Tim Cortese

Patients with breast cancer aged 40 or younger who have BRCA genes may benefit from receiving surgical interventions. 

Among patients who have breast cancer with the 

gene and are aged 40 years or younger, risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO) showed higher rates of overall survival (OS), disease-free survival (DFS) and breast cancer-free interval (BCFI), according to findings presented at the 

2024 San Antonio Breast Cancer Symposium (SABCS)

At the median follow-up of 8.2 years, 691 (13%) OS, 1,928 (36.3%) DFS and 1,753 (33%) BCFI events were recorded.

Patients from 33 countries were included in the study and 6,238 patients were registered for participation and 5,290 were included in the final retrospective study. Analysis was split between patients who did (2,910 patients) or did not (2,380 patients) undergo RRM and patients who did (2,782 patients) or did not (2,508 patients) undergo RRSO.

For patients who experienced RRM, there was a notably reduced risk of 42% for DFS and a reduced risk of 45% for events, irrespective of BRCAgene, age at diagnosis, tumor subtype, tumor size and nodal status. OS events were also noted with a risk reduction of 35%.

At the time of RRM, the median age was 36.6 years; the median time from diagnosis to RRM was 0.8 years and the median follow-up after RRM was 5.1 years. Per the sensitivity analyses, only patients tested for BRCA before or at diagnosis were included, as well as those with delayed entry and when the three-year landmark analysis was performed.

For patients who experienced RRSO, there was a 35% reduction in the risk of BCFI events and a 32% reduction in the risk of DFS events. Patients in this group also had a 42% reduced risk of OS events, irrespective of age at diagnosis, tumor size and nodal status. There was significant interaction with regard to tumor subtype. Patients with triple-negative breast cancer had a 57% risk reduction and those with hormone receptor-positive breast cancer had a reduced risk of 20%. Specific to BRCAg enes, BRCA1 had a reduced risk of 56% and BRCA2 had a reduced risk of 15%.

At the time of RRSO, the median age was 39.7 years; the median time from diagnosis to RRSO was three years; the median follow-up after RRSO was 4.9 years. Per the sensitivity analysis, only patients tested for 

before or at diagnosis were included, when delayed entry was accounted for, and when the three-year landmark analysis was performed.

“Our results showed that undergoing RRM and or RRSO was associated with improved OS, DFS and BCFI in this special clinical setting,” Dr. Matteo Lambertini, associate professor and consultant in medical oncology at the University of Genova – IRCCS Policlinico San Martino Hospital in Genova, Italy, wrote in the presentation. “These findings may help to improve the counseling on cancer-risk management strategies for BRCAcarriers with young-onset breast cancer but should not be used to counsel BRCAhealthy carriers nor BRCAcarriers with a diagnosis of breast cancer at an older age.”

The median age at diagnosis was 35: 1,105 patients (20.9%) were 30 years of age or younger, 1,929 patients (36.5%) were aged between 31 and 35 years old and 2,256 patients (42.6%) were aged between 36 and 40 years.

Regarding genes, 3,361 patients (63.5%) had the BRCA1 gene; 1,891 patients (35.7%) had the BRCA2 gene. Of them, 2,581 patients (48.8%) were tested for BRCA genes before or at diagnosis.

“This global study provides the first evidence that risk-reducing surgeries improve survival outcomes among young BRCA mutation carriers with a prior history of early-onset breast cancer,” Lambertini said. “We believe that our findings are critical for improving the counseling of BRCA mutation carriers with early onset breast cancer on cancer-risk management strategies.”

“Association between risk-reducing surgeries and survival in young BRCA carriers with breast cancer: results from an international cohort study.” By Dr. Lambertini M, et al. Presented at the 2024 San Antonio Breast Cancer Symposium; GS1-08.

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Articles

Risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO) significantly enhance overall survival (OS), disease-free survival (DFS), and breast cancer-free interval (BCFI) in young breast cancer patients with BRCA mutations. The study, involving 5,290 patients from 33 countries, revealed substantial risk reductions in DFS, BCFI, and OS events for those undergoing these surgeries. The findings underscore the importance of these procedures in managing cancer risk for young BRCA mutation carriers, though they are not recommended for healthy carriers or older patients with breast cancer.

Younger patients with breast cancer and the BRCA gene showed improved survival after undergoing risk-reducing mastectomy and/or risk-reducing salpingo-oophorectomy.

Surgical Intervention May Improve Survival in Young Patients with Breast Cancer

Postoperative radiation therapy improved quality of life and reduced side effects for older women with stage 1 breast cancer compared to endocrine therapy.

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.

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.

Ischemic heart disease: narrowed heart arteries.

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).

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.

Older patients with stage 1 luminal-like breast cancer showed improved health-related quality of life (HRQOL) and fewer side effects with exclusive postoperative radiation therapy compared to endocrine therapy at 24 months. The EUROPA trial data presented at the 2024 SABCS indicated better physical, emotional, cognitive, and social functioning in the radiation group. No breast cancer recurrences or deaths were reported in either group. Treatment-emergent adverse events were more common in the endocrine group. A multidisciplinary approach is recommended for personalized care in this patient population.

Radiation therapy resulted in improved quality of life and fewer side effects for older patients with stage 1 luminal-like breast cancer than endocrine therapy. 

Tim Cortese

Surgical Intervention May Improve Survival in Young Patients with Breast Cancer

Postoperative Radiation Offers Higher Quality of Life, Fewer Side Effects in Some with Breast Cancer

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