Neoplasms

Symptoms and General Pathology

All Conditions

Rare Diseases

Neoplasm Metastasis

Neuroendocrine Tumors

Neoplastic Processes

Neuroectodermal Tumors

Neuroectodermal Tumors, Primitive

Neoplasms, Germ Cell and Embryonal

Neoplasms by Histologic Type

Neoplasms, Nerve Tissue

Neuroendocrine Tumor

Neuroepithelioma

All Drugs and Chemicals

Hematinics

Antineoplastic Agents

Gastrointestinal Agents

Somatostatin

Liver Extracts

Octreotide

Hormones

Hormone Antagonists

Patients in this arm receive systemic pharmacologic therapy alone

Patients in this arm receive systemic pharmacologic therapy and TAE

approved pharmacologic therapy

A Colao, M.D.

A Faggiano, M.D.

R D'Angelo, M.D.

F Fiore, MD

F Perrone, MD

C Gallo, MD

MC Piccirillo, MD

The purpose of this study is to verify if adding a locoregional treatment of liver metastasis (with trans-arterial embolization-TAE) to medical treatments of proven efficacy can prolong the progression free survival of patients affected by neuroendocrine tumors (NET) with inoperable liver metastases

Systemic Therapy With or Without Upfront Transarterial Embolization for Inoperable Liver Metastasis of Neuroendocrine Tumors

Randomized Phase 3 Trial Evaluating the Efficacy of Locoregional Treatment With Transarterial Embolization (TAE) for Liver Metastases, in Combination With Pharmacotherapy, in Patients With Neuroendocrine Tumor and Inoperable Liver Metastasis.

clinical factors will be explored in relation to patient outcomes

Federico II University

University of Campania "Luigi Vanvitelli"

National Cancer Institute, Naples

Skin and Connective Tissue Diseases

Breast Neoplasms

Breast Diseases

Skin Diseases

This group will receive standard loco-regional treatment i.e. surgery (modified radical mastectomy (MRM)/ Simple SMAC/BCT) +/- radiotherapy

Surgery for breast cancer

This group will not receive any loco-regional treatment

No Loco-regional treatment

Rajendra A Badwe, MS (Surgery)

Traditionally metastatic breast cancer patients are not offered loco-regional treatment except in cases of fungation or bleeding. However, scientific evidence for such omission of loco-regional treatment in metastatic breast cancer patients is lacking. On one hand, studies have shown that removal of primary tumor at times leads to complete disappearance of metastases and improvement in survival in renal cell carcinoma patients. However, such studies have never been performed in other solid tumors. On the other hand, there is a strong body of evidence in experimental settings that show that removal of primary tumor allows growth of metastasis. There is lack of similar data in humans in clinical settings. Offering loco-regional treatment in metastatic breast cancer patients in a setting of randomized controlled trial will help in improving survival of such patients and understanding the natural history of breast cancer.

PRESENT KNOWLEDGE:

Loco-regional treatment should not be attempted in metastatic breast cancer patients is a traditional teaching, which lacks scientific basis. Omission of loco-regional treatment can not be part of standard care if the scientific evidence is inadequate. Today such a treatment is offered for fungation and/or bleeding.

Studies in metastatic renal cell carcinoma have shown that removal of primary tumor can cause disappearance of metastases \[1\] and improve survival\[2,3\]. The exact mechanism of this phenomenon is not understood. Although immunologic mechanisms have been suggested, these remain largely unproven.\[1\] On the contrary, metastases autonomy hypothesis on animal models suggests that removal of primary tumor renders autonomy to metastases, which start growing rapidly.\[4\] The suggested mechanism for this is anti-angiogenic/ angiostatic activity of the primary tumor. However, such studies have never been performed in human subjects.

Which hypothesis is true? What does removal of primary tumor cause - suppression or stimulation of growth of metastases? Whether such suppression or stimulation affects survival? These are few questions, which need to be answered to improve our understanding of natural history of breast cancer. vascular endothelial growth factor (VEGF)\[5\], basic fibroblast growth factor (bFGF)\[6\] are some of the angiogenic and proliferative factors which stimulate tumor/ metastasis growth. Angiostatin\[7\] and Endostatin\[8\] are the some of the inhibitors of angiogenesis. It is the balance between angiogenic factors and anti-angiogenic factors that determines the tumor/metastases growth\[7\]. Lot of ongoing research\[9\] is focused on administration of Angiostatin and Endostatin to tilt this balance in favor of anti-angiogenesis. Does removal of the primary tumor change this balance? And what impact this change in balance (if any) have on survival? These questions have not been answered by in-vivo studies in humans. Demonstration of such effects or absence of these effects can help us in refining our therapeutic targets in metastatic patients.

