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Eliminating Surgery or Radiotherapy After Systemic Therapy in Treating Patients With HER2 Positive or Triple Negative Breast Cancer

Primary Purpose

Estrogen Receptor Negative, HER2 Positive Breast Carcinoma, HER2/Neu Negative

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
External Beam Radiation Therapy
Laboratory Biomarker Analysis
Quality-of-Life Assessment
Questionnaire Administration
Whole Breast Irradiation
Sponsored by
M.D. Anderson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Estrogen Receptor Negative

Eligibility Criteria

30 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • (Cohort A) Pathologically confirmed unicentric invasive breast cancer defined as radiologic clinical stage T1 or T2 (=< 5 cm), N0 or N1 (=< 4 abnormal axillary nodes on initial ultrasound), clinical stage M0
  • (Cohort A) HER2 positive (immunohistochemistry [IHC] 3+ and or fluorescence in situ hybridization [FISH] amplified) or triple receptor negative (triple negative [TN], estrogen receptor [ER]/progesterone receptor [PR] < 10% HER2 negative [IHC 1+ or 2+ FISH non-amplified]) receiving any standard routine clinical NST regimen
  • (Cohort A) Patient desires breast conserving therapy
  • (Cohort A) Age 40 years or older; this age cutoff is justified because breast cancers in women under the age of 40 are known to have a significantly higher risk of IBTR presumably due to underlying biologic differences
  • (Cohort A) Female sex
  • (Cohort A) If the patient has a history of a prior non-breast cancer, all treatment for this cancer must have been completed prior to study registration and the patient must have no evidence of disease for this prior non-breast cancer
  • (Cohort A) Patient must have an initial nodal ultrasound that does not demonstrate more than four suspicious lymph nodes, any suspicious lymph nodes should be biopsied to determine if nodal metastatic disease present
  • (Cohort B) ER and/or PR positive, HER2 negative
  • (Cohort B) Clinical stage T1N0M0, unicentric non-lobular breast cancer, no lymphovascular space invasion,
  • (Cohort B) At least 40 years of age.
  • (Cohort B) Oncotype ≤ 25 if age ≥ 50 years
  • (Cohort B) Oncotype 0-20 and tumor size ≤ 1.5cm if age 40-49 years.
  • (Cohort B) Patient agrees to take anti-estrogen therapy and is interested in breast conservation
  • (Cohort B) Female sex.
  • (Cohort B) If the patient has a history of a prior non-breast cancer, all treatment for this cancer must have been completed prior to study registration and the patient must have no evidence of disease for this prior non-breast cancer.
  • (Cohort B) No history of prior radiation to the area of the breast that would require protocol-mandated treatment
  • (Cohort C) Pathologically confirmed invasive breast cancer defined as radiologic clinical stage T1 or T2 (≤ 5 cm), N0, clinical stage M0.
  • (Cohort C) HER2 positive (IHC 3+ and or FISH amplified) receiving any standard routine clinical NST regimen.
  • (Cohort C) Patient desires breast conserving therapy.
  • (Cohort C) Age 30 years or older.
  • (Cohort C) Female sex.
  • (Cohort C) If the patient has a history of a prior non-breast cancer, all treatment for this cancer must have been completed prior to study registration and the patient must have no evidence of disease for this prior non-breast cancer.
  • (Cohort C) Patient must have an initial nodal ultrasound that does not demonstrate suspicious lymph nodes; any suspicious lymph nodes should be biopsied to determine if nodal metastatic disease present.
  • (Cohort C) Patient must have no evidence of residual invasive tumor or DCIS on pathologic review of the lumpectomy surgical specimen
  • (Cohort C) Patient must have no evidence of metastatic disease involving the lymph nodes on pathologic review of the lymph node surgical specimen.
  • (Cohort C) Unifocal disease or limited multifocal disease that can be excised in a single lumpectomy specimen

Exclusion Criteria:

  • Radiologic evidence for a stage T3 or clinical stage T4 breast cancer in Cohort A/C; radiologic evidence for a stage T2-T3 or clinical stage T4 breast cancer in Cohort B.
  • Clinical or pathologic evidence for distant metastases
  • Prior diagnosis of invasive or ductal carcinoma in situ breast cancer in the ipsilateral breast
  • Clinical evidence of progression of disease > 20% in the breast or new evidence of nodal metastases
  • Patient is known to be pregnant
  • Patient is participating in a NST protocol in which surgical excision of the breast and or lymph nodes are required in Cohort A/B.

