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Optimising Adjuvant Chemotherapy Prescription in Young Patients With Hormone-dependent Breast Cancer Using Genomic Tests
Sponsor: UNICANCER
Summary
Rationale: Around 70 to 80% of breast cancers are so-called "hormone-dependent" (HR+)/HER2-. For more than 50 years, studies have shown that chemotherapy and optimised hormonal treatments (hormone therapy), including a drug associated with ovarian suppression (OFS), improve survival in patients with these cancers, which are characterised by a high risk of relapse. However, younger patients suffer more side effects than older women, particularly from chemotherapy. This can affect their quality of life and reduce their ability to work. For post-menopausal women, genetic tests exist to assess whether chemotherapy is really necessary in addition to hormonal treatment. However, for high-risk premenopausal patients, chemotherapy is still systematically recommended, as no study has proved that it can be safely avoided. Clinical trials based on risk stratification using genetic tests have not been conclusive, but the majority of premenopausal women included had not received optimal hormone treatment. It is possible that the beneficial effect of chemotherapy is partly due to the artificial menopause it induces. Some experts believe that, for patients with a high clinical risk but a low genetic risk, an optimised hormonal treatment (drug + OFS) could suffice, without the need for chemotherapy. Objectives: Main objective: The aim of the study is to determine whether the use of a genetic test (Prosigna®) to decide whether or not to administer chemotherapy produces results as good as standard treatment (systematic chemotherapy) in premenopausal women with hormone-dependent (HR+) breast cancer/HER2-, by assessing their risk of cancer recurrence. The secondary objectives include verifying whether, in patients with a low Prosigna® score (around 70% of cases), optimised hormonal treatment (including suppression of ovarian function) is as effective as chemotherapy combined with hormonal in treatment preventing cancer recurrence. The study also seeks to compare the efficacy of treatment Prosigna®-guided versus systematic chemotherapy in terms of recurrence and quality of life, as well as economic aspects. Finally, the aim is to understand patients' concerns about the concept of reducing treatment (therapeutic de-escalation) and the way in which this information is communicated to them. The primary endpoint of the study is to measure the time elapsed between the start of participation in the study and the appearance of an event indicating a return of the cancer. This includes the return of cancer in the same breast or neighbouring areas, the spread of cancer to other parts of the body, the appearance of new cancer in the other breast or death from any cause. Trial Population: The study includes women major premenopausal diagnosed with invasive, hormone receptor-positive (ER+) and HER2-negative breast cancer. Patients must have undergone breast and axillary surgery recent and have a tumour sample suitable for analysis by the testProsigna® . They must be able to receive the study treatments Postmenopausal women, women with stage IV breast cancer, women who have already received adjuvant systemic treatment (except short neoadjuvant hormone therapy), women with a recent history of invasive cancer, pregnant women or women who are breast-feeding will not be able to take part in the study. Interventions: After agreeing to take part, patients will enter the pre-inclusion period (up to 28 days before randomisation), during which the investigator will carry out all the necessary tests to assess their eligibility. The investigator will then randomise the patients to find out which treatment they have been assigned, no more than 2 weeks later: the experimental group will receive a treatment decided on the basis of the results of a genomic test: either chemotherapy and hormone therapy, or hormone therapy alone. The control group will receive the standard treatment. The treatment and follow-up phases are the same as for standard care. Information on the quality of life patient's will and other information (associated costs, perception of their participation in the study, etc.) also be collected by means of questionnaires completed by the patients during the 5 years following randomisation.
Official title: Optimal Personalized Treatment of Early Breast Cancer Using Multi-parameter Analysis: Focus on YOUNGer Women
Key Details
Gender
FEMALE
Age Range
35 Years - 45 Years
Study Type
INTERVENTIONAL
Enrollment
3380
Start Date
2026-04-01
Completion Date
2038-08-15
Last Updated
2026-03-24
Healthy Volunteers
No
Interventions
test-directed treatment: allocated treatment will depend on the PAM50 score result (centrally assessed) : chemo-endocrine therapy or endocrine therapy alone
In this experimental arm, the treatment is driven by the score of the Prosigna test. If the score is superior to 60, the patient is considered at hight risk so the patient will receive chemo-endocrine therapy. If the result is under or equal to 60, only endocrine therapy will be prescribed to the patient.
