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Study of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction (BCSMANC)

Primary Purpose

Breast Cancer

Status
Unknown status
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
Ultrasound
CNB
BCS, Modified Radical Mastectomy
Pathologic Large Tissue Selected Table
Leica TP1020
Pathologic Large Tissue Embedded Table
Leica SM2000 R
HE Stain
CX22
Epson V600
MRI
Three-Dimensional Reconstruction
Mammography
TAC,TC,TA,CAF,CEF
AC-P,TEC,AC,TC,TCH,CEF,TAC,CAF
Sponsored by
Shandong Cancer Hospital and Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Breast Cancer focused on measuring Breast Cancer, shrinkage modes, three-dimensional reconstruction, neoadjuvant chemotherapy, Magnetic Resonance Imaging

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  1. Female patients,locally advanced breast cancer,age ≥18 years.
  2. Histologically confirmed invasive adenocarcinoma of the breast.
  3. Primary palpable disease confined to a breast and axilla on physical examination. For patients without clinically suspicious axillary adenopathy, the primary tumor must be larger than 2 cm in diameter by physical exam or imaging studies (clinical T2-T3, N0-N1, M0). For patients with clinically suspicious axillary adenopathy, the primary breast tumor can be any size (clinical T1-3, N1-2, M0). (T1N0M0 lesions are excluded.)
  4. Patients without clearly defined palpable breast mass or axillary lymph nodes but radiographically measurable tumor masses are acceptable. Accepted procedures for measuring breast disease are mammography, MRI, and breast ultrasound. This will need to be re-evaluated after 3 cycles and prior to surgery.
  5. ECOG 0 or 2
  6. No distant metastasis, as documented by complete staging workup ≤6 weeks prior to initiation of study treatment.
  7. No previous treatment for breast cancer.
  8. Adequate hematologic function with:

    Absolute neutrophil count (ANC) >1500/μL. Platelets ≥100,000/μL. Hemoglobin ≥10 g/dL.

  9. Adequate hepatic function with:

    Serum bilirubin ≤ the institutional upper limit of normal (ULN). Aspartate aminotransferase (AST) ≤2.5 x institutional ULN. Alanine aminotransferase (ALT) ≤2.5 x institutional ULN.

  10. Adequate renal function with serum creatinine ≤1.5 x ULN.
  11. Planned primary systemic (neoadjuvant) chemotherapy and surgical resection of residual primary tumor (mastectomy or lumpectomy/breast conservation) following completion of neoadjuvant chemotherapy

Exclusion Criteria:

  1. inflammatory breast cancer
  2. Pregnancy or breast-feeding.A negative serum pregnancy test within 7 days prior to first study treatment (Day 1, Cycle 1) for all women of childbearing potential is required. Patients of childbearing potential must agree to use a birth control method that is approved by their study physician while receiving study treatment and for 3 weeks after their last dose of study treatment. Patients must agree to not breast-feed while receiving study treatment.
  3. Concurrent treatment with an ovarian hormonal replacement therapy or with hormonal agents such as raloxifene, tamoxifen or other selective estrogen receptor modulator (SERM). Patients must have discontinued use of such agents prior to beginning study treatment.
  4. Uncontrolled intercurrent illness including (but not limited to) ongoing or active infection.
  5. Concurrent treatment with any anti-cancer therapy other than those agents used in this study.
  6. Mental condition or psychiatric disorder that would prevent patient comprehension of the nature, scope, and possible consequences of the study or that would limit compliance with study requirements.

Sites / Locations

  • Shandong Cancer HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Half Cycles Group

Whole Cycles Group

Arm Description

Patients complete half of the whole cycles of neoadjuvant chemotherapy.

Patients complete whole cycles of neoadjuvant chemotherapy.

Outcomes

Primary Outcome Measures

The shrinkage modes of breast tumor after NAC.
The tumor shrinkage modes of the primary tumor in patients with locally advanced breast cancer after 3 cycles and whole cycles of neoadjuvant chemotherapy(NAC).