Sites / Locations

  • Banner Health/Banner Research
  • Baptist MD Anderson Cancer Center
  • Queen's Medical CenterRecruiting
  • Mayo ClinicRecruiting
  • MD Anderson Cancer Center at Cooper-Voorhees
  • Carolinas Medical Center/Levine Cancer InstituteRecruiting
  • University of Pittsburgh Cancer Institute (UPCI)Recruiting
  • M D Anderson Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Cohort A

Cohort B

Cohort C

Arm Description

Neoadjuvant chemotherapy therapy Biopsy: if no disease remaining - stay on the study and receive radiation (skip breast surgery) H&P and Imaging every 6 months Treatment (whole breast irradiation, EBRT) Within 12 weeks of completing neoadjuvant systemic therapy, patients undergo whole breast irradiation over 15-25 fractions on consecutive days. Patients then undergo EBRT boost over 7 fractions on consecutive days beginning the day following completion of whole breast irradiation.

Neoadjuvant endocrine therapy for 6 months Radiation if there is less than 25% tumor increase Biopsy: if negative - additional endocrine therapy under the guidance of medical oncologist (skip breast surgery) H&P and Imaging every 6 months Cohort B Radiation: Treatment (Stereotactic ablative radiotherapy -SABR) Following 3-6 months of endocrine therapy, if less than 25% tumor increase, patients undergo SABR irradiation over 10 fractions every other business day.

Optional biopsy for nanomechanical biomarker assessment Neoadjuvant chemotherapy therapy Surgery (& optional biopsy nanomechanical biomarker assessment): if no disease remaining - stay on the study and skip radiation H&P and Imaging every 6 months

Outcomes

Primary Outcome Measures

Ipsilateral breast tumor recurrence-free survival (IBT-RFS)
Will monitor IBT-RFS using the method of Thall et al. Will be estimated using the Kaplan-Meier method log-rank test will be performed to test the difference in time-to-event distributions between patient groups. Cox proportional hazards model will be used to include multiple covariates in the time-to-event analysis.
Overall survival
Will be estimated using the Kaplan-Meier method log-rank test will be performed to test the difference in time-to-event distributions between patient groups. Cox proportional hazards model will be used to include multiple covariates in the time-to-event analysis.

