Sentinel Lymph Node Biopsy Versus No Axillary Surgery in Early Breast Cancer

NCT ID: NCT05315154

Last Updated: 2024-12-12

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

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-02

Study Completion Date

2030-10-02

Brief Summary

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The VENUS trial is a prospective, multicenter, noninferiority, randomized, controlled clinical trial that compares sentinel lymph node biopsy versus no axillary surgery in women with early breast cancer (tumor \<5cm) and node-negative after clinical palpation and axillary ultrasound.

Detailed Description

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The standard approach to women with early breast cancer (BC) and clinically negative nodes is sentinel lymph node dissection (SLND). Studies showed that axillary lymph node dissection (ALND) can be safely omitted in presence of positive sentinel lymph node in patients treated with breast conserving therapy.Therefore, the pertinence of SLND in the approach to women with early BC is being questioned, once it is not injury-free.

The ACOSOG Z0011 trial examined the safety of omitting ALND in patients with early BC and up to 2 positive nodes at SLND, undergoing conservative surgery plus breast radiotherapy. The 10-year worth of data from this trial strongly suggested that omitting the procedure in these restrict, well-selected, subsets of patients maybe safe. Neoadjuvant chemotherapy (NAC) may be the starting treatment step for women with aggressive BC subtypes even in early stages.The SENTINA and ACOSOG Z1071 trials revealed that for women with three or more negative nodes in SLND, the procedure's accuracy and false-negative rate lie within acceptable boundaries. Our hypothesis is that for patients with early BC (regardless of neoadjuvant systemic therapy), with clinically and ultrasound negative axilla, avoiding SLND may be safe from the oncological perspective.The VENUS trial will investigate whether there may be still room for further de-escalation of the approach to the axilla in well-selected subsets of BC patients, by including women for whom the de-escalation has not been tested in previous trials dealing with the subject.

The VENUS trial is a prospective, noninferiority, multicenter, randomized controlled clinical trial that was approved by the Local Research Ethic Committee .The trial will compare SLND with no axillary surgery in women with T1-2 invasive BC and N0 disease, as ascertained after clinical palpation and axillary ultrasound. Mastectomy and primary systemic therapy are allowed whether node negative previous start the treatment . All women accrued to the trial must sign the informed consent. Randomization 1:1 will be stratified by age (≤50 and \>50 years old) and clinical tumor size (≤2 cm and \>2 cm).

The sample size estimated is 364 women in each arm (400 to account for losses to follow-up). Sample size was calculated according to the following parameters: 90% disease-free survival in patients undergoing SLND and a minimum 85% in those not undergoing the procedure, 80% power and 95% confidence intervals, with a tolerated risk ratio of 0.8. After surgery, regardless of adjuvant therapies, and for at least 48 months, patients will undergo physical examination of their breasts and axilla every 6 months and mammography will be performed annually or at closer intervals if indicated. Adjuvant chemotherapy and radiotherapy will be performed according to the protocol of each participating center and patients without axillary surgery should be considered N0 for decision making.

Conditions

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Breast Cancer

Keywords

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Breast cancer Sentinel Lymph Node

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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No axillary surgery

Group Type EXPERIMENTAL

No axillary surgery

Intervention Type PROCEDURE

In the study arm will be omitted surgery in axilla

Sentinel lymph node biopsy

Group Type ACTIVE_COMPARATOR

SLNB

Intervention Type PROCEDURE

in the control arm will be realized SLNB

Interventions

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No axillary surgery

In the study arm will be omitted surgery in axilla

Intervention Type PROCEDURE

SLNB

in the control arm will be realized SLNB

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Women
* Aged 18 years or older
* Histologically confirmed invasive breast carcinoma (core or open biopsy), independent of hormone receptor and HER2 status
* Tumor smaller than 5 cm (T1 or T2) in clinical and radiological exams
* Clinically negative axilla
* Sonographically negative axilla or negative core biopsy/ fine needle biopsy (FNB) when ultrasound is suspect (lymph node tissue is required in core/FNB sample)
* Planned breast conservative surgery or mastectomy
* Written informed consent

Exclusion Criteria

* Previous diagnostic of any invasive neoplasia (excluded skin cancer no melanoma)
* Metastatic disease in biopsy or image before treatment
* Withdrawal from participating of the study
* Initiated treatment for current breast cancer prior to study enrollment
* Pregnancy
* Breastfeed
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Campinas, Brazil

OTHER

Sponsor Role lead

Responsible Party

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Giuliano Mendes Duarte

MD PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Giuliano Duarte, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Universidade Estadual de Campinas, Unicamp

