Supplementary Table 1. Risk factors associated to MaBC.
Increasing Age
Genetic factors Well-established Family history BRCA2 >> BRCA1
Possible PALB2
Androgen Receptor CYP17
CHEK2 Conditions
associated with an abnormal estrogen- to-androgen ratio
Klinefelter syndrome
Exogenous estrogen or testosterone use Obesity
Marijuana use Orchitis/epididymitis Thyroid disfunction Finasteride Lifestyle Lack of exercise
Exposures Well-established Radiation
Possible Electromagnetic fields Heat
Volatile organic compounds (eg, tetrachloroethylene, perchloroethylene, trichloroethylene, dichloroethylene, and benzene) or chemicals Miscellaneous
possible risk factors Birth order (possible higher risk in first borns) Bone fracture after age 45
Trial Number Test Lymph node status Number of patients enrolled
N. of men enrolled
(%)
Primary Outcome Enrollment period NCT00310180
TAILORx Oncotype DX Negative 10,253 0 (0%)* iDFS 2006 – 2010
NCT00433589
MINDACT MammaPrint Negative or positive
(max 3) 6,693 0 (0%)* DMFS
DFS 2007 – 2011
NCT01049425
WSG PlanB Oncotype DX Negative or positive 3,198 0 (0%)* DFS 2009 – 2011
NCT01272037
RxPONDER Oncotype DX Positive (1-3) 10,000 0 (0%)* DFS 2011 – 2015
ISRCTN42400492 OPTIMA
Prosigna (PAM50)
Positive (max 9) 4,500 (estimated
main trial)
ongoing, open to men
iDFS Cost-effectiveness
of test-directed therapy
2017 – ongoing
Supplementary Table 2. Multi-parameter gene expression assays trials for EBC. *male gender was an
exclusion criterion for this trial. Abbreviations: DFS: Disease-Free Survival; iDFS: invasive Disease-Free
Survival; DMFS: Distant Metastasis-Free Survival; RS: Recurrence Score.
Trial Number Experimental Treatment
Arm
Control Arm/Active Comparator
Phase Setting Number of patients enrolled
N. of men
enrolled (%) Primary
Outcome Enrollment period
NSABP B-05 Adj L- phenylalanine mustard
Adj Placebo 3 Adjuvant
N+ 379 0 (0%)* DFS 1972 - 1974
NSABP B-09 L-phenylalanine mustard + 5-FU + Tamoxifen
L-
phenylalanine mustard + 5-FU
3 Adjuvant
N+ 1891 0 (0%)* DFS 1977 - 1981
NSABP B13 Methotrexate + Fluorouracil followed by Leucovorin
Observation 3 Adjuvant
TNBC N0
760 0 (0%)* DFS 1981 - 1988
NSABP B-14 Tamoxifen Placebo 3 Adjuvant
HR+/HER2- N0
2,892 0 (0%)* DFS
OS 1982 - 1988 NSABP B-15 Arm1: AC x 4
Arm 2: AC x 4 ->
CMF x 3 Arm 3: CMF x 6
n.a. 3 Adjuvant
N+
Tamoxifen non- responsive
2,194 0 (0%)* DFS
DDFS OS
1984 - 1988
NSABP B-20 Arm1: CMF + Tamoxifen Arm 2:
Methotrexate + 5-FU followed by Tamoxifen
Tamoxifen 3 Adjuvant
HR+/HER2- 2,306 0 (0%)* DFS
OS 1988 - 1993
NSABP B-22 Arm 1: AC (intensification of C)
Arm 2: AC (intensification + increased total dose of C)
AC “standard
dose” 3 Adjuvant
N+ 2,305 0 (0%)* DFS 1989 - 1991
Trial MA5 FEC CMF 3 Adjuvant
N+ 710 0 (0%)* RFS
OS 1989 - 1993
INT 0101 (E5188) Arm 1: CAF-Z
Arm 2: CAF-ZT CAF 3 Adjuvant
HR+/HER2- N+
1,503 0 (0%)* DFS
OS 1989 - 1994
NCT00929591
SWOG-8814 Arm 1: CAF followed by Tamoxifen for five years.
