Stereotaktisk ablativ strålebehandling for oligometastatisk brystkræft (TAORMINA)
Behandling af oligometastatisk brystkræft - et randomiseret fase 3-forsøg, der sammenligner stereootaktisk ablativ strålebehandling og systemisk behandling med systemisk behandling alene som førstelinjebehandling
TAORMINA is an international, multicentre, randomised phase 3 trial for patients with oligometastatic breast cancer (OMBC) that will be allocated to combined stereotactic ablative radiotherapy (SABR) + systemic therapy (investigational arm) versus systemic therapy alone (control arm) as 1st line therapy.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
TAORMINA is an international, multicentre, randomised phase 3 trial for patients with oligometastatic breast cancer (OMBC) that will be allocated to combined stereotactic ablative radiotherapy (SABR) + systemic therapy (investigational arm) versus systemic therapy alone (control arm) as 1st line therapy.
Patients with 1-5 metastases in 1-2 organs (confirmed by PET-CT) with any breast cancer subtype can be enrolled. All metastases must be available for SABR.
The primary aim is to investigate if the addition of SABR to the oligometastatic sites in addition to the standard first-line treatment can improve progression-free survival (PFS).
Secondary aims are to compare overall survival (OS), response rate and time to development of new lesions, acute and late toxicity. quality of life, time to start of chemotherapy (luminal patients).
Exploratory analyses:
Circulating tumour DNA as an early sign of disease progression. Immun panel for determination of the effect of SABR on patients´ immune response.
To investigate the survival for each BC subtype (Luminal, HER2+ and TNBC). To investigate survival in patients with de novo OMBC and recurrent OMBC respectively.
Stratifications are based on subtype (luminal, HER2-positive vs TNBC) and type of OMBC (de novo vs. recurrent) without formal sample size calculation for the stratification factor (exploratory analysis).
Patients with de novo metastatic OMBC that is planned for neoadjuvant treatment are recommended to complete treatment followed by standard surgery and radiotherapy or SABR towards the primary tumour lesion(s).
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Katarzyna Kulbacka-Ortiz, CTO
- Telefonnummer: +46721470685
- E-mail: katarzyna.kulbacka-ortiz@vgregion.se
Undersøgelse Kontakt Backup
- Navn: Annika Baan
- Telefonnummer: +46700906097
- E-mail: annika.baan@vgregion.se
Studiesteder
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Cork, Irland, T12 DC4A
- Rekruttering
- Cork University Hospital
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Kontakt:
- Ella O'Sullivan, MD
- Telefonnummer: +353 (0) 21 4922000
- E-mail: ella.osullivan@hse.ie
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Ledende efterforsker:
- Aisling Barry, Prof.
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Cork, Irland, T12 DV56
- Rekruttering
- Bon Secours Cork In Partnership with UPMC Hillman Cancer Centre
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Kontakt:
- Karen Molan, MD
- Telefonnummer: +353 (0)21-486 1100
- E-mail: molank@upmc.ie
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Ledende efterforsker:
- Kathy Rock, MD
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Dublin, Irland
- Rekruttering
- St Luke's Radiation Oncology Network (SLRON) at St Luke's Hospital Dublin, St James Hospital Dublin and Beaumont Hospital Dublin
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Kontakt:
- Vitor Oliviera
- Telefonnummer: +353 (0) -1-420 6900
- E-mail: Vitor.Oliveira@slh.ie
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Ledende efterforsker:
- Frances Duane, Prof.
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Galway, Irland, H91 YR71
- Rekruttering
- University Hospital Galway (UHG)
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Kontakt:
- Laura Nally
- Telefonnummer: +353 91 54 2785
- E-mail: laura.nally@hse.ie
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Ledende efterforsker:
- Ronan McDermott, MD
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Tel Aviv, Israel, 5265601
- Rekruttering
- Sheba Medical Center Institute of Oncology
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Kontakt:
- Aliza Ackerstein
- Telefonnummer: +972-3-5302542
- E-mail: aliza.ackerstein@sheba.health.gov.il
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Kontakt:
- Chen Gross
- E-mail: Chen.Gross@sheba.health.gov.il
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Ledende efterforsker:
- Einav Nili Gal-Yam, MD
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Florence, Italien, 3 50134
- Rekruttering
- Azienda Ospedaliero - Universitaria Careggi
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Kontakt:
- Michela Carracino
- Telefonnummer: +390552751828
- E-mail: carracinom@aou-careggi.toscana.it
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Ledende efterforsker:
- Icro Meattini, Prof.
