Comparing two radiation therapies for node-positive breast cancer

SWIFT RT: Ultra-Hypofractionated vs. Hypofractionated Radiation for Node-Positive Breast Cancer

This study is testing if a new type of radiation therapy that gives higher doses in fewer sessions can help people with node-positive breast cancer just as well as the standard treatment, while also making their lives easier.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 220 (estimated)
• Ages: 18 Years and up
• Sex: Female
• Sponsor: Washington University School of Medicine (other)
• Drugs / interventions: chemotherapy, immunotherapy, radiation
• Locations: 1 site (St Louis, Missouri)
• Trial ID: NCT06559540 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the effectiveness of ultra-hypofractionated radiation therapy compared to standard hypofractionated radiation therapy in patients with node-positive breast cancer. The study aims to determine if the ultra-hypofractionated approach, which delivers a higher dose over fewer sessions, can provide similar oncologic outcomes while potentially improving quality of life and reducing treatment time. Participants will receive either treatment after undergoing surgery for their breast cancer, with careful monitoring of their health outcomes. The trial is designed to contribute to the evolving standards of care in breast cancer treatment.

Who should consider this trial

Good fit: Ideal candidates include women with histologically confirmed invasive breast cancer that has spread to nearby lymph nodes and who have undergone appropriate surgical intervention.

Not a fit: Patients with non-invasive breast cancer or those who have not had surgery to remove the tumor may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to a more efficient radiation therapy regimen that minimizes treatment time while maintaining effectiveness.

How similar studies have performed: Previous studies have shown that ultra-hypofractionated radiation can be non-inferior to standard hypofractionated radiation, indicating potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

* Histologically confirmed invasive carcinoma of the breast. Metaplastic breast cancer is allowed.
* AJCC 8th Edition Stage: cT1-3 primary tumor. cN1-2 or pN1-2.
* Biopsy-proven involved axillary node(s) (either at baseline and/or at time of surgery).
* Undergone either partial mastectomy (with negative final histologic margins (defined as no tumor on ink, after initial surgery or re-excision)) or mastectomy (with negative histologic margins defined as tumor (either invasive or in situ disease) \> 2 mm from the final margin).
* Nodal surgery with either sentinel lymph node biopsy or axillary lymph node dissection. Effort to recover the original biopsy-proven node should be performed at time of surgery.
* Systemic therapy (chemotherapy and/or endocrine therapy) should be administered as per standard of care and recommendation of medical oncology. Neoadjuvant and/or adjuvant systemic therapy is allowed. Concurrent endocrine therapy, anti-HER2 therapy, and immunotherapy during RT is allowed.
* All radiation therapy must be planned to be delivered at BJH or a Siteman satellite location.
* Female.
* Age ≥ 18 years at diagnosis.
* ECOG Zubrod performance status 0 or 1.
* English speaker.
* Able to understand and willing to sign IRB-approved written informed consent document.

Exclusion Criteria:

* Presence of distant metastases.
* Diagnosis of nonepithelial breast malignancies such as sarcoma or lymphoma.
* Diagnosis of bilateral breast cancer.
* AJCC cT4 disease, pT4 disease, or any skin involvement on exam or pathology, including dermal LVSI.
* Presence of palpable or radiographically suspicious supraclavicular, infraclavicular, or internal mammary nodes.
* Prior radiation therapy which would have any overlap with current radiation therapy plan.
* Diagnosis of prior breast cancer or diagnosis of current breast cancer more than one year prior to enrollment.
* Diagnosis of systemic lupus erythematosis, scleroderma, or dermatomyositis.
* Diagnosis of a coexisting medical condition which limits life expectancy to \< 2 years.
* Prior or concurrent malignancy whose natural history has the potential to interfere with the safety or efficacy assessment of the investigational treatment. Patients with prior or concurrent malignancy that does NOT meet that definition are eligible for this trial.
* Time between last breast cancer surgery to RT simulation is greater than 10 weeks, or time between completion of chemotherapy to RT simulation is greater than 8 weeks, whichever is performed last prior to RT.
* Planning to undergo concurrent chemotherapy.
* Pregnancy, which will be excluded prior to simulation.

Where this trial is running

St Louis, Missouri

• Washington University School of Medicine — St Louis, Missouri, United States (RECRUITING)

Study contacts

• Principal investigator: Maria Thomas, M.D., Ph.D. — Washington University School of Medicine
• Study coordinator: Maria Thomas, M.D., Ph.D.

Conditions: Node-positive Breast Cancer, Breast cancer, Radiation, Hypofractionation, QOL, Cosmesis, Toxicity