Secondary Outcome Measures

The WMSS and 3D pathological reconstruction of the residual tumors after NAC.
The whole-mount serial section(WMSS) and three-dimensional(3D) pathological reconstruction of the residual tumors after NAC.

Full Information

First Posted
August 4, 2013
Last Updated
August 4, 2013
Sponsor
Shandong Cancer Hospital and Institute
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1. Study Identification

Unique Protocol Identification Number
NCT01917578
Brief Title
Study of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction
Acronym
BCSMANC
Official Title
Phase III Trail of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction
Study Type
Interventional

2. Study Status

Record Verification Date
August 2013
Overall Recruitment Status
Unknown status
Study Start Date
August 2008 (undefined)
Primary Completion Date
March 2014 (Anticipated)
Study Completion Date
July 2014 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Shandong Cancer Hospital and Institute

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The main clinical goal of NAC is to down-stage the primary tumor for BCS,yet BCS after NAC has been associated with significantly higher ipsilateral breast tumor recurrences.The accuracy of breast tumor excision in BCS can dramatically reduce IBTR.The main reseason of IBTR might be the uncertain shrinkage modes of the breast cancer after NAC.This clinical trial is firstly carried out to make clear the shrinkage modes of the primary tumor after 3 cycles and whole cycles of NAC,respectively,with whole-mount serial section(WMSS) and three-dimensional(3D) pathological reconstruction of the residual tumor.The second objective is to investigate the predictive value of 3D MRI reconstruction for the shrinkage modes of the primary tumor after NAC.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
Breast Cancer, shrinkage modes, three-dimensional reconstruction, neoadjuvant chemotherapy, Magnetic Resonance Imaging

