Older patients with stage 1 luminal-like breast cancer experienced better health-related quality of life (HRQOL) and experienced fewer treatment-related side effects with exclusive postoperative radiation therapy than with exclusive endocrine therapy at 24 months, study results have shown.
Data from the randomized, phase 3 EUROPA trial was presented at the 2024 San Antonio Breast Cancer Symposium (SABCS).
Regarding HRQOL, the radiation therapy group had a median QLQ-C30 GHS score of 71.9 and the endocrine therapy group had a baseline median score of 75.5. At 24 months, the radiation therapy group had a mean change from baseline of –1.1 and the endocrine therapy group had a mean change from baseline of –10. Adjusted for age and G8 score, the radiation therapy group had a median change of –3.4, and the endocrine therapy group had a median change of –9.79, both at 24 months.
Additionally, per the QLQ-C30 function scale, the radiation therapy group showed better outcomes in physical functioning, role functioning, emotional functioning, cognitive functioning and social functioning. Per the QLQ-C30 symptom scales, the radiation therapy group had more favorable outcomes for most symptoms including fatigue, nausea and vomiting, pain, dyspnea, insomnia and appetite loss.
Glossary:
QLQ-C30 GHS score: a score measuring a patient’s quality of life, with higher scores representing a higher quality of life.
G8 score: a screening tool used to evaluate older patients.
Skin mucositis: soreness and inflammation of the mouth and gastrointestinal membranes.
Ipsilateral breast tumor recurrence (IBTR): when breast cancer recurs in the same breast.
Esophageal neoplasia: esophageal cancer.
Ischemic heart disease: narrowed heart arteries.
Arthralgia: joint pain or stiffness.
Myalgia: muscle pain.
Alopecia: hair loss.
Per the QLQ-BR45 symptoms scale, the radiation therapy group again showed better outcomes compared with the endocrine therapy group, which demonstrated statistically significant worse rates of systemic therapy and skin mucositis symptoms.
Survival outcomes in the interim analysis showed that, at 24 months, neither group had any occurrences of ipsilateral breast tumor recurrence (IBTR), locoregional relapse or breast cancer-related death.
Treatment-related treatment-emergent adverse events (TEAEs, side effects) were experienced by 65 patients (67%) in the radiation therapy group and 76 patients (85.4%) in the endocrine therapy group. In each group, two patients were reported to have experienced TEAEs that were fatal: esophageal neoplasia and Listena meningitis in the radiation therapy group and pneumonia and ischemic heart disease in the endocrine therapy group.
The most common TEAEs (occurring in more than 20% of patients) were arthralgia (28.9%), fatigue (33.0%), breast pain (38.1%) and bone pain (23.7%) in the radiation therapy group and arthralgia (69.7%), fatigue (44.9%), hot flashes (32.6%), myalgia (31.5%), bone pain (28.1%) and alopecia (25.8%) in the endocrine therapy group.
Within 24 months, 22.5% of patients who received endocrine therapy switched to a different treatment, and 12.4% of patients discontinued endocrine therapy.
“Radiation therapy or endocrine therapy may be a viable single-modality treatment option, emphasizing the need for a multidisciplinary and patient-centered personalized care,” lead study author Dr. Icro Meattini, an associate professor at the Department of Clinical and Experimental Biomedical Sciences “M. Serio” of the University of Florence in Florence, Italy, and coauthors wrote in the presentation.
A total of 926 patients were enrolled and randomly assigned and stratified by age and G8 score to either the exclusive postoperative radiation therapy group or the exclusive adjuvant endocrine therapy group.
In this analysis, 207 patients were included (104 in the radiation therapy group and 103 in the endocrine therapy group). In the radiation therapy group, 88 patients (84.6%) received partial breast irradiation, and 16 patients (15.4%) received whole breast radiation. The majority of patients were between the ages of 70 and 79 (74% in the radiation group and 71.8% in the endocrine group) and had G8 scores higher than 14 (59.6% in the radiation group and 60.2% in the endocrine group).
Reference:
“Exclusive endocrine therapy or radiation therapy in women aged 70+ years with luminal-like early breast cancer (EUROPA): preplanned interim analysis of a randomized phase 3 trial” by Dr. Icro Meattini et al., presented at: 2024 San Antonio Breast Cancer Symposium; December 10-13; 2024; San Antonio, Texas.
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