What happens with TNT is much less clear.
You can critisize that, but that's how the trial was designed. It is good to look at these kinds of details when you interpret studies and make sure that you believe negative studies are convincingly negative.Up to now, women who present with a new diagnosis of breast cancer that is already in an advanced stage (stage IV) face an unanswered question about whether surgery and radiation to the tumor in the breast (local therapy) will prolong survival compared to the traditional treatment of systemic...Up to now, women who present with a new diagnosis of breast cancer that is already in an advanced stage (stage IV) face an unanswered question about whether surgery and radiation to the tumor in the breast (local therapy) will prolong survival compared to the traditional treatment of systemic...Would this be the biggest statistical OS benefit from XRT seen in any ±XRT study in medical history?
Or 12 to 20%.
They assumed a doubling of pCR (12% to 26%) with an extra 4 weeks of waiting in their power/sample size calculation.
Several retrospective studies have investigated the effect of increasing the delay after RCT.
This trial is nicely done with lots to think about, but one thing I'm always bothered by are these new fashionable combination primary endpoints. Is rapido really a fair study, they got more chemo preop in the short course arm compared to the conventional course arm... a lot of places are moving towards TNT so i don't see why they just give it all upfront and keep the short vs long course issue as the trial question. They really were asking TNT vs not and when they designed the trial there was not much data. University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, Netherlands; Leiden University Medical Center, Department of Surgery, Leiden, Netherlands; University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, Netherlands; Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, Netherlands; Leiden University Medical Center, Department of Medical Statistics, Leiden, Netherlands; Radboud University Medical Center, Department of Pathology, Nijmegen, Netherlands; Netherlands Cancer Institute, Department of Radiology, Amsterdam, Netherlands; Karolinska Institutet and University Hospital, Department of Imaging and Physiology, Stockholm, Sweden; Karolinska University Hospital, Department of Oncology and Pathology, Stockholm, Sweden; Amphia Hospital, Department of Medical Oncology, Breda, Netherlands; Vall Hebron University Hospital, Department of Medical Oncology, Barcelona, Spain; Northwest Clinics, Department of Medical Oncology, Alkmaar, Netherlands; Institute of Oncology Ljubljana, Department of Surgical Oncology, Ljubljana, Slovenia; Biomedical Research Institute Incliva, University of Valencia, Department of Medical Oncology, Valencia, Spain; Karolinska University Hospital, Department of Surgery, Stockholm, Sweden; Uppsala University, Department of Immunology, Genetics and Pathology, Uppsala, Sweden
Gotta be in top 5 (median OS 26 w/ XRT vs 17 mos w/o, p<0.001)?
If you go by EQD2 alone it shouldn’t be as good but if you compare the apples to apples data that exists (pCR with a 4-6 week delay to surgery) there is no measurable difference in the literature. "to cure sometimes, to relieve often, to comfort always."
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Or 12 to 20%.
Organ preservation is not path CR, but 58% is still fairly impressive.
I think we also don’t know how many patients without a path CR may have ultimately had one given more time. TNT historically means full dose CT and long-course CRT, but it's not wrong to call 5x5 and chemotherapy TNT as well.
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