Arm 2: CAF with concurrent Tamoxifen for five years
Tamoxifen for
five years 3 Adjuvant 1,558 0 (0%)* DFS
OS Toxicity
1989 - 1995
NCT00309491
ABCSG Trial 6 Tamoxifen +
Aminoglut. Tamoxifen 3 Adjuvant
HR+/HER2- 2,020 0 (0%)* OS 1990 - 1999
NCT00003678
aTTom Tamoxifen for 10
yrs Tamoxifen for
5 yrs 3 Adjuvant
HR+/HER2- 6,953 0 (0%)* OS 1991 - 2005
GABG-IV D-93 Tamoxifen after
risk-adapted CT Observation after risk- adapted CT
3 Adjuvant
TNBC 829 0 (0%)* DFS
OS Toxicity
1993 - 2000
GABG-IV A-93 Goserelin CMF 3 Adjuvant
HR+/HER2- N0
771 0 (0%)* EFS 1993 - 2001
NSABP B-28 AC (4 cycles) -->
Paclitaxel (4 cycles)
AC alone
(4 cycles) 3 Adjuvant
N+ 3,060 0 (0%)* DFS
OS 1995 - 1998
NCT00300508
ABCSG Trial 6a Anastrazole after Tamoxifen +/- AI (tot 5 yrs)
Observation after Tamoxifen +/- AI (tot 5 yrs)
3 Adjuvant
HR+/HER2- 856 0 (0%)* RFS
OS 1996 - 1999
NCT00849030
ATAC n.a. Arm 1:
Tamoxifen + Anastrozole Arm 2:
Tamoxifen + Placebo Arm 2:
Anastrozole + Placebo
3 Adjuvant
HR+/HER2- 9,358 0 (0%)* DFS
Safety and AEs
1996 - 2000
NCT00287534 ARNO 95
Anastrazole after Tamoxifen (tot 5 yrs)
Tamoxifen (tot 5 yrs)
2 Adjuvant
HR+/HER2-
1,059 0 (0%)* DFS 1996 – 2002
NCT00291759
ABCSG 8 Anastrazole after Tamoxifen (tot 5 yrs)
Tamoxifen
(tot 5 yrs) 3 Adjuvant
HR+/HER2- 3,901 0 (0%)* EFS
OS 1996 – 2004
NCT00003016 ATLAS
Tamoxifen for 10 yrs
Tamoxifen for 5 yrs
3 Adjuvant
HR+/HER2-
12,894 0 (0%) OS 1996 – 2005
NCT00003088
CALGB-9741 Arm 1: A -> T ->
C (21 days) Arm 2: AC -> T (14 days) Arm 3: A -> T ->
C (14 days)
n.a 3 Adjuvant
N+ 2,005 0 (0%)* DFS 1997 - 1999
Arm 4: AC -> T (21 days) US Oncology
Research Trial 9735
TC (4 cycles) AC (4 cycles) 3 Adjuvant
N+ 1,016 0 (0%)* DFS
OS 1997 - 2000
NCT00286117
ITA Anastrazole after Tamoxifen (tot 5 yrs)
Tamoxifen
(tot 5 yrs) 3 Adjuvant
HR+/HER2- 426 0 (0%)* DFS 1998 - 2002
NCT00003140
MA.17 Letrozole after Tamoxifen (tot 5 yrs)
Placebo after Tamoxifen (tot 5 yrs)
3 Adjuvant
HR+/HER2- 5,187 0 (0%)* DFS 1998 - 2003
NCT00038467
IES Exemestane
after Tamoxifen (tot 5 yrs)
Tamoxifen
(tot 5 yrs) 3 Adjuvant
HR+/HER2- 4,742 0 (0%)* DFS 1998 - 2003
NCT00004205
BIG 1-98 Arm 1:
Tamoxifen for 5 yrs
Arm 2: Letrozole for 5 yrs Arm 3:
Tamoxifen for 2 yrs followed by Letrozole for 3 yrs
Arm 4: Letrozole for 2 yrs followed by Tamoxifen for 3 yrs
n.a. 3 Adjuvant
HR+/HER2- 8,010 0 (0%)* DFS 1998 - 2003
NCT00004125
ECOG E1199 Paclitaxel or Docetaxel after AC (different schedules)
n.a. 3 Adjuvant 4,950 0 (0%)* DFS 1999 - 2002
NSABP B30 Arm 1:
ACDocetaxel Arm 2: A + Docetaxel Arm 3: AC + Docetaxel
