How will the LORETTA and COMET trials influence your treatment of low-risk DCIS?

Clearly, postop RT can be avoided, but the pink elephant in the room is, can 5 years of endocrine therapy likewise be avoided? Treatment de-intensification requires addressing all aspects of therapy, particularly if one argues against adjuvant therapies for reasons of cost and toxicity. I can't reca...

Am I alone in not understanding how these studies represent de-intensification? Why was this question even asked in the first place? Seems like the logical first therapy to omit for essentially a breast-only disease process (whether it is hormonally driven or not) would be a drug that you take for f...

The COMET and LORETTA trials were designed to address whether women with low-risk DCIS can safely be treated without surgery. The endpoint of both trials was ipsilateral invasive cancer. The COMET trial randomized 995 women to receive guideline-concordant care (surgery ± radiation) vs active monitor...

I think neither of these is a definitive study for de-escalation in DCIS. Patients who are elderly and too old for surgical intervention can do hormone therapy alone, but that often also has side effects. I do think a trial studying local therapy alone with XRT would be most helpful to these patient...

The deeper question here is, where are we heading as a field when trading 5 fractions of partial breast RT for 5 years of a pharmaceutical agent is considered de-escalation (or is even considered reasonable). While the question of whether a treatment is needed at all is certainly a reasonable one, t...

I would like to see the DCISion RT score for this group of patients who did not get either radiation therapy or endocrine therapy, or either one form of adjuvant therapy vs both, and the incidence of local control rates.