Audio Journal of Oncology Podcast

RAPCHEM Study Shows Risk-Based Radiotherapy De-Escalation is Safe After Primary Systemic Therapy for Early Breast Cancer An interview with: Fleur Mauritz MD, Resident in Radiation Oncology, MAASTRO Institute of Radiation Oncology and Research, Maastricht, Netherlands BACELONA, Spain—Radiation therapy after primary systemic therapy for early breast cancer can be safely de-escalated according to risk in the light of 10-year follow-up findings from the RAPCHEM study reported at the 2026 European Breast Cancer Conference. First author Fleur Mauritz MD, who is a resident in radiation oncology at the MAASTRO Institute of Radiation Oncology and Research in Maastricht, Netherlands, gave the Audio Journal of Oncology’s Peter Goodwin the latest: AUDIO JOURNAL OF ONCOLOGY; Fleur Mauritz MD IN: [GOODWIN]”….Welcome to the ….. OUT: ….for the Audio Journal of Oncology, Goodbye.” 6:08secs EBCC 2026 Abstract no: 1, ‘Radiotherapy Long term results of Radiation therapy de-escalation in cT1-2N1 breast cancer After Primary CHEMotherapy (RAPCHEM: BOOG 2010-03): 10-year follow-up results of a Dutch, prospective, registry study’ Authors: Mauritz1,, L. de Munck2,, J. Simons3,, J. Verloop2,, T. van Dalen4,, P. Elkhuizen5,, A. Scholten5,, R. Houben1,, A.E. van Leeuwen6,, S. Linn7,, R. Pijnappel8,, P. Poortmans9,10, L. Strobbe11,, J. Wesseling12,, A. Voogd2,13, L. Boersma1,. 1Maastricht University Medical Centre+, Dept. of Radiation Oncology Maastro- GROW Research Institute for Oncology and Developmental Biology, Maastricht, The Netherlands. 2Netherlands Comprehensive Cancer Organisation, Dept. of Research and Development, Utrecht, The Netherlands. 3Erasmus MC, Dept. of Radiation Oncology, Rotterdam, The Netherlands. 4Erasmus MC, Dept. of Surgery, Rotterdam, The Netherlands. 5Antoni van Leeuwenhoek Hospital, Dept. of Radiation Oncology, Amsterdam, The Netherlands. 6f Dutch Breast Cancer Research Group, BOOG Study Center, Amsterdam, The Netherlands. 7Antoni van Leeuwenhoek Hospital, Dept. of Medical Oncology, Amsterdam, The Netherlands. 8University Medical Centre Utrecht, Dept. of Radiology, Utrecht, The Netherlands. 9Iridium Netwerk, Dept. of Radiation Oncology, Wilrijk-Antwerp, Belgium. 10University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium. 11Canisius Wilhelmina Hospital Nijmegen, Dept. of Surgery, Nijmegen, The Netherlands. 12Antoni van Leeuwenhoek Hospital, Dept. of Pathology, Amsterdam, The Netherlands. 13Maastricht University Medical Centre+, Dept. Epidemiology- GROW Research Institute for Oncology and Developmental Biology, Maastricht, The Netherlands. BACKGROUND The five-year results of the RAPCHEM study (De Wild et al, 2022) and the recently published NSABP-B51 trial (Mamounas et al, 2025) suggest that locoregional radiation therapy (RT) can be tailored to the ypN-status in cT1-2N+ breast cancer (BC) patients treated with primary systemic treatment (PST). However, long-term results are lacking. Here we present the 10-year results of the RAPCHEM study, a prospective registry study, evaluating the long-term safety of tailoring locoregional RT to the nodal response after PST, for locoregional recurrence rate (LRR), recurrence free interval (RFI) and overall survival (OS). MATERIAL AND METHODS From January 2011 to January 2015, cT1-2N+M0 (<4 suspicious nodes at imaging) BC patients were prospectively included. Patients were treated with PST followed by lumpectomy or mastectomy in combination with a sentinel lymph node biopsy (SNLB) and/or removal of marked axillary lymph nodes (MARI), or an axillary lymph node dissection (ALND). cN+ status was histologically confirmed. Three risk groups were defined based on ypN-status, with corresponding RT strategy. Low-risk group (ypN0): whole breast RT (WBRT) after lumpectomy, no RT after mastectomy. Intermediate-risk group (ypN1): WBRT or chest