Study: Active monitoring without surgery safe for certain low-risk DCIS patients

Editor's Note

Active monitoring for certain breast cancer patients offers similar outcomes to surgery with fewer side effects, according to research detailed in a December 16 article from Oncology News Central.

Presented at the 2024 San Antonio Breast Cancer Symposium and published in JAMA, The COMET trial supports the safety and efficacy of active monitoring for patients with low-risk, hormone receptor (HR)-positive, HER2-negative ductal carcinoma in situ (DCIS). Results suggest active monitoring provides similar clinical and quality-of-life outcomes to guideline-concordant treatment, which typically involves surgery with or without radiation, Onocology News Central reports.

According to the article, the study enrolled 957 patients across 141 U.S. sites, randomly assigning 484 to active monitoring and 473 to standard care. Active monitoring involved close observation, with surgery reserved for progression to invasive cancer or patient choice. Both groups could opt for endocrine therapy.

At a median follow-up of 36.9 months, the two-year invasive ipsilateral breast cancer rate was 4.2% in the active monitoring group versus 5.9% in the standard care group, the outlet reports. A per-protocol analysis of patients adhering to their assigned interventions showed rates of 3.1% and 8.7%, respectively. Surgery rates were notably lower in the active monitoring group (82 vs. 264 patients), while endocrine therapy use was slightly higher (345 vs. 310 patients).

According to the article, a parallel study on patient-reported outcomes (PROs) found no significant differences in quality of life, anxiety, depression, or DCIS-related concerns between groups. Physical scores were slightly lower in the surgery cohort, with higher reports of arm pain and numbness.