Use of Quantitative Ultrasound to Guide Adaptive Chemotherapy Among Women With Breast Cancer

A Phase 2 Study of Quantitative Ultrasound to Guide Adaptive Chemotherapy Among Women With Breast Cancer

The primary objective of this study is to assess the feasibility of randomizing breast cancer patients to quantitative ultrasound to guide adaptive Neoadjuvant Chemotherapy as compared to standard clinical monitoring and therapy. The Investigators have previously demonstrated that high-frequency ultrasound and spectroscopy, and recently conventional-frequency ultrasound and spectroscopy may be used to detect cell death in vitro, in situ and in vivo. The method can detect different forms of cell death and has been demonstrated to be sensitive to apoptotic, necrotic and mitotic cell death. By detecting cell death early in a treatment on the order of hours to days, rather than traditional anatomical assessments that take place weeks to months after the completion of therapy, ineffective therapies could be switched to more efficacious treatments or aggressive salvage therapy which has shown to already benefit patients. The overarching goal of this research is to transform the delivery of neoadjuvant chemotherapy using quantitative ultrasound (QUS), which is non-invasive, inexpensive and portable.

Patient in the control arm will receive standard neoadjuvant chemotherapy and clinical monitoring as per standard of care. Patients will be imaged but no modifications to treatment will occur in this trial arm depending on response by quantitative ultrasound. Patients in the experimental arm will receive adaptive neoadjuvant chemotherapy based on quantitative ultrasound monitoring. Non-responders to neoadjuvant chemotherapy based on quantitative ultrasound will be switched to different chemotherapy or other treatments reflecting current clinical practice. The treatment option will be left to the discretion of the treating medical oncologist and the care team.

Inclusion Criteria: Women ≥ 18 years of age Diagnosis of breast cancer with a primary tumour >2cm in size With conditions meeting criteria for chemotherapy administration Normal hematological blood counts (hemoglobin ≥ 100 g/l, platelet count ≥ 100 x 109, absolute neutrophil count ≥ 2.0 x109 cells per L) Creatinine ≤175 µmol/L Liver enzymes (AST and ALT) ≤ 1.5 times upper limit of normal Cardiac function (left ventricular ejection fraction) ≥55% Eligible for neoadjuvant chemotherapy. Exclusion Criteria: Inflammatory breast cancer Contraindications to neoadjuvant treatment including pregnancy or lactation Past medical history of connective tissue disease Past history of dermatologic disease involving the breast Eastern Cooperative Group Status (ECOG) ≥3 No peripheral neuropathy of a severity of grade ≥2 Evidence of distant metastatic disease Known sensitivity to components present in ultrasound gel.