wall RT, and in case of no ALND, RT of axillary levels 1-2. High-risk group (ypN2+): WBRT or chest wall RT, RT of the non-resected part of the axilla (levels 3-4 after ALND, and levels 1-4 if no ALND) with/without internal mammary nodes RT. The endpoints of the current analysis were 10-year LRR, RFI and OS. RFI was defined as time between primary diagnosis until first event (either local, regional, or distant recurrence, or death from BC). Kaplan-Meier survival analysis was used, and log-rank test to compare differences between groups. RESULTS Of the 848 included patients, ten were lost to follow-up. Twenty-four patients had a LRR without synchronous distant metastases. The 10-year LRR was 2.7% for the total cohort, and 2.1%, 3.2% and 2.8% respectively, for the low-, intermediate- and high-risk group. The 10-year RFI was 79.2% and the 10-year OS was 83.0%, both with significant differences between risk groups (Table 1). CONCLUSION De-escalation of locoregional RT after PST appears to be safe in terms of LRR. Stratification in risk groups seems appropriate, even when omitting regional RT (and chest wall RT in case

‘Lord’ Trial Finds Active Surveillance for Estrogen-Receptor-Positive, HER2-Negative, Grade 1–2 DCIS Just As Effective as Standard Therapy An interview with: Jelle Wesseling MD PhD, Pathologist, Medical Director, Early Cancers Detection Centre, Netherlands Cancer Institute, Division of Molecular Pathology, Amsterdam, The Netherlands. BARCELONA, Spain: Because low-risk ductal carcinoma in situ (DCIS) is often unlikely to progress to breast cancer, de-escalating therapy was on the agenda of the Lord trial of active surveillance, that was reported at the 2026 European Breast Cancer Conference. The findings were reassuring: So much so that randomization was stopped early. The lead study author, pathologist Jelle Wesseling MD PhD who is Medical Director of the Early Cancers Detection Centre at the Netherlands Cancer Institute in Amsterdam, gave the details to the Audio Journal of Oncology’s Peter Goodwin. AUDIO JOURNAL OF ONCOLGY: Jelle Wesseling MD PhD IN: [GOODWIN]” I am at the European Breast …. OUT: ….of Oncology, I’m Peter Goodwin 10:34secs EBCC 2025 Abstract no: 2LBA: “De-escalating treatment for low-risk Ductal Carcinoma In Situ: early safety of active surveillance without endocrine therapy in the prespecified interim analysis of the LORD-trial* (BOOG 2014-04)” Authors: Wesseling1,2,3,4, M. Nieberg1, S. Aleikhaneshir1, L. Elshof1, R. Schmitz1, C. Sondermeijer5, S. Balduzzi5, K. Pengel5, J. Weiner1, M. Gerritsma6, E. Engelhardt6, E. Bleiker6, E. Verschuur7, I. Langerak8, R. Mann9, E. van Leeuwen-Stok10, E. Lips1, N. Bijker11, F. van Duijnhoven12 1The Netherlands Cancer Institute, Division of Molecular Pathology, Amsterdam, The Netherlands 2Leiden University Medical Center, Department of Pathology, Leiden, The Netherlands 3 The Netherlands Cancer Institute, Center of Early Cancer Detection, Amsterdam, The Netherlands 4The Netherlands Cancer Institute, Department of Pathology, Amsterdam, The Netherlands 5The Netherlands Cancer Institute, Biometrics Department, Amsterdam, The Netherlands 6The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands 7Europa Donna & Dutch Breast Cancer Patient Association BVN, Patient Advocacy, Utrecht, The Netherlands 8Dutch Breast Cancer Patient Association BVN, Patient Advocacy, Utrecht, The Netherlands 9The Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands 10BOOG Study Center, National Breast Cancer Trial Coordination, Utrecht, The Netherlands 11The Netherlands Cancer Institute, Depratment of Radiation Oncology, Amsterdam, The Netherlands 12The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, The Netherlands Background Active surveillance has been proposed as a de-escalation strategy for women with low-risk ductal carcinoma in situ (DCIS). The LORD-trial