Icro Meattini MD; 2026 EBCC: Safe to Avoid Endocrine Therapy in Older Women with Low Risk Breast Cancers: EUROPA Study Interim Findings

Safe to Avoid Endocrine Therapy in Older Women with Low Risk Breast Cancers: EUROPA Study Interim Findings

An interview with:

Icro Meattini MD, Associate Professor of Radiotherapy, University of Florence, Clinical Oncologist, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy

BARCELONA, Spain—More evidence has emerged showing that older women with breast cancers that are not life threatening can safely receive only radiotherapy after breast conserving therapy, without adding hormone treatments.  At the 2026 European Breast Cancer Conference emerging findings from the EUROPA study of women over 70 with “luminal-like” early breast cancer were discussed by Icro Meattini MD, Associate Professor of Radiotherapy at the University of Florence, and Clinical Oncologist at Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy. He talked with Peter Goodwin about the findings and clinical implications:

AUDIO JOURNAL OF ONCOLOGY: Iccro Mettini MD

IN: [GOODWIN]”Peter Goodwin here  in Barcelona…..

OUT:  ….. of Oncology, I’m Peter Goodwin

2026 European Breast Cancer Conference:

“EUROPA Study: Endocrine or Radiation Therapy for Elderly Patient with Small Early Breast Cancers, Luminal A-like”

(Follow up from SABCS interim findings report (2024))

DETAILS:

At SABCS 2024, Dr. Icro Meattini presented a preplanned interim analysis of the EUROPA trial, a randomized phase III study comparing exclusive endocrine therapy (ET) vs. radiation therapy (RT) in women aged 70+ with luminal-like early breast cancer. The study aimed to evaluate quality of life (HRQOL) and ipsilateral breast tumor recurrence (IBTR) to guide treatment decisions in this patient population.

Key Findings:

RT preserved HRQOL scores better than ET at 24 months (mean change: -3.4 RT vs. -9.79 ET, p=0.045).

Treatment-related adverse events (AEs) were lower in the RT arm (67%) compared to the ET arm (85.4%).

No significant differences in IBTR rates at this interim analysis, but longer follow-up is needed for definitive conclusions.

RT showed better functional outcomes compared to ET across multiple QLQ-C30 domains

Clinical Implications:

These results suggest that both RT and ET may be viable single-modality treatment options in this population, with HRQOL and toxicity profiles playing a key role in treatment selection. The study underscores the importance of multidisciplinary, patient-centered approaches in older women with early-stage breast cancer.

2024 EUROPA Findings:

Looking back at SABCS 2024, the EUROPA trial continues to provide valuable insights into optimizing treatment decisions for older breast cancer patients.

SABCS PAPER (Lancet Oncology):

00661-2/abstract

Single-modality endocrine therapy versus radiotherapy after breast-conserving surgery in women aged 70 years and older with luminal A-like early breast cancer (EUROPA): a preplanned interim analysis of a phase 3, non-inferiority, randomised trial

Icro Meattini, MDa,b icro.meattini@unifi.it ∙ Maria Carmen De Santis, MDc ∙ Luca Visani, MDb ∙ Prof Marta Scorsetti, MDd ∙ Alessandra Fozza, MDe ∙ Bruno Meduri, MDf ∙ et al. Show more

Background

Optimal therapy following breast-conserving surgery in older adults with low-risk, early-stage breast cancer remains uncertain. The EUROPA trial aims to compare the effects of radiotherapy and endocrine therapy as single-modality treatments on health-related quality of life (HRQOL) and ipsilateral breast tumour recurrence (IBTR) outcomes in this population.

Methods

This non-inferiority, phase 3, randomised study was conducted at 18 academic hospitals across Italy (17 centres) and Slovenia (one centre). Eligible patients were women aged 70 years or older with histologically confirmed, stage I, luminal A-like breast cancer, who had undergone breast-conserving surgery and had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients were randomly assigned (1:1) to receive single-modality endocrine therapy or radiotherapy. Endocrine therapy consisted of daily oral aromatase inhibitors or tamoxifen, for a total planned duration of 5–10 years as per clinical discretion, while radiotherapy was administered as either whole breast or partial breast irradiation, delivered in 5–15 fractions. Randomisation was stratified by health status according to the Geriatric 8 (G8) screening tool and by age, with allocation concealed and no blinding. The co-primary endpoints were the change in HRQOL, assessed by the global health status (GHS) scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core module at 24 months, and 5-year IBTR rates (not reported here). This preplanned interim analysis was performed once at least 152 patients completed the 24-month GHS HRQOL assessment. The safety population comprised patients who received the study intervention at least once after randomisation. The study is registered with ClinicalTrials.gov, NCT04134598, and is ongoing and actively recruiting.

Findings

Between March 4, 2021, and June 14, 2024, 731 women were randomly assigned to receive radiotherapy (n=365) or endocrine therapy (n=366). This analysis included 104 patients in the radiotherapy group and 103 in the endocrine therapy group, with a median follow-up of 23·9 months (IQR 22·9–24·2). Patients were predominantly White (204 [99%] of 207) and the median age was 75·0 years (IQR 73·0–80·0) in the radiotherapy group and 74·0 years (72·0–80·0) in the endocrine therapy group. 86 patients in the radiotherapy group and 75 in the endocrine therapy group completed the 24-month HRQOL assessment. The mean baseline GHS score was 71·9 (SD 19·1) in the radiotherapy group and 75·5 (19·3) in the endocrine therapy group. At 24 months, the age-adjusted, G8 score-adjusted mean change from baseline in GHS was –3·40 (95% CI –7·82 to 1·03; p=0·13) in the radiotherapy group and –9·79 (–14·45 to –5·13; p<0·0001) in the endocrine therapy group, with an adjusted mean difference of 6·39 (0·14 to 12·65; p=0·045) favouring radiotherapy. Treatment-related adverse events were less frequent in the radiotherapy group (65 [67%] of 97 patients) compared with the endocrine therapy group (76 [85%] of 89). The most common grade 3–4 adverse events were arthralgia (six [7%] of 89 in the endocrine therapy group vs 0 of 97 in the radiotherapy group), pelvic organ prolapse (three [3%] vs 0), fatigue, hot flashes, myalgia, bone pain, and fractures (two [2%] vs 0 for each). Serious adverse events were reported in 15 (15%) patients in the radiotherapy group and 13 (15%) in the endocrine therapy group. There were no treatment-related deaths in either group.

Interpretation

Endocrine therapy was associated with a greater reduction in HRQOL, as measured by GHS, compared with radiotherapy at 24 months. While these interim results suggest radiotherapy might better preserve HRQOL in older women with low-risk early breast cancer, further data on disease control outcomes and final patient accrual are needed to draw definitive conclusions.

EBCC 2026 Icro Meattini MD Audio Journal of Oncology TEXT