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Therapeutic Nipple Sparing Mastectomy. (MAPAM-01)

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ClinicalTrials.gov Identifier: NCT02311959
Recruitment Status : Active, not recruiting
First Posted : December 9, 2014
Last Update Posted : August 3, 2022
Institut Paoli-Calmettes
Information provided by (Responsible Party):
Institut Claudius Regaud

Brief Summary:

This is a phase III, multicentric, single arm study with a sequential design using the exact conditional Poisson test.

The primary objective of this prospective study is to evaluate whether selected breast carcinoma patients could be treated with nipple sparing mastectomy (NSM) with an acceptable low local recurrence rates.

450 patients will be included over a period of 4 years and will be followed for a 5 years period (twice a year).

All patients must have a complete preoperative evaluation (bilateral mammography, bilateral breast ultrasonography +/- MRI), and a histopathological diagnostic proof of carcinoma (invasive or in situ, all histopathological types, first treatment or relapse).

The study procedure is represented by nipple areola skin-sparing mastectomy followed by immediate breast reconstruction.

After surgery, early and late complications, including specific complications (suffering of the nipple-areolar complexe and suffering of the skin flaps), will be evaluate.

An esthetic evaluation (by patient and clinician) and a quality of life evaluation will be realized throughout the study.

A complementary study, prospective, non-interventional, will be proposed to patients who will benefit from the same surgical technique (NSM) followed by immediate reconstruction, but in the context of preventive surgery (prophylactic surgery for patients mutated or high genetic risk). The aim of this complementary study, which will include a maximum of 60 patients, is to evaluate associated morbidity in prophylactic NSM.

Data will be collected over a 3 months period after surgery.

Condition or disease Intervention/treatment Phase
Breast Cancer Procedure: Nipple sparing mastectomy Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 450 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Therapeutic Nipple Areola Skin-sparing Mastectomy.
Actual Study Start Date : February 9, 2015
Estimated Primary Completion Date : February 2025
Estimated Study Completion Date : February 2025

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Mastectomy

Arm Intervention/treatment
Experimental: Invasive or in situ breast carcinoma. Procedure: Nipple sparing mastectomy

Standardized surgical procedure by :

  • Nipple sparing mastectomy with nipple core histopathology.
  • Immediate breast reconstruction (flap and/or implant).
  • +/- lymph node evaluation (sentinel node procedure or axillary dissection).

Primary Outcome Measures :
  1. Local recurrence rate. [ Time Frame: 9 years. ]
    Annual incidence of local recurrence defined by the number of local recurrences (skin, thoracic wall and nipple) among the patient years of follow-up..

Secondary Outcome Measures :
  1. Early and late complications [ Time Frame: 9 years. ]
    Early and late complications will be evaluated using NCI toxicity scale version 4.0.

  2. Disease free Survival. [ Time Frame: 9 years. ]

    Disease-free survival is the period between the date of origin and date of the first event as defined below, or date of latest news (Censored Data).

    The events included in the definition of disease-free survival are local recurrence, lymph node metastases, contralateral locations, distant metastases, second breast cancer and death from any causes.

  3. Metastasis Free Survival. [ Time Frame: 9 years. ]
    Metastasis free survival is defined as the time from inclusion until the date of metastasis recurrence or the date of the latest news (Censored data).

  4. Overall Survival. [ Time Frame: 9 years ]
    Overall survival is defined as the time from inclusion until the date of death or the date of the latest news (Censored data).

  5. Aesthetic evaluation. [ Time Frame: 9 years. ]
    The aesthetic evaluation will be realized by both the surgeon and the patient using to the Licket scale.

  6. Quality of life. [ Time Frame: 9 years. ]
    The quality of life will be evaluated according to the Breast-Q questionnaire.

Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient with invasive breast carcinoma stage T1 or T2 and / or in situ (any histological type) proved on histopathological diagnosis.
  • Patient with an indication of total mastectomy.
  • Patient without preoperative indication of adjuvant radiotherapy according to regional and / or national guidelines.
  • Disease located more than 2 cm from the nipple after complete clinical and radiologic breast evaluation (mammography, ultrasound +/- MRI).
  • Initial breast cancer or recurrence.
  • Patient wishing to receive immediate breast reconstruction.
  • WHO performance < or = 2.
  • Patient older than 40 years.
  • For patients of childbearing age, use an effective contraceptive methods for the duration of the study.
  • For patients of childbearing potential, negative pregnancy test available before inclusion.
  • Patient affiliated to a social health insurance in France.
  • Patient who signed informed consent before enrollment in the study and before any specific procedure for the study.

Exclusion Criteria :

  • Positive node on physical examination or proved by cytology.
  • Combination of 2 predictive factors of postoperative radiotherapy : macroscopic multifocal, grade 2 or 3, vascular emboli, overexpressed HER2 (human epidermal growth factor receptor-2), triple negative (Estrogen Receptor, Progesterone Receptor and HER2 negative).
  • Neoadjuvant treatment for the current disease.
  • Patient with bilateral breast cancer.
  • Paget disease.
  • T3 or T4 carcinoma.
  • Metastatic breast cancer (disease staging realized according to national or regional guidelines).
  • Breast hypertrophy requiring a nipple support flap.
  • Nursing or pregnant woman.
  • Patient participating in any other interventional clinical study.
  • Any psychological, familial, geographic or social situation not to comply with medical monitoring and/or procedures in the study protocol.
  • Patient protected by law.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02311959

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Sponsors and Collaborators
Institut Claudius Regaud
Institut Paoli-Calmettes
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Principal Investigator: Eva JOUVE, Md. IUCT-O
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Institut Claudius Regaud
ClinicalTrials.gov Identifier: NCT02311959    
Other Study ID Numbers: 14 SEIN 10
First Posted: December 9, 2014    Key Record Dates
Last Update Posted: August 3, 2022
Last Verified: August 2022
Keywords provided by Institut Claudius Regaud:
Invasive carcinoma
In situ carcinoma
Nipple areola
Local recurrence