Omitting Radiation Therapy for Breast Cancer

(TAILOR RT Trial)

Recruiting at475 trial locations

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Recruiting

Sponsor: Canadian Cancer Trials Group

Must be taking: Endocrine therapy

Disqualifiers: Pregnancy, Prior chest radiation, Others

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Trial Summary

What is the purpose of this trial?

The purpose of this study is to compare the effects on low risk breast cancer receiving usual care that includes regional radiation therapy, with receiving no regional radiation therapy. Researchers want to see if not giving this type of radiation treatment works as well at preventing breast cancer from coming back.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, it mentions that endocrine therapy should be initiated or planned for at least 5 years, and it can be given concurrently or following radiation therapy.

What data supports the effectiveness of omitting radiation therapy for breast cancer?

The research indicates that while radiation therapy reduces local recurrence and improves survival in many breast cancer cases, there is uncertainty about its benefits for patients receiving modern systemic therapy, especially in those with high-risk features but no lymph node involvement. This suggests that omitting radiation might be considered in specific patient groups, although more evidence is needed to confirm this approach. ^{1 2 3 4 5}

Is it safe to omit radiation therapy for breast cancer?

Omitting radiation therapy in older women with early-stage estrogen-receptor-positive breast cancer who are receiving endocrine therapy is considered safe based on trial data. Efforts are ongoing to minimize long-term side effects of radiation, and some studies suggest that omitting radiation in certain cases does not increase the risk of cancer recurrence. ^{5 6 7 8 9}

How does omitting radiation therapy differ from other breast cancer treatments?

Omitting radiation therapy for breast cancer is unique because it involves not using radiation after breast-conserving surgery, especially in older women with early-stage, hormone-receptor-positive breast cancer, if they are receiving hormone therapy. This approach is considered acceptable for certain patients and aims to reduce the side effects associated with radiation, while still maintaining effective cancer control. ^{8 10 11 12 13}

Research Team

Timothy Whelan

Principal Investigator

Juravinski Cancer Centre at Hamilton Health Sciences, Ontario Canada

Eligibility Criteria

This trial is for women over 35 with early-stage breast cancer that hasn't spread, specifically T3N0 or limited nodal micrometastases. They should have an Oncotype DX score ≤25, be ER ≥1% and HER2 negative, and can start treatment within 6 weeks of joining the study. Participants must not be pregnant, have serious illnesses preventing protocol adherence, or a history of certain cancers within the last 5 years.

Inclusion Criteria

My breast cancer recurrence score is 25 or less.

I agree to provide a tumor tissue sample for research.

I am a woman newly diagnosed with invasive breast cancer without spread beyond the breast.

Exclusion Criteria

I have had breast cancer or DCIS on the same side treated with radiation before.

I have had breast cancer in both breasts, either at the same time or at different times.

I have had cancer other than breast cancer, but it was treated over 5 years ago with no current signs of the disease.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either regional radiotherapy or no regional radiotherapy, along with standard care including endocrine therapy and possibly chemotherapy

6-8 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of arm volume, mobility, and quality of life

9.5 years

Treatment Details

Interventions

• No Radiation (Other)
• Radiation (Radiation)

Trial Overview The study is examining if skipping regional radiation therapy after usual care (like surgery) prevents breast cancer from returning in low-risk patients as effectively as including it. Women will either receive no radiation or the standard regional radiation to see which approach works best.

Participant Groups

Group I: Regional Radiotherapy Active Control 1 Intervention

A. WBI plus RT to the regional nodes (supraclavicular, non-dissected axillary, and internal mammary) following BCS or; B. RT to the chestwall and regional nodes (supraclavicular, non-dissected axillary, and internal mammary) following mastectomy

Group II: No Regional Radiotherapy Active Control 2 Interventions

A. Whole Breast Irradiation (WBI) following BCS or; B. No Radiotherapy (RT) following mastectomy

Who Is Running the Clinical Trial?

Canadian Cancer Trials Group

Lead Sponsor

Trials

135

Recruited

70,300+

Dr. Janet Dancey

Canadian Cancer Trials Group

Chief Medical Officer since 2014

MD, FRCPC

Susan Marlin

Canadian Cancer Trials Group

Chief Executive Officer since 2012

BSc (Hons) from Dalhousie University, MSc in Community Health and Epidemiology from Queen’s University

