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Early Stage Breast CarcinomaEXPERTNCT02889874

EXamining PErsonalised Radiation Therapy for Low-risk Early Breast Cancer

A study testing Omission of radiation therapy in people with Early Stage Breast Carcinoma, run by Breast Cancer Trials, Australia and New Zealand at 68 sites in 9 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
Search all trials

Trial summary

This is a randomised, phase III, non-inferiority trial evaluating radiation therapy versus observation following breast conserving surgery and planned endocrine therapy in patients with stage I breast cancer of luminal A subtype defined using the Prosigna (PAM50) Assay. Read more about this study

Who is it for?
Ages 50 years and older, women only
Conditions the study is for
Early Stage Breast Carcinoma
What is being tested?
Omission of radiation therapy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,167 participants
Where
68 sitesin 9 countries
Study dates
21 Aug 2017to Apr 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Female patients aged ≥ 50 years of any menopausal status.
  • Primary tumour characteristics as assessed by conventional histopathology:
  • Unifocal histologically confirmed invasive breast carcinoma
  • Maximum microscopic size ≤2 cm
  • Grade 1 or 2 histology
  • ER and PR positive in ≥10% of tumour cells in either the biopsy or breast conserving surgical specimen
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  • HER2 negative on IHC (score 0 or 1+) or in situ hybridisation (ERBB2-amplification Ratio ERBB2/centromeres <2.0 or mean gene copy number <6). Equivocal IHC score (2+) must be assessed by ISH.
  • Primary tumour must be resected by breast conserving surgery with microscopically negative margins for invasive carcinoma and any associated ductal carcinoma in situ (no cancer cells adjacent to any inked edge/surface of specimen) or re-excision showing no residual disease.
  • Histologically confirmed negative nodal status determined by sentinel node biopsy or axillary dissection. Patients with pN0 (i+) disease are eligible for study participation (malignant cells ≤0.2 mm in regional lymph node(s) detected by hematoxylin-eosin (H\&E) stain or IHC, including isolated tumour cells).
  • No evidence of distant metastasis.
  • Eligible for and willing to have adjuvant endocrine therapy.
  • ECOG performance status 0-2.
  • Availability of FFPE tumour block for Prosigna (PAM50) Assay.
  • For randomization to the study, patients must fulfill all of the following criteria:
  • 1. Primary tumour characteristics as assessed by Prosigna (PAM50) Assay:
  • Luminal A intrinsic subtype
  • ROR score ≤60

Who cannot join

  • Any one of the following is regarded as a criterion for exclusion from the study:
  • Primary tumour characteristics:
  • Presence of multifocal or multicentric invasive carcinoma or ductal carcinoma in situ;
  • Evidence of clinical or pathologic T4 disease (extension to the chest wall, oedema or ulceration of skin, satellite skin nodules, inflammatory carcinoma);
  • The invasive component of the primary tumour is present as micro-invasion only;
  • Grade 3 histology;
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  • Presence of lymphovascular invasion
  • Contra-indication or unwillingness to have adjuvant endocrine therapy.
  • Planned to receive adjuvant chemotherapy or biologic therapy after breast cancer surgery, i.e. any systemic therapy other than endocrine therapy is not permitted. Any therapy unrelated to cancer is permitted at the discretion of investigators.
  • Treated with neoadjuvant endocrine therapy, chemotherapy or biologic therapy prior to breast cancer surgery.
  • Prior breast or thoracic RT for any condition.
  • Pre-operative breast imaging evidence of disease aside from the primary carcinoma resected by breast conserving surgery.
  • Concurrent invasive breast carcinoma or ductal carcinoma in situ (synchronous or metachronous).
  • Prior diagnosis of invasive breast carcinoma or ductal carcinoma in situ in either breast irrespective of disease free interval.
  • A diagnosis of non-breast malignancy <5 years prior to randomisation with the following exceptions:
  • Patients who are diagnosed with carcinoma in situ of cervix, endometrium or colon; melanoma in situ; and basal or squamous cell carcinoma of the skin at any time prior to randomisation are not excluded from study participation.
  • Patients who are diagnosed with other non-breast malignancy ≥5 years prior to randomisation and without evidence of disease recurrence are not excluded from study participation.
  • Significant comorbidity precluding definitive RT for breast cancer (e.g. cardiovascular or pulmonary disease, scleroderma, systemic lupus erythematosus).
  • Life expectancy <10 years.
  • Documented mutation of BRCA1, BRCA2 or TP53, or at high genetic risk of breast cancer.
  • Pregnant or lactating patients.
  • Inability to be registered to the study ≤8 weeks after the last surgical procedure for breast cancer.
  • Inability to commence RT (if randomised to receive RT) no later than 12 weeks from the last surgical procedure for breast cancer.
  • Inability to provide written informed consent.
  • Psychiatric, addictive, or any disorder that precludes compliance with protocol requirements.

