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Locoregional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients
Sponsor: UNICANCER
Summary
Approximately 3.5% to 6% of newly diagnosed breast cancer patients are stage IV metastatic. De novo metastatic breast cancer accounts for 20% to 25% of these cases. Despite a decrease in mortality in Europe and North America due to early detection and access to treatment, breast cancer remains the 2ⁿᵈ leading cause of cancer deaths in developed countries after lung cancer and the world's leading cause. In the ESME French national retrospective cohort (NCT03275311), the newly diagnosed estrogen receptor (ER)-positive and HER2-negative (luminal) metastatic patients had a 59.1 months overall survival (OS) for pre-menopausal women and 44.7 months for postmenopausal women. In the same cohort, the median OS was 47.4 months for de novo metastatic patients with hormone receptor (HR)-positive / HER2-negative breast cancer. The most important current treatment for metastatic breast cancer remains systemic therapy. Surgery and radiation are mainly used to treat symptoms. However, more than 15 retrospective studies have assessed the impact of locoregional treatment on relapse and OS. These studies suggested an improvement of the OS in patients with de novo metastatic breast cancer thanks to the addition of locoregional treatment to systemic therapy. Recent data from the ESME cohort suggest that patients with de novo luminal or HER2-positive metastatic breast cancer may benefit from local treatment of the primary tumor. Several prospective trials have attempted to demonstrate the benefit of locoregional treatment with mixed results. This can be explained by a limited power of statistical analysis, on the recruitment of patients with breast cancer of all types, and on a limited access to effective systemic therapies in some cases and all before the area of anti CD4/6 which is the current standard treatment in patients with HR-positive / HER2-negative luminal metastatic disease. However, guidelines indicate that a "multimodal approach, including curative locoregional treatments, should be considered". As a result, many clinicians offer locoregional treatment of the primary tumor, especially if there is a good response to the first line of systematic treatment. Taken together, these data underscore the need for an evaluation of the value of combined therapy - endocrine therapy - CDK4/6 inhibitor and locoregional treatment - in this population of patients with newly diagnosed HR-positive / HER2-negative breast cancer.
Official title: PALbociclib in Advanced Breast Cancer: Therapy INtegrating locorEgional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients
Key Details
Gender
FEMALE
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
200
Start Date
2019-10-23
Completion Date
2027-10-23
Last Updated
2024-09-19
Healthy Volunteers
No
Interventions
Palbociclib
The included patients will first receive the following systemic treatment according standard of care: * Non-steroidal aromatase inhibitor (letrozole) * Palbociclib * Monthly Luteinizing hormone-releasing hormone (LHRH) analogue for non-menopausal patients only. Surgical bilateral oophorectomy is an acceptable option.
locoregional treatment
After normally 6 courses of systemic treatment initiation, the loco-regional treatment of the primary tumour will be performed: surgery (conservative or mastectomy) with or without radiotherapy, or radiotherapy
Locations (26)
Institut de Cancérologie de l'Ouest-Site Paul Papin
Angers, France
Institut Sainte Catherine
Avignon, France
Centre François Baclesse
Caen, France
Hôpital privé sainte Marie
Chalon-sur-Saône, France
CH Cholet
Cholet, France
Centre Jean Perrin
Clermont-Ferrand, France
Centre George François Leclerc
Dijon, France
Centre Léon Bérard
Lyon, France
Hôpital St Joseph
Marseille, France
Institut Paoli Calmettes
Marseille, France
Hôpital saint Eloi CHU Montpellier
Montpellier, France
ICM Val d'Aurelle
Montpellier, France
Institut Curie Site Paris
Paris, France
Hôpital Saint Louis APHP
Paris, France
Hôpital St Joseph
Paris, France
Hôpital Tenon
Paris, France
Centre Hospitalier de Pau
Pau, France
CH René Dubos
Pontoise, France
Institut Jean Godinot
Reims, France
Centre Eugène Marquis
Rennes, France
Institut Curie Hôpital René Huguenin
Saint-Cloud, France
Hôpital Privé à Saint Grégoire
Saint-Grégoire, France
GCS RISSA - Institut de cancérologie Paris Nord
Sarcelles, France
Institut Claudius Regaud
Toulouse, France
Institut de Cancérologie de Lorraine
Vandœuvre-lès-Nancy, France
Gustave Roussy
Villejuif, France