Primary Operation in SYnchronous meTastasized InVasivE Breast Cancer

Not Applicable

Completed

Brief Summary: Primary Operation in synchronous metastasized invasive breast cancer to evaluate the use of local therapy

Detailed Description: This study is a prospective, randomized, multicentre, study concerning the influence of local treatment on the patients with synchronous metastasized breast cancer. Patients will be stratified at inclusion according to the centre, the menopausal status (pre-menopausal, post-menopausal), the hormone-receptor status (ER-/PR-/not determinable; any PR and/or Er+), the HER-2 status (positive vs. negative/not determinable), the grading (G1/G2/not determinable vs. G3), location of metastases (visceral ± vs bone only), organs with metastases (single organ vs multiple organs) and use of first line chemotherapy (anthracycline ± vs. taxane vs others). Thereafter patients will be randomly assigned to receive either local therapy of the breast (lumpectomy or mastectomy + axillary surgery /± radiotherapy) versus no local therapy. Systemic therapy will be administered at the centers policy.

Recruitment & Eligibility

Inclusion Criteria

Patients age ≥ 18 years
Eastern Cooperative Oncology Group Performance Status is 0 -2
Untreated synchronous metastasized invasive carcinoma of the breast with the primary tumor in situ (bilateral synchronous metastasized breast cancer patients are eligible)
The primary tumor must be identified and may be any size, however, primary resection with resection free margins must be possible
Invasive adenocarcinoma of the breast on histological examination
The metastatic site must be identified by radiological assessment(Computer Tomography of the chest and the abdomen OR ultrasound and chest x ray for visceral metastases; bone scan AND/OR computer tomography AND/OR magnetic resonance for bone metastases). A biopsy is not necessary.
Written informed consent must be obtained and documented prior to beginning any protocol specific procedures and according to local regulatory requirements
able to comply with the protocol requirements during the treatment and follow-up period.

Exclusion Criteria

Patients in whom a R0 resection (microscopic free margins) is clinically questionable
Inflammatory cancer
Patients with a brain metastasis
Patients who are not eligible for general anesthesia and operations
Patients without metastatic breast cancer (patients with a tumor marker value (CEA, CA15-3) above normal levels without the radiological proven evidence of metastases are not eligible for the study)
Patients with a second untreated malignancy
Any previous malignancy treated with curative intent and the patient has not been disease-free for 5 years - exceptions are: (a)carcinoma in situ of the cervix, (b)squamous carcinoma of the skin, (c)basal cell carcinoma of the skin
Patients with any recurrent cancer disease
Pregnant or lactating women
Patients are not allowed to be part of another local therapy trial

Arm && Interventions

Group	Intervention	Description
B: Surgery on Demand	Surgery on Demand	In Arm B (no local therapy) it may be necessary to perform local therapy on demand (surgery, radiotherapy). Reasons may be uncontrolled bleeding or infected exulcerations with a septic component and no treatment benefit from conservative therapy. This will be considered as protocol deviation. However, the patient's follow up is recorded and data are available for analyses as intention to treat.
A: Surgical Therapy	Surgery	Local therapy consists of lumpectomy or mastectomy with or without radiotherapy (according to center tumor board decision) with a resection free margin of at least 1 mm or more demonstrated on paraffin embedded histological sections. Intraoperative frozen sections are allowed but not definitive for margin assessment. Sentinel node biopsy may be performed and has always to be followed by axillary dissection of level I and II (axillary surgery level I and II is mandatory).

Primary Outcome Measures

Name	Time	Method
Overall Survival (OS)	Time from randomization until the last visit of the last participant; maximum time on study was 63.9 months	Overall Survival with vs without local therapy (surgery)

Secondary Outcome Measures

Name	Time	Method
Time to Distant Progression	Time from randomization until the last visit of the last participant; maximum time on study was 63.9 months	Time to distant progression with vs without local therapy (surgery)
Time to Local Progression (TTPl)	Time from randomization until the last visit of the last participant; maximum time on study was 63.9 months	Time to local progression with vs without local therapy (surgery)

Locations (14): Hospital Guessing
🇦🇹
Guessing, Burgenland, Austria
Gynaegological Medical University Graz
🇦🇹
Graz, Styria, Austria
Medical University Graz, Oncology
🇦🇹
Graz, Styria, Austria
Ordensklinikum Linz GmbH - Elisabethinen Linz
🇦🇹
Linz, Upper Austria, Austria
Klinikum Wels-Grieskirchen GmbH
🇦🇹
Wels, Upper Austria, Austria
Medical University of Vienna-General Hospital Vienna
🇦🇹
Vienna, Austria
State Hospital Feldkirch
🇦🇹
Feldkirch, Vorarlberg, Austria
Paracelsus Medical University Salzburg-Oncology, Coop. Group
🇦🇹
Salzburg, Austria
Medical University of Vienna
🇦🇹
Vienna, Austria
Ordination Dr. Wette
🇦🇹
St. Veit a. d. Glan, Carinthia, Austria
Ordensklinikum Linz GmbH - BHS Linz, Coop. Study Group
🇦🇹
Linz, Upper Austria, Austria
Hospital Oberpullendorf
🇦🇹
Oberpullendorf, Burgenland, Austria
Medical University of Innsbruck
🇦🇹
Innsbruck, Tyrol, Austria
General Hospital Linz
🇦🇹
Linz, Upper Austria, Austria