Trial locations and contacts

68 sites in 9 countries.

68 sites in 9 countries

Australia32 sites
  • Genesis Cancer Care Wesley

    Auchenflower, Queensland, 4066

  • Ballarat Austin Radiation Oncology Centre

    Ballarat, Victoria, 3353

  • Peter MacCallum Cancer Centre - Bendigo

    Bendigo, Victoria, 3550

  • Peter MacCallum Cancer Centre - Moorabin

    Bentleigh East, Victoria, 3165

  • Box Hill Hospital

    Box Hill, Victoria, 3128

  • Cancer Care Service - Bundaberg

    Bundaberg, Queensland, 4670

  • Cancer Care Service - Hervey Bay

    Bundaberg, Queensland, 4670

  • Macarthur Cancer Therapy Centre

    Campbelltown, New South Wales, 2560

  • The Chris O'Brien Lifehouse

    Camperdown, New South Wales, 2050

  • The Canberra Hospital

    Canberra, Australian Capital Territory, 2605

  • St Vincent's Hospital, Sydney

    Darlinghurst, New South Wales, 2010

  • Icon Cancer Centre Richmond

    East Melbourne, Victoria, 3002

  • St Vincent's Hospital Melbourne

    Fitzroy, Victoria, 3065

  • GenesisCare Radiation Oncology Centre Frankston

    Frankston, Victoria, 3199

  • Genesis Cancer Care Newcastle

    Gateshead, New South Wales, 2290

  • University Hospital Geelong

    Geelong, Victoria, 3220

  • Gosford Hospital

    Gosford, New South Wales, 2250

  • Austin Hospital

    Heidelberg, Victoria, 3084

  • GenesisCare Tennyson

    Kurralta Park, South Australia, 5037

  • Liverpool Hospital

    Liverpool, New South Wales, 1871

  • Peter MacCallum Cancer Centre

    Melbourne, Victoria, 8006

  • Sir Charles Gairdner Hospital

    Nedlands, Western Australia, 6009

  • Calvary Mater Newcastle

    Newcastle, New South Wales, 2298

  • Mater Hospital Sydney

    North Sydney, New South Wales, 2060

  • Port Macquarie Base Hospital

    Port Macquarie, New South Wales, 2444

  • Prince of Wales Hospital

    Randwick, New South Wales, 2031

  • Ringwood Radiation Oncology Centre

    Ringwood East, Victoria, 3135

  • Tamworth Rural Referral Hospital

    Tamworth, New South Wales, 2340

  • Latrobe Regional Hospital

    Traralgon, Victoria, 3844

  • Westmead Hospital

    Westmead, New South Wales, 2145

  • Wollongong Hospital

    Wollongong, New South Wales, 2500

  • Princess Alexandra Hospital

    Woolloongabba, Queensland, 4102

Other trials in Australia

Taiwan10 sites
  • Changhua Christian Hospital

    Changhua, 500

  • Kaohsiung Medical University Hospital

    Kaohsiung City

  • Taichung Veterans General Hospital

    Taichung, 407204

  • National Cheng Kung University Hospital

    Tainan, 704

  • National Taiwan University Hospital

    Taipei, 100

  • Mackay Memorial Hospital

    Taipei, 10449

  • Taipei Veterans General Hospital

    Taipei, 11217

  • Tri-Service General Hospital

    Taipei, 114

  • Taipei Medical University Hospital

    Taipei

  • Chang-Gung Memorial Hospital

    Taoyuan, 10449

Other trials in Taiwan

Chile5 sites
  • Centro Oncologico del Norte

    Antofagasta

  • Hospital Sotero del Rio

    Puente Alto

  • Hospital Barros Luco Trudeau

    San Miguel

  • Hospital Luis Tisne Brousse

    Santiago, Santiago Metropolitan

  • Instituto Nacional del Cancer

    Santiago, 1010

Other trials in Chile

Spain5 sites
  • Hospital Universitari Vall d'Hebron