n.a. 3 Adjuvant
N+ 5,351 0 (0%)* DFS 1999 - 2004
ISRCTN76560285
FinHER Arm 1 HER2+:
Docetaxel/FEC/
Trastuzumab Arm 2 HER2+:
Vinorelbine/FEC /Trastuzumab Arm 1 HER2-:
Docetaxel/FEC/
Arm 2 HER2-:
Vinorelbine/FEC
Arm 1 HER2+:
Docetaxel/
FEC Arm 2 HER2+:
Vinorelbine/
FEC
3 Adjuvant
HER2+
N+ or high- risk
1,010 0 (0%)* DFS 2000 - 2003
NCT00004067
NSABP B31 AC followed by Paclitaxel + Trastuzumab
AC followed
by Paclitaxel 3 Adjuvant HER2+
N+
2,130 0 (0%)* DFS
Cardiotoxicity 2000 - 2005 NCT00005970
NCCTG N9831 Arm1 & 2: AC followed by Paclitaxel + Trastuzumab +/- Tamoxifene/AI (different schedules)
AC followed by Paclitaxel +/-
Tamoxifene/AI
3 Adjuvant
HER2+
N+ or high- risk N0
3,436 0 (0%)* DFS 2000 - 2005
ISRCTN79718493
TACT FEC x 4 -->
Docetaxel x 4 FEC x 8 or epirubicin x 4 --> CMF x 4
3 Adjuvant
N+ or high- risk N0
4,162 0 (0%)* DFS 2001 - 2003
NCT00054587
PACS04 Epirubicin -Docetaxel x 6 -->Trastuzumab
FEC x 6 -->
Trastuzumab 3 Adjuvant
HER2+
N+
3,010 0 (0%)* PFS 2001 - 2004
NCT00021255
BCIRG 006 Arm 1: AC followed by Docetaxel + Trastuzumab Arm 2:
Carboplatin + Docetaxel + Trastuzumab
AC followed
by Docetaxel 3 Adjuvant
HER2+
N+ or high- risk N0
3,222 0 (0%)* DFS 2001 - 2004
NCT00045032
HERA Arm 1: Adj Trastuzumab for 1 yr
Arm 2: Adj Trastuzumab for 1 yrs
Observation 3 Adjuvant
HER2+ 5,081 0 (0%)* DFS 2001 - 2005
NCT00279448 NCT00032136 NCT00036270
TEAM
Exemestane for
5 yrs Tamoxifen for
2-3 years, followed by Exemestane for a total 5 yrs
3 Adjuvant 9,779 0 (0%)* DFS 2001 - 2006
NCT00024102
CALGB 49907 Capecitabine Physician
choice 3 Adjuvant
≥ 65 yrs 633 0 (0%)* DFS 2002 - 2006
-old NCT00070564
SWOG S0221
Doxorubicin+
cyclophosphami de followed by paclitaxel (different schedules)
Doxorubicin + cyclophospha mide followed by paclitaxel (different schedules)
3 Adjuvant
EBC, LABC
3,294 23 (0.7%) DFS
OS
2003 - 2010
NCT00066703
TEXT Exemestane + OFS (GnRH analogue) for 5 yrs
Tamoxifen + OFS (GnRH analogue) for 5 yrs
3 Adjuvant
HR+/HER2- 2,672 0 (0%)* DFS 2003 – 2011
NCT00066690
SOFT Arm 1:
Tamoxifen + OFS (GnRH analogue) for 5 yrs
Arm 2:
Exemestane + OFS (GnRH analogue) for 5 yrs
Tamoxifen for
5 yrs 3 Adjuvant
HR+/HER2- 3,066 0 (0%)* DFS 2003 – 2011
NSABP B-36 AC x 4 FEC x 6 3 Adjuvant
N0 2,722 0 (0%)* DFS 2004 - 2008
NCT00754845
MA.17R Letrozole for 5 yrs after Adj Tamoxifen
Placebo for 5 yrs
after Adj Tamoxifen
3 Adjuvant
HR+/HER2- 1,918 0 (0%)* DFS 2004 - 2009
NCT00301457
DATA Anastrozole for
6 yrs Anastrozole
for 3 yrs 3 Adjuvant
HR+/HER2- 1,912 0 (0%)* DFS 2006 – 2009
NCT00381901