There is dearth of reliable data on change in the levels of angiogenic, proliferative growth factors and anti-angiogenic factors in relation to the time after removal of primary. Removal of primary tumor resulted in growth of metastases in animal experiments in five days\[4\] and the metastases tripled in size by thirteenth day. Hence, we decide to measure levels of these factors at the end of one week following surgery and at the end of three months.

This study aims at:

Firstly, assessing impact of loco-regional treatment on survival in metastatic breast cancer patients.

Secondly, understanding the mechanism of suppression/ stimulation of growth of the metastases through measurement of angiogenic, proliferative growth factors and anti-angiogenic factors before and after intervention.

TRIAL DESIGN:

Patients with metastatic breast cancer diagnosed by incision biopsy and staging investigations will undergo six cycles of anthracycline-based chemotherapy. At the end of chemotherapy, these patients will be randomized into two groups. First group will receive standard loco-regional treatment i.e. surgery (modified radical mastectomy(MRM)/ Simple Mastectomy with Axillary Clearance (SMAC)/ Breast Conservation Therapy (BCT) +/- radiotherapy (depending on type of surgery performed or histopathology report). Second group will not receive any loco-regional treatment.

INVESTIGATIONS:

A. Diagnostic: Incision biopsy for primary diagnosis and estrogen receptor (ER)/ progesterone receptor (PgR) status.

B. Staging:

* Liver function tests
* Chest X-ray \& USG - Abdomen \& pelvis \&/ CECT chest with Upper Abdomen
* Bone scan with relevant x-ray skeletal survey (MRI in doubtful cases)

ELIGIBILITY:

Inclusion criteria:

1. Metastatic breast cancer patients with expected survival of at least one year
2. Age 21-65 years

Exclusion criteria:

1. Patients who are not fit to receive anthracycline based chemotherapy.
2. More than two visceral organ involvement.
3. Multiple liver metastases with deranged liver function tests serum glutamic oxaloacetic transaminase (SGOT) / serum glutamic-pyruvic transaminase (SGPT) more than four times the upper normal limit).
4. Locally static or progressive disease or systemically progressive disease as shown by repeat staging investigations guided by worsening symptoms.
5. Ulceration/ fungation/ bleeding after completion of chemotherapy, which mandates surgery.
6. Expected survival of less than six months after completion of chemotherapy.
7. Unfit for anesthesia due to metastatic disease.

CONSENT AND RANDOMIZATION:

Computerized randomization will be carried out at the central office after confirmation of eligibility and obtaining informed written consent. Randomization will be stratified by

1. Visceral or bone and/ or soft tissue metastasis.
2. Less than or equal to 3, or more than three metastases.
3. Hormone responsive or non-responsive tumor.

TRIAL SIZE AND ACCRUAL:

Breast cancer patients who have metastatic disease at presentation have a median survival of eighteen months. Detection of six-month improvement in this survival with 95% confidence and 80% power by a two tailed analysis will require a minimum of 350 patients.

METHODOLOGY:

1. All eligible patients will be provisionally marked for the trial.
2. Number and sites of all the metastases will be documented along with the size.
3. Patients will receive maximum of six cycles of Cyclophosphamide (600 mg/m2), Adriamycin (60 mg/m2), 5- Fluoro-Uracil (600 mg/m2).
4. Patients will be reassessed at the end of chemotherapy (approximately five months later). Staging investigations viz. CECT thorax and upper abdomen (in cases of visceral metastasis) and relevant X-rays will be repeated. All eligible patients will be randomized into two groups (stratified randomization). First group will undergo standard loco-regional treatment (surgery followed by radiotherapy depending on histopathology report or type of surgery performed e.g. BCT) and surgical oophorectomy (at the time of surgery) followed by hormone therapy (in ER and/ or PgR positive pre-menopausal patients). Postmenopausal patients will receive hormone therapy. Second group will be started on hormone therapy (all ER and/ or PgR positive and/ or postmenopausal patients). Hormone therapy will be in the form of Aromatase inhibitors (Letrozole 2.5mg OD/ Anastrozole 1.0mg OD)
5. All patients in loco-regional treatment group will have two or three blood samples (10-cc blood in plain bulbs) collected. These samples will be used for estimation of VEGF, bFGF, Angiostatin and Endostatin by ELISA.