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Milan, Italien
- Rekruttering
- Humanitas Cancer Centre
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Kontakt:
- Marta Scorsetti, MD, PhD
- Telefonnummer: +39 02 8224 8524
- E-mail: marta.scorsetti@hunimed.eu
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Ledende efterforsker:
- Marta Scorsetti, Prof.
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Milan, Italien
- Rekruttering
- Istituto Nationale Tumori (INT)
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Kontakt:
- Maria Carmen De Santis, MD
- Telefonnummer: +39-0223903280
- E-mail: mariacarmen.desantis@istitutotumori.mi.it
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Ledende efterforsker:
- Maria Carmen De Santis, Prof.
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Bergen, Norge, 5021
- Rekruttering
- Haukeland University Hospital
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Kontakt:
- Vidhi Shukla, MD
- Telefonnummer: +47 55 97 50 00
- E-mail: vidi.shukla@helse-bergen.no
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Ledende efterforsker:
- Vidhi Shukla, MD
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Oslo, Norge, 0424
- Rekruttering
- Oslo University Hospital, Radiumhospitalet
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Kontakt:
- Veronica Feilum
- Telefonnummer: +47-942244
- E-mail: uxfeve@ous-hf.no
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Kontakt:
- Maria Elena Rodriguez Aguillar
- E-mail: maerod@ous-hf.no
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Ledende efterforsker:
- Vidar Gordon Flote, MD, PhD
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Tromsø, Norge, 9019
- Rekruttering
- Universitetssykehuset Nord-Norge
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Kontakt:
- Kristin Iren Jensen
- Telefonnummer: + 47 77 66 92 12
- E-mail: Kristin.Iren.Jensen@unn.no
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Kontakt:
- Maria Therese Danielsen
- E-mail: maria.theres.danielsen@unn.no
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Ledende efterforsker:
- Hanna Stromholt Bremnes, MD
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Trondheim, Norge, 7006
- Rekruttering
- St. Olavs Hospital
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Kontakt:
- Kjerstin Olaussen
- Telefonnummer: +47-72825782
- E-mail: Kjerstin.Olaussen@stolav.no
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Kontakt:
- Britt Torun Fjær Nydal
- E-mail: Britt.Torunn.Fjer.Nydal@stolav.no
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Ledende efterforsker:
- Solveig Hoff
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Ljubljana, Slovenien, 1000
- Rekruttering
- Institute of Oncology Ljubljana
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Kontakt:
- Minka Macanovic
- Telefonnummer: +386 (0)1 58 79 550
- E-mail: mmacanovic@onko-i.si
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Kontakt:
- Erika Primc
- E-mail: eprimc@onko-i.si
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Ledende efterforsker:
- Ivica Ratoša, MD
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Region Jönköpings Län
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Jönköping, Region Jönköpings Län, Sverige, 551 85
- Rekruttering
- Ryhov County Hospital
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Ledende efterforsker:
- Maria Ekholm, MD, PhD
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Kontakt:
- Therese Karlsson, Study nurse
- Telefonnummer: +46 10-242 59 62
- E-mail: therese.i.karlsson@rjl.se
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Region Skåne
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Malmö, Region Skåne, Sverige
- Rekruttering
- Skånes University Hospital
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Kontakt:
- Charlotta Wollheim, Study nurse
- Telefonnummer: +46 40 337461
- E-mail: charlotta.wollheim@skane.se
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Ledende efterforsker:
- Muhammad Kadum, MD
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Region Stockholm
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Stockholm, Region Stockholm, Sverige, 17176
- Rekruttering
- Karolinska University Hospital
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Kontakt:
- Karin Hedgren, Study nurse
- Telefonnummer: +46-8-123 71746
- E-mail: karin.hedgren@regionstockholm.se
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Ledende efterforsker:
- Caroline Boman, MD
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Region Västerbotten
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Umeå, Region Västerbotten, Sverige, 901 85
- Rekruttering
- Norrlands University Hospital
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Kontakt:
- Dmitry Domkin, Study nurse
- Telefonnummer: +46 90-785 35 95
- E-mail: dmitry.domkin@regionvasterbotten.se
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Kontakt:
- Jeanette Johansson, Study nurse
- Telefonnummer: +46-90-785 06 89
- E-mail: jeanette.johansson@regionvasterbotten.se
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Ledende efterforsker:
- Kristina Weibring, MD, PhD
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Region Örebro Län
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Örebro, Region Örebro Län, Sverige, SE-701 85
- Rekruttering
- Örebro University Hospital
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Kontakt:
- Emma Nordh, Study nurse
- Telefonnummer: +46 19 602 27 19
- E-mail: emma.nordh@regionorebrolan.se
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Kontakt:
- Jenny Larsson, Study nurse
- Telefonnummer: +46-31-3426791
- E-mail: jenny.larsson4@regionorebrolan.se
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Ledende efterforsker:
- Eva Tegnelius, MD
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Västra Götalandsregionen
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Gothenburg, Västra Götalandsregionen, Sverige, 41345
- Rekruttering
- Sahlgrenska University Hospital
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Kontakt:
- Katarzyna Kulbacka, Head CTO
- E-mail: katarzyna.kulbacka-ortiz@vgregion.se
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Kontakt:
- Mitra Sharifi Jahanfard, Study nurse
- Telefonnummer: +46-31-3426791
- E-mail: mitra.sharifi-jahanfard@vgregion.se
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
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Histologically or cytological confirmed recurrent OMBC.