    Barcelona, 08035

  • Hospital Clinic de Barcelona

    Barcelona

  • Hospital Universitari Arnoa de Vilanova de Lleida

    Lleida

  • Hospital Universitario Virgen de la Macarena

    Seville

  • Hospital Universitario Virgen del Rocio

    Seville

Other trials in Spain

Switzerland5 sites
  • Hirslanden Clinique des Grangettes

    Chêne-Bougeries, 1224

  • Fondazione Oncologia Lago Maggiore

    Locarno, 6600

  • Kantonsspital Winterthur

    Winterthur, 8400

  • Brust-Zentrum AG Zurich

    Zurich, 8008

  • Universitatsspital Zurich

    Zurich, 8091

Other trials in Switzerland

New Zealand4 sites
  • Christchurch Hospital

    Christchurch, 8011

  • Waikato Hospital

    Hamilton, 3240

  • Palmerston North Hospital

    Palmerston North, 4414

  • Wellington Hospital

    Wellington, 6021

Other trials in New Zealand

Argentina3 sites
  • Sanatorio Britanico Rosariio

    Rosario, Santa Fe Province, S2000

  • Instituto de Oncologia de Rosario

    Santa Fe

  • Clinica Viedma

    Sarmiento, R8500ACE

Other trials in Argentina

Ireland2 sites
  • St Luke's Radiation Oncology Network

    Dublin

  • University Hospital Galway

    Galway

Other trials in Ireland

Italy2 sites
  • ASST Ospedale A. Manzoni UOS Oncologia

    Lecco

  • Istituto Europeo di Oncologia

    Milan

Other trials in Italy

About this study

Official title: A Randomised Phase III Trial of Adjuvant Radiation Therapy Versus Observation Following Breast Conserving Surgery and Endocrine Therapy in Patients With Molecularly Characterised Luminal A Early Breast Cancer

This is a randomised, phase III, non-inferiority trial evaluating radiation therapy versus observation following breast conserving surgery and planned endocrine therapy in patients with stage I breast cancer of luminal A subtype defined using the Prosigna (PAM50) Assay.

Read the detailed description

Radiation therapy (RT) after breast conserving surgery to improve local control and survival is the current standard of care for patients with early breast cancer. However, breast cancer is a heterogeneous disease, and the absolute benefit of RT in individual patients varies substantially. Thus, a pressing priority in contemporary breast cancer management is to tailor RT utilisation to the individual recurrence risks by identifying patients who are unlikely to benefit from RT, thereby avoiding the morbidity and costs of over-treatment.

It is recognised that selected patients with early breast cancer are unlikely to derive benefits from RT after breast conserving surgery. However, randomised trials have not consistently identified patients who may safely omit RT using conventional clinical-pathologic characteristics.

Breast cancer intrinsic subtypes distinguished by gene expression profiling are shown to be associated with distinct clinical outcomes. There is substantial evidence supporting the clinical validity of multigene assays including the PAM50-based Prosigna Assay that identifies intrinsic subtypes and generates a Risk of Recurrence score (ROR) to quantify individual risks of distant relapse. Multigene assays are increasingly integrated into clinical practice to inform chemotherapy decision, highlighting their substantial practice changing potential in personalising the use of RT for early breast cancer.

