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Classified Treatment Strategy for De-novo Metastatic Breast Cancer After Systemic Adjuvant Therapy (CS)

17. juli 2022 opdateret af: Yue Yu, Changhai Hospital

Classified Treatment Strategy for De-novo Metastatic Breast Cancer After Systemic Adjuvant Therapywhich Patients Will Benefit From Surgery

For patients with de novo stage IV breast cancer, the current debate is whether local surgery can improve the survival of patients. There is no clinical study on the classification after systemic treatment of de novo stage IV breast cancer patients. In fact, the clinical stage of tumor can change with the change of treatment. For example, the stage Ⅲ of locally advanced breast cancer can down-staging to the stage Ⅱ after systemic treatment. Similarly, patients with stage Ⅳ can down-staging to stage Ⅱ or stage Ⅲ after systemic treatment. At this time, the patient can receive surgical treatment. Therefore, this study is to first treat de novo stage IV breast cancer patients with systemic treatment, according to the response after systemic treatment to give different treatment measures（surgery or continued systemic treatment）. The investigators hope that this study will provide new ideas for the treatment of de novo stage IV breast cancer and other de novo stage IV cancers.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

This study analysed and summarized the outcomes of the primary and metastatic lesions after first-line systemic therapy in patients with newly diagnosed breast cancer and then inferred the timing of surgical treatment. According to the tumour heterogeneity characteristics between the primary and metastatic tumours, the investigators investigated the following A, B and C scenarios. After systemic therapy in patients with de novo metastatic breast cancer, the outcomes of primary and metastatic lesions were mainly divided into four categories (Fig. 1a, b, c, d). It is worth noting that after treatment, the four conditions of a, b, c, and d may alternate with the progression of the tumour or modification of the treatment plan. Therefore, only a proactive evaluation and timely treatment can identify the time window for tumour treatment. The time window for surgical treatment is important because, once missed, the tumour may progress with new metastatic lesions. Figure 1-a: Imaging study indicates complete remission of primary and metastatic tumours. Diagnostic surgical treatment can be performed to determine whether a pathologic complete response (PCR) is achieved and to develop a subsequent treatment plan. Figure 1-b: Imaging study indicates complete remission of the metastatic tumour with residual primary tumour. The state of the patient in this scenario could be equivalent to that of patients with early resectable breast cancer. Surgical treatment of the primary tumour should be promptly performed. Figure 1-c: Complete remission of the primary and residual metastatic tumour. Surgical treatment can be selected for isolated and resectable metastatic tumour. Figure 1-d: No remission or even progression of the primary and metastatic tumours. The systemic treatment plan should be replaced, and the surgical treatment should not be considered.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

362

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 75 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Kvinde

Beskrivelse

Study Population Operable stage IV breast cancer patients, whose primary lesion is invasive breast cancer confirmed by pathology, and metastases can be confirmed by pathology or imaginology examination

Inclusion Criteria:

  • Operable stage IV breast cancer patients,whose primary lesion is invasive breast cancer confirmed by pathology, and metastases can be confirmed by pathology or imageology examination.
  • ECOG-PS 0-2.
  • Bone marrow, liver and kidney should be fully functional.
  • Patients didn't received the locoregional surgery of the primary tumor in de novo.
  • For the patient who accepted systematic treatment before operation, the systematic treatment must be administered within a year since diagnosed.

Exclusion Criteria:

  • Accompanied with other primary malignant tumors.
  • More than two visceral organ involvement.
  • Patients who can't plan for follow-up effectively and regularly.
  • Multiple liver metastases with deranged liver function tests (SGOT/SGPT more than four times the upper normal limit).

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Sekventiel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: 1 Primary and metastatic lesions PCR
surgery 1 Mastectomy OR Breast conserving surgery
Procedure: surgical treatment 1
Mastectomy OR Breast conserving surgery
Andre navne:
  • surgery 1
Eksperimentel: 2 Primary lesions NPCR and metastatic lesions PCR
surgery 1 Mastectomy OR Breast conserving surgery
Procedure: surgical treatment 1
Mastectomy OR Breast conserving surgery
Andre navne:
  • surgery 1
Eksperimentel: 3 Primary lesions PCR and metastatic lesions NPCR
surgery 2 Resection of metastasis
Procedure: surgical treatment 2
Resection of metastasis
Andre navne:
  • surgery 2
Eksperimentel: 4 Primary lesions NPCR and metastatic lesions NPCR
Systemic therapy Endocrine therapy or chemotherapy or targeted therapy
Medicin: Systemic therapy
Endocrine therapy or chemotherapy or targeted therapy

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Overall survival
Tidsramme: 5 years
Overall survival (OS), which defined as the time from the beginning of diagnosis of breast cancer to the death with any causes.
5 years

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Lokoregional progressionsfri overlevelse
Tidsramme: 5 år
Defineret som tiden mellem tidspunktet for diagnosen og tidspunktet for lokoregionalt tilbagefald eller dødsfald.
5 år
Fjern progressionsfri overlevelse
Tidsramme: 5 år
Fjern sygdomsfri overlevelse (D-DFS), der defineres som tiden fra diagnosen de novo stadium IV brystkræft til det bekræftede tidspunkt for fjern progression eller død på grund af enhver anden årsag.
5 år

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Changhai Hospital

Efterforskere

  • Studiestol: YU YUE, doctor, Department of thyroid and breast surgery, Changhai Hospital

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Forventet)

1. august 2022

Primær færdiggørelse (Forventet)

31. december 2030

Studieafslutning (Forventet)

1. maj 2031

Datoer for studieregistrering

Først indsendt

9. marts 2022

Først indsendt, der opfyldte QC-kriterier

16. marts 2022

Først opslået (Faktiske)

17. marts 2022

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

19. juli 2022

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

17. juli 2022

Sidst verificeret

1. juli 2022

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • ChanghaiHTB

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

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