Local Therapy for ER/PR-positive Oligometastatic Breast Cancer

Study Overview
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Brief Summary
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Randomized phase 2 trial to evaluate the efficacy of local therapy for oligometastasis from ER/PR-positive breast cancer. The study hypothesis is that local therapy in addition to systemic therapy improves progression-free survival in comparison with systemic therapy alone.

Detailed Description
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Patients with estrogen receptor/ progesterone receptor-positive oligometastatic breast cancer with disease controlled after at least six months of systemic therapy will be enrolled in the study. Patients will be randomized to receive local therapy for oligometastatic sites in addition to systemic therapy or systemic therapy alone. Local therapy strategies will include surgery, radiotherapy, and radiofrequency ablation.

Official Title
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Local Therapy for Hormone Receptor-positive Oligometastatic Breast Cancer - a Phase II Randomized Trial

Conditions
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Breast Cancer

Intervention / Treatment
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* Radiation: Radiotherapy
* Procedure: Surgery
* Other: Radiofrequency ablation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female sex ≥ 18 years of age Histologically confirmed invasive breast cancer, with oligometastatic disease defined as one of the following criteria: 1) One to four bone lesions; 2) One to four lung and/ or hepatic lesions; 3) Distant metastasis limited to ipsilateral cervical lymph nodes; 4) Distant metastasis limited to contralateral axillary lymph nodes Oligometastatic sites amenable to treatment with a local therapy modality, including surgical resection, stereotactic radiotherapy, or radiofrequency ablation Estrogen receptor-positive and/ or progesterone receptor-positive breast cancer Partial response or stable disease after at least six months of systemic therapy for breast cancer Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 Measurable or non-measuble disease according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 Life expectancy of at least 12 weeks For women in childbearing age, negative pregnancy test until 21 days before the date of study enrollment. Signed informed consent form Disposition and aptitude to fulfill the study protocol during the study duration Exclusion Criteria: HER2-positive breast cancer Progressive disease during the last systemic treatment received for metastatic disease Previous local therapy for distant metastasis Current or previous history of severe diseases, such as clinically relevant heart failure, acute myocardium infarction in the last six months, chronic obstructive lung disease, HIV infection, chronic active hepatitis B or C infection, current serious uncontrolled infections or other severe diseases that may impact patients' expected survival) Current or previous history of other invasive malignancy within the last five years, excluding non-melanoma skin cancer

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Systemic therapy<br>Patients will receive standard of care with systemic therapy alone. | |
| Experimental: Local therapy + systemic therapy<br>In addition to systemic therapy, patients will receive local therapy for all oligometastatic sites. Options of local therapy will be radiotherapy, radiofrequency ablation, and/ or surgery. | Radiation: Radiotherapy<br>* Radiation therapy for oligometastatic sites<br>Procedure: Surgery<br>* Surgery for oligometastatic sites<br>Other: Radiofrequency ablation<br>* Radiofrequency ablation for oligometastatic sites<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 2-year progression-free survival (PFS) | PFS will be defined as the time from randomization until the date of progression or death. 2-year PFS rate will represent the probability of a patient being free of progression after 2 years of randomization and will be estimated using the Kaplan-Meier method. | from baseline up to 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall-survival (OS) | OS will be calculated from the date of randomization until the date of death from any cause. | from baseline up to 10 years | 
| Local therapy complication rate | Local therapy complications will be registered, including the occurrence of bleeding, local infections, pneumothorax, or other events attributed to local therapy by the medical team. Acute complications will be considered as those occurring until one month after procedure, while late complication will be those occurring later than one month. | from baseline up to 10 years | 
| 1. European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Core 30 (QLQ-C30) | The EORTC QLQ-C30 provide points for questions related to global health status, functional scales, and symptom scales, providing scores ranging from 0-100. Higher scores represent higher health status, higher functioning, and higher symptom burden. | from baseline up to 1 year | 
| 2. European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Breast Cancer (QLQ-BR23) | EORTC-QLQ-BR23 is composed of questions related to functional scales and symptom scales specific for breast cancer, providing scores ranging from 0-100. Higher scores for functional scales represent better functioning, while higher scores for symptom scales represent higher levels of symptoms. | from baseline up to 1 year | 
| Chemotherapy-free survival | Chemotherapy-free survival will be calculated from the date of randomization until the first date of application of a new chemotherapy line. | from baseline up to 10 years | 
| Subgroup analysis - PFS according to type of metastatic disease (de novo versus recurrent) and metastatic sites | PFS will be calculated for subgroups, according to type of metastatic disease (de novo versus recurrent) and sites of oligometastasis | from baseline up to 10 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Oligometastasis, Hormone Receptor Positive, Surgery, Radiotherapy, Radiofrequency ablation