Pre-Operative Window of Adjuvant Endocrine Therapy to Inform RT Decisions in Older Women With Early-Stage Breast Cancer (POWER)

Pre-Operative Window of Adjuvant Endocrine Therapy to Inform Radiation Therapy Decisions In Older Women With Early-Stage Breast Cancer

This is a prospective multisite exploratory study for women ≥ 65 years of age with early stage estrogen receptor positive (ER+) breast cancer. These individuals will be treated with 3 months of pre-operative endocrine therapy (pre-ET) with assessment of tolerance to the endocrine therapy by patient reported outcome (PRO) measures (patient surveys).

Study Overview

• Status: Active, not recruiting
• Conditions: Breast Cancer Female
• Intervention / Treatment: Drug: tamoxifen, letrozole, anastrozole, or exemestane; Behavioral: Patient reported outcomes

Detailed Description

This single arm pilot study evaluates the use of pre-operative endocrine therapy in women with early stage ER+ breast cancer who are 65 years or older and are scheduled to have breast conservation surgery (BCS). The purpose of this study is to see if tolerance of pre-operative endocrine therapy helps inform decisions on whether or not to omit radiation. Participants will be treated with the novel approach of 3 months of pre-operative endocrine therapy, so that the participants and providers will have some indication of tolerance prior to making a decision about radiation omission. Tolerance of the endocrine therapy will be assessed by patient reported outcome (PRO) measures during neoadjuvant and adjuvant endocrine therapy treatment periods. Breast cancer participants and their surgical oncologists will be asked their preference regarding radiation therapy before starting endocrine therapy and again pre-operatively. They will make a determination regarding radiation therapy as per standard care. The hypothesis is that knowledge of tolerance of endocrine therapy will influence the decision by the patient and the surgical oncologist whether or not to elect radiation omission.

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Virginia
    • Charlottesville, Virginia, United States, 22908
      • University of Virginia
    • Richmond, Virginia, United States, 23298
      • Virginia Commonwealth University Massey Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria (Summary):

• ECOG performance status 0-2
• Diagnosed with anatomic stage I, ER positive, PR positive or negative, and HER2 non amplified invasive breast cancer and clinically negative nodes; any invasive breast cancer histologic subtype may be enrolled
• Tumor size ≤ 2 cm
• Patient has elected BCS as surgical choice
• Eligible to receive tamoxifen or an aromatase inhibitor
• Ability to take oral medication and be willing to adhere to the endocrine therapy for the 3 month period prior to BCS

Exclusion Criteria (Summary):

• Prior or current use of endocrine therapy for breast cancer
• History of ipsilateral breast radiation
• Pregnancy or lactation
• Has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer.
• Current or planned use of a strong CYP2D6 inhibitor (e.g. Fluoxetine, Paroxetine) and is not able to receive an endocrine therapy agent that does not use the CYP2D6 pathway

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Pre-operative endocrine therapy; All participants enrolled to the study will receive 3 months of pre-operative endocrine therapy (e.g. tamoxifen or aromatase inhibitors (AIs) such as letrozole, anastrozole, or exemestane). The choice and dose of endocrine therapy will be at the discretion of the treating medical oncologist.

Drug: tamoxifen, letrozole, anastrozole, or exemestane; choice and dose of neoadjuvant endocrine therapy at the discretion of the treating medical oncologist; Other Names: Endocrine therapy; Behavioral: Patient reported outcomes; Questionnaire inquiries include the following: how cancer affects daily living; beliefs about medicines and sensitivity to medicine; symptoms; adherence to endocrine therapy; general health and well being; depression and anxiety; preference regarding radiation therapy; Other Names: surveys, questionnaires

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Who Changed Their Preference for Adjuvant Radiation Treatment	Change in participant response to question regarding preference for adjuvant radiation treatment	up to 6 months
Change in Surgeon Preference for Adjuvant Radiation Treatment	Change in surgical oncologist response to question regarding preference for adjuvant radiation treatment	up to 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health Related Quality of Life Surveys as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS	Health related quality of life will be assessed using the EORTC QLQ-C30 and QLQ-BR23.	Through 24 months after start of adjuvant treatment period
General Symptom Burden as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS	General symptom burden will be assessed using the Breast Cancer Prevention Trial Symptom Checklist.	Through 24 months after start of adjuvant treatment period
Illness Perception as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS	Illness perception will be assessed using the Brief Illness Perception Questionnaire.	Through 24 months after start of adjuvant treatment period
Beliefs About Medicine as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS	Beliefs about medicine will be assessed using the Beliefs about Medicines Questionnaire.	Through 24 months after start of adjuvant treatment period
Perceived Sensitivity to Medicine as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS	Perceived sensitivity to medicine will be assessed using the Perceived Sensitivity to Medicine Scale.	Through 24 months after start of adjuvant treatment period
Breast Cancer Beliefs as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS	Breast cancer beliefs will be assessed using the UVA Breast Cancer Belief Survey, a novel series of questions regarding patient beliefs about breast cancer and breast cancer medications.	Through 24 months after start of adjuvant treatment period
Treatment Decision as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS.	Treatment decision will be assessed using the Treatment Decision Survey, a novel series of questions regarding why subjects decide to have or not to have radiation therapy, and why or why not to restart endocrine therapy.	up to 90 days after surgery, chemotherapy completion, or RT completion, whichever is later
Perceptions Related to Medical Choices as Predictive Measure for Endocrine Therapy Adherence and to Assess Effect of Pre-ET on Decision Outcomes for Adjuvant Therapy After BCS.	Subjects' perceptions related to their medical choices will be assessed using the Decisional Conflict Scale and the Decision Regret Scale.	Through 24 months after start of adjuvant treatment period
Depression and Anxiety as Predictive Measure for Endocrine Therapy Adherence	Depression and anxiety will be assessed using the Center for Epidemiologic Studies Depression Scale Revised.	Through 24 months after start of adjuvant treatment period

Collaborators and Investigators

• Sponsor: Shayna Showalter, MD
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Shayna L Showalter, MD, University of Virginia

Study record dates

Study Major Dates

• Study Start (Actual): April 7, 2020
• Primary Completion (Actual): June 5, 2024
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: February 4, 2020
• First Submitted That Met QC Criteria: February 14, 2020
• First Posted (Actual): February 17, 2020

Study Record Updates

• Last Update Posted (Estimated): October 22, 2025
• Last Update Submitted That Met QC Criteria: September 25, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: breast cancer; radiation; tamoxifen; geriatric; anastrozole; questionnaire; survey; letrozole; endocrine therapy; exemestane
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Skin Diseases; Breast Diseases; Skin and Connective Tissue Diseases; Breast Neoplasms; Health Services Administration; Health Care Quality, Access, and Evaluation; Organic Chemicals; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Investigative Techniques; Epidemiologic Methods; Azoles; Hydrocarbons; Hydrocarbons, Cyclic; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Hydrocarbons, Aromatic; Benzene Derivatives; Health Care Economics and Organizations; Nitriles; Outcome Assessment, Health Care; Outcome and Process Assessment, Health Care; Triazoles; Stilbenes; Benzylidene Compounds; Health Planning; Health Care Surveys; Health Services Research; Patient Outcome Assessment; Letrozole; Anastrozole; Tamoxifen; Surveys and Questionnaires; exemestane; Patient Reported Outcome Measures
• Other Study ID Numbers: 22040 (City of Hope Medical Center); 5R21CA277311-02 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No