evaluates the safety of active surveillance compared with standard treatment in women with estrogen-receptor-positive, HER2- negative, grade 1–2 DCIS. Methods The LORD-trial is a multicentre study that followed a patient-preference design after initial randomization proved infeasible. The primary endpoint is ipsilateral invasive breast cancer (iiBC)-free rate at 10 years. A prespecified, non-binding interim futility analysis was planned after 60 iiBC events. Results DSMB prespecified interim analysis 1,423 women had been enrolled with a median follow-up of 23 months. The first n=73 were randomized between the two arms. After transforming to a patient preference design, n=1,025 patients opted for active surveillance and n=330 for standard treatment. No patients received endocrine therapy. On an intention-to-treat basis, iiBC occurred in 4/363 (1%) women allocated to standard treatment and 63/1,060 (6%) women undergoing active surveillance. Based on these findings, the Data Safety Monitoring Board (DSMB) advised cessation of registration and recruitment, while continuing follow-up of enrolled patients. Cohort analysis When iiBCs detected at primary surgery in the standard-treatment group were additionally considered, cumulative iiBC incidence was similar between strategies: 33/363 (9%) in the standard-treatment arm and 63/1060 (6%) in active surveillance. Cases with full pathology characteristics available – for 31 and 55, respectively – were compared between the two arms (Table 1). Conclusions The prespecified DSMB interim analysis resulted in a recommendation to stop inclusion for reasons of futility, leading to early closure of trial inclusion. Follow-up of included women was recommended and is ongoing to assess long-term outcomes and inform the safety of de-escalation strategies for DCIS. Table 1. Comparison iiBCs with fully known pathology characteristics per arm in the cohort analysis https://cm.eortc.org/cmPortal/Searchable/ebcc15/config/Normal#!abstractdetails/0000992920 https://clinicaltrials.gov/study/NCT02492607 Jelle Wesseling Audio Journal of Oncology TEXT April 2nd, 2026

Circulating Tumor DNA Trumps Clinical Prognostic Markers After Neoadjuvant Therapy for Patients with Early Breast Cancer An interview with: Elisa Agostinetto MD, Institut Jules Bordet, Brussels, Belgium BARCELONA, Spain—Among patients being treated with neoadjuvant therapy for their early breast cancers, circulating tumor DNA performed better as an independent prognostic marker for predicting relapse and disease progression than clinical markers such as pathological complete remission. This was according to prospective study data from Belgium and Italy reported at the 2026 European Breast Cancer Conference by Elisa Agostinetto MD, a medical oncologist from the Institut Jules Bordet in Brussels. She discussed her findings with Audio Journal of Oncology reporter, Peter Goodwin: AUDIO J0URNAL OF ONCOLOGY: Elisa Agostinetto MD IN: [GOODWIN] “I’m here at the …… OUT: ……of Oncology, I’m Peter Goodwin 10:04secs EBCC 2026: Abstract no: 12 Circulating tumor DNA at completion of neoadjuvant therapy is an independent prognostic marker: an individual patient-level pooled analysis of two prospective studies Agostinetto1, V. Appierto2, P. Minicozzi3, C. Sotiriou1, F. Rothé1, E. Tamborini2, F. Lebrun4, Belfiore2, D. t’Kint4, L. De Cecco5, L. Buisseret4, M.C. De Santis6, A. Gombos4, G. Bianchi7, Aftimos4, P. Verderio3, D. Vincent4, G. Pruneri2, M. Ignatiadis4, S. Di Cosimo MD2 1Institut Jules Bordet- Université libre de Bruxelles ULB- Hôpital Universitaire de Bruxelles H.U.B, Breast Cancer Translational Research Laboratory, Brussels, Belgium 2Fondazione IRCCS Istituto Nazionale dei Tumori, Advanced Diagnostics, Milan, Italy 3Fondazione IRCCS Istituto Nazionale dei Tumori, Epidemiology and Data Science, Milan, Italy 4Institut Jules Bordet- Université