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
4 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Half Cycles Group
Arm Type
Experimental
Arm Description
Patients complete half of the whole cycles of neoadjuvant chemotherapy.
Arm Title
Whole Cycles Group
Arm Type
Experimental
Arm Description
Patients complete whole cycles of neoadjuvant chemotherapy.
Intervention Type
Device
Intervention Name(s)
Ultrasound
Other Intervention Name(s)
GE LOGIQ C5
Intervention Description
Evaluation of the tumor size by sonography is performed before neoadjuvant chemotherapy and prior to surgery. Measurement of tumor size refers to WHO standards.
Intervention Type
Procedure
Intervention Name(s)
CNB
Other Intervention Name(s)
core needle biopsy
Intervention Description
Typically, the pretreatment tumor specimen will be a core needle biopsy. Because 15% to 28% of patients will have no residual tumor after NAT, it is important to have an adequate pretreatment sample in which an unequivocal diagnosis of invasive carcinoma is established and evaluation of hormone receptors and HER2/ neu status is completed before treatment.
Intervention Type
Procedure
Intervention Name(s)
BCS, Modified Radical Mastectomy
Other Intervention Name(s)
BCS: breast conservative surgery
Intervention Description
All patients after neoadjuvant chemotherapy are performed BCS and modified radical mastectomy.
Intervention Type
Device
Intervention Name(s)
Pathologic Large Tissue Selected Table
Intervention Description
Pathologic large tissue selected table has obtained Chinese patent.Its license ID is CN101261200. Each piece of breast tissues by cutting with the table has 3mm thickness.
Intervention Type
Device
Intervention Name(s)
Leica TP1020
Other Intervention Name(s)
Semi-enclosed Benchtop Tissue Processor Leica TP1020
Intervention Description
Procedure: Alcohol 70 % 1h Alcohol 80 % 1h Alcohol 85 % 1h Alcohol 90 % 1h Alcohol 95 % 1h Alcohol Ⅰ 100 % 1h Alcohol Ⅱ 100 % 1h Xylene Ⅰ 2h Xylene Ⅱ 2h Xylene Ⅲ 2h Paraffin 6h Paraffin 6h
Intervention Type
Device
Intervention Name(s)
Pathologic Large Tissue Embedded Table
Intervention Description
The table is made of brass .It is applying for a chinese patent. The table can simultaneously embed 8 piece of breast tissues.
Intervention Type
Device
Intervention Name(s)
Leica SM2000 R
Other Intervention Name(s)
Sliding microtome Leica SM2000 R
Intervention Description
Each of paraffin section has 4 um thickness.
Intervention Type
Procedure
Intervention Name(s)
HE Stain
Intervention Description
Procedure: Xylene Ⅰ 60℃ 15-20 minutes Xylene Ⅱ 60℃ 15-20 minutes Alcohol 100% Ⅰ 3-5 minutes Alcohol 100% Ⅱ 3-5 minutes Alcohol 95% Ⅱ 3-5 minutes Alcohol 90% Ⅱ 3-5 minutes Wash in running tap water for 3 minutes Hematoxylin 5-10 minutes Wash in running tap water for 3 minutes Differentiate in 1% acid alcohol for 30 seconds Wash in running tap water for 1 minute Bluing in 0.2% ammonia water for 30-60 seconds Wash in running tap water for 3 minutes Counterstain in eosin Y solution for 30-60 seconds Wash in running tap water for 1 minute Alcohol 90% Ⅱ 2-3 minutes Alcohol 95% Ⅱ 2-3 minutes Alcohol 100% Ⅱ 3-5 minutes Alcohol 100% Ⅱ 3-5 minutes Xylene Ⅲ 5-10 minutes Xylene Ⅳ 5-10 minutes Mounting with neutral resin
Intervention Type
Device
Intervention Name(s)
CX22
Other Intervention Name(s)
Biological Microscope CX22(Olympus)
Intervention Description
The residual tumor areas are microscopically outlined on each slice by pathologist.
Intervention Type
Device
Intervention Name(s)
Epson V600
Other Intervention Name(s)
Epson Perfection V600 Photo Scanner
Intervention Description
Each slice that has been microscopically outlined is scanned by Epson V600. Every image by scanning should be saved as JPG.
Intervention Type
Device
Intervention Name(s)
MRI
Other Intervention Name(s)
Philips Achieva 3.0T MRI System
Intervention Description
Evaluation of the tumor size by MRI was performed before neoadjuvant chemotherapy and prior to surgery. Measurement of tumor size refers to WHO standards. The images of patients which were scanned by MRI should be burned onto disc for 3d reconstruction.
Intervention Type
Procedure
Intervention Name(s)
Three-Dimensional Reconstruction
Intervention Description
