Omission of Axillary Surgery in Breast Cancer Patients

NCT ID: NCT06259513

Last Updated: 2024-02-14

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

350 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-06

Study Completion Date

2033-12-31

Brief Summary

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The treatment and prognosis of breast cancer (BC) are dependent on its molecular subtype and nodal burden. In early BCs with favourable molecular subtype, the incidence of axillary node involvement is low. However, these patients are still subjected to an axillary operation, which can result in additional cost, operating time and morbidities. Similarly, in patients with limited nodal burden of 1-2 metastatic nodes, there is emerging evidence that these patients may need sentinel lymph node biopsy (SLNB) only, instead of an axillary clearance (AC), which has more surgical morbidities.

We aimed to determine if axillary surgery could be safely tailored in BC patients based on their molecular subtype and nodal burden, without compromising their oncological outcomes. This could in turn reduce the morbidities associated with the axillary surgery,

Total 350 patients will be enrolled. 50 patients with early BC and favourable molecular subtype will be enrolled in a pilot study A (SentiOMIT), whereby SLNB is omitted. For eligible patients who declined study A and other stage I-II patients, with preoperative N0 status, undergoing upfront surgery but did not meet the inclusion criteria of Study A, these patients will be enrolled into study B (SentiMACRO) to undergo SLNB.

In study B, the patients will be categorized based on SLNB into 3 groups with 100 patients in each arm: B1 with pN0, B2- 1-2 metastatic nodes and B3- \>/=3 metastatic nodes. In Study B, we aim to investigate if the B2 group (100 patients) can be treated with a less invasive procedure of SLNB alone instead of AC, without affecting oncological outcomes. B1 and B3 are controls.

The outcomes for study A and B include short term outcomes such as morbidity rates, cost and operating time savings. Long term outcomes include recurrence and survival rates. This study will allow individualisation of axillary surgery based on the patient's molecular subtype and nodal burden, to benefit patients' care.

Detailed Description

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Conditions

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Breast Cancer Sentinel Lymph Node Breast Neoplasms

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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patients with omission of SLNB

early breast cancer patients with cT1-2N0 Luminal A subtype with omission of SLNB

Group Type EXPERIMENTAL

omission of SLNB in SentiOMIT or omission of ALND in SentiMACRO

Intervention Type PROCEDURE

Omission of SLNB in cT1-2N0 or Omission of ALND in patients with \</= 2 macrometastasis in SLNB

patients with </=2 macrometastasis and omission of ALND

breast cancer patients with 1-2 macrometastasis on SLNB and had omission of ALND

Group Type EXPERIMENTAL

omission of SLNB in SentiOMIT or omission of ALND in SentiMACRO

Intervention Type PROCEDURE

Omission of SLNB in cT1-2N0 or Omission of ALND in patients with \</= 2 macrometastasis in SLNB

patients with cT1-2N0 and SLNB

early breast cancer patients with cT1-2N0 Luminal A subtype and SLNB

Group Type NO_INTERVENTION

No interventions assigned to this group

patients with </=2 macrometastasis and ALND

breast cancer patients with 1-2 macrometastasis on SLNB and had ALND

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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omission of SLNB in SentiOMIT or omission of ALND in SentiMACRO

Omission of SLNB in cT1-2N0 or Omission of ALND in patients with \</= 2 macrometastasis in SLNB

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* female patients aged \>/=55 years old
* unifocal cancer on imaging
* breast tumour size based on imaging of \</=3cm
* no evidence of axillary adenopathy on imaging
* patients with strongly positive ER and PR and negative HER2 on biopsy
* grade 1-2 tumour on core biopsy
* patient who opt for mastectomy

Exclusion Criteria

* patients with T3/T4 or stage IV disease, patients with preoperative known N+ disease, bilateral breast cancers, patients planned for neoadjuvant chemotherapy, patients with other malignancies.
Minimum Eligible Age

21 Years

Maximum Eligible Age

80 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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KK Women's and Children's Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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KK Women's and Children's Hospital

Singapore, , Singapore

Site Status RECRUITING

Countries

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Singapore

Central Contacts

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Geok hoon Lim

Role: CONTACT

Facility Contacts

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Geok H Lim

Role: primary

Other Identifiers

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CIRB Ref: 2023/2735

Identifier Type: -

Identifier Source: org_study_id

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