libre de Bruxelles ULB- Hôpital Universitaire de Bruxelles H.U.B, Medical Oncology, Brussels, Belgium 5Fondazione IRCCS Istituto Nazionale dei Tumori, Experimental Oncology, Mian, Italy 6Fondazione IRCCS Istituto Nazionale dei Tumori, Radiation Oncology, Milan, Italy 7Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Oncology, Milan, Italy Background: Circulating tumor DNA (ctDNA) is a promising biomarker in early breast cancer. However, limited sample sizes in available clinical studies weaken neoadjuvant evidence. Materials and methods: Data from two independent prospective observational studies, one at the Institut Jules Bordet (Brussels), and one at the Istituto Nazionale dei Tumori (Milan), were pooled at the individual patient level for joint analysis. In both studies, women with early breast cancer received neoadjuvant therapy and underwent primary tumor-informed ctDNA assays at predefined time points: baseline (before initiation of neoadjuvant therapy), end of neoadjuvant therapy before surgery (EoT), and during follow-up. Associations between ctDNA detection and clinico- pathological variables (age, tumor size [e.g. T ≤5 cm vs. >5 cm], hormone receptor status, HER2 status, and pathological complete response (pCR) were evaluated using χ2 or Wilcoxon tests, as appropriate. The effect of ctDNA on event-free survival (EFS) was analyzed by univariable and multivariable Cox proportional hazards models adjusted for relevant covariates. A two-sided p value< 0.05 was considered statistically significant. Results: A total of 81 patients were analyzed. Median age was 48 (range 27-75) years at diagnosis; most had T≤5 cm (72%), node positive (68%) and triple negative (60%) disease. Breast cancer events were 26 throughout a median follow-up of 7 years (IQR 5.3-8.8). ctDNA was detected in 31/54 (57.4%) plasma samples at baseline, and in 11/64 (17%) plasma samples at the EoT. The detection of ctDNA was significantly associated with hormone receptor-negative status both at baseline and at the EoT (p<0.05). No association with pCR was observed at any time point. Patients with baseline ctDNA detection showed a non significant trend toward worse EFS (HR 1.56, 95% CI 0.58-4.22). Notably, detection of ctDNA at the EoT predicted breast cancer events and remained independently associated with decreased EFS even after adjustment for all other clinicopathological variables including pCR (HR 3.58, 95% CI 1.33-9.60). Conclusions: This individual patient-level pooled analysis includes one of the largest numbers of events reported to date in the ctDNA literature. ctDNA predicted breast cancer relapse, particularly when detected at the end of treatment, supporting the use of ctDNA for post-neoadjuvant risk stratification and subsequent therapeutic strategies.

Polyurethane-Coated Implants Reduce Capsular Contracture Risk after Mastectomy with Radiotherapy for Breast Cancer An interview with: Kerstin Wimmer MD, Medical University of Vienna, Department of General Surgery, Vienna, Austria; Post-Doctoral Researcher, Karolinska Institute, Stockholm, Sweden BARCELONA, Spain—Women who had mastectomy with immediate pre-pectoral breast reconstruction followed by radiotherapy had less risk of capsular contracture when polyurethane-coated breast implants were used rather than un-coated implants. This finding from the OPBC-09 PRExRT study was reported at the 2026 European Breast Cancer Conference by Kerstin Wimmer MD, from the Medical University of Vienna’s Department of General Surgery in Vienna, Austria, who is currently doing post-doctoral researcher at the Karolinska Institute in Stockholm, Sweden. After her presentation, she discussed the findings with Audio Journal of Oncology correspondent Peter Goodwin: AUDIO JOURNAL OF ONCOLOGY: Kerstin Wimmer MD IN: [GOODWIN]”Peter Goodwin here, reporting…… OUT: on Oncology, I’m Peter