Vabb After Neoadjuvant Therapy to Avoid Surgery-pCR to Avoid Breast Surgery

Breast Cancer Clinical Trial

— BETTY-CRASY  

Official title:

Non-inferiority Study in Patients With Complete Pathological Response After Neoadjuvant Chemotherapy and Negative VABB Biopsy Undergoing RT Alone, Omitting Surgical Treatment

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06281210
• Other study ID #: IEO 2034
• Status: Recruiting
• Phase: N/A
• Start date: December 11, 2023
• Est. completion date: December 31, 2028

Study information

• Verified date: February 2024
• Source: European Institute of Oncology
• Contact: Elisabetta Rossi, MD
• Phone: +39-0294372191
• Email: ElisabettaMariaCristina.Rossi[@]ieo.it
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This single arm study aims to evaluate the efficacy and safety of a non-surgical approach, consisting of radiotherapy (RT) alone, for patients who have achieved a complete pathological response (pCR) following neoadjuvant chemotherapy (NACT). The study design involves the histological confirmation of pCR using vacuum-assisted biopsy (VABB) or vacuum-assisted excision (VAE) guided by ultrasound. The primary objective is to demonstrate that the non-surgical, RT-only treatment and follow-up approach is not inferior to the traditional surgical approach in patients with pCR after NACT.

Description:

Neoadjuvant chemotherapy (NACT) in breast cancer is considered the "gold standard" for the treatment of locally advanced and inoperable malignancies.

In recent years, in view of the evidence gathered, it has also become a conventional treatment alternative for patients with operable disease who are possible candidates for adjuvant chemotherapy. NACT thus aims to reduce mortality and increase surgical options, while at the same time allowing in vivo chemosensitivity testing. In view of this, NACT represents the ideal setting for clinical and translational research, which nowadays also has to address the question of future treatment options.

It is indeed a source of lively debate whether chemotherapy should be considered the only possible treatment option for the patient.

This study falls into this context, the innovative aim of which is to demonstrate histologically with the use of VABB, the complete pathological response (pCR) and to avoid surgery.

The main aim of this study is to show that a non-surgical, radiotherapy-only treatment and follow-up approach is not inferior to a surgical approach for patients who have shown complete pathological response (pCR) following neoadjuvant chemotherapy (NACT), as confirmed through histological analysis of imaging-guided sampling.

Histology will be performed by sampling 4 grams of tissue by vacuum-assisted biopsy (VABB) or vacuum-assisted excision (VAE) by ultrasound guidance (on breast marker).

The hypothesis of the study is that the VAE/VABB will be used in patients with pCR at post-NACT imaging to demonstrate the absence of disease in the previous tumour bed and, accordingly, that the use of VAE/VABB with negative histology would lead to a gold standard of treatment without surgical overtreatment.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 77
• Est. completion date: December 31, 2028
• Est. primary completion date: December 31, 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• age> 18 years

• infiltrating breast carcinoma, non-special histotype, triple negative or HER2 +, T1-T2 N0

• single lesion

• neo-adjuvant chemotherapy treatment for at least 12 weeks according to clinical practice

• conservative surgery proposal

• M0

• tumour bed identified by breast markers placed in pre NACT by radiologist

Exclusion Criteria:

• Bilateral or multicentric tumour

• Presence of microcalcifications visualised on mammography

• Presence of associated DCIS

• Positive history of previous breast cancer

• Positive history of medical or psychiatric conditions preventing adherence to the protocol

• High risk patient

Related Conditions & MeSH terms

• Breast Cancer
• Breast Neoplasms
• HER2-positive Breast Cancer
• Neoadjuvant Chemotherapy
• Triple Negative Breast Cancer
• Triple Negative Breast Neoplasms

Intervention

Procedure:
• Omission of surgical treatment
Omission of surgery in patients with pCR after neoadjuvant chemotherapy and negative VABB biopsy

Locations

Country	Name	City	State
Italy	Istituto di Candiolo IRCCS	Candiolo	Turin
Italy	European Institute of Oncology	Milan

Sponsors (1)

Lead Sponsor	Collaborator
European Institute of Oncology

Country where clinical trial is conducted

Italy, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Event-free survival	Absence of disease recurrence or progression, second primary tumor, or death	5 years
Secondary	Positive predictive value of MRI	Evaluation of the accuracy of breast MRI in predicting pCR following NACT	6 months
Secondary	Contrast-Enhanced Mammography (CEM) positive predictive value	Evaluation of the accuracy of breast CEM in predicting pCR following NACT	6 months