Breast Cancer Trials: An EXPERT trial to avoid unnecessary treatment

Topics:ACTA Members

Breast cancer is the most commonly diagnosed cancer in Australia, and the most common cause of cancer death for women aged 30-54.

Current standard of care for patients with early breast cancer is radiation therapy after surgery to achieve local control. However, breast cancer is a complex disease, and the benefits of radiation therapy vary substantially, and significant side effects can be devastating for patients.

With the aim to avoid over-treatment, including unnecessary treatment and financial and logistical burdens for patients, ACTA Member Breast Cancer Trials (BCT) has developed the EXamining PErsonalised Radiation Therapy for low-risk early breast cancer (EXPERT) Trial.

EXPERT is a randomised, phase III trial which uses genomic testing to identify women who may be able to safely avoid radiation therapy and its associated side-effects.

The trial will enrol more than 1100 women globally aged 50 years or older, with Hormone Receptor (HR) positive, Human Epidermal Growth Factor Receptor 2 (HER2) negative, early stage breast cancer. 

The need for radiation therapy after breast cancer surgery depends on the risk of the cancer reoccurring. If the risk is very small, there may be no need for radiation therapy. and the clinical impact and potential health care cost savings with reduced treatment would be substantial. More than 1,680,000 patients worldwide are diagnosed with breast cancer every year—a figure which continues to rise.

Patients enrolled in the EXPERT trial will be closely monitored to ensure no increased risk. They will be carefully assessed at baseline and then quarterly during the study, continuing annually for 10 years. Clinic assessments include annual mammograms, review of symptoms and patient outcome questionnaires covering fear of recurrence, convenience of care, quality of life and treatment. By including outcome questionnaires in clinic visits, researchers hope to gain a comprehensive understanding of quality of life post-radiation therapy.

“As my breast cancer was hormone positive, I had to go on hormone therapy—that was a given. However, in terms of radiation, no one could tell me whether I should go on radiation therapy, they just talked about the pluses and minuses,” said Louise, an EXPERT trial participant, “so a radiation oncologist told me about the EXPERT trial.”

In the beginning, Louise was more interested in the potential to help other patients who may find themselves in a similar situation post-diagnosis. By enrolling in the trial, Louise wanted to help relieve some of the uncertainty around radiation therapy for patients.

“I knew in that process that I would be getting the latest technology, research and ideas about breast cancer. It’s given me the confidence that I’m doing the right thing for my treatment.”