In the control arm, the treatment will be as standard of care : chemo-endocrine therapy
Standard treatment: Chemotherapy followed by endocrine therapy
Locations (105)
Institut Jules Bordet
Brussels, Belgium
Cliniques Universitaires Saint-Luc
Brussels, Belgium
Grand Hôpital de Charleroi
Charleroi, Belgium
CHU Helora Hôpital de La Louvière - Site Jolimont
Haine-Saint-Paul, Belgium
CHU UCL Namur - Site Sainte Elisabeth
Namur, Belgium
Clinique Saint Pierre
Ottignies, Belgium
CHR Verviers
Verviers, Belgium
Centre Hospitalier d'Auxerre
Auxerre, France
Sainte Catherine - Institut du Cancer Avignon-Provence
Avignon, France
Centre Hospitalier de la Côte Basque
Bayonne, France
Centre Hospitalier Simone Veil de Beauvais
Beauvais, France
Hôpital de Blois
Blois, France
Avicenne Hospital (APHP)
Bobigny, France
Clinique Tivoli
Bordeaux, France
Centre Hospitalier Fleyriat Bourg en Bresse
Bourg-en-Bresse, France
Clinique Pasteur - CFRO
Brest, France
Groupement Hospitalier Est - Hospices Civils de Lyon
Bron, France
Centre Francois Baclesse
Caen, France
Centre Hospitalier Métropole Savoie
Chambéry, France
CH Cholet
Cholet, France
Pôle Santé République
Clermont-Ferrand, France
Centre Jean Perrin
Clermont-Ferrand, France
Centre Léonard De Vinci
Dechy, France
Centre Georges François Leclerc
Dijon, France
CH Annecy Genevois
Épagny Metz-Tessy, France
Centre Hospitalier Intercommunal de Fréjus Saint Raphael
Fréjus, France
Groupe Hospitalier Mutualiste de Grenoble
Grenoble, France
Centre Hospitalier Le Mans - Centre De Cancérologie De La Sarthe
Le Mans, France
Centre Oscar Lambret
Lille, France
CHU de Limoges
Limoges, France
Hôpital de la croix Rousse - Hospices Civils de Lyon
Lyon, France
Centre Léon Bérard
Lyon, France
Hôpital Européen
Marseille, France
Hôpital Privé Clairval
Marseille, France
Institut Paoli Calmettes
Marseille, France
Hôpital Privé Nancy Lorraine
Nancy, France
Hôpital Privé du Confluent
Nantes, France
Centre Hospitalier de Pau
Pau, France
Hôpital Lyon Sud-Hospices Civils de Lyon
Pierre-Bénite, France
Hôpital NOVO - Site de Pontoise
Pontoise, France
Institut Godinot
Reims, France
CLCC Eugène Marquis
Rennes, France
Centre Henri Becquerel
Rouen, France
Clinique Mutualiste de l'Estuaire
Saint-Nazaire, France
CHU de Saint Etienne
Saint-Priest-en-Jarez, France
Clinique Médico Chirurgicale Charcot
Sainte-Foy-lès-Lyon, France
Strasbourg Oncologie Libérale - Clinique Sainte Anne
Strasbourg, France
Hôpitaux du Léman
Thonon-les-Bains, France
Oncopole Claudius Regaud, IUCT-Oncopole
Toulouse, France
Clinique Pasteur
Toulouse, France
CHU Tours
Tours, France
Centre de cancérologie Les Dentellières
Valenciennes, France
Institut de Cancérologie de Lorraine
Vandœuvre-lès-Nancy, France
Institut Gustave Roussy
Villejuif, France
University Hospital 'Aretaieio'
Athens, Greece
University General Hospital 'Attikon'
Athens, Greece
Hygeia Hospital
Athens, Greece
IASO Hospital
Athens, Greece
Metropolitan Hospital
Athens, Greece
Cork University Hospital
Cork, Ireland
Mater Misericordiae University Hospital
Dublin, Ireland
Mater Private Hospital
Dublin, Ireland
St James's Hospital
Dublin, Ireland
University Hospital Limerick
Limerick, Ireland
Midland Regional Hospital Tullamore
Tullamore, Ireland
University Hospital Waterford
Waterford, Ireland
Centro Di Riferimento Oncologico Di Aviano
Aviano, Italy
ASS Territoriale Papa Giovanni XXIII
Bergamo, Italy
AUSL di Modena - Ospedale B. Ramazzini
Carpi, Italy
ASST Ospedale Maggiore di Crema
Crema, Italy
Azienda Ospedaliero Universitaria Careggi
Florence, Italy
IRCCS Ospedale Policlinico San Martino
Genova, Italy
ASST Lecco - P.O. A. Manzoni
Lecco, Italy
IRCCS Istituto Romagnolo per lo Studio Dei Tumori (IRST) "Dino Amadori"
Meldola, Italy
Fondazione IRCCS Istituto Nazionale Dei Tumori
Milan, Italy
A.O.U Policlinico di Modena
Modena, Italy
IRCCS San Gerardo
Monza, Italy
A.O.U. Federico II - Policlinico
Naples, Italy
IRCCS Istituto Nazionale Tumori Fondazione Pascale
Naples, Italy
Istituto Oncologico Veneto
Padova, Italy
A.O.U. di Parma
Parma, Italy
A.O. di Perugia - Ospedale S. Maria della Misericordia
Perugia, Italy
"OSPEDALE P. PEDERZOLI" Casa di Cura Privata S.p.A.
Peschiera del Garda, Italy
AUSL Della Romagna
Ravenna, Italy
AUSL - IRCCS di Reggio Emilia
Reggio Emilia, Italy
AUSL della Romagna - Ospedale Infermi di Rimini
Rimini, Italy
A.O.U. Policlinico Umberto I
Roma, Italy
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Roma, Italy
Klinika Onkologii I Radioterapii Universeryteckie Centrum Kliniczne- Gdansk
Gdansk, Poland
MSC National Research Institute Of Oncology
Gliwice, Poland
Instytut Centrum Zdrowia Matki Polki
Lodz, Poland
ZP ZOZ Opolskie Centrum Onkologii im.prof. Tadeusza Koszarowskiego
Opole, Poland
Oncology Clinic, University Clinical Hospital in Pozan, Medical University
Poznan, Poland
Zachodniopomorskie Centrum Onkologii
Szczecin, Poland
Militray Institute of Medicine
Warsaw, Poland
Hospital General Universitario Dr. Balmis
Alicante, Spain
Hospital Clinic De Barcelona
Barcelona, Spain
Consorcio Hospitalario Provincial De Castellon
Castillón, Spain
Hospital Universitario Virgen De Las Nieves
Granada, Spain
Hospital Universitario Ramon Y Cajal
Madrid, Spain
Althaia Xarxa Assistencial Universitaria De Manresa Fundacio Privada
Manresa, Spain
University Hospital Son Espases
Palma, Spain
Hospital Universitario Virgen De La Macarena
Seville, Spain
University Hospital Virgen Del Rocio
Seville, Spain
Hospital General Universitario De Valencia
Valencia, Spain