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Age ≥18 years old.
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OMBC defined as 1-5 metastases in a maximum of two organs confirmed by PET-CT.
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Patients already on 1st line systemic treatment can be enrolled if repeated tumour evaluations show stable disease.
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Patients with de novo stage IV OMBC must have a controlled primary tumour regardless of primary surgery or primary systemic treatment.
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Patients with local recurrence and OMBC must have a controlled local recurrence.
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ECOG/WHO 0-2.
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Life expectancy > 6 months.
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Known ER, PgR and HER2 status of either primary tumour or metastasis (preferred).
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Symptomatic bone metastases are allowed if ablative therapy can be delivered.
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Adequate organ function for the planned treatment according to local guide-lines.
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For patients with liver metastasis:
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No cirrhosis or hepatitis
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Hepatic function:
- Total bilirubin level < 3.0 x institutional ULN
- ALT, AST, GGT, and alkaline phosphatase levels < 3.0 x institutional ULN
- Albumin > 2.5 mg/dL
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Metastasis not adjutant to stomach or small bowel.
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For patients with abdominal metastases: adequate renal function with a calculated creatinine clearance of > 60mL/min.
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Toxicities from previous adjuvant therapies (excluding alopecia) must have recovered to grade 1 (defined by CTCAE 5.0). Stable grade 2 peripheral neuropathy are considered individually by the investigator.
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Negative pregnancy test within 14 days prior to start of treatment*.
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If childbearing potential, willing to use an effective form of contraception*.
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No other malignancy during the last 5 years except for radically treated basal or squamous cell carcinoma of the skin or CIS of the cervix.
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Signed informed consent and willingness to follow the trial procedures.
Exclusion Criteria:
- > 1 line of systemic treatment for OMBC due to previous progressing disease (previous treatment of isolated local recurrences with a 2nd adjuvant treatment not included). Change due to toxicity allowed.
- Oligometastases in brain.
- Malignant pleural effusion or ascites.
- Metastasis growth that involves > 3 vertebra and adjacent spinal cord, spine instability or neurological deficit resulting from compression, 25% spinal canal compromise or progressive neurological deficit.
- Unable to undergo imaging by either CT scan or MRI.
- Evidence of any other medical conditions (such as psychiatric illness, infectious diseases, neurological conditions, physical examination or laboratory findings) that may interfere with the planned treatment or affect patient compliance.
- Pregnancy or breast-feeding.
- Concurrent malignancy requiring therapy (excluding non-invasive carcinoma or carcinoma in situ).
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Experimental SABR arm
Standard first line systemic therapy + SABR. |
Stereotactic Ablative Radiotherapy is delivered to all metastatic lesions. |
|
Ingen indgriben: Control systemic therapy arm
Standard first line systemic therapy. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Progression-free survival (PFS)
Tidsramme: 3 years after the last patient inclusion
|
Time from the date of randomisation to the date of disease-progression at any site or death from any cause. |
3 years after the last patient inclusion
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Overall survival (OS)
Tidsramme: 3 years after the last patient inclusion
|
Time from the date of randomisation to the date of death from any cause. |
3 years after the last patient inclusion
|
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Local Control Rate (LCR)
Tidsramme: 3 years after the last patient inclusion
|
Time from the date of randomisation to the date of progress in previously treated metastases |
3 years after the last patient inclusion
|
|
Safety analysis - acute toxicity
Tidsramme: From the first dose of SABR to 3 months after the last dose of SABR
|
Reported according to CTCAE v.5.0 |
From the first dose of SABR to 3 months after the last dose of SABR
|
|
Safety analysis - late toxicity
Tidsramme: From the first dose of SABR to 3 years after the last dose of SABR
|
Reported according to CTCAE v.5.0 |
From the first dose of SABR to 3 years after the last dose of SABR
|
|
Health-related quality of life Cancer-30
Tidsramme: At base-line and after 3, 6, 9, 12, 18, 24 and 36 months after registration.
