Monitoring Response After The First Chemotherapy Cycle After Neoadjuvant Breast Cancer Therapy (PETBreast)
Recruitment status was: Active, not recruiting
|Invasive Ductal Carcinoma Lobular Breast Carcinoma Inflammatory Breast Carcinoma||Procedure: PET scan after course 1 and surgery after 8 courses|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
|Official Title:||Monitoring Response After The First Chemotherapy Cycle In Newly Diagnosed Breast Cancer As A Guide For Neoadjuvant Therapy|
- Pathologic response [ Time Frame: After 1st course of chemo and after definitive surgery ]
|Study Start Date:||July 2007|
|Estimated Study Completion Date:||April 2013|
|Primary Completion Date:||December 2011 (Final data collection date for primary outcome measure)|
Procedure: PET scan after course 1 and surgery after 8 courses
PET scan and surgery
The use of neo-adjuvant systemic therapy in women recently diagnosed with breast cancer is growing in popularity based on its proven benefit (1). Pre-operative chemotherapy not only can assist in regards to breast conservation therapy (2) but data suggest prognostic benefits in those subset of patient's obtaining complete pathological response (3,4) .
It is imperative for clinicians to detect as early as possible those patients likely to obtain the desired clinical and /or pathologic response, thus identifying those patients who don't benefit from the first line neoadjuvant treatment so that their treatment can be modified accordingly.
Response to treatment based on clinical data or structural imaging, usually requires several chemotherapeutic cycles to establish degree of effectiveness (5). Lately, FDG-PET/CT has been used in different types of neoplasms, breast cancer among them, to establish early response to treatment (6,7). Recent data has established the usefulness of metabolic analysis via FDG-PET, in separating subgroups of chemotherapy. For such analytical approach, sequential estimation of SUVs (Standardized Uptake Value) have been measured along the duration of the treatment. Reduction in SUVs presumes adequate response to treatment (8), while little or no change in metabolic activity presumes sub-optimal response .
However, no definite consensus has been established in regards to what degree of metabolic response is predictive of the desired clinical benefit, particularly early in the treatment . Establishing such criteria could potentially serve as a guideline for monitoring neoadjuvant treatment. Schelling et al, was able to separate a group of patients that eventually showed either progression of the disease or no clinical response as early as the first course of chemotherapy.
The aim of our study is to establish a simple formula using FDG-PET/CT, as early as the first course of chemotherapy, to stratify patients undergoing neoadjuvant chemotherapy for recently diagnosed breast cancer. Those who will benefit from continuing the same treatment will be regarded as responders versus non-responders, which are those in need of changing strategy.
The primary goal of this study is to correlate the results of FDG-PET/CT performed 15 days after the first course of chemotherapy versus those of clinical assessment and breast MRI obtained after the 3rd course of chemotherapy. At that time, a clinical decision on which therapeutic path to be followed will be made.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01038258
|Hospital Auxilio Mutuo Cancer Center|
|San Juan, Puerto Rico, 00919|
|Principal Investigator:||Fernando Cabanillas, MD||Hospital Auxilio Mutuo Cancer Center|