Goodwin 2026 EBCC: Barcelona Abstract no: 2 The impact of polyurethane coated implants on the risk of capsular contracture after immediate prepectoral breast reconstruction in the setting of postmastectomy radiotherapy: the OPBC-09 PRExRT study Wimmer1, R. Kiblawi2, F. Fitzal3, C. Kohl4, L. Stenman Skarsgård5, G. Franceschini6, D. Virzi7, Molska8, J.M. Broyles9, A. Agrawal10, G. Montagna11, M. Rivas Ibarra12, M. Banys-Paluchowski13, M. Knauer14, E. Gonzales15, J. Letzkus Berrios16, G. Karadeniz Çakmak17, D. Vorburger18, Ferrucci19, W.P. Weber20 OPBC study group 1Medical University of Vienna, Department of General Surgery, Vienna, Austria 2University Hospital Basel, Department of Gynaecology & Obstetrics, Basel, Austria 3Hanusch Hospital, Department of Breast Reconstruction, Vienna, Austria 4Kliniken Essen-Mitte, Interdisciplinary Breast Center, Essen, Germany 5Oslo University Hospital, Department of Plastic and Reconstructive Surgery, Oslo, Norway 6Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Science and Health of Women- Children and Public Health, Rome, Italy 7Humanitas Istituto Clinico Catanese, Plastic Surgery Unit, Catania, Italy 8University Hospital Zielona Góra, Clinical Department of General and Oncological Surgery, Zielona Góra, Poland 9Dana Farber/Brigham Cancer Center, Division of Breast Surgery- Brigham and Women’s Hospital, Boston, USA 10Cambridge University Hospitals, Department of Breast Surgery, Cambridge, United Kingdom 11Memorial Sloan Kettering Cancer Center, Breast Service- Department of Surgery, New York, USA 12Arturo López Pérez Foundation, Department of Breast Surgery, Santiago, Chile 13University Hospital Schleswig-Holstein- Campus Lübeck, Department of Gynecology and Obstetrics, Lübeck, Germany 14Tumor and Breast Center Eastern Switzerland, Tumor and Breast Center, St.Gallen, Switzerland 15Sanatorio Modelo Quilmes, Department of Senology, Buenos Aires, Argentina 16San Borja Arriarán Clinical Hospital-Clínica MEDS, Breast Surgical Unit, Santiago, Chile 17Zonguldak Bülent Ecevit University Faculty of Medicine, Department of General Surgery, Zonguldak, Turkey 18University Hospital Zurich, Breast Cancer Center- Department of Gynecology, Zurich, Switzerland 19IRCCS, Veneto Institute of Oncology, Padova, Italy 20University Hospital Basel, Breast Clinic, Basel, Switzerland Introduction Patients with breast cancer undergoing mastectomy with implant-based breast reconstruction (IBBR), who are at high risk of locoregional recurrence, often require postmastectomy radiotherapy (PMRT), which increases the risk of capsular contracture (CC). The present study assessed the association between use of polyurethane coated (PUc) versus non-PUc implants and the need for surgical revision due to CC in the setting of PMRT. Material and methods This international multicenter retrospective real-world study included patients with breast cancer who underwent nipple- (NSM) or skin-sparing mastectomy (SSM) with prepectoral IBBR with or without PUc implants followed by PMRT. Primary endpoint was surgical revision due to CC and was analyzed using Cox regression models. Results 1183 women treated between 2016 to 2022 at 19 sites in 13 countries (4 continents) were included. Of them, 773 (65.3%) underwent non-PUc IBBR and 410 (34.7%) PUc IBBR. Median age was 47 years (IQR 41-54) and median BMI was 24.4 kg/m2 (IQR 22- 27.6). Median follow-up was 30.8 months (IQR 18.4-45.4) in the non-PUc group and 37.4 months (IQR 30-46.2) in the PUc group (p<0.001). Of 1183 patients, 863 (73%) had invasive ductal carcinoma and 654 (55.3%) hormone receptor–positive/HER2 negative disease, with a median Ki-67 of 25% (IQR 12-44%). Compared to PUc IBBR, use of non-PUc implants was associated with less frequent NSM (32.5% vs. 73.7%, p <0.001), more frequent use of synthetic mesh (20.3% vs. 1%, p <0.001) or acellular dermal matrix (20.