   Sample 1: A day prior to surgery. Sample 2: Seventh post operative day. Sample 3: Three months after the surgery.
6. The metastases will be reassessed after twelve weeks of surgery for any change in size and number by repeat staging investigations viz. CECT thorax and upper abdomen (in cases of visceral metastasis) and relevant X-rays and again on symptomatic progression.

Patients with symptomatic bony metastases will in addition receive local radiotherapy (wherever indicated) and/ or bisphosphonates (wherever indicated).

Patients in both the arms will undergo metastasectomy wherever indicated.

PATHOLOGY: Pathological tumor size, number of axillary lymph nodes dissected and number positive for metastasis, histological type of the primary tumour (infiltrating duct carcinoma with standard grades, infiltrating lobular carcinoma, other rare histologies\[medullary, papillary, colloid etc.\]), presence or absence of lymphatic, vascular and peri-neural invasion should be noted in all patients. Estimation of other biological markers ER, PgR is mandatory. Entries will be made in case report forms (CRFs).

END POINT:

Primary: 1. Overall survival (time to death) 2. Progression free survival

Secondary:

Changes in VEGF, bFGF, Angiostatin and Endostatin.

DATA COLLECTION, QUALITY CONTROL AND ANALYSIS:

Data collection will be carried out by individual clinician on prescribed forms: Pre-randomization form, primary data sheet, and pathology information. At least 20% of the data will be cross-checked by internal/external review. The trial centre data manager with the help of individual clinician will maintain completeness of data but the latter will be responsible for the correctness of information. All forms will be maintained in duplicate at the central trial office.

Data monitoring committee will periodically review the trial. Univariate comparison between randomization arms will be carried out using chi-squared test.

Assessing Impact of Loco-regional Treatment on Survival in Metastatic Breast Cancer at Presentation

A Randomized Trial To Assess The Impact Of Loco-Regional Treatment On Survival Of Patients With Metastatic Breast Cancer At First Presentation

Overall survival (OS) : Time interval between randomization and death

PFS: Time interval between randomization and first date of progression of disease

The secondary endpoints include the assess of loco-regional treatment on levels

Tata Memorial Hospital

Director

Letrozole

Palbociclib

Prolactin Release-Inhibiting Factors

Aromatase Inhibitors

Protein Kinase Inhibitors

Enzyme Inhibitors

All patients will receive the standard of care treatment ie Palbociclib + letrozole for 24-26 weeks (a delay of +/- 2 weeks to initiate the locoregional treatment is authorized after the day 1 of cycle 1 of palbociclib plus letrozole). After this period, patient will have the most adapted locoregional treatment ie surgery (conservative or mastectomy) with or without radiotherapy, or radiotherapy. The palbociclib will be continued until progression

The included patients will first receive the following systemic treatment according standard of care:

* Non-steroidal aromatase inhibitor (letrozole)
* Palbociclib
* Monthly Luteinizing hormone-releasing hormone (LHRH) analogue for non-menopausal patients only. Surgical bilateral oophorectomy is an acceptable option.

After normally 6 courses of systemic treatment initiation, the loco-regional treatment of the primary tumour will be performed: surgery (conservative or mastectomy) with or without radiotherapy, or radiotherapy

locoregional treatment

Claire Bonneau, MD

Approximately 3.5% to 6% of newly diagnosed breast cancer patients are stage IV metastatic. De novo metastatic breast cancer accounts for 20% to 25% of these cases. Despite a decrease in mortality in Europe and North America due to early detection and access to treatment, breast cancer remains the 2ⁿᵈ leading cause of cancer deaths in developed countries after lung cancer and the world's leading cause.

