1;32(34):3902. doi: 10.1200/JCO.2014.57.3717. Epub 2014 Sep 22. No abstract available.

Reference Type BACKGROUND
PMID: 25245444 (View on PubMed)

Related Links

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Other Identifiers

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ISRCTN Number

Identifier Type: REGISTRY

Identifier Source: secondary_id

RD-5103-001-13

Identifier Type: -

Identifier Source: org_study_id

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