I wanted to give a shout-out to the LUMINA trial because it’s done by the Canadian group and I am in Canada now. This is a very pragmatic trial, I’m not biased, this is a very good trial. 

This is a trial that looked at T1 N0 luminal A breast cancer, grade 1-2, and the question they were asking is should we give them radiotherapy or rather, I would say, can we spare them radiotherapy? Is it safe enough not to give them radiotherapy? They tried to answer this very pragmatically. They defined a non-inferiority limit of less than 5%. So if the five year local regional recurrence rate, the 95% confidence interval’s upper bound was less than 5% then they would consider it non-inferior, that means they would be happy with skipping radiotherapy. 

What they found was it was five year local regional