Alliance for Clinical Trials in Oncology

Collaborator

Trials

521

Recruited

224,000+

Suzanne George

Alliance for Clinical Trials in Oncology

Chief Medical Officer since 2015

MD from Harvard Medical School

Evanthia Galanis

Alliance for Clinical Trials in Oncology

Chief Executive Officer since 2022

MD from Mayo Clinic

SWOG Cancer Research Network

Collaborator

Trials

403

Recruited

267,000+

Dr. Charles D. Blanke

SWOG Cancer Research Network

Chief Executive Officer since 2012

MD from Oregon Health & Science University

Dr. Dawn Hershman

SWOG Cancer Research Network

Chief Medical Officer since 2020

MD from Columbia University

Southwest Oncology Group

Collaborator

Trials

389

Recruited

260,000+

Dr. Lyudmila Bazhenova

Southwest Oncology Group

Chief Medical Officer since 2021

MD from University of California, San Diego

Dr. Richard Schilsky

Southwest Oncology Group

Chief Executive Officer since 2013

MD from University of California, San Diego

Eastern Cooperative Oncology Group

Collaborator

Trials

272

Recruited

153,000+

Dr. Mitchell D. Schnall

Eastern Cooperative Oncology Group

Chief Medical Officer

MD, PhD from University of Pennsylvania

Dr. Peter J. O'Dwyer

Eastern Cooperative Oncology Group

Chief Executive Officer

MD from University of Pennsylvania

NRG Oncology

Collaborator

Trials

242

Recruited

105,000+

Stephanie Gaillard

NRG Oncology

Chief Medical Officer

MD from Johns Hopkins University

Norman Wolmark

NRG Oncology

Chief Executive Officer since 2023

MD from Harvard Medical School

Findings from Research

In a study of 657 patients with T1 to T2N0 breast cancer who underwent mastectomy and received systemic therapy, the locoregional disease recurrence (LRR) rate was low at 4.7%, suggesting that many patients may not require postmastectomy radiotherapy (PMRT).

The study found that while larger tumor size was associated with a higher risk of recurrence, other high-risk features did not significantly impact LRR, indicating that PMRT may not be necessary solely based on these features in patients receiving modern systemic therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are there patients with T1 to T2, lymph node-negative breast cancer who are "high-risk" for locoregional disease recurrence? Mamtani, A., Patil, S., Stempel, MM., et al.[2018]

Postmastectomy irradiation significantly reduces the locoregional recurrence rate of breast cancer by a factor of 3, but this does not necessarily translate into improved long-term survival for all patients.

Recent studies indicate that high-risk premenopausal patients receiving both postmastectomy radiotherapy and adjuvant chemotherapy may experience a clinically relevant survival benefit, highlighting the importance of systemic therapy in conjunction with radiation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Overview of randomized trials in high risk breast cancer patients treated with adjuvant systemic therapy with or without postmastectomy irradiation. Overgaard, M.[2019]

Radiation therapy (RT) is crucial in breast cancer treatment, effectively reducing local recurrence and mortality, with short courses of RT (3-4 weeks) being as effective as longer ones.

Certain patients, particularly older individuals with good prognosis tumors and clear margins, may safely omit radiation boosts, while untreated regional nodes can lead to reduced survival, highlighting the need for tailored treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Radiation therapy and early breast cancer: current controversies. Boyages, J.[2019]

Radiation therapy is crucial in breast cancer treatment, significantly reducing local recurrence and improving survival rates, especially with advancements in techniques since the late 1980s.

Shorter courses of radiation therapy (3-4 weeks) are generally as effective as longer ones, and modern techniques like volumetric modulated arc therapy (VMAT) help minimize complications while enhancing treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evolution of radiotherapy techniques in breast conservation treatment. Boyages, J., Baker, L.[2020]

Radiation therapy is an effective and safe option for breast conservation therapy in localized breast cancer, with careful consideration of factors like patient history and breast size.

Acute skin reactions during treatment do not predict long-term complications, suggesting that with proper techniques, most patients can achieve good outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conservation Therapy of the Breast: Optimizing Long-term Results. Greenberg, HM.[2019]

Breast conservation, combined with adjuvant radiation therapy, is a safe and effective treatment for most women with early-stage breast cancer, significantly reducing the risk of recurrence and improving survival rates.

Current research is focused on minimizing long-term side effects of radiation, such as heart disease, and exploring shorter treatment options like accelerated hypofractionated irradiation, especially for elderly patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

ACR Appropriateness Criteria® conservative surgery and radiation--stage I and II breast carcinoma: expert panel on radiation oncology: breast. Bellon, JR., Harris, EE., Arthur, DW., et al.[2017]

In a study of 13,321 older women with stage I ER+ breast cancer, those who did not receive any treatment (neither radiation therapy nor endocrine therapy) had a significantly higher risk of developing second breast cancer events compared to those who received both treatments.

Radiation therapy alone did not increase the risk of second breast cancer events, suggesting it may be a safe option for older patients, while the omission of endocrine therapy was linked to a higher risk of recurrence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Radiation Without Endocrine Therapy in Older Women With Stage I Estrogen-Receptor-Positive Breast Cancer is Not Associated With a Higher Risk of Second Breast Cancer Events. Gerber, NK., Shao, H., Chadha, M., et al.[2022]

A study of 1,292 elderly women with stage I, estrogen receptor-positive breast cancer showed that after 2004, when new guidelines were introduced, there was a significant decrease in the use of radiation therapy (RT), particularly among women aged 80 and older, where RT use dropped from 80% to 41%.

