Condition category
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting

Contact information



Primary contact

Prof Charles R Coombes


Contact details

Faculty of Medicine
Imperial College London
Hammersmith Hospitals NHS Trust
8th Floor
MRC Cyclotron Building
Du Cane Road
W12 0NN
United Kingdom
+44 (0)20 8383 5828

Additional identifiers

EudraCT number number


Protocol/serial number


Study information

Scientific title

Neoadjuvant study of Chemotherapy versus EndocriNe Therapy in postmenopausal patients with primary breast cancer



Study hypothesis

Neoadjuvant chemotherapy is considered the standard of care in the management of locally advanced breast cancer but phase III trials involving third generation aromatase inhibitors have established both the efficacy of these agents in the neoadjuvant setting. However it is not known whether endocrine therapy is as effective in the neoadjuvant setting as neoadjuvant chemotherapy.

There are still many aspects of the pathways of cytoreduction triggered by both chemotherapy and endocrine therapy which are poorly characterized and a study such as this is a valuable opportunity to study these pathways in vivo. In addition, there are currently no reliable biomarkers which will predict for a given patient with estrogen-receptor positive breast cancer whether endocrine or chemotherapy will offer more effective downstaging. If it can be established that endocrine neoadjuvant chemotherapy is as effective as neoadjuvant chemotherapy for estrogen-receptor positive breast cancer, (or more likely a molecular subset thereof), then the result of an in vivo assay of hormone sensitivity in the form of degree of clinical and pathological response may help define a potentially large subset of patients currently receiving adjuvant chemotherapy without survival benefit.

Please note as of 08/02/2011 the overall trial end date has been extended from 31/12/2008 to 31/03/2011 and the target number of participants increased from 644 to 716.

Ethics approval

Leeds (East) Research Ethics Committee on 23/01/2008 (ref: 07/H1306/164).

Study design

Multi-centre randomised parallel-group comparative phase III trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet


Breast Cancer


Arm A: fluorouracil (5 FU) 600 mg/m2, epirubicin 75 mg/m2 and cyclophosphamide 600 mg/m2;
six cycles every 21 days
Arm B: letrozole 2.5 mg po per day for 21 weeks

Intervention type



Phase III

Drug names

Epirubicin, cyclophosphamide, fluorouracil and letrozole

Primary outcome measure

1. Clinical response rates

Secondary outcome measures

1. Radiological response rates using breast ultrasound and mammogram
2. To compare the rates of conservation surgery

3. To compare degree of pathological response
4. To compare Ki-67 protein changes and its relationship to treatment response
5. To investigate the roles of members of the forkhead family in mediating endocrine and chemotherapy-induced regression
6. To evaluate the length of time to maximum response within the treatment period
7. To compare effects on markers of apoptosis and the cell cycle
8. To compare tolerability of the various treatments
9. To compare quality of life (QoL) of the various treatments

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. Histologically proven primary breast cancer which is thought to require mastectomy and where it is felt that cytoreductive systemic therapy would enable conservative surgery to be performed.
2. Postmenopausal up to the age of 75 years of age
3. Estrogen-receptor positive
4. Pre-treatment haematology and biochemistry values within acceptable limits
5. World Health Organisation (WHO) performance status zero or one
6. Primary breast tumour amenable to biopsy
7. Consent to having a repeat biopsy of breast tumour
8. Written informed consent prior to commencement of specific protocol procedures

Participant type


Age group




Target number of participants

40 for feasibility study and 676 for main study (716 total)

Participant exclusion criteria

1. Indicated for urgent neoadjuvant therapy, i.e., inflammatory or near ulcerating breast cancer
2. Bilateral invasive breast cancer
3. Any prior chemotherapy, hormone therapy or radiation for breast cancer
4. Evidence of distant metastatic disease as disclosed by bone scan, liver ultrasound scan and chest radiology
5. Past or current history of neoplasm other than breast carcinoma, except for:
a. curatively treated non-melanoma skin cancer
b. in situ carcinoma of the cervix
c. other cancer curatively treated and with no evidence of disease for at least ten years
d. ipsilateral Ductal Carcinoma In-Situ (DCIS) of the breast
e. Lobular Carcinoma In-Situ (LCIS) of the breast
6. Other serious illness or medical condition:
a. congestive heart failure or unstable angina pectoris, previous history of myocardial infarction within one year from study entry, uncontrolled hypertension or high-risk uncontrolled arrhythmias
b. history of significant neurologic or psychiatric disorders including psychotic disorders, dementia or seizures that would prohibit the understanding and giving of informed consent
c. active uncontrolled infection
d. active peptic ulcer, unstable diabetes mellitus
7. In the opinion of the investigator, any evidence of severe or uncontrolled systemic disease such as unstable hypertension, respiratory, cardiac, hepatic, and renal disease

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Imperial College London
W12 0NN
United Kingdom

Sponsor information


Imperial College London (UK)

Sponsor details

Charing Cross Campus
Fulham Palace Road
W6 8RF
United Kingdom

Sponsor type




Funder type


Funder name

Cancer Research UK (CRUK) (UK) (ref: C37/A9356)

Alternative name(s)


Funding Body Type

private sector organisation

Funding Body Subtype

other non-profit


United Kingdom

Funder name

Novartis Pharmaceuticals (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

2014 results in:

Publication citations

Additional files

Editorial Notes

18/10/2018: Cancer Research UK lay results summary link added to Results (plain English)