In the ESME French national retrospective cohort (NCT03275311), the newly diagnosed estrogen receptor (ER)-positive and HER2-negative (luminal) metastatic patients had a 59.1 months overall survival (OS) for pre-menopausal women and 44.7 months for postmenopausal women. In the same cohort, the median OS was 47.4 months for de novo metastatic patients with hormone receptor (HR)-positive / HER2-negative breast cancer.

The most important current treatment for metastatic breast cancer remains systemic therapy. Surgery and radiation are mainly used to treat symptoms. However, more than 15 retrospective studies have assessed the impact of locoregional treatment on relapse and OS. These studies suggested an improvement of the OS in patients with de novo metastatic breast cancer thanks to the addition of locoregional treatment to systemic therapy. Recent data from the ESME cohort suggest that patients with de novo luminal or HER2-positive metastatic breast cancer may benefit from local treatment of the primary tumor.

Several prospective trials have attempted to demonstrate the benefit of locoregional treatment with mixed results. This can be explained by a limited power of statistical analysis, on the recruitment of patients with breast cancer of all types, and on a limited access to effective systemic therapies in some cases and all before the area of anti CD4/6 which is the current standard treatment in patients with HR-positive / HER2-negative luminal metastatic disease.

However, guidelines indicate that a "multimodal approach, including curative locoregional treatments, should be considered". As a result, many clinicians offer locoregional treatment of the primary tumor, especially if there is a good response to the first line of systematic treatment.

Taken together, these data underscore the need for an evaluation of the value of combined therapy - endocrine therapy - CDK4/6 inhibitor and locoregional treatment - in this population of patients with newly diagnosed HR-positive / HER2-negative breast cancer.

Locoregional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients

PALbociclib in Advanced Breast Cancer: Therapy INtegrating locorEgional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients

Unicancer will share de-identified individual data that underlie the results reported. A decision concerning the sharing of other study documents, including protocol and statistical analysis plan will be examined upon request.

Follow-up of the disease status by imaging exams until surgery

Pathological response (tumour size, cellularity... ) evaluated at the surgery or at the biopsy

Rate of modification of indication of mastectomy

Rate of locoregional recurrence after surgery and/or radiotherapy

Follow-up of the disease status by imaging exams

Will be evaluated using the National Cancer Institute - common terminology criteria for adverse events (NCI-CTCAE) v5.0

Records of cancer treatments prescribed to patients after disease progression

self-administered questionnaire of quality of life EORTC QLQ-C30 taking into account the patient's activity and his/her physical and psychological state

self-administered questionnaire of quality of life EORTC QLQ-BR23, complementary module to QLQ C30 questionnaire, is more specifically interested in patients with se cancer and the impact of treatment on their lives

self-administered questionnaire of quality of life Euroquol EQ-5D-5L consists of a descriptive system and a visual scale

Pfizer

UNICANCER

Digestive System Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Participants in this group will undergo liver-localized interventions, which may include surgical resection and/or ablation therapy and/or SBRT, aiming to achieve NED.

Participants in this group will receive standard palliative chemotherapy. The focus is on managing symptoms and controlling the progression of the disease.

Participants may receive surgical resection and/or ablation therapy and/or stereotactic body radiotherapy

Surgical resection and/or ablation therapy and/or SBRT

Participants in this group may continue the original systemic chemotherapy regimen. Patients with tumor control after 10-12 cycles can either transition to maintenance treatment or temporarily suspend treatment until disease progression, at which point they switch to a second-line treatment regimen.The selection of second-line and subsequent treatment regimens follows CSCO guidelines and clinical practices.

Palliative Chemotherapy

Yuhong Li, PhD

The goal of this clinical trial is to investigate the effectiveness of localized interventions in improving the 5-year survival rate for colorectal cancer patients with ≥10 liver metastases. We aim to answer the following question:

Can localized interventions, including surgery and/or ablation and/or stereotactic body radiotherapy (SBRT), enhance the 5-year survival rate compared to palliative chemotherapy alone in patients with ≥10 colorectal liver metastases (CRLM)?

Participants in this study, who have achieved disease control through chemotherapy, will undergo either localized interventions (surgery and/or ablation and/or SBRT) or receive palliative chemotherapy alone. Researchers will compare the survival outcomes between these groups to determine the potential benefits of localized interventions for patients with ≥10 CRLM.

