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Pre-operative Hormonal Treatment for Hormone Receptor Positive Breast Cancer

This study is currently recruiting participants.
See Contacts and Locations
Verified September 2017 by The Netherlands Cancer Institute
Information provided by (Responsible Party):
The Netherlands Cancer Institute Identifier:
First received: August 19, 2008
Last updated: September 13, 2017
Last verified: September 2017
To investigate prospectively whether short term endocrine treatment can induce molecular changes, predictive for therapy response.

Condition Intervention Phase
Breast Cancer Drug: Anastrozole Drug: Anastrozole+Fulvestrant Drug: Tamoxifen Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: A Randomized, Prospective Trial of 2-6 Weeks Pre-operative Hormonal Treatment for Hormone Receptor Positive Breast Cancer: Anastrozole +/- Fulvestrant or Tamoxifen Exposure - Response in Molecular Profile (AFTER-study).

Resource links provided by NLM:

Further study details as provided by The Netherlands Cancer Institute:

Primary Outcome Measures:
  • Decrease in tumor cell proliferation and induced apoptosis. [ Time Frame: At baseline and after 2-6 weeks of endocrine treatment ]

Secondary Outcome Measures:
  • Comparison of changes in gene expression after different endocrine treatment exposures [ Time Frame: At baseline and after endocrine treatment ]

Estimated Enrollment: 250
Actual Study Start Date: July 2008
Estimated Study Completion Date: June 2020
Estimated Primary Completion Date: June 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1
Drug: Anastrozole
1 mg,QD,PO
Experimental: 2
Anastrozole + Fulvestrant
Drug: Anastrozole+Fulvestrant
Anastrozole; 1 mg, QD, PO Fulvestrant; 500 mg, IM, day 1, 15, 29 and monthly thereafter
Active Comparator: 3
Drug: Tamoxifen
loading dose of 40 mg, TID, PO, during 7 days, Thereafter 20 mg, QD, PO
Tamoxifen (pre-menopausal and male patients)
Drug: Tamoxifen
loading dose of 40 mg, TID, PO, during 7 days, Thereafter 20 mg, QD, PO

Detailed Description:
We will perform a randomized, open-label, single-institution study. It will compare the efficacy of three different endocrine treatment regimens (Anastrozole +/- Fulvestrant or Tamoxifen) in changing proliferation-index and inducing apoptosis during a 2-6 week pre-operative treatment period in breast cancer patients. These results will be correlated to gene expression profiles, phosphorylation status of the ER, SNPs in CYP450 sequences, tamoxifen metabolite concentrations, changes in estrogen serum levels and protein expression patterns.

Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with proven invasive adenocarcinoma of the breast
  • Any tumor with a size ≥ 1cm (NOT inflammatory breast cancer)
  • WHO-performance score 0 or 1
  • Written informed consent

Exclusion Criteria:

  • Clues of metastatic disease by clinical examination according to most recent NABON guidelines
  • Multicentric breast cancer
  • Inflammatory breast cancer
  • Hormone replacement during the last 12 months
  • Other systemic treatment during the waiting time till surgery
  • Already planned date for surgery within the next 2 weeks
  • Any psychological, familial, sociological or geographical condition potentially hampering adequate informed consent or compliance with the study protocol
  • Patient's refusal to undergo a core biopsy procedure of the primary tumor before the start of treatment

NB: a concomitant malignancy within the last five years is not an exclusion criterium, because survival is not the primary endpoint. Just as prior invasive breast cancer or DCIS within the last 15 years is not an exclusion criterium.

NB: Patients of childbearing potential must implement adequate non-hormonal contraceptive measures during the study.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00738777

Contact: Sabine C Linn, MD +31-20-5129111 ext 2591
Contact: Rutger HT Koornstra, MD +31-20-5129111 ext 6900

Medisch Centrum Haaglanden Recruiting
den Haag, ZH, Netherlands
Contact: H M Oosterkamp, MD         
Principal Investigator: H M Oosterkamp, MD         
NKI-AVL Recruiting
Amsterdam, Netherlands, 1066 CX
Contact: Sabine C Linn, MD    +31-20-5129111 ext 2591   
Contact: Annelot van Rossum, MD    +31-20-5129111 ext 2004   
Principal Investigator: Sabine C Linn, MD         
St. Antonius ziekenhuis Not yet recruiting
Nieuwegein, Netherlands
Contact: Paul C de Jong, MD         
Principal Investigator: Paul C de Jong, MD         
UMC St. Radboud Recruiting
Nijmegen, Netherlands
Contact: Hanneke WM Laarhoven, MD         
Principal Investigator: Hanneke WM Laarhoven, MD         
Sponsors and Collaborators
The Netherlands Cancer Institute
Principal Investigator: Sabine C Linn, MD NKI-AvL
  More Information

Responsible Party: The Netherlands Cancer Institute Identifier: NCT00738777     History of Changes
Other Study ID Numbers: N08AFT
EudraCT; 2008-000644-13
Study First Received: August 19, 2008
Last Updated: September 13, 2017

Keywords provided by The Netherlands Cancer Institute:
endocrine treatment
drug resistance

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Estrogen Antagonists
Hormone Antagonists
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Selective Estrogen Receptor Modulators
Estrogen Receptor Modulators
Bone Density Conservation Agents
Estrogen Receptor Antagonists
Aromatase Inhibitors
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action processed this record on September 21, 2017