Dr Jagsi on the Feasibility of Radiation Omission Following Surgery in Breast Cancer Care

Reshma Jagsi, MD, Dphil, Lawrence W. Davis Professor, chair, Department of Radiation Oncology, Emory University School of Medicine, discusses 5-year findings from the IDEA trial (NCT02400190) evaluating the feasibility of breast conserving surgery followed by endocrine therapy without radiotherapy in postmenopausal patients with breast cancer.

The prospective, multicenter cohort trial was conducted to investigate the safety of omitting radiation therapy in the treatment of younger postmenopausal patients, adding a genomic assay to classic selection factors. In the study, investigators provided patients with a thorough understanding of the individual risks of breast cancer recurrence, allowing for informed decision-making regarding treatment options.

A total of 200 patients between the ages of 50 and 69 with stage I unifocal invasive breast cancer were enrolled onto the study from June 2015 to October 2018 across 13 collaborating sites. This primary analysis was conducted 5 years after the last patient enrolled completed surgery.

Results showed that after a median follow-up of 5.2 years, the overall and breast-cancer specific survival rates in the 186 patients with clinical follow-up of at least 56 months were both 100%. Moreover, 5-year freedom from any recurrence was 99% (95% CI, 96%- 100%), Jagsi reports. Two patients experienced disease recurrence before 5 years, both of whom were compliant with endocrine therapy, Jagsi notes. Another 6 patients recurred later than 5 years after breast-conserving surgery, 3 of whom were endocrine therapy compliant. Notably, no distant recurrences were observed, she adds.

Jagsi emphasizes that it's essential to approach these results with caution, especially for younger postmenopausal women, considering the limited follow-up period of 5 years. Accordingly, longer-term follow-up of this and other trials can help assess the durability of these outcomes beyond 5 years and help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women, Jagsi explains.

Findings from this preliminary study have also provided the foundation for the ongoing, phase 3 NRG-BR007/DEBRA trial (NCT04852887), Jagsi details. The trial is evaluating the de-escalation of breast radiation following breast-conserving surgery in stage 1, hormone receptor– positive, HER2-negative breast cancer. It aims to provide valuable insights into the de-escalation of breast radiation therapy and gather essential quality-of-life data through randomized treatment allocation, Jagsi concludes.Reshma Jagsi, MD, Dphil, Lawrence W. Davis Professor, chair, Department of Radiation Oncology, Emory University School of Medicine, discusses 5-year findings from the IDEA trial (NCT02400190) evaluating the feasibility of breast conserving surgery followed by endocrine therapy without radiotherapy in postmenopausal patients with breast cancer.

The prospective, multicenter cohort trial was conducted to investigate the safety of omitting radiation therapy in the treatment of younger postmenopausal patients, adding a genomic assay to classic selection factors. In the study, investigators provided patients with a thorough understanding of the individual risks of breast cancer recurrence, allowing for informed decision-making regarding treatment options.

A total of 200 patients between the ages of 50 and 69 with stage I unifocal invasive breast cancer were enrolled onto the study from June 2015 to October 2018 across 13 collaborating sites. This primary analysis was conducted 5 years after the last patient enrolled completed surgery.

Results showed that after a median follow-up of 5.2 years, the overall and breast-cancer specific survival rates in the 186 patients with clinical follow-up of at least 56 months were both 100%. Moreover, 5-year freedom from any recurrence was 99% (95% CI, 96%- 100%), Jagsi reports. Two patients experienced disease recurrence before 5 years, both of whom were compliant with endocrine therapy, Jagsi notes. Another 6 patients recurred later than 5 years after breast-conserving surgery, 3 of whom were endocrine therapy compliant. Notably, no distant recurrences were observed, she adds.

Jagsi emphasizes that it's essential to approach these results with caution, especially for younger postmenopausal women, considering the limited follow-up period of 5 years. Accordingly, longer-term follow-up of this and other trials can help assess the durability of these outcomes beyond 5 years and help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women, Jagsi explains.

Findings from this preliminary study have also provided the foundation for the ongoing, phase 3 NRG-BR007/DEBRA trial (NCT04852887), Jagsi details. The trial is evaluating the de-escalation of breast radiation following breast-conserving surgery in stage 1, hormone receptor– positive, HER2-negative breast cancer. It aims to provide valuable insights into the de-escalation of breast radiation therapy and gather essential quality-of-life data through randomized treatment allocation, Jagsi concludes.