EUROPA data

[Bequerel]

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A med onc I work with is at San Antonio breast and just texted me that interim analysis was presented and RT is better than endocrine therapy! Data to be published in Lancet soon. Anyone there to give more info??? This is exciting news

 

[OTN]

I've heard that as well- I think it's going to represent a major paradigm shift in breast ca tx.

 

[drowsy12]

hopeuflly the data will be online soon

 

[Surf Rx]

It was the interim 2 year QOL outcomes presented. Better tolerated than ET and no increase in recurrence for RT. Here are the slides.

 

[BobbyHeenan]

God bless the folks running this trial.

Anyone that ever actually sees follow ups in the 5 fraction APBI IMRT era knew this - they have zero xrt problems but are miserable on their AI. NRG should be ashamed for the trash XRT omission trial they're running instead of this.

 

[OTN]

God bless the folks running this trial.

Anyone that ever actually sees follow ups in the 5 fraction APBI IMRT era knew this - they have zero xrt problems but are miserable on their AI. NRG should be ashamed for the trash XRT omission trial they're running instead of this.

One could argue, given the EUROPA data, that trial is no longer ethical and should be closed

 

[yesmaster]

What proportion of patients received whole breast v apbi? If whole breast substantial then that would not reflect current practice and bias HRQOL against radiation.

 

[BobbyHeenan]

What proportion of patients received whole breast v apbi? If whole breast substantial then that would not reflect current practice and bias HRQOL against radiation.

All of hte patients on EUROPA had APBI.

I think this will be the the way forward for these low risk patients.

 

[Aptamer]

Lancet Oncology: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00661-2/

 

[HolySmokes]

All of hte patients on EUROPA had APBI.

I think this will be the the way forward for these low risk patients.

I guess I'm a little unclear what the slide means. It says 85% randomized to RT got partial breast tx. Does that mean 15% got whole breast (protocol violation)? Or does it mean 15% randomized to RT never got RT at all?

 

[rymd]

The last sentence of the abstract...

"While these interim results suggest radiotherapy might better preserve HRQOL in older women with low-risk early breast cancer, further data on disease control outcomes and final patient accrual are needed to draw definitive conclusions."

 

[BobbyHeenan]

The last sentence of the abstract...

"While these interim results suggest radiotherapy might better preserve HRQOL in older women with low-risk early breast cancer, further data on disease control outcomes and final patient accrual are needed to draw definitive conclusions."

it is early, I agree.

So far, so good though.

In this population though 5 year data probably more useful than for a more 50 year old patient population.

 

[yesmaster]

85% partial, 15% whole breast

 

[JustAdocInBox]

Just this morning I saw an otherwise healthy stage I breast cancer patient develop a PE on Tamoxifen. This study can't mature fast enough.

 

[radoncftw]

Med oncs gonna say "we need 15 yr data" this like we were historically trained to say.

 

[seper]

for those of you who do a lot of 5x APBI (I don’t), have you noticed any unexpected acute problems like infections / abscesses?

 

[BobbyHeenan]

Med oncs gonna say "we need 15 yr data" this like we were historically trained to say.

I don't know. med oncs like to give the juice but in my experience they too hate AI's.

 

[BobbyHeenan]

for those of you who do a lot of 5x APBI (I don’t), have you noticed any unexpected acute problems like infections / abscesses?

I've treated almost 50 patients I'd estimate. had one patient that had a seroma flair/infection that calmed with antibiotics but otherwise it has gone amazingly. I have been quite frankly shocked at how little side effects they have. I typically treat QOD but others do daily regularly. If there is a time constraint I'll go daily but on trial many were QOD and It think anecdotally it slightly cuts down on acute erythema. I do try to avoid M-F straight through, if doing Qday I'll start on a Weds or Thurs.

I follow them long term and cosmesis is great. Patient satisfaction through the roof. It is night and day IMO between 42.56/16 and 30/5 APBI.

 

[TheWallnerus]

for those of you who do a lot of 5x APBI (I don’t), have you noticed any unexpected acute problems like infections / abscesses?

Since 5fx APBI, at the quite evidence based dose of 26 Gy in 5 fx, is significantly less acute BED than 40/15, or 42/16, or 50/25, or 66/33, unexpected acute problems would certainly be… unexpected! For acute effects, total Rx dose governs acute effects more than fraction dose... and volume treated arguably governs acute effects even more than that.

The data is about as robust as one can reasonably hope for (you won't get much more data on this in the future) that 5-fx PBI regimens don't cause more acute effects... or late effects... vs more fractions, and vs treating whole breast.*

I follow them long term and cosmesis is great. Patient satisfaction through the roof. It is night and day IMO between 42.56/16 and 30/5 APBI.

Even better cosmesis w/ 26/5 APBI 😉



* of course see ASTRO guidelines on why PBI is actually preferred for most women with breast cancer.

 

[Tigerstang]

I don't know. med oncs like to give the juice but in my experience they too hate AI's.

Correct. Because they get no money from AI rx's.

 

[Palex80]

for those of you who do a lot of 5x APBI (I don’t), have you noticed any unexpected acute problems like infections / abscesses?

