MIDLOTHIAN, Va. (WWBT) - The Bon Secours Cancer Institute is participating in the Evangeline national clinical trial, which aims to find the best way to treat premenopausal women with breast cancer without chemotherapy before surgery.

It's part of Atossa Therapeutics' Phase 2 study evaluating (Z)-endoxifen in premenopausal women with newly diagnosed early-stage estrogen-receptor positive (ER+/HER2) breast cancer.

Dr. William Irvin, of the Bon Secours Cancer Institute, said that it accounts for more than 70% of cases.

In these cases, the main treatment involves blocking estrogen rather than using chemotherapy.

"In estrogen-positive breast cancer, a lot of the times, you know 70% plus, we're trying not to give chemotherapy or chemotherapy is not indicated. So the mainstay of medical therapy is blocking estrogen," Dr. Irvin said.

Tamoxifen, an estrogen blocker, has been a standard treatment for premenopausal women because it doesn't turn off the ovaries, which can cause serious side effects.

However, the drug has limitations in pre-surgery treatment.

"Tamoxifen doesn't work very well in the pre-surgery setting while the tumor is still in the body," Dr. Irvin said.

The Evangeline trial is studying (Z)-endoxifen, which is produced when tamoxifen breaks down in the liver.

In this trial, patients take (Z)-endoxifen directly rather than relying on their bodies to convert tamoxifen.

"The hypothesis and preliminary data show that it will be superior to Tamoxifen in treating breast cancer," he said.

The Bon Secours Cancer Institute has enrolled two patients so far.

According to the Breast Cancer Research Foundation, breast cancer rates are rising among women under 50, though there is no clear explanation for the increase.

Studies suggest environmental factors may play a role.

"Where it used to be I would see somebody in their thirties three or four times a year, it's now three or four times a month," he said.

(Z)-endoxifen could provide a non-chemotherapy treatment option that doesn't impact women's ovaries, potentially improving quality of life.

"So as drugs and knowledge and technology have gotten better, we've always been able to improve upon that, improve quality of life, improve cure rates. So this is really one of those next steps," Dr. Irvin said.

The national trial is expected to be complete at the end of 2026.