OASIS-4 Trial Finds Elinzanetant Cuts Vasomotor Symptoms (“Hot Flashes”) in Endocrine Therapy-Treated Patients with Breast Cancer An interview with: Fatima Cardoso MD, Medical Oncologist, Head of Clinical Research & International Collaboration in Breast Cancer, Centre Antoine Lacassagne, Nice, France BARCELONA, Spain—Vasomotor symptoms, or “hot flashes”, were greatly reduced in the OASIS-4 phase three placebo-controlled trial among patients receiving endocrine therapy for their breast cancers who were randomized to treatment with the dual neurokinin receptor antagonist elinzanetant. This was in data reported to the 2026 European Breast Cancer Conference by Professor Fatima Cardoso, a medical oncologist who is Head of Clinical Research and International Collaboration in Breast Cancer at the Centre Antoine Lacassagne in Nice, France. After talking at the conference she met up with the Audio Journal of Oncology’s reporter, Peter Goodwin: AUDIO JOURNAL OF ONCOLOGY: Fatima Cardoso MD IN: [GOODWIN]”I am here now with Fatima …. OUT: …..Oncology, I’m Peter Goodwin 10:30 EBCC 2026 ABSTRACT Abstract no: 3 Efficacy of elinzanetant for the treatment of vasomotor symptoms in women with breast cancer: subgroup analysis of the OASIS-4 trial by type of endocrine therapy Cardoso1, D. Brennan2, T. Simoncini3, L. Wahyudi4, K. Laapas5, C. Seitz6,7 1Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Breast Unit, Lisbon, Portugal 2UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland 3University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy 4Bayer CC AG, Medical & Evidence CGT- OPH & WHC CH, Basel, Switzerland 5Bayer Oy, Development- Pharmaceuticals, Espoo, Finland 6Bayer AG, Clinical Development, Berlin, Germany 7Charité – Universitätsmedizin Berlin, Medical Faculty, Berlin, Germany Background In the Phase III trial OASIS-4 (NCT05587296), elinzanetant (EZN), a dual neurokinin (NK)-targeted therapy (NK1 and NK3 receptor antagonist), significantly reduced vasomotor symptom (VMS) frequency vs placebo (PBO) in women taking endocrine therapy (ET) for hormone receptor positive (HR+) breast cancer. This subgroup analysis evaluated EZN’s effects on VMS frequency and severity by type of ET in OASIS-4. Materials and methods Women aged 18–70 years experiencing ≥35 moderate-to-severe VMS/week caused by ET for HR+ breast cancer were randomized 2:1 to receive EZN 120 mg for 52 weeks or PBO for 12 weeks followed by EZN for 40 weeks. Mean changes from baseline in daily moderate-to-severe VMS frequency and severity to weeks 1 (frequency only), 4 and 12 were analyzed by ET type (tamoxifen [TAM], aromatase inhibitor [AI], ovarian function suppression [OFS; i.e., GnRH], no OFS). This post hoc analysis was not powered for statistical testing. Results Mean age (years) was 50.4 for TAM, 51.9 for AI, 45.2 for OFS and 53.4 for no OFS. At baseline, mean average daily moderate-to-severe VMS frequency ranged from 10.8-12.5 per day while VMS severity was 2.5 in all subgroups. Greater reductions in VMS frequency with EZN vs PBO were seen by week 1 across all subgroups (range EZN: -3.3 to -4.2; PBO: -1.6 to -2.1), with further reductions at week 4 (range EZN: -5.6 to -6.9; PBO: -2.5 to -3.7) and 12 (range EZN: -6.9 to -8.1; PBO: -3.0 to -5.8). A similar trend was observed for VMS severity at weeks 4 and 12 (Table). Reductions in VMS frequency and severity were maintained throughout the 52-week treatment period. Conclusions Consistent with results in the overall population, EZN had greater reductions in VMS frequency and severity than PBO with rapid onset and sustained effect over 52 weeks, irrespective of the type of ET. Fatima Cardoso MD at EBCC 2026 A J Oncology March 28, 2026