Factors influencing the omission of RT included older age, higher comorbidity scores, smaller tumor sizes, and the absence of axillary surgery, indicating that patient and tumor characteristics, along with institutional practices, play a crucial role in the adoption of treatment guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of guideline changes on use or omission of radiation in the elderly with early breast cancer: practice patterns at National Comprehensive Cancer Network institutions. McCormick, B., Ottesen, RA., Hughes, ME., et al.[2022]

In a study of 1105 older women with low-risk breast cancer, omitting adjuvant radiation treatment after breast-conserving surgery did not increase the risk of cancer-specific death in the short term (5- and 10-year follow-up) for those with moderate to high comorbidity burden.

However, for women with low comorbidity burden, omitting radiation treatment may double the risk of long-term cancer-specific death, indicating that further research is needed to understand the implications of this treatment choice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between adjuvant radiation treatment and breast cancer-specific mortality among older women with comorbidity burden: A comparative effectiveness analysis of SEER-MHOS. Lee, E., Hines, RB., Zhu, J., et al.[2023]

Omitting endocrine therapy in older women receiving adjuvant radiation after breast-conserving surgery may provide similar local control and survival rates, suggesting a potential alternative treatment strategy for those who struggle with endocrine therapy side effects.

Current evidence on this approach is limited, highlighting the necessity for future prospective, randomized studies to better understand the outcomes of omitting endocrine therapy in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimizing Adjuvant Treatment Recommendations for Older Women with Biologically Favorable Breast Cancer: Short-Course Radiation or Long-Course Endocrine Therapy? McDuff, SGR., Blitzblau, RC.[2023]

Radiotherapy can be an effective alternative to surgery for breast cancer treatment, especially in cases where surgery is not possible or when it can provide similar outcomes in terms of cancer control and aesthetic results, particularly for larger tumors (T > 3 cm).

Recent studies indicate that the type of treatment (conservative vs. radical) does not significantly affect survival rates, and advancements in radiotherapy have improved its tolerability, allowing for lower doses and making it a viable option for patients who may eventually require surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Radiotherapy--an alternative to surgery in the treatment of breast cancer]. Baillet, F.[2006]

In a study of 2618 older women with early-stage, hormone-receptor-positive breast cancer who omitted radiation therapy, 30.9% did not receive endocrine therapy (ET), highlighting a significant gap in treatment.

Receiving endocrine therapy was linked to improved overall survival, indicating its importance for patients who forgo radiation; however, older patients were less likely to initiate ET, suggesting a need for targeted interventions in this group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Endocrine therapy initiation and overall survival outcomes with omission of radiation therapy in older Medicare patients with early-stage hormone-receptor-positive breast cancer. Shen, C., Li, N., Zhou, S., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Radiation therapy in the management of breast cancer. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Are there patients with T1 to T2, lymph node-negative breast cancer who are "high-risk" for locoregional disease recurrence? [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Overview of randomized trials in high risk breast cancer patients treated with adjuvant systemic therapy with or without postmastectomy irradiation. [2019]

4. Australia pubmed.ncbi.nlm.nih.gov

Radiation therapy and early breast cancer: current controversies. [2019]

5. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

Evolution of radiotherapy techniques in breast conservation treatment. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Conservation Therapy of the Breast: Optimizing Long-term Results. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

ACR Appropriateness Criteria® conservative surgery and radiation--stage I and II breast carcinoma: expert panel on radiation oncology: breast. [2017]

8. United States pubmed.ncbi.nlm.nih.gov

Radiation Without Endocrine Therapy in Older Women With Stage I Estrogen-Receptor-Positive Breast Cancer is Not Associated With a Higher Risk of Second Breast Cancer Events. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Impact of guideline changes on use or omission of radiation in the elderly with early breast cancer: practice patterns at National Comprehensive Cancer Network institutions. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Association between adjuvant radiation treatment and breast cancer-specific mortality among older women with comorbidity burden: A comparative effectiveness analysis of SEER-MHOS. [2023]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Optimizing Adjuvant Treatment Recommendations for Older Women with Biologically Favorable Breast Cancer: Short-Course Radiation or Long-Course Endocrine Therapy? [2023]

12. France pubmed.ncbi.nlm.nih.gov

[Radiotherapy--an alternative to surgery in the treatment of breast cancer]. [2006]

13. United States pubmed.ncbi.nlm.nih.gov

Endocrine therapy initiation and overall survival outcomes with omission of radiation therapy in older Medicare patients with early-stage hormone-receptor-positive breast cancer. [2023]