|
European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaires Cancer-30 (EORTC-QLQ C30) |
At base-line and after 3, 6, 9, 12, 18, 24 and 36 months after registration.
|
|
Health-related quality of life Breast-23
Tidsramme: At base-line and after 3, 6, 9, 12, 18, 24 and 36 months after registration.
|
European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Breast-23 (EORTC-QLQ B23) |
At base-line and after 3, 6, 9, 12, 18, 24 and 36 months after registration.
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Barbro K Linderholm, MD, PhD, Sahlgrenska University Hospital, Gothenburg
Publikationer og nyttige links
Generelle publikationer
- Milano MT, Katz AW, Zhang H, Okunieff P. Oligometastases treated with stereotactic body radiotherapy: long-term follow-up of prospective study. Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):878-86. doi: 10.1016/j.ijrobp.2011.08.036. Epub 2011 Dec 13.
- Milano MT, Zhang H, Metcalfe SK, Muhs AG, Okunieff P. Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy. Breast Cancer Res Treat. 2009 Jun;115(3):601-8. doi: 10.1007/s10549-008-0157-4. Epub 2008 Aug 22.
- Trovo M, Furlan C, Polesel J, Fiorica F, Arcangeli S, Giaj-Levra N, Alongi F, Del Conte A, Militello L, Muraro E, Martorelli D, Spazzapan S, Berretta M. Radical radiation therapy for oligometastatic breast cancer: Results of a prospective phase II trial. Radiother Oncol. 2018 Jan;126(1):177-180. doi: 10.1016/j.radonc.2017.08.032. Epub 2017 Sep 21.
- Milano MT, Katz AW, Zhang H, Huggins CF, Aujla KS, Okunieff P. Oligometastatic breast cancer treated with hypofractionated stereotactic radiotherapy: Some patients survive longer than a decade. Radiother Oncol. 2019 Feb;131:45-51. doi: 10.1016/j.radonc.2018.11.022. Epub 2018 Dec 28.
- Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D, Ahmad B, Senthi S, Swaminath A, Kopek N, Liu M, Moore K, Currie S, Schlijper R, Bauman GS, Laba J, Qu XM, Warner A, Senan S. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol. 2020 Sep 1;38(25):2830-2838. doi: 10.1200/JCO.20.00818. Epub 2020 Jun 2.
- Chalkidou A, Macmillan T, Grzeda MT, Peacock J, Summers J, Eddy S, Coker B, Patrick H, Powell H, Berry L, Webster G, Ostler P, Dickinson PD, Hatton MQ, Henry A, Keevil S, Hawkins MA, Slevin N, van As N. Stereotactic ablative body radiotherapy in patients with oligometastatic cancers: a prospective, registry-based, single-arm, observational, evaluation study. Lancet Oncol. 2021 Jan;22(1):98-106. doi: 10.1016/S1470-2045(20)30537-4.
- Scorsetti M, Franceschini D, De Rose F, Comito T, Villa E, Iftode C, Navarria P, D'Agostino GR, Masci G, Torrisi R, Testori A, Tinterri C, Santoro A. Stereotactic body radiation therapy: A promising chance for oligometastatic breast cancer. Breast. 2016 Apr;26:11-7. doi: 10.1016/j.breast.2015.12.002. Epub 2016 Jan 3.
- David S, Tan J, Savas P, Bressel M, Kelly D, Foroudi F, Loi S, Siva S. Stereotactic ablative body radiotherapy (SABR) for bone only oligometastatic breast cancer: A prospective clinical trial. Breast. 2020 Feb;49:55-62. doi: 10.1016/j.breast.2019.10.016. Epub 2019 Nov 6.
- Li MP, Kelly D, Tan J, Siva S, Kron T, David S. Single-fraction stereotactic ablative body radiotherapy for sternal metastases in oligometastatic breast cancer: Technique and single institution experience. J Med Imaging Radiat Oncol. 2020 Aug;64(4):580-585. doi: 10.1111/1754-9485.13075. Epub 2020 Jun 25.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
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Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
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