A.Pathological images three-dimensional reconstruction: Pathological images registration is based on skin and shear mark by Photoshop 13.0 software. Residual tumor boundary on Pathological images after registration are outlined and taken three-dimensional reconstruction by 3D-doctor 4.0 software. Observe the shrinkage modes in three-dimensional space. According to WHO standard,the boundaries of all residual tumor images are displayed in one plane and the longest diameter and its longest perpendicular diameter of boundaries are measured in one-dimensional space. According to RECIST standard,the longest diameter of boundaries of residual tumor images in three-dimensional space. B.MRI images three-dimensional reconstruction:the procedure is similar to Pathological images three-dimensional reconstruction
Intervention Type
Device
Intervention Name(s)
Mammography
Other Intervention Name(s)
GE Mammography
Intervention Description
Evaluation of the tumor size by mammography is performed before neoadjuvant chemotherapy and prior to surgery. Measurement of tumor size and calcification extent refers to WHO standards. Calcification extent is not only measured in mammography image but also under microscope.
Intervention Type
Drug
Intervention Name(s)
TAC,TC,TA,CAF,CEF
Other Intervention Name(s)
1.TAC(docetaxel/doxorubicin/cyclophosphamide), 2.TC(docetaxel/cyclophosphamide), 3.TA(paclitaxel/doxorubicin), 4.CAF(fluorouracil/doxorubicin/cyclophosphamide), 5.CEF(cyclophosphamide/epirubicin//fluorouracil)
Intervention Description
TAC:Docetaxel 75 mg/㎡ iv day 1 + Doxorubicin 50 mg/㎡ in day 1 + Cyclophosphamide 500 mg/㎡ iv day 1(Cycled every 21 days for 3 cycles) TC:Docetaxel 75 mg/㎡ iv day 1 + Cyclophosphamide 600 mg/㎡in day 1(Cycled every 21 days for 2 cycles) TA:Docetaxel 75 mg/㎡ iv day 1 + Doxorubicin 50 mg/㎡ in day 1(Cycled every 21 days for 2 cycles) CAF:Cyclophosphamide 100 mg/㎡ po days 1-14 + Doxorubicin 30 mg/㎡ iv days 1,8 +5-fluorouracil 500 mg/㎡ iv days 1,8(cycled every 28 days for 3 cycles) CEF:Cyclophosphamide 75 mg/㎡ po day 1-14 + Epirubicin 60 mg/㎡ iv days 1,8 + 5-fluorouracil 500mg/㎡ iv days 1,8(cycled every 28 days for 3 cycles)
Intervention Type
Drug
Intervention Name(s)
AC-P,TEC,AC,TC,TCH,CEF,TAC,CAF
Other Intervention Name(s)
1.AC(doxorubicin/cyclophosphamide)-P(paclitaxel), 2.TEC(docetaxel/epirubicin/cyclophosphamide), 3.AC(doxorubicin/cyclophosphamide)-T(docetaxel), 4.TC(docetaxel/cyclophosphamide), 5.TCH(docetaxel/carboplatin/trastuzumab), 6.CEF(cyclophosphamide/epirubicin/fluorouracil), 7.TAC(docetaxel/doxorubicin/cyclophosphamide), 8.CAF(fluorouracil/doxorubicin/cyclophosphamide)
Intervention Description
AC-P:Doxorubicin 60 mg/㎡ iv day 1 +Cyclophosphamide 600 mg/㎡ iv day 1(Cycled every 14 days for 4 cycles)→ Paclitaxel 175mg/㎡ by 3h iv infusion day 1(Cycled every 14 days for 4 cycles) or Paclitaxel 80mg/㎡ by 1h iv infusion weekly for 12 wks. TEC:Docetaxel 75 mg/㎡ iv day 1 + Epirubicin 75 mg/㎡ in day 1 + Cyclophosphamide 500 mg/㎡ iv day 1(Cycled every 21 days for 6 cycles) AC:Doxorubicin 60 mg/㎡ in day 1 + Cyclophosphamide 600 mg/㎡ iv day 1(Cycled every 21 days for 4 cycles) TC:Docetaxel 75 mg/㎡ iv day 1 + Cyclophosphamide 600 mg/㎡in day 1(Cycled every 21 days for 4 cycles) TCH:Docetaxel 75 mg/㎡ iv day 1 + Carboplatin AUC 6 iv day1(Cycled every 21 days for 6 cycles) + Trastuzumab 4 mg/kg iv wk 1 → Trastuzumab 2 mg/kg iv for 17 wks → Trastuzumab 6 mg/kg iv every 3 wks to complete 1 year. CEF:Cyclophosphamide 75 mg/㎡ po day 1-14 + Epirubicin 60 mg/㎡ iv days 1,8 + 5-fluorouracil 500mg/㎡ iv days 1,8(cycled every 28 days for 6 cycles)
Primary Outcome Measure Information:
Title
The shrinkage modes of breast tumor after NAC.
Description
The tumor shrinkage modes of the primary tumor in patients with locally advanced breast cancer after 3 cycles and whole cycles of neoadjuvant chemotherapy(NAC).
Time Frame
6 year
Secondary Outcome Measure Information:
Title
The WMSS and 3D pathological reconstruction of the residual tumors after NAC.
Description
The whole-mount serial section(WMSS) and three-dimensional(3D) pathological reconstruction of the residual tumors after NAC.
Time Frame
6 year
Other Pre-specified Outcome Measures:
Title
The predictive value of 3D MRI reconstruction for the shrinkage modes of primary tumor after NAC.
Description
The predictive value of 3D MRI reconstruction for the shrinkage modes of the primary tumor after whole cycles of NAC.
Time Frame
4 year

