Julia R. White, MD, a breast cancer physician and radiation oncologist at the Ohio State University Comprehensive Cancer Center–The James, discusses research with regional nodal irradiation in node-positive breast cancer.

The phase 3 Alliance A011202 trial (NCT01901094) is comparing axillary lymph node dissection with axillary radiation in patients with node-positive disease; this research may serve to help those who experience a positive clinical response to neoadjuvant chemotherapy, with their positive nodes becoming clinically negative, White says. If patients are found to have disease per sentinel node biopsy, it is worth questioning whether they need axillary node dissection, considering its accompanying toxicities such as arm swelling and numbness, or whether can they receive radiation alone.

For patients who remain node positive following adjuvant chemotherapy, they have the benefit of not undergoing axillary lymph node dissection, as they will be receiving regional nodal irradiation. This study may be beneficial to patients due to its potential for symptom control, White adds.

A sister trial to this effort is the phase 3 NSABP B-51/RTOG 1304 (NCT01872975) study. In this trial, if a patient started off with node-positive disease and became pathologically node negative at the time of surgery, they were randomized to receive either regional nodal radiation, with the chest wall and mastectomy or with the breast, following breast conserving surgery, or no regional nodal irradiation. For patients who have had a mastectomy this would mean no use of radiation, while those who have had a lumpectomy would only receive radiation of the breast, White concludes.

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Julia R. White, MD, discusses research with regional nodal irradiation in node-positive breast cancer.

Dr. White on Research With Regional Nodal Irradiation in Node-Positive Breast Cancer

Julia White, MD, The Ohio State University Comprehensive Cancer Center, discusses brain metastases in patients with HER2-positive breast cancer.

CNS metastases occur in about 50% of patients who have HER2-positive breast cancer. During imaging, metastases previously unseen are being discovered in both HER2-positive and triple-negative disease.

According to White, these new metastases provide an opportunity to evaluate the effectiveness of systemic therapy agents in combination with radiation therapy.

Dr. White on CNS Metastases in HER2+ Breast Cancer

Julia White, MD, professor of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, discusses RTOG-1119 trial for patients with breast cancer. 

RTOG-1119, is an ongoing randomized phase II trial focusing on adding lapatinib (Tykerb) to whole-brain radiation therapy to improve cancer control of patients with HER2-positive breast cancer who have brain metastases. In HER2-positive metastatic breast cancer, there is an increasing number of agents that extend progression-free survival and overall survival, but there is still a high rate of failure in the brain for this subtype of cancer, White explains.  

The standard of care for brain metastases is radiotherapy initiated to the whole brain. However, stereotactic surgery targets the cancer with conformal radiation. What this study wants to discover is whether the addition of lapatinib to radiation therapy can extend cancer control in the brain, says White. 

Julia White, MD, professor of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, discusses RTOG-1119 trial for patients with breast cancer.

Dr. White On RTOG 1119 Trial for Breast Cancer

Julia White, MD, professor of Radiation Oncology, Ohio State University Comprehensive Cancer Center, discusses the omission of radiation therapy for patients with breast cancer.

Omitting radiation in this space requires finding a population of patients that has a low enough overall risk following lumpectomy, says White. The omission of radiation will leave patients with a slightly higher locoregional recurrence risk than if they had been radiated or had undergone a mastectomy.

The omission of radiation in younger patients with breast cancer. This is a bit harder, says White, because there are some subgroups of patients that can have quite high recurrence risks. Biologic selection criteria can be used along with the basic, clinical pathologic criteria to find a group of patients who may, indeed, have a slightly higher risk of local recurrence, but whose overall survival will not be significantly affected.

Dr. White on Omitting Radiation in Breast Cancer

Julia White, MD, professor of Radiation Oncology, Ohio State University Comprehensive Cancer Center, discusses the relationship between multigene assays and radiation therapy in patients with breast cancer.

Dr. White on Relationship Between Multigene Assays and RT in Breast Cancer

Julia White, MD, professor, director, Breast Radiation Oncology, vice chair, Clinical Research, The Ohio State University Comprehensive Cancer Center, describes the BR-002 trial for patients with breast cancer.

This trial seeks to confirm that a local intervention does not change the outcome of a patient, White says. Participants of the trial will be informed that the regular treatment for metastatic breast cancer is systemic therapy and locoregional therapy is reserved if there is a problem. Patients will be randomized to ablation to other areas of metastases or standard treatment.

Women are only qualified for the trial if they are responding to chemotherapy or are in their first line of chemotherapy and are relatively healthy.

Dr. White Describes the BR-002 Trial in Breast Cancer

Julia White, MD, professor, director, Breast Radiation Oncology, vice chair, Clinical Research, The Ohio State University Comprehensive Cancer Center, discusses the potential to cure patients with metastatic breast cancer.

Administering radiotherapy to a patient whose breast cancer is widespread will not greatly affect their outcome. There is, however, an intermediate, White hypothesizes, in the case of a breast cancer that has spread but not so much that it cannot be eradicated. There is genetic and biologic underpinning to suggest that this type of metastatic breast cancer exists.

White says a treatment may exist that could target metastatic sites and potentially cure a patient.

Dr. White on Curing Patients With Metastatic Breast Cancer

Julia White, MD, professor, director, Breast Radiation Oncology, vice chair, Clinical Research, The Ohio State University Comprehensive Cancer Center, discusses the use of ablative radiotherapy in patients with metastatic breast cancer.

White says an ablative radiotherapy approach to metastatic regions allows a patient to not have to undergo a surgical procedure. Even though surgical procedures are typically well tolerated, there are inherent risks of both anesthesia and complications following surgery.

When metastatic breast cancer patients have to undergo surgery, they have to stop systemic therapy, White says, which interrupts the treatment process. With an ablative radiotherapy approach, there are no treatment interruptions.

Julia White, MD

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