Nothing

 

[OTN]

I've treated almost 50 patients I'd estimate. had one patient that had a seroma flair/infection that calmed with antibiotics but otherwise it has gone amazingly. I have been quite frankly shocked at how little side effects they have. I typically treat QOD but others do daily regularly. If there is a time constraint I'll go daily but on trial many were QOD and It think anecdotally it slightly cuts down on acute erythema. I do try to avoid M-F straight through, if doing Qday I'll start on a Weds or Thurs.

I follow them long term and cosmesis is great. Patient satisfaction through the roof. It is night and day IMO between 42.56/16 and 30/5 APBI.

I agree with everything here. I've also treated about 50 patients. Very, very few side effects if any. Only 2 patients with any skin changes, and those were asymptomatic. I do QOD delivery.

 

[JustAdocInBox]

for those of you who do a lot of 5x APBI (I don’t), have you noticed any unexpected acute problems like infections / abscesses?

I do a lot of 5 fx APBI, no issues. I've done 26/5 apbi daily , 30 /5 daily and every other day, they all do fine.

 

[HolySmokes]

I've treated ~100 patients. I've had 2 total significant skin toxicities (moist desquamation), both in patients whose breasts were large and cavities were abutting the IM fold. So not unexpected given the location regardless of fractionation. I let patients choose if they want QD or QOD and haven't noticed any difference.

 

[salubalu]

Med oncs already asking if we’re not giving endocrine do we have to follow up with these patients or will you all…

 

[thesauce]

I don't know. med oncs like to give the juice but in my experience they too hate AI's.

Then why are they pushing AI instead of RT? It was like a preconceived notion that they were obviously going to give AI and it was only the RT they were questioning.

Took this trial for them to even consider omitting the AI and they still won’t.

 

[Bequerel]

RVU based med oncs are incentivized to give AI. Level 4 f/u q3 months at $100/RVU is easy money.

 

[medgator]

RVU based med oncs are incentivized to give AI. Level 4 f/u q3 months at $100/RVU is easy money.

Yeah. Easy fu. Med oncs typically aren't following these pts unless they are prescribing an AI

 

[BobbyHeenan]

Then why are they pushing AI instead of RT? It was like a preconceived notion that they were obviously going to give AI and it was only the RT they were questioning.

Took this trial for them to even consider omitting the AI and they still won’t.

I’d argue it’s the academic rad oncs that set this train of thought more than non academic med oncs. It’s just how the prior trials were run and how NRG/“Biomarker” investors (rad onc) have driven the discussion in this space.

Though my experience has been variable. Some meds oncs are more than happy to quickly drop an AI. With 5 fraction APBI I don't get much "push" back about need to omit XRT and just give AI. This is just anecdotal though, i'm sure it varies from tumor board/community to community.

 

[medgator]

Though my experience has been variable. Some meds oncs are more than happy to quickly drop an AI.

💯. Some of the most recently trained ones get it

 

[BobbyHeenan]

💯. Some of the most recently trained ones get it

Exactly my experience. THe young med oncs are quick to downplay the need for AI and fine with XRT in these low risk cases.

 

[TheWallnerus]

Postoperative Radiation Improves HRQOL Over Endocrine Therapy in Breast Cancer | Targeted Oncology - Immunotherapy, Biomarkers, and Cancer Pathways

In the phase 3 EUROPA trial, exclusive postoperative radiation therapy led to better health-related quality of life and fewer treatment-related adverse events in older patients with stage I luminal-like breast cancer at 24 months.

www.targetedonc.com

This data is a home run. I think if all the breast patients had gotten partial breast EBRT at 26 Gy, it woulda been a grand slam. I respect brachytherapists but brachy just seems to make no sense here. I do *not* respect whole mammarists here.

 

[IonsAreOurFuture]

for those of you who do a lot of 5x APBI (I don’t), have you noticed any unexpected acute problems like infections / abscesses?

If anything, I have noticed much worse toxicity in the whole breast patients in terms of seroma concerns, breast redness and being put on antibiotics.

When I think about where the worst skin reactions occur for whole breast, it's almost always the axilla, inframammary fold and nipple. We pretty much avoid those completely with APBI. I have yet to see any skin desquam in my 5 fx APBI patients.

Some get residual tenderness and fibrosis of the tumor bed but no worse than with whole breast plus a boost, and usually much less, like zero side effects.

Thank goodness for the Europeans!

 

[OTN]

This data is a home run. I think if all the breast patients had gotten partial breast EBRT at 26 Gy, it woulda been a grand slam. I respect brachytherapists but brachy just seems to make no sense here. I do *not* respect whole mammarists here.

I'm trying to get my breast surgeons to avoid oncoplastic lumpectomy when possible to keep APBI on the table. Slowly moving the needle. Slowly.

 

[Gfunk6]

Thank goodness for the Europeans!

Seriously. This is why I quit ASTRO and joined ESTRO.

 

[medgator]

Seriously. This is why I quit ASTRO and joined ESTRO.

Better meeting locations too

 

[randomname2018]

Better meeting locations too

What the open sewers of San Antonio don't appeal to you?