Secondary Outcome Measures

Full Information

First Posted
October 24, 2016
Last Updated
August 5, 2023
Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02945579
Brief Title
Eliminating Surgery or Radiotherapy After Systemic Therapy in Treating Patients With HER2 Positive or Triple Negative Breast Cancer
Official Title
Multicenter Trial for Eliminating Breast Cancer Surgery or Radiotherapy in Exceptional Responders to Neoadjuvant Systemic Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 20, 2017 (Actual)
Primary Completion Date
January 31, 2026 (Anticipated)
Study Completion Date
January 31, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This clinical trial studies eliminating surgery and how well radiation therapy after systemic therapy works in treating patients with HER2 positive or triple negative breast cancer when image-guided biopsy shows no residual cancer. Patients then receive standard breast radiotherapy.
Detailed Description
PRIMARY OBJECTIVES: I. To determine the 6 months (mo), 1, 2, 3, and 5-year biopsy confirmed ipsilateral breast tumor recurrence rate (IBTR, invasive, and/or in situ) among patients who do not undergo surgery (cohort A). II. To determine the pCR rate 6 months after radiation therapy based on image- guided biopsy (cohort B). III. To determine the 6 months, 1, 2, 3, and 5-year ipsilateral breast tumor recurrence rate among patients who undergo surgery alone without radiation (cohort C). SECONDARY OBJECTIVES: I. To determine the 6 months, 1, 2, 3, and 5-year biopsy confirmed ipsilateral breast tumor recurrence rate (IBTR, invasive and/or in situ) among patients who do not undergo surgery (cohort C). II. To determine the number (%) of patients where final biopsy reveals residual disease and quantify the residual disease (residual cancer burden, RCB) determined by routine pathologic examination of surgery specimens. III. To assess baseline, 6 months, 1, 3, and 5 years decisional comfort of clinical trial participation using the Decisional Regret Scale (DRS). IV. To determine patient-reported cosmetic outcome, breast pain, and functional status using the Breast Cancer Treatment Outcomes Scale (BCTOS) at baseline, 6 months, 1, 3, and 5 years. V. To determine the 6 mo, 1, 2, 3, and 5-year incidence of ipsilateral breast and nodal recommendation and performance of biopsy based on breast imaging follow-up. VI. Correlate "liquid biopsy" analyses (after neoadjuvant systemic therapy [NST], 6 months and one year postradiotherapy or surgery) among protocol participants with pathologic complete response (pCR), utilizing circulating tumor cells (CTCs) and circulating tumor-deoxyribonucleic acid (DNA) (ctDNA). VII. Among patients who decide to proceed with routine surgery, record the results of final biopsy compared with routine pathologic examination of surgery specimens. VIII. To determine patient-reported quality of life using the Functional Assessment of Cancer Therapy-Breast version 4 (FACT B+4) instrument at baseline, 6 months, 1, 3, and 5 years after treatment. IX. To explore if radiation genomic sensitivity scores and Oncotype performed on the initial diagnostic core biopsy specimen correlate with pCR rates in Cohort B. X. To determine if changes in blood-based RNA Sequencing are elicited with radiation in Cohort B, measured at baseline, at the first 4-6 week follow-up after radiation, and at the 6 month post-radiation follow-up. XI. In Cohort B to determine the 3 year rate of tumor control/progression free survival (PFS). XII. In Cohort C to determine whether nanomechanical biomarkers or quantification of stromal and tumor TILS can predict for low risk of local recurrence in exceptional responders who omit radiation therapy. OUTLINE: For Cohorts A and B, within 12 weeks of completing neoadjuvant systemic therapy, patients undergo whole breast irradiation over 15-25 fractions on consecutive days. Patients then undergo external beam radiation therapy (EBRT) boost over 7 fractions on consecutive days beginning the day following completion of whole breast irradiation. After completion of study treatment, patients are followed up every 6 months for 5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Estrogen Receptor Negative, HER2 Positive Breast Carcinoma, HER2/Neu Negative, Invasive Breast Carcinoma, Progesterone Receptor Negative, Stage I Breast Cancer AJCC v7, Stage IA Breast Cancer AJCC v7, Stage IB Breast Cancer AJCC v7, Stage II Breast Cancer AJCC v6 and v7, Stage IIA Breast Cancer AJCC v6 and v7, Stage IIB Breast Cancer AJCC v6 and v7, Triple-Negative Breast Carcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cohort A
Arm Type
Experimental
Arm Description