A recent analysis of archived tumour specimens of 1,308 patients with early breast cancer has shown significant associations between local recurrence risk and the PAM50-defined intrinsic subtypes and ROR score. EXPERT presents a unique opportunity of clinical and public health importance to optimise personalised local therapy for early breast cancer through precise, individualised quantification of local recurrence risk to identify low-risk patients for whom RT after breast conserving surgery may be safely omitted.

Being tested
Omission of radiation therapy
Keywords
Radiation therapy, omission, non-inferiority, breast cancer
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Omission of radiation therapyRadiation

    Omission of radiation therapy (adjuvant endocrine therapy only).

Study groups in NCT02889874
Study groupRoleWhat they receive
A: Radiation Therapy & endocrine therapyNo interventionPatients randomized to Arm A will receive standard radiation therapy and adjuvant endocrine therapy (standard of care).
B: No Radiation Therapy (ET only)ExperimentalPatients randomized to Arm B will not receive radiation therapy (omission of radiation therapy) and receive adjuvant endocrine therapy only.
Receives: Radiation: Omission of radiation therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Local recurrence rate after breast conserving surgery

    The time from randomisation to the date of local recurrence (LR) as a site of first recurrence.

    Measured: 10 years

Secondary outcomes (9)
  1. Local-regional recurrence-free interval (LRRFI)

    Time from randomisation to the date of local or regional recurrence as a site of first recurrence.

    Measured: 10 years

  2. Distant recurrence-free interval (DRFI)

    Time from randomisation to the date of distant recurrence, regardless of occurrence of any intervening local or regional recurrence, contralateral breast cancer or second (non-breast) primary invasive cancer.

    Measured: 10 years

  3. Disease free survival including DCIS (DFS-DCIS)

    Time from randomisation to date of first evidence of local (invasive breast carcinoma or DCIS), regional or distanct recurrence; contralateral breast cancer (invasive breast carcinoma or DCIS); second (non-breast) primary invasive cancer; or death.

    Measured: 10 years

  4. Invasive disease free survival (iDFS)

    Time from randomisation to date of first evidence of local (invasive breast carcinoma), regional or distanct recurrence; contralateral breast cancer (invasive breast carcinoma); second (non-breast) primary invasive cancer; or death.

    Measured: 10 years

  5. Recurrence-free interval

    Time from randomisation to the date of local, regional or distant recurrence as a site of first recurrence.

    Measured: 10 years

  6. Overall survival (OS)

    Time from randomisation to date of death from any cause.

    Measured: 10 years

  7. Salvage RT or mastectomy rate

    Time from randomisation to the receipt of salvage RT or mastectomy, individually and in combination (one or the other) as a composite endpoint.

    Measured: 10 years

  8. Adverse events for patients

    Adverse events during treatment (up to 5 years of endocrine therapy) assessed using NCI CTCAE v4.0.

    Measured: 5 years

  9. Assessment of the impact of endocrine therapy

    FACT-ES measure of endocrine symptoms.

    Measured: 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Sep 2016 (estimated)
  2. Study start21 Aug 2017
  3. Primary completionSep 2027 (estimated)
  4. Study completionApr 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,167 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02889874
Sponsor's protocol ID
ANZ1601/BIG 16-02
Other IDs
2016-003527-33, 2016
Acronym
EXPERT
Status last verified
Sep 2025
First submitted
25 Aug 2016
Last updated
18 Sep 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Anonymised Individual Patient Data (IPD) collected during the trial as per BCT Data Sharing Guidelines.

Questions about this trial

What is this clinical trial studying?

A study testing Omission of radiation therapy in people with Early Stage Breast Carcinoma, run by Breast Cancer Trials, Australia and New Zealand at 68 sites in 9 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 18 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 68 sites in Australia, Taiwan, Chile, Spain, Switzerland and 4 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Local recurrence rate after breast conserving surgery (time frame: 10 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Sep 2025.

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