The goal of this performance study is to learn if treatment with neoadjuvant endocrine therapy compared to chemotherapy has comparable efficacy, but better quality of life outcomes in endocrine responsive participants with early and locally advanced ER+/HER2-negative breast cancer and no detectable ctDNA in peripheral blood. The main question it aims to answer is: Is neoadjuvant endocrine therapy at least equivalent to neoadjuvant chemotherapy for treatment of patients with ER-positive, HER2-negative breast cancer with no detectable ctDNA (as assessed with the SignateraTM test) prior to treatment start and a Ki-67-value smaller or equal to 10% after 3 weeks of initial aromatase inhibitor treatment (=endocrine responsive). Researchers will compare neoadjuvant Standard of Care aromatase inhibitors (AI) or tamoxifen, if AI is not tolerated, with neoadjuvant Standard of Care chemotherapy to see if treatment efficacy is at least comparable between the treatment arms, when measured with the modified preoperative endocrine prognostic index (PEPI) score at surgery. Participants will: * Provide blood and tumor samples for ctDNA-assessment with the SignateraTM test by Natera prior to treatment starts * Take AI therapy for 4 weeks in the initial Run-in phase * Undergo tumor biopsy after 3 weeks of AI for local evaluation of Ki-67 * Receive either 8 months of neoadjuvant Standard of Care AI/ tamoxifen or 6-8 months of neoadjuvant Standard of Care chemotherapy in one of the three treatment arms of the Main Treatment Phase, depending on SignateraTM test result and Ki-67 value after 3 weeks of AI therapy (see "detailed description" for details). * Visit the clinic for checkups and tests at timepoints: * Prior to starting trial treatment * 3 weeks after start of endocrine treatment in the Run-in phase * Approx. 1 week later, prior to start of Main Treatment * After half of the therapy in the Main Therapy Phase has been completed * Once Main Treatment Phase treatment is complete (after 7-9 months overall) * For surgery and post-surgery checkup * Annually during the 5 years follow-up phase after surgery. * A subset of patients, who receive adjuvant chemotherapy after surgery, are asked to come to site for an additional visit after completion of chemotherapy. * Provide blood samples for ctDNA-assessment and future research when visiting the clinic * Answer patient-reported questionnaires about their quality of life, symptoms and sexual health
This is a prospective, randomized, controlled, open-label phase II performance study for participants with ER+/ HER2- early or locally advanced breast cancer. At the start of the trial, ctDNA is assessed for all participants with the SignateraTM test by Natera, using (archived) tumor tissue and blood samples. Eligible patients start AI therapy per Standard of Care in the Run-in Phase and after 3 weeks of treatment, Ki-67 levels are measured locally, to determine endocrine response. Following the Run-in Phase, participants, whose SignateraTM test result shows no detectable ctDNA and whose Ki-67 value is ≤ 10% are randomized 2:1 to receive either neoadjuvant AI or, if AI is not tolerated, tamoxifen in arm A or neoadjuvant chemotherapy in arm B. Participants with a Ki-67 value of \>10% or detectable ctDNA, according to the SignateraTM test, receive chemotherapy in the third treatment arm C. All study treatment is applied as per standard of care. The planned duration of treatment is 4 weeks in the Run-in phase and 6-8 months in either arm of the Main Treatment Phase. The primary endpoint is the modified PEPI score. Patients will be followed for 5 years from surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
350
ctDNA: Evaluation of ctDNA-status prior to treatment start (ctDNA not detected or ctDNA-positive) until the last of five follow-up visit
Ki67: Evaluation of Ki-67-value after 3 weeks of aromatase inhibitor
Evaluation of ctDNA status prior to treatment start
Allg. Gynäkologie u. gyn. Onkologie/Senologie
Vienna, Austria, Austria
RECRUITINGLandesklinikum Baden BGZ; Abt. f. Allgemein- u. Viszeralchirurgie
Baden, Austria
ACTIVE_NOT_RECRUITINGDornbirn BGZ; Frauenheilkunde u. Geburtshilfe
Dornbirn, Austria
ACTIVE_NOT_RECRUITINGLandeskrankenhaus Feldkirch Interne E
Feldkirch, Austria
ACTIVE_NOT_RECRUITINGMUG - LKH Graz Klin. Abt. f. Onkologie
Graz, Austria
ACTIVE_NOT_RECRUITINGMUG - Univ. Frauenklinik Graz, Gyn. Abteilung
Graz, Austria
ACTIVE_NOT_RECRUITINGMUI - Univ. Klinik f. Frauenheilkunde Innsbruck Klin. Abteilung f. Gynäkologie u. Geburtshilfe
Innsbruck, Austria
RECRUITINGTumorZentrum Kepler Universitätsklinikum Linz
Linz, Austria
ACTIVE_NOT_RECRUITINGLKH Salzburg - PMU, Univ.Klinik f. Innere Medizin III / SCRI CCCIT
Salzburg, Austria
NOT_YET_RECRUITINGUniversitätsklinikum St. Pölten, Klin. Abteilung f. Innere Medizin 1
Sankt Pölten, Austria
ACTIVE_NOT_RECRUITING...and 4 more locations
Modified PEPI (Preoperative Endocrine Prognostic Index) score
The proportions of patients with a modified PEPI score of 0 are compared between treatment arm A and treatment arm B. The score ranges between 0 and 12 with 0 indicating the lowest risk of relapse.
Time frame: From randomization to the timepoint of surgery
RCB (Residual Cancer Burden) score
The continuous RCB scores are compared between treatment arm A and treatment arm B. The score ranges from 0 to 100.
Time frame: From randomization to the timepoint of surgery
BCTOR (Breast Conservation Turn-Over Rate)
The proportion of patients with actual breast conservation surgery as planned are compared between treatment arm A and treatment arm B.
Time frame: From randomization to the timepoint of surgery
EFS (Event-Free Survival)
Time from randomization to the date of first event: local-regional progression prior surgery, distant progression prior surgery, invasive ipsilateral breast tumor recurrence, local-regional invasive recurrence, invasive contralateral breast cancer, distant recurrence, second primary invasive cancer of non-breast origin or death from any cause.
Time frame: From randomization until the end of the 5-year follow-up post-surgery period
iDFS (Invasive Disease-Free Survival )
Time from primary surgery to the date of the first event: invasive ipsilateral breast tumor recurrence, local-regional invasive recurrence, invasive contralateral breast cancer, distant recurrence, second primary invasive cancer of non-breast origin or death from any cause.
Time frame: From primary surgery until the end of the 5-year follow-up post-surgery period
iBCFS (Invasive Breast Cancer-Free Survival )
Time from primary surgery to the date of the first event: invasive ipsilateral breast tumor recurrence, local-regional invasive recurrence, invasive contralateral breast cancer, distant recurrence, or death from any cause.
Time frame: From primary surgery until the end of the 5-year follow-up post-surgery period
DRFS (Distant Recurrence-Free Survival)
Time from primary surgery to the date of the first event: distant recurrence or death from any cause.
Time frame: From primary surgery until the end of the 5-year follow-up post-surgery period
OS (Overall Survival)
Time from randomization to death.
Time frame: From randomization until the end of the 5-year follow-up post-surgery period
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