Neoadjuvant chemotherapy therapy Biopsy: if no disease remaining - stay on the study and receive radiation (skip breast surgery) H&P and Imaging every 6 months Treatment (whole breast irradiation, EBRT) Within 12 weeks of completing neoadjuvant systemic therapy, patients undergo whole breast irradiation over 15-25 fractions on consecutive days. Patients then undergo EBRT boost over 7 fractions on consecutive days beginning the day following completion of whole breast irradiation.
Arm Title
Cohort B
Arm Type
Experimental
Arm Description
Neoadjuvant endocrine therapy for 6 months Radiation if there is less than 25% tumor increase Biopsy: if negative - additional endocrine therapy under the guidance of medical oncologist (skip breast surgery) H&P and Imaging every 6 months Cohort B Radiation: Treatment (Stereotactic ablative radiotherapy -SABR) Following 3-6 months of endocrine therapy, if less than 25% tumor increase, patients undergo SABR irradiation over 10 fractions every other business day.
Arm Title
Cohort C
Arm Type
Experimental
Arm Description
Optional biopsy for nanomechanical biomarker assessment Neoadjuvant chemotherapy therapy Surgery (& optional biopsy nanomechanical biomarker assessment): if no disease remaining - stay on the study and skip radiation H&P and Imaging every 6 months
Intervention Type
Radiation
Intervention Name(s)
External Beam Radiation Therapy
Other Intervention Name(s)
Definitive Radiation Therapy, EBRT, External Beam Radiotherapy, External Beam RT, external radiation, External Radiation Therapy, external-beam radiation
Intervention Description
Undergo EBRT
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
Quality-of-Life Assessment
Other Intervention Name(s)
Quality of Life Assessment
Intervention Description
Ancillary studies
Intervention Type
Other
Intervention Name(s)
Questionnaire Administration
Intervention Description
Ancillary studies
Intervention Type
Radiation
Intervention Name(s)
Whole Breast Irradiation
Intervention Description
Undergo whole breast irradiation
Primary Outcome Measure Information:
Title
Ipsilateral breast tumor recurrence-free survival (IBT-RFS)
Description
Will monitor IBT-RFS using the method of Thall et al. Will be estimated using the Kaplan-Meier method log-rank test will be performed to test the difference in time-to-event distributions between patient groups. Cox proportional hazards model will be used to include multiple covariates in the time-to-event analysis.
Time Frame
From confirmation of pathologic complete response (pCR) to the time of ipsilateral breast tumor recurrence or death, whichever occurs first or the time of last contact, assessed for up to 5 years
Title
Overall survival
Description
Will be estimated using the Kaplan-Meier method log-rank test will be performed to test the difference in time-to-event distributions between patient groups. Cox proportional hazards model will be used to include multiple covariates in the time-to-event analysis.
Time Frame
Up to 5 years
Other Pre-specified Outcome Measures:
Title
Change in biomarkers in blood and plasma
Description
Biomarkers in blood and plasma, specifically CTC and cDNA, will be assessed by exploratory data analysis and graphical methods, which will be applied to examine distributions and to identify data errors and outliers. Linear mixed effect models for repeated measures analysis will be employed to assess the change of the data over time with multi-covariates including disease characteristics (tumor stage, site, pathology), and other patient prognostic factors.
Time Frame
Baseline, 6 months, 12 months
Title
Quality of Life measured by FACT-B+4 questionnaire
Description
The FACT-B+4 will assess the general quality of life of the patient.
Time Frame
Baseline, 6 months, 12 months, 36 months, 60 months
Title
Quality of Life measured by BCTOS questionnaire
Description
The Breast Cancer Treatment Outcome Scale (BCTOS) will assess patient-reported cosmetic outcome, breast pain, and functional status by comparing the affected breast with her unaffected breast.
Time Frame
Baseline, 6 months, 12 months, 36 months, 60 months
Title
Quality of Life measured by DRS questionnaire
Description
The Decisional Regret Scale (DRS) questionnaire will assess the decisional comfort of the clinical trial participant. Question answers range : Strongly Agree, Agree, Neither Agree Nor Disagree, Disagree, or Strongly Agree
Time Frame
Baseline, 6 months, 12 months, 36 months, 60 months
Title
Incidence of ipsilateral breast and nodal recommendation and performance of biopsy based on breast imaging follow-up
Description
Multivariable logistic regression analysis using generalized estimating equations to take the intra-patient correlation into account will be used to determine factors significantly associated with the outcome.
Time Frame
Up to 5 years
Title
Residual cancer burden (RCB)
Description
Will be assessed by biopsy and routine surgery. Descriptive statistics will be used. The final biopsy will be compared with the response status determined by routine pathologic examination of surgery specimens using McNemar test.
Time Frame
Up to 5 years