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Female patients,locally advanced breast cancer,age ≥18 years. Histologically confirmed invasive adenocarcinoma of the breast. Primary palpable disease confined to a breast and axilla on physical examination. For patients without clinically suspicious axillary adenopathy, the primary tumor must be larger than 2 cm in diameter by physical exam or imaging studies (clinical T2-T3, N0-N1, M0). For patients with clinically suspicious axillary adenopathy, the primary breast tumor can be any size (clinical T1-3, N1-2, M0). (T1N0M0 lesions are excluded.) Patients without clearly defined palpable breast mass or axillary lymph nodes but radiographically measurable tumor masses are acceptable. Accepted procedures for measuring breast disease are mammography, MRI, and breast ultrasound. This will need to be re-evaluated after 3 cycles and prior to surgery. ECOG 0 or 2 No distant metastasis, as documented by complete staging workup ≤6 weeks prior to initiation of study treatment. No previous treatment for breast cancer. Adequate hematologic function with: Absolute neutrophil count (ANC) >1500/μL. Platelets ≥100,000/μL. Hemoglobin ≥10 g/dL. Adequate hepatic function with: Serum bilirubin ≤ the institutional upper limit of normal (ULN). Aspartate aminotransferase (AST) ≤2.5 x institutional ULN. Alanine aminotransferase (ALT) ≤2.5 x institutional ULN. Adequate renal function with serum creatinine ≤1.5 x ULN. Planned primary systemic (neoadjuvant) chemotherapy and surgical resection of residual primary tumor (mastectomy or lumpectomy/breast conservation) following completion of neoadjuvant chemotherapy Exclusion Criteria: inflammatory breast cancer Pregnancy or breast-feeding.A negative serum pregnancy test within 7 days prior to first study treatment (Day 1, Cycle 1) for all women of childbearing potential is required. Patients of childbearing potential must agree to use a birth control method that is approved by their study physician while receiving study treatment and for 3 weeks after their last dose of study treatment. Patients must agree to not breast-feed while receiving study treatment. Concurrent treatment with an ovarian hormonal replacement therapy or with hormonal agents such as raloxifene, tamoxifen or other selective estrogen receptor modulator (SERM). Patients must have discontinued use of such agents prior to beginning study treatment. Uncontrolled intercurrent illness including (but not limited to) ongoing or active infection. Concurrent treatment with any anti-cancer therapy other than those agents used in this study. Mental condition or psychiatric disorder that would prevent patient comprehension of the nature, scope, and possible consequences of the study or that would limit compliance with study requirements.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yong-sheng Wang, MD
Phone
+8613505409989
Email
wangysh2008@aliyun.com
First Name & Middle Initial & Last Name or Official Title & Degree
Tao Yang, MD
Phone
+8618264190568
Email
yangtao133252@aliyun.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yong-sheng Wang, MD
Organizational Affiliation
Shandong Cancer Hospital and Institute
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Tao Yang, MD
Organizational Affiliation
Shandong Cancer Hospital and Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Shandong Cancer Hospital
City
Jinan
State/Province
Shandong
ZIP/Postal Code
250117
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yong-sheng Wang, MD
Phone
+8613505409989
Email
wangysh2008@aliyun.com
First Name & Middle Initial & Last Name & Degree
Tao Yang, MD
Phone
+8618264190568
Email
yangtao133252@aliyun.com
First Name & Middle Initial & Last Name & Degree
Yong-sheng Wang, MD
First Name & Middle Initial & Last Name & Degree
Tao Yang, MD

12. IPD Sharing Statement

Citations:
Citation
Y-S Wang, Z-P Zhang, G Liu, D-B Mu, and X-Y Sun.Study of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction. Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-17.
Results Reference
result

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Study of Breast Cancer Shrinkage Modes After Neoadjuvant Chemotherapy With Whole-mount Serial Sections and Three-dimensional Pathological and MRI Reconstruction

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