Locations

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Hospital Geral de Fortaleza

Fortaleza, Ceará, Brazil

Site Status RECRUITING

Maternidade Dona Iris

Goiânia, Goiás, Brazil

Site Status RECRUITING

Universidade Federal de Goiás

Goiânia, Goiás, Brazil

Site Status RECRUITING

Hospital de Clínica da Universidade Federal de Minas Gerais

Belo Horizonte, Minas Gerais, Brazil

Site Status RECRUITING

Hospital do Câncer de Muriaé da Fundação Cristiano Varella

Muriaé, Minas Gerais, Brazil

Site Status RECRUITING

Universidade Federal do Paraná

Curitiba, Paraná, Brazil

Site Status RECRUITING

Hospital Barão de Lucena

Recife, Pernambuco, Brazil

Site Status RECRUITING

Oncocenter

Teresina, Piauí, Brazil

Site Status RECRUITING

Universidade Federal do Piauí

Teresina, Piauí, Brazil

Site Status RECRUITING

Hospital Federal da Lagoa

Rio de Janeiro, Rio de Janeiro, Brazil

Site Status RECRUITING

Liga Norte Riograndense Contra o Câncer

Natal, Rio Grande do Norte, Brazil

Site Status RECRUITING

Hospital de Clínicas de Porto Alegre - UFRS

Porto Alegre, Rio Grande do Sul, Brazil

Site Status RECRUITING

Hospital de Amor - Fundação Pio XII

Barretos, São Paulo, Brazil

Site Status RECRUITING

Unesp

Botucatu, São Paulo, Brazil

Site Status RECRUITING

Hospital Celso Pierro - PUCC

Campinas, São Paulo, Brazil

Site Status RECRUITING

Hospital da Mulher Prof.Dr. J A Pinotti - UNICAMP

Campinas, São Paulo, Brazil

Site Status RECRUITING

Hospital da Mulher

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Hospital do Servidor Público Estadual

São Paulo, São Paulo, Brazil

Site Status NOT_YET_RECRUITING

Countries

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Brazil

Central Contacts

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Giuliano Duarte, MD, PhD

Role: CONTACT

Phone: +55 19 35219305

Email: [email protected]

Danielle Cristina Myamoto de Araujo, MD

Role: CONTACT

Facility Contacts

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Francisco Pimentel Cavalcante

Role: primary

Leonardo R Soares, MD PhD

Role: primary

Rosemar Rahal, MD, PhD

Role: primary

Clécio Enio M de Lucena, MD PhD

Role: primary

René Aloisio C Vieira, MD PhD

Role: primary

Vinícius Budel, MD PhD

Role: primary

Darley de Lima Ferreira Filho, MD

Role: primary

Sabas Vieira, MD, PhD

Role: primary

Sabas Vieira, MD, PhD

Role: backup

Kamila Diocesano, MD

Role: primary

Kamila Diocesano, MD

Role: backup

Rafael Henrique S Machado, MD PhD

Role: primary

Roberta D Jales Alves de Andrade, MD

Role: primary

Andréa PS Damin, MD PhD

Role: primary

Idan Oliveira, MD PhD

Role: primary

Eduardo Pessoa, MD, PhD

Role: primary

Julio César N Gomes

Role: primary

Giuliano M Duarte, MD, PhD

Role: primary

André Mattar, MD, PhD

Role: primary

André Mattar, MD, PhD

Role: backup

Marcelo Antonini

Role: primary

References

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Araujo DCM, Duarte GM, Jales RM, Shinzato JY, Cardoso Filho C, Torresan RZ, Brenelli FP, Esteves SCB, Sarian LO. Sentinel lymph node biopsy vs no axillary surgery in early breast cancer clinically and ultrasonographically node negative: A prospective randomized controlled trial-VENUS trial. Breast J. 2020 Oct;26(10):2087-2089. doi: 10.1111/tbj.13994. Epub 2020 Jul 30. No abstract available.

Reference Type BACKGROUND
PMID: 32729181 (View on PubMed)

Duarte GM, Araújo DCM, Jales RM, Shinzato JY, Cardoso Filho C, Torresan RZ, Brenelli FB, Kraft MBPL, Esteves SCB, Sarian LOZ, Rahal RMS, Freitas Jr R, Pessoa EC, Lucena CEM, Damin APS, Biazus JV, Budel VM, Oliveira Jr I, Vieira RAC, Gomes JCN. Sentinel lymph node biopsy versus no axillary surgery in early breast cancer clinically and ultrasonographically node negative: A multicentre prospective randomized controlled trial (VENUS trial. Cancer Research. 2022 82 (4_Supplement): OT1-04-03. DOI: https://doi.org/10.1158/1538-7445.SABCS21-OT1-04-03 Published: 15 February 2022

Reference Type BACKGROUND

Other Identifiers

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RBR-8g6jbf

Identifier Type: REGISTRY

Identifier Source: secondary_id

06805118.2.1001.5404

Identifier Type: -

Identifier Source: org_study_id