Colorectal cancer is one of the most common malignant tumors, ranking second globally in cancer-related mortality. In recent years, both the incidence and mortality rates of colorectal cancer in China have shown a gradual upward trend. According to literature reports, 20% of colorectal cancer patients are diagnosed with liver metastases (CRLM), and as the disease progresses, up to 50% of patients may develop liver metastases, a primary cause of treatment failure for these patients. Surgical resection of liver metastases remains the main curative treatment for colorectal cancer patients, with 5-year and 10-year survival rates reaching 33% and 23%, respectively. However, only 15%-20% of patients are eligible for liver surgery. Advances in targeted drugs and systemic chemotherapy in recent years have improved the response rate of colorectal cancer patients with liver metastases. Several clinical studies confirm that neoadjuvant chemotherapy can reduce the size and stage of liver metastases, allowing initially unresectable patients the opportunity for surgical intervention. Simultaneously, various local treatment modalities for colorectal liver metastases, including surgery, ablation therapy, and stereotactic body radiotherapy (SBRT), have evolved, aiming to achieve no evidence of disease (NED).

However, not all patients benefit from liver metastasis surgical resection, and the number of liver metastases is a crucial factor influencing the prognosis of colorectal cancer patients undergoing liver surgery. In the 1970s and 1980s, it was considered a contraindication for surgery if there were more than 3 liver metastatic lesions. In a subsequent phase II clinical trial, the CLOCC study, 119 initially unresectable colorectal cancer patients with fewer than 10 metastatic lesions were randomized into either palliative chemotherapy (control group) or systemic chemotherapy combined with liver ablation ± surgical resection (experimental group). The overall survival of patients in the combination therapy group was significantly higher than that in the palliative chemotherapy group (HR=0.58, 95% CI 0.38-0.88, p=0.01). The 3-year, 5-year, and 8-year survival rates in the combination therapy group were 56.9%, 43.1%, and 35.9%, respectively, confirming that for colorectal cancer patients with fewer than 10 unresectable liver metastases, the efficacy of systemic chemotherapy combined with surgery and ablation therapy is superior to palliative chemotherapy alone.

To explore the impact of surgical resection on the survival of colorectal cancer patients with ≥10 liver metastases after first-line treatment, several retrospective studies have been conducted. A study by L. Viganò et al. found that in 106 colorectal cancer patients with ≥8 metastatic lesions, the 5-year survival rate and 5-year recurrence-free survival rate after surgical resection were 20.1% and 13.6%, respectively. There was no significant difference in the 5-year survival rate among patients with 8-10, 10-15, and ≥15 metastatic lesions (p=0.848). Multifactorial analysis of patients with ≥ 8 metastatic lesions showed that the presence of extrahepatic lesions before surgery (HR=2.38, 95% CI 1.23-4.60, p=0.010) and poor response to preoperative chemotherapy (HR=2.14, 95% CI 1.11-4.12, p=0.023) were independent risk factors for overall survival in patients with ≥10 CRLM. Another large observational study by M. A. Allard included 529 patients with ≥10 liver metastases, yielding an overall 5-year survival rate of 30%. Among the colorectal cancer patients with ≥10 lesions, 68.4% (362/529) received chemotherapy before surgery, and 96.3% of these patients underwent surgical resection when the disease was controlled or stable. 72.8% patients underwent R0 or R1 ± ablation therapy, while 27.2% underwent R2 resection or did not undergo surgical resection. Patients who underwent R0 resection and R1 resection ± ablation therapy had better 3-year and 5-year survival rates than those who underwent R2 resection or did not undergo surgical resection (61% and 39% vs. 29% and 5%; p\<0.0001). The study also found that among these patients, there was no significant difference in the 3-year and 5-year survival rates between those who underwent R0 resection and R1 resection ± ablation therapy (73% and 45% vs. 60% and 44%; p\<0.72), and those who underwent R2 resection or did not undergo surgical resection (29% and 6% vs. 28% and 0%; p=0.77). The results of this study also showed that among patients with ≥10 CRLM, those who underwent MRI before surgery, achieved R0/R1 resection, and received adjuvant therapy after surgery had a longer survival.