PHARE Adj
Trastuzumab for 6 months
Adj Trastuzumab for 12 months
3 Adjuvant
HER2+ 3,384 0 (0%)* DFS 2006 - 2010
NCT00382070
NSABP-B42 Letrozole for up
to 5 yrs. Placebo for up
to 5 yrs 3 Adjuvant
HR+/HER2- 3,966 0 (0%)* DFS 2006 – 2010
NCT00528567
BEATRICE Bevacizumab +
CT CT 3 Adjuvant
TNBC 2,591 0 (0%) iDFS 2007 – 2010
NCT00542451
APT Adj Paclitaxel +
Trastuzumab n.a. 2 Adjuvant
HER2+
N0
420 1 (0.2%) DFS 2007 – 2010
NCT00490139 BIG 2-06/N063D
ALTTO
Arm 1. Lapatinib Arm 2. Lapatinib followed by Trastuzumab Arm 3. Lapatinib +Trastuzumab
Trastuzumab 3 Adjuvant
HER2+
EBC and LABC
8,382 9 (0.1%) DFS 2007 – 2011
Eudra-CT 2006- 003958-16
IDEAL
Letrozole for 5 years after 5-yrs adj ET
Letrozole for 2.5 years after 5-yrs adj ET
3 Adjuvant
HR+/HER2- 1,824 0 (0%) DFS 2007 – 2011
UMIN000000843
CREATE-X Capecitabine Observation 3 Adjuvant
TNBC residual invasive disease after neoadj
CT
910 0 (0%)* DFS 2007 – 2012
NCT00541086
FATA-GIM3 Arm 1:
Anastrozole for 5 yrs Arm 2:
Exemestane for 5 yrs
Arm 3: Letrozole for 5 yrs
Arm 4:
Tamoxifen for 2 yrs followed by
anastrozole for 3 yrs.
Arm 5:
Tamoxifen for 2 yrs followed by
exemestane for 3 yrs.
Arm 6:
Tamoxifen for 2 yrs followed by Letrozole for 3 yrs.
3 Adjuvant
HR+/HER2- 3,697 0 (0%)* DFS 2007 - 2012
NCT01358877
APHINITY Pertuzumab + Trastuzumab + CT
Placebo + Trastuzumab + CT
3 Adjuvant
HER2+ 4,805 11 (0.2%) iDFS 2011 – 2013
NCT01772472
KATHERINE T-DM1 Trastuzumab 3 Adjuvant
HER2+
with residual disease
1,486 5 (0.3%) iDFS 2013 – 2015
NCT02040857 Palbociclib, + ET n.a. 2 Adjuvant
HR+
EBC, LABC
162 5 (3%) Treatment
Discontinua- tion Rate
2014 – 2015
NCT02132949 Cohort A – neoadj: dose dense AC, Paclitaxel,
n.a. 2 Neoadj/
Adjuvant HER2+
EBC,
400 1 (0.3%) Cardiotoxicity 2014 – 2016
Pertuzumab, Trastuzumab;
Adj:
Pertuzumab, Trastuzumab;
Cohort B - neoadj: FEC, Docetaxel, Pertuzumab, Trastuzumab;
Adj:
Pertuzumab, Trastuzumab;
LABC, IBC
NCT02032823 NSABP B55
OlympiA
Olaparib after
Adj treatment Placebo after
Adj treatment 3 Adjuvant gBRCA1-2 HR+/HER2-
or TNBC
1,836 n.a. iDFS 2014 – 2019
NCT02586025 Trastuzumab, Pertuzumab, Docetaxel
Trastuzumab, Placebo, Docetaxel
3 Neoadj/
Adjuvant HER2+
EBC and LABC
329 0 (0%) tpCR 2016 – 2017
Supplementary Table 3. Clinical trials mentioned for the adjuvant setting in the NCCN Clinical Practice Guidelines in Oncology – version 2.2020. Gender-related inclusion criteria and number of men enrolled are reported. *male gender was an exclusion criterion for this trial. Abbreviations: adj: adjuvant; neoadj:
neoadjuvant; yrs: years; yr: year; ET: endocrine therapy; CMF: cyclophosphamide, methotrexate, fluorouracil, and tamoxifen; N: Lymph Node status; mut: mutated; HR+: Hormone Receptor-positive; HER2-:
HER2-negative; DFS: Disease-Free Survival; GnRH: Gonadotropin-Releasing Hormone; OFS: Ovarian Function Suppression; F-up: Follow-up; A: Adriamycin; C: Cyclophosphamide; AI: Aromatase Inhibitor; AE:
Adverse Event; CAF: cyclophosphamide + doxorubicin + fluorouracil; CAF-Z: CAF followed by 5 years of monthly goserelin; CAF-ZT: CAF followed by 5 years of monthly goserelin and daily tamoxifen; EFS: Event- free survival; tot: total; Aminoglut: Aminoglutethimide; DFS: Disease-Free Survival; iDFS: invasive Disease- Free Survival; OS: Overall Survival; EFS: Event-Free Survival; T: Paclitaxel; TC: docetaxel / cyclophosphamide; AC: doxorubicin/cyclophosphamide; FEC: 5-FU, Epirubicin, Cyclophosphamide.
Trial Number
Name Experimental
Treatment Arm
Control
Arm Phas
e Setting Primary Outcome Status Actual/
Estimated Primary Completion
Date NCT04247633
HIPEx Palbociclib + ET Palbociclib 2 Adjuvant
High Risk ER+ HER2-
EFS Not yet
recruiting February, 2023
NCT02927249 ET + Aspirin ET + Placebo 3 Adjuvant
HR+/HER2- N+ EBC
iDFS Recruiting April, 2021
NCT03726879
IMpassion050 Neoadj: atezolizumab + ddAC followed by atezolizumab + paclitaxel + trastuzumab + pertuzumab Adj: atezolizumab + trastuzumab + pertuzumab
Neoadj:
placebo + ddAC followed by placebo + paclitaxel + trastuzumab + pertuzumab
Adj: placebo + trastuzumab + pertuzumab
3 Neoadjuvant/Adjuvant HER2+
Known PD-L1 status
pCR Note: Participants
who do not achieve pCR have
the option of receiving blinded atezolizumab + T-
DM1
Recruiting April 21, 2021
NCT02926196
A-Brave Avelumab after
Adjuvant CT No Intervention after Adj CT
3 Adjuvant/Post- Neoadjuvant High-risk TNBC
EBC, LABC
DFS Recruiting June, 2021
NCT03858322
ADVANCE Arm 1: Paclitaxel + Carboplatin
Arm 2: Paclitaxel + Cyclophosphamide
n.a. 1 Adjuvant
HR+/HER2-
≥ 70 yrs at enrollment
Toxicity Receipt of Planned Therapy
Recruiting June 21, 2021
NCT02488967 AC followed by carboplatin + weekly Paclitaxel
AC followed by weekly Paclitaxel
3 Adjuvant
N+ or High-Risk N- TNBC
iDFS Recruiting July, 2021
NCT03498716
IMpassion030 Atezolizumab + CT CT 3 Adjuvant
TNBC Confirmed tumor PD-L1 evaluation
iDFS Recruiting January 15, 2022
NCT03587740
ATOP T-DM1 n.a. 2 Adjuvant
HER2+
≥ 65 yrs at enrollment EBC and LABC
iDFS Recruiting January 31, 2022
NCT03561740
SMART Metronomic
Capecitabine No Intervention 3 Adjuvant HER2+
High-risk EBC
