Circulating Tumor DNA After Neoadjuvant Chemotherapy

Study Overview
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Brief Summary
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Trial assessing the prognostic value of ctDNA mutations from samples taken sequentially in patients with invasive breast cancer initially treated with neoadjuvant chemotherapy and whose tumor is not in complete histological response.

Detailed Description
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Patients with an invasive breast cancer on neoadjuvant chemotherapy (with the exception of cT2cN0 tumors) are preselected before the surgical procedure. They are definitely included during the post-surgery visit following the analysis of the surgical specimen (only patients whose tumor did not achieve a complete pathological response are included). Sequential plasma samples for ctDNA mutations analysis will be taken during the post-surgery visit (within 2-5 weeks after surgery) and every 6 months (+/- 1 month) thereafter for 5 years. In case of relapse patients will be proposed to participate to an optional research program with a blood test for ctDNA assessment and biopsies from a metastasis (when these biopsies are clinically indicated).

Official Title
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Detection of Circulating Tumoral DNA Mutations (Sequential Assessment) Following Neoadjuvant Chemotherapy for Breast Cancer: Clinical Validity (ALIENOR Study)

Conditions
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Breast Cancer

Intervention / Treatment
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* Other: Follow-up after neoadjuvant chemotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria : Age ≥ 18 years (no age limit). Women or men. Invasive breast cancer proven histologically at diagnosis (before neoadjuvant chemotherapy): Locally advanced tumor known to be inoperable from the start: cT4a, b, c, d whatever the cN or cN2 or cN3 whatever the cT. Operable tumors: cT2cN1 or cT3cN0 or cT3N1, or cT2cN0 for which ganglionic invasion has been proven by cytology or histology. Lack of clinically or radiologically detectable metastases in the initial diagnosis before the neoadjuvant chemotherapy (M0). Unilateral or bilateral breast cancer. Multifocality is accepted. Patients who received 6 to 8 cycles of neoadjuvant chemotherapy. Preoperative radiation therapy allowed. Breast surgery performed and pathology report of a non-complete histological response (i.e. all the different results of ypT0 /is ypN0). Signed informed consent. Patients affiliated to a French social security scheme in accordance with Article 1121-11 of the French Code of Public Health. Possible inclusion in another interventional research (surgical, radiotherapy or drug study). Exclusion Criteria : cT2cN0 tumor without cytological or histological lymph node involvement. Progression during neoadjuvant chemotherapy. Exclusive neoadjuvant hormone therapy. Complete blood transfusion within 120 days prior to 1st sampling. History of invasive cancer regardless of the time elapsed since the diagnosis of this cancer, including a history of contralateral invasive breast cancer. However, patients who have been treated for in situ breast cancer, basocellular skin cancer or cervical cancer treated in situ are eligible. Patient unable to follow and comply with research procedures for geographical, social or psychological reasons. Patient deprived of liberty or subject to a legal protection measure.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Follow-up after neoadjuvant chemotherapy<br>Patients with an invasive breast cancer on neoadjuvant chemotherapy (with the exception of cT2cN0 tumors) are preselected before the surgical procedure. They are definitely included during the post-surgery visit following the analysis of the surgical specimen (only patients whose tumor did not achieve a complete pathological response are included). | Other: Follow-up after neoadjuvant chemotherapy<br>* Sequential plasma samples for ctDNA mutations analysis will be taken during the post-surgery visit (within 2-5 weeks after surgery) and every 6 months (+/- 1 month) thereafter for 5 years. In case of relapse patients will be proposed to participate to an optional research program with a blood test for ctDNA assessment and biopsies from a metastasis (when these biopsies are clinically indicated). Next Generation Sequencing (NGS) analysis will be performed on post-neoadjuvant chemotherapy residual tumor tissue samples. The mutations identified by NGS in residual tumor will be tracked in ctDNA using personalized digital PCR (dPCR) or by an NGS technique whose bioinformatics pipeline is adapted to the analysis of ctDNA. In case of relapse patients will be proposed to participate to an optional research program with a blood test for ctDNA assessment and biopsies from a metastasis (when these biopsies are clinically indicated).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prognostic value of the presence of ctDNA mutation(s) measured by dPCR on recurrence-free interval (RFI) at 3 years. |  | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prognostic value of the presence of ctDNA mutation(s) on overall survival (OS) at 3 years. |  | 3 years | 
| Prognostic value of the presence of ctDNA mutation(s) on distant-metastasis-free interval (DRFI) at 3 years. |  | 3 years | 
| Prognostic value of the presence of ctDNA mutation(s) on OS at 5 years. |  | 5 years | 
| Prognostic value of the presence of ctDNA mutation(s) on DRFI at 5 years. |  | 5 years | 
| Prognostic value of the presence of ctDNA mutation(s) on a single sample assessment after surgery (measured by dPCR) on RFI at 3 years. |  | 3 years | 
| Prognostic value of the presence of ctDNA mutation(s) on a single sample assessment after surgery (measured by dPCR) on DRFI at 3 years. |  | 3 years | 
| Prognostic value of the presence of ctDNA mutation(s) on a single sample assessment after surgery (measured by dPCR) on RFI at 5 years. |  | 5 years | 
| Prognostic value of the presence of ctDNA mutation(s) on a single sample assessment after surgery (measured by dPCR) on DRFIat 5 years. |  | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer, Neoadjuvant chemotherapy, Circulating tumor DNA