手術を省略したER+乳がんの高齢女性に対する縦断的ctDNAサーベイランス
一次内分泌療法を優先して事前の手術を控えたER+乳がんの高齢女性におけるctDNAの長期モニタリング
This prospective study recruits patients with ER+/HER2-, non-metastatic breast cancer who omit upfront surgery in favor of primary endocrine therapy for sample collection and prospective circulating tumor DNA (ctDNA) measurement to guide disease surveillance.
調査の概要
状態
状態
条件
条件
詳細な説明
Age is one of the most important risk factors for the development of breast cancer. Nearly a third of all breast cancer cases occur in older women (aged ≥ 70 years), with most cases being estrogen receptor-positive (ER+). Such tumours are unlikely to be the ultimate cause of death for older women, particularly when considering other comorbidities. Our group has recently shown that risk of breast cancer-related mortality is only around 3% for older women who forego upfront surgery and instead treated with primary endocrine monotherapy. However, with omission of surgery, surveillance for tumor growth or treatment failure is important but requires patients (and their caregivers) to have regular imaging and to see their oncology team every 3 months, which can be quite burdensome. Thus, this study employs a ctDNA surveillance scheme to monitor for potential tumor growth. Partnering with Natera, this study uses a bespoke, tumor-specific ctDNA assay (Signatera) to monitor for changes in ctDNA dynamics while the patient is on endocrine therapy.
This study is for patients who choose not to undergo primary surgical intervention and are managed medically on primary endocrine therapy (any endocrine therapy permitted). Patients will undergo Signatera testing at the time of regularly scheduled clinic follow-up visits and/or at the time of surveillance imaging, which will occur every 3-6 months. Patients will also be asked to complete regular surveys while participating in the study.
研究の種類
研究の種類
入学 (実際)
入学
連絡先と場所
研究場所
-
-
Pennsylvania
-
Pittsburgh、Pennsylvania、アメリカ、15232
- UPMC Magee Womens Hospital - Surgical Oncology
-
-
参加基準
適格基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
Women 70 years of age or older with ER+/HER2-, non-metastatic breast cancer who forego upfront surgery in favor of primary endocrine therapy.
説明
Inclusion Criteria:
- early-stage (stages I-III) breast cancer
- estrogen receptor positive (ER+) and/or progesterone receptor positive (PR+) and HER2 receptor negative
- able to provide blood samples
- decision made by treating physician and patient to forego upfront surgery in favor of medical management with endocrine therapy
- non-metastatic disease at diagnosis (patients need not have staging scans; patients at higher risk for de novo stage IV disease should not have any symptoms concerning for metastatic disease)
- patients may be taking any endocrine therapy
- patients may be taking any CDK4/6 inhibitor as deemed necessary by their treating physician
- any ECOG Performance Status allowed
- if patients have synchronous bilateral ER+ breast cancer, tissue from both sites should be submitted to Natera to perform ctDNA testing
- patients with multifocal/multicentric tumors are eligible and the largest focus of cancer should be submitted for testing
Exclusion Criteria:
- under 70 years of age
- breast cancer that is not estrogen receptor positive (ER+) or progesterone receptor (PR+)
- unable to provide blood samples or insufficient tumor tissue for Signatera testing
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 観測モデル：COHORT
- 時間の展望：PROSPECTIVE
この研究は何を測定していますか？
主要な結果の測定
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Proportion of ctDNA positivity
時間枠：Up to 5 years
|
Proportion of patients with ER+/HER2- breast cancer who omit upfront surgery in favor of primary endocrine therapy who have any ctDNA positivity using Signatera assay. |
Up to 5 years
|
二次結果の測定
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Progression-free survival (PFS)
時間枠：Up to 5 years
|
The length of time after treatment initiation that patient is alive and without any evidence of tumor progression as defined by RECIST1.1 criteria. Per RECISIT v1.1: Progressive Disease (PD): ≥20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). The sum must also demonstrate an absolute increase of ≥5 mm. The appearance ≥1 new lesion(s) is considered progression. |
Up to 5 years
|
|
Breast cancer-specific survival (BCSS)
時間枠：Up to 5 years
|
BCSS is defined as the length of time from the date of diagnosis through the end of follow up that patients are free from breast cancer-related mortality. |
Up to 5 years
|
|
Overall survival (OS)
時間枠：Up to 5 years
|
The length of time from the date of diagnosis through the end of follow up that patients are still alive. |
Up to 5 years
|
|
Longitudinal quality of life assessment using National Comprehensive Cancer Network/Functional Assessment of Cancer Therapy Breast Cancer Symptom Index - 16 Item Version (NCCN NFBSI-16)
時間枠：Up to 5 years
|
This assessment is a 16 item questionnaire using Likert scale (0-4) measured with each ctDNA blood draw. Score ranges from 0-64 with higher scores indicative of higher quality of life / asymptomatic from cancer-related therapy. |
Up to 5 years
|
協力者と研究者
捜査官
捜査官
- 主任研究者：Priscilla McAuliffe, MD, PhD、UPMC Magee Women's Hospital, UPMC Hillman Cancer Center
研究記録日
主要日程の研究
研究開始 (実際)
研究開始
一次修了 (実際)
一次修了
研究の完了 (推定)
研究の完了
試験登録日
最初に提出
最初に提出
QC基準を満たした最初の提出物
QC基準を満たした最初の提出物
最初の投稿 (実際)
最初の投稿
学習記録の更新
投稿された最後の更新 (実際)
投稿された最後の更新
QC基準を満たした最後の更新が送信されました
QC基準を満たした最後の更新が送信されました
最終確認日
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
その他の研究ID番号
- HCC 22-088
- STUDY21100091 (その他の識別子：University of Pittsburgh)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
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米国FDA規制機器製品の研究
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