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: (Cohort A) Pathologically confirmed unicentric invasive breast cancer defined as radiologic clinical stage T1 or T2 (=< 5 cm), N0 or N1 (=< 4 abnormal axillary nodes on initial ultrasound), clinical stage M0 (Cohort A) HER2 positive (immunohistochemistry [IHC] 3+ and or fluorescence in situ hybridization [FISH] amplified) or triple receptor negative (triple negative [TN], estrogen receptor [ER]/progesterone receptor [PR] < 10% HER2 negative [IHC 1+ or 2+ FISH non-amplified]) receiving any standard routine clinical NST regimen (Cohort A) Patient desires breast conserving therapy (Cohort A) Age 40 years or older; this age cutoff is justified because breast cancers in women under the age of 40 are known to have a significantly higher risk of IBTR presumably due to underlying biologic differences (Cohort A) Female sex (Cohort A) If the patient has a history of a prior non-breast cancer, all treatment for this cancer must have been completed prior to study registration and the patient must have no evidence of disease for this prior non-breast cancer (Cohort A) Patient must have an initial nodal ultrasound that does not demonstrate more than four suspicious lymph nodes, any suspicious lymph nodes should be biopsied to determine if nodal metastatic disease present (Cohort B) ER and/or PR positive, HER2 negative (Cohort B) Clinical stage T1N0M0, unicentric non-lobular breast cancer, no lymphovascular space invasion, (Cohort B) At least 40 years of age. (Cohort B) Oncotype ≤ 25 if age ≥ 50 years (Cohort B) Oncotype 0-20 and tumor size ≤ 1.5cm if age 40-49 years. (Cohort B) Patient agrees to take anti-estrogen therapy and is interested in breast conservation (Cohort B) Female sex. (Cohort B) If the patient has a history of a prior non-breast cancer, all treatment for this cancer must have been completed prior to study registration and the patient must have no evidence of disease for this prior non-breast cancer. (Cohort B) No history of prior radiation to the area of the breast that would require protocol-mandated treatment (Cohort C) Pathologically confirmed invasive breast cancer defined as radiologic clinical stage T1 or T2 (≤ 5 cm), N0, clinical stage M0. (Cohort C) HER2 positive (IHC 3+ and or FISH amplified) receiving any standard routine clinical NST regimen. (Cohort C) Patient desires breast conserving therapy. (Cohort C) Age 30 years or older. (Cohort C) Female sex. (Cohort C) If the patient has a history of a prior non-breast cancer, all treatment for this cancer must have been completed prior to study registration and the patient must have no evidence of disease for this prior non-breast cancer. (Cohort C) Patient must have an initial nodal ultrasound that does not demonstrate suspicious lymph nodes; any suspicious lymph nodes should be biopsied to determine if nodal metastatic disease present. (Cohort C) Patient must have no evidence of residual invasive tumor or DCIS on pathologic review of the lumpectomy surgical specimen (Cohort C) Patient must have no evidence of metastatic disease involving the lymph nodes on pathologic review of the lymph node surgical specimen. (Cohort C) Unifocal disease or limited multifocal disease that can be excised in a single lumpectomy specimen Exclusion Criteria: Radiologic evidence for a stage T3 or clinical stage T4 breast cancer in Cohort A/C; radiologic evidence for a stage T2-T3 or clinical stage T4 breast cancer in Cohort B. Clinical or pathologic evidence for distant metastases Prior diagnosis of invasive or ductal carcinoma in situ breast cancer in the ipsilateral breast Clinical evidence of progression of disease > 20% in the breast or new evidence of nodal metastases Patient is known to be pregnant Patient is participating in a NST protocol in which surgical excision of the breast and or lymph nodes are required in Cohort A/B.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Henry Kuerer
Phone
713-745-5043
Email
hkuerer@mdanderson.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Henry M Kuerer
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Banner Health/Banner Research
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85006
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
Baptist MD Anderson Cancer Center
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32207
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Beth A. Lesnikoski
Email
beth.lesnikoski@hcahealthcare.com
First Name & Middle Initial & Last Name & Degree
Beth A. Lesnikoski
Facility Name
Queen's Medical Center
City
Honolulu
State/Province
Hawaii
ZIP/Postal Code
96813
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Clayton D. Chong
Phone
808-691-8777
Email
clchong@queens.org
First Name & Middle Initial & Last Name & Degree
Clayton D. Chong
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Judy C. Boughey
Phone
507-284-2511
Email
boughey.judy@mayo.edu
First Name & Middle Initial & Last Name & Degree
Judy C. Boughey
Facility Name
MD Anderson Cancer Center at Cooper-Voorhees
City
Voorhees
State/Province
New Jersey
ZIP/Postal Code
08043
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
Carolinas Medical Center/Levine Cancer Institute
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28203
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Richard L. White
Phone
980-442-6358
Email
Richard.White@atriumhealth.org
First Name & Middle Initial & Last Name & Degree
Richard L. White
Facility Name
University of Pittsburgh Cancer Institute (UPCI)
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15232
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Emilia J. Diego
Phone
412-641-3083
Email
diegoe@upmc.edu
First Name & Middle Initial & Last Name & Degree
Emilia J. Diego
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Henry M. Kuerer
Phone
713-745-5043
Email
hkuerer@mdanderson.org
First Name & Middle Initial & Last Name & Degree
Henry M. Kuerer

12. IPD Sharing Statement

Citations:
PubMed Identifier
36306810
Citation
Kuerer HM, Smith BD, Krishnamurthy S, Yang WT, Valero V, Shen Y, Lin H, Lucci A, Boughey JC, White RL, Diego EJ, Rauch GM; Exceptional Responders Clinical Trials Group. Eliminating breast surgery for invasive breast cancer in exceptional responders to neoadjuvant systemic therapy: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2022 Dec;23(12):1517-1524. doi: 10.1016/S1470-2045(22)00613-1. Epub 2022 Oct 25.
Results Reference
derived
PubMed Identifier
35617923
Citation
Hariharan N, Rao TS, Rajappa S, Naidu CCK. Precision medicine - A new era in multidisciplinary care. Cancer Treat Res Commun. 2022;32:100577. doi: 10.1016/j.ctarc.2022.100577. Epub 2022 May 17. No abstract available.
Results Reference
derived
Links:
URL
http://www.mdanderson.org
Description
MD Anderson Cancer Center

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Eliminating Surgery or Radiotherapy After Systemic Therapy in Treating Patients With HER2 Positive or Triple Negative Breast Cancer

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