Furthermore, Lin et al. used univariate and multivariate analysis to identify ≥10 liver metastases as an independent prognostic factor for colorectal cancer patients with CRLM (HR=1.629; 95% CI 1.007-2.636; p=0.043). Subsequently, a retrospective study was conducted specifically for colorectal cancer patients with liver metastases using 10 metastases as the cutoff value. The results showed that the conversion rate of patients with ≥10 liver metastases (43.4%) was significantly lower than that of patients with \<10 liver metastases (57.3%; p=0.001). Among successfully converted patients, the 2-year survival rate of patients with \<10 liver metastases was significantly higher than that of patients with ≥10 liver metastases (89.9% \[95% CI 82.5%-98.0%\] vs. 58.2% \[95% CI 42.2%-80.4%\], p=0.008). In patients with ≥10 liver metastases, there was no significant difference in the 2-year survival rate between those who successfully underwent conversion surgery and those who did not (58.2% \[95% CI 42.2%-80.4%\] vs. 49.6% \[95% CI 37.5%-65.7%\], p=0.160). For patients with \<10 CRLM, the 2-year survival rate of successfully converted patients was significantly higher than that of those who did not convert successfully (89.9% \[95% CI 82.5%-98.0%\] vs. 58.9% \[95% CI 45.2%-76.7%\], p\<0.001).

In summary, for colorectal cancer patients with liver metastases, adopting a locoregional treatment approach can enhance the survival of those with \<10 liver metastatic lesions. However, significant controversy remains regarding whether surgical treatment significantly improves the survival of colorectal cancer patients with ≥10 CRLM. Currently, there is a lack of randomized controlled study data to address the question of whether colorectal cancer patients with ≥10 CRLM can further benefit from chemotherapy plus a surgical approach versus palliative chemotherapy alone.

To that end, the present study will focus on patients with ≥10 CRLM who have achieved disease control in liver metastatic lesions after chemotherapy and can potentially attain a disease-free state through surgery and/or ablation and/or stereotactic body radiotherapy (SBRT). The primary objective of this study is to investigate whether liver-localized intervention can improve the 5-year survival rate compared to palliative chemotherapy, for colorectal cancer patients with ≥10 CRLM.

The participants who meet the inclusion criteria will be grouped using a stratified block randomization method. The stratification factors include the entire RAS/BRAF gene (wild-type vs. mutated), the number of liver metastases (10-20 vs. \>20), and the location of the primary lesion (left vs. right). The random grouping of participants will be accomplished using our center's Interactive Web Response System (IWRS). The participants will be randomly assigned to either the liver-localized treatment group or the palliative chemotherapy group in a 2:1 ratio.

Localized Treatment Versus Palliative Chemotherapy in CRC Patients With 10 or More CRLM

The DECIDE-CRLM-10 Randomized Controlled Study: Comparison of Chemotherapy Combined With Localized Treatment for Liver Metastases Versus Palliative Chemotherapy Alone in Colorectal Patients With 10 or More Liver Metastases

Data and materials used in this study can be made available following study completion upon reasonable request to the corresponding author, subject to ethical and legal considerations and applicable data-sharing agreements.

The proportion of patients who are still alive five years following diagnosis

The duration of time from the initiation of treatments until disease progression or death.

The duration of time from diagnosis until death

The proportion of patients experiencing disease progression specifically in the liver over the study period.

The proportion of patients experiencing disease progression outside the liver over the study period.

Assessment of adverse events related to surgical interventions, including but not limited to complications compared to palliative chemotherapy

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Systemic Therapy With or Without Upfront Transarterial Embolization for Inoperable Liver Metastasis of Neuroendocrine Tumors	NCT01755182	Neuroendocrine ...	approved pharma... TAE	18 Years - 80 Years	National Cancer Institute, Naples
Assessing Impact of Loco-regional Treatment on Survival in Metastatic Breast Cancer at Presentation	NCT00193778	Cancer of the B...	Surgery for bre... No Loco-regiona...	21 Years - 65 Years	Tata Memorial Hospital
Locoregional Treatment and Palbociclib in de Novo, Treatment Naive, Stage IV ER+, HER2- Breast Cancer Patients	NCT03870919	Breast Cancer S... Radiotherapy Surgery	Palbociclib locoregional tr...	18 Years -	UNICANCER
Localized Treatment Versus Palliative Chemotherapy in CRC Patients With 10 or More CRLM	NCT06208371	Colorectal Neop...	Surgical resect... Palliative Chem...	18 Years -	Sun Yat-sen University

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