iDFS Recruiting June 15, 2023 NCT03756298 Atezolizumab +
Capecitabine Capecitabine 2 Adjuvant/Post- Neoadjuvant with
residual disease TNBC EBC and LABC
iDFS Recruiting January 31, 2024
NCT03876886 AC-T
(dose-dense) TP
(dose-dense) 3 Adjuvant
TNBC and HRD 3-years DFS Recruiting February, 2024 NCT03820830
POLAR Palbociclib + ET ET 3 Adjuvant
HR+/HER2- Isolated Locoregional
Recurrence
iDFS Recruiting May 1, 2024
NCT03609047
Appalaches Palbociclib + ET CT followed by
ET 2 Adjuvant
ER+/HER2- Age ≥70 years
distant RFS Recruiting June 13, 2024 NCT03562637 Adagloxad simolenin +
OBI-821 Placebo 3 Adjuvant/Post-
Neoadjuvant with residual disease TNBC high-risk EBC
iDFS Recruiting November 30, 2025
NCT03701334
NATALEE Ribociclib + ET ET 3 Adjuvant
HR+/HER2- iDFS Recruiting December
26, 2025 NCT02954874 Pembrolizumab observation 3 Adjuvant, with
Residual Disease after neoadjuvant
TNBC or low-ER/equivocal
HER2
iDFS Severity of fatigue
Physical function
Recruiting May 31, 2026
NCT03725059 KEYNOTE-
756
Neoadj:
Pembrolizumab+CT Adj:
Permbrolizumab+ET
Neoadj:
Placebo + CT Adj: Placebo +
ET
3 Neoadjuvant/Adjuvant ER+/HER2-
tpCR Rate; EFS Recruiting January 24, 2031
NCT04109066 CheckMate
7FL
Nivolumab + neoadj CT and Nivolumab +
adj ET
Placebo + neoadj CT and Placebo +
adj ET
3 Neoadjuvant/Adjuvant High-risk BC
EBC, LABC
pCR EFS
Recruiting June 20, 2032
NCT01853748
ATEMPT T-DM1 Paclitaxel and
Trastuzumab 2 Adjuvant
HER2+ DFS Active,
not recruiting
January, 2020 NCT03078751
EarLEE-1 Ribociclib + ET n.a. 2 Adjuvant
HR+/HER2- High-risk EBC
Tolerability/
Safety Active,
not recruiting
March 5, 2020
NCT02513394
PALLAS Palbociclib + ET ET 3 Adjuvant
ER+/HER2- iDFS Active,
not recruiting
September, 2020 NCT03716180
DAPHNe Paclitaxel+
Trastuzumab+ n.a. 1 Adjuvant/Post-
Neoadjuvant Adherence after
tpCR Active,
not January 1, 2021
Pertuzumab HER2+ recruiting NCT03155997
monarchE Abemaciclib + ET ET 3 Adjuvant
HR+/HER2- iDFS Active,
not recruiting
April 12, 2021
NCT01674140 ET + everolimus ET 3 Adjuvant
HR+/HER2- High-risk EBC
iDFS Active,
not recruiting
December, 2022 NCT01966471 Anthracycline
Followed by T-DM1 and Pertuzumab
Anthracycline followed by Trastuzumab,
Pertuzumab, and Taxane
3 Adjuvant
HER2+ iDFS Active,
not recruiting
January 31, 2024
NCT00301925
TACT2 E + Capecitabine or Acc. E + Capecitabine or
E + Acc. CMF
E + CMF 3 Adjuvant
EBC DFS Active,
not recruiting
September, 2024
NCT03036488 KEYNOTE-
522
Pembrolizumab + CT Placebo + CT 3 Neoadjuvant /Adjuvant
TNBC EBC pCR
EFS Active,
not recruiting
September 30, 2025