Intelligent Vacuum Assisted Biopsy Immediately Before Surgery As an Intra- or Pre-Operative Surrogate for Patient Response to Neoadjuvant Chemotherapy for Breast Cancer

NCT ID: NCT04289935

Last Updated: 2024-10-23

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

RECRUITING

Clinical Phase

NA

Total Enrollment

420 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-17

Study Completion Date

2025-06-30

Brief Summary

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Neoadjuvant chemotherapy (NAC) is common practice in the primary treatment of breast cancer, leading to a complete pathologic remission (pCR) of the tumor in more than 50% in aggressive tumor types. As NAC induces different response patterns, radiologic imaging is not sufficiently accurate in predicting residual disease. Because of this uncertainty, surgery is so far the only valid option to either ascertain complete response or to remove the complete residual disease.

Vacuum-assisted biopsy (VAB) with the possibility of obtaining tissue of the former tumor center could contribute more reliably to detect any residual tumor or respectively, rule out residual disease. Ultrasound (US) or mammographically (MG) guided VAB will be used in this trial in order to detect residual tumor lesions in patients with radiological complete response (rCR) after NAC. The investigators will evaluate the diagnostic accuracy of the post-NAC VAB sample in comparison to the sample obtained in open surgery.

Detailed Description

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Neoadjuvant chemotherapy (NAC), initially indicated to downstage tumors to achieve the option of breast conserving surgery, has lately become common practice in the primary treatment of breast cancer. The use of modern NAC regimens lead to a complete pathologic remission (pCR) of the tumor in more than 50% in aggressive tumor types.

In general, it is difficult to predict pCR in the absence of invasive surgical techniques, as it depends on several factors such as biological subtype, the used chemotherapy regimen and anatomic stage. The most common imaging methods beside clinical examination are breast ultrasound, mammography and breast magnetic resonance imaging (MRI). As NAC induces different response patterns, radiologic imaging is not sufficiently accurate in predicting residual disease. Because of this uncertainty, surgery (and the standardized assessment of resected tissue) is so far the only valid option to either ascertain complete response or to remove the complete residual disease.

Vacuum-assisted biopsy (VAB) with the possibility of obtaining tissue of the former tumor center could contribute more reliably to detect any residual tumor or respectively, rule out residual disease. Ultrasound (US) or mammographically (MG) guided VAB will be used in this trial in order to detect residual tumor lesions in patients with radiological complete response (rCR) after NAC. The investigators will evaluate the diagnostic accuracy of the post-NAC VAB sample in comparison to the sample obtained in open surgery.

The main objective of the trial is to determine the diagnostic accuracy of I-VAB using the full pathologic specimen evalutation obtained after open surgery to detect residual tissue.

Conditions

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Breast Cancer

Study Design

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Allocation Method

NA

Intervention Model

SEQUENTIAL

multicenter, prospective, single arm, feasibility trial
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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single arm

* Unicentric histologically confirmed invasive luminal B, HER2- enriched, triple negative breast cancer + Clipping + Neoadjuvant chemotherapy
* rCR / near-rCR in MRI / US
* Registration
* US-guided VAB
* Breast conserving surgery / mastectomy
* Pathology examination 1. Preoperative VAB, 2. Surgical specimen

Group Type EXPERIMENTAL

Vacuum assisted biopsy (VAB)

Intervention Type PROCEDURE

The trial intervention consists of a diagnostic interventional procedure, US-guided or mammographically guided VAB post-NAC, prior to the standard breast surgery.

Interventions

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Vacuum assisted biopsy (VAB)

The trial intervention consists of a diagnostic interventional procedure, US-guided or mammographically guided VAB post-NAC, prior to the standard breast surgery.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Written informed consent according to ICH/GCP regulations before registration and prior to any trial specific procedures
* unifocal, histologically confirmed invasive breast cancer with IHC luminal B (with or without overexpression or amplification of the HER2 receptor) and all ER negative (ER \< 10%) breast cancers
* Initial tumor size larger than 1 and less than 5 cm (cT1c to cT2), any N, M0
* Clipping of the primary tumor center prior to the start of neo-adjuvant chemotherapy
* Neo-adjuvant chemotherapy resulting in a radiological complete response or near complete response on MR-Imaging (confirmed within 28 days before or on registration) as described in the trial specific MR-Imaging instructions (available on the welcome page of the study specific SecuTrial link). MRI is strongly recommended, alternative ultrasound
* Former tumor bed must be accessible for biopsy
* Female or male aged ≥ 18 years
* Adequate condition for breast cancer surgery
* Patients with a previously treated malignancy are eligible, when the risk of the prior malignancy interfering with either safety or efficacy endpoints is very low

Exclusion Criteria

* Metastatic breast cancer
* Multifocal/Multicentric breast cancer
* Inflammatory breast cancer
* Luminal-A types of breast cancers (ER ≥ 10% and PgR ≥ 10 % and G1 or 2, and/or Ki-67 ≤ 20%, HER2 negative) or low risk if assessed by a validated genomic prognostic test (e.g. Mammaprint, Endopredict, Oncotype or Nanostring)
* Distinct radiological sign of residual disease in the breast after neo-adjuvant chemotherapy by imaging
* Intra-/peritumoral microcalcifications larger than 2 cm at time of diagnosis
* Any local therapy (irradiation or surgery) to the currently treated breast prior to the trial intervention
* Any other serious underlying medical, psychiatric, psychological, familial or geographical condition, which in the judgment of the investigator may interfere with the planned staging, trial intervention and follow-up, affect patient compliance or place the patient at high risk from trial intervention-related complications
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Oncoplastic Breast Consortium (OPBC)

UNKNOWN

Sponsor Role collaborator

Klinik Hirslanden, Zurich

OTHER

Sponsor Role lead

Responsible Party

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PD Dr. med. Christoph Tausch

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christoph Tausch, MD

Role: STUDY_CHAIR

Brust-Zentrum, Zürich

Locations

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Universitätsspital Salzburg

Salzburg, , Austria

Site Status NOT_YET_RECRUITING

Brustzentrum Schwaz

Schwaz, , Austria

Site Status RECRUITING

St. Josef Krankenhaus Wien

Vienna, , Austria

Site Status RECRUITING

Agaplesion Markus Krankenhaus

Frankfurt, , Germany

Site Status RECRUITING

Brustzentrum Heidelberg

Heidelberg, , Germany

Site Status RECRUITING

UFK Klinikum Südstadt Rostock

Rostock, , Germany

Site Status RECRUITING

Helios Universitätsklinikum Wuppertal

Wuppertal, , Germany

Site Status RECRUITING

Tumor Zentrum Aarau

Aarau, , Switzerland

Site Status RECRUITING

Kantonsspital Baden

Baden, , Switzerland

Site Status RECRUITING

Universitätsspital Basel

Basel, , Switzerland

Site Status RECRUITING

Bethesda Spital

Basel, , Switzerland

Site Status RECRUITING

St. Claraspital

Basel, , Switzerland

Site Status RECRUITING

Hirslanden Brustzentrum Bern Biel

Bern, , Switzerland

Site Status RECRUITING

Kantonsspital Graubünden

Chur, , Switzerland

Site Status RECRUITING

Spital Thurgau AG Frauenfeld und Münsterlingen

Frauenfeld, , Switzerland

Site Status RECRUITING

Clinique de Genolier

Genolier, , Switzerland

Site Status RECRUITING

Luzerner Kantonsspital

Lucerne, , Switzerland

Site Status RECRUITING

Hirslanden Klinik St. Anna

Lucerne, , Switzerland

Site Status RECRUITING

Ente Ospedaliero Cantonale, Dipartimento di ginecologia e ostretricia

Lugano, , Switzerland

Site Status RECRUITING

Brustzentrum Rheinfelden

Rheinfelden, , Switzerland

Site Status RECRUITING

Kantonsspital St. Gallen

Sankt Gallen, , Switzerland

Site Status RECRUITING

Tumor- und BrustZentrum Ostschweiz

Sankt Gallen, , Switzerland

Site Status RECRUITING

Kantonsspital Winterthur

Winterthur, , Switzerland

Site Status RECRUITING

Brust-Zentrum Seefeld

Zurich, , Switzerland

Site Status RECRUITING

Universitäts Spital Zürich

Zurich, , Switzerland

Site Status RECRUITING

Mediclinic City Hospital Dubai

Dubai, , United Arab Emirates

Site Status RECRUITING

Countries

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Austria Germany Switzerland United Arab Emirates

Central Contacts

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Daniel Tschopp

Role: CONTACT

+41 44 387 9545

Facility Contacts

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Andreas Sir

Role: primary

+43 572 555 74 34

Andreas Sir, MD

Role: backup

Michael Hubalek, MD

Role: primary

+43 5242 655 290

Michael Hubalek, MD

Role: backup

Ulrich Schmidbauer, MD

Role: primary

+43 187 844 8200

Ulrich Schmidbauer, MD

Role: backup

Marc Thill, Prof.

Role: primary

+49 69 9533 2228

Marc Thill, Prof.

Role: backup

Jörg Heil, Prof.

Role: primary

+49 6221 488 60 20

Joerg Heil, Prof.

Role: backup

Steffi Hartmann, MD

Role: primary

+49 381 4401 47 00

Steffi Hartmann, MD

Role: backup

Vesna Bjelic-Radisic, Prof.

Role: primary

+49 202 896 14 11

Vesna Bjelic-Radisic, Prof.

Role: backup

Andreas Jakob, MD

Role: primary

+41 62 836 78 30

Andreas Jakob, MD

Role: backup

Cornelia Leo, Prof

Role: primary

+41 56 486 35 14

Cornelia Leo, Prof

Role: backup

Christian Kurzeder, Prof

Role: primary

+41 61 328 79 90

Christian Kurzeder, Prof

Role: backup

Dieter Müller, MD

Role: primary

+41 61 823 77 00

Dieter Müller, MD

Role: backup

Roberto Rodriguez, MD

Role: primary

+41 61 685 34 53

Roberto Rodriguez, MD

Role: backup

Patrizia Sager, MD

Role: primary

+41 31 337 89 70

Patrizia Sager, MD

Role: backup

Martina Gabriella Maranta, MD

Role: primary

+41 81 254 81 64

Martina Maranta, MD

Role: backup

Mathias Fehr, Prof

Role: primary

+41 52 723 72 55

Mathias Fehr, Prof

Role: backup

Magdalena Kohlik, MD

Role: primary

+41 22 366 93 67

Magdalena Kohlik, MD

Role: backup

Kathrin Schwedler, MD

Role: primary

+41 41 205 12 36

Kathrin Schwedler, MD

Role: backup

Peter Dubsky, Prof

Role: primary

+41 41 208 37 54

Peter Dubsky, Prof

Role: backup

Maria Luisa Gasparri, Prof.

Role: primary

+41 91 811 61 54

Maria Luisa Gasparri, Prof.

Role: backup

Maik Hauschild, MD

Role: primary

+41 61 835 62 20

Maik Hauschild, MD

Role: backup

Christine Strub, MD

Role: primary

+41 71 494 97 14

Christine Strub, MD

Role: backup

Michael Knauer, Prof

Role: primary

+41 71 552 33 33

Michael Knauer, Prof

Role: backup

Denise Vorburger, MD

Role: primary

+41 52 266 31 73

Denise Vorburger, MD

Role: backup

Christoph Tausch, MD

Role: primary

+41 44 533 81 00

Christoph Tausch, MD

Role: backup

Heike Frauchiger-Heuer, MD

Role: primary

+41 44 255 42 37

Heike Frauchiger-Heuer, MD

Role: backup

Annett Al-Hamadi, MD

Role: primary

+971 4555 9112

Annett Al Hamadi, MD

Role: backup

Other Identifiers

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HIRSLANDEN 01 OPBC SAKK 23/18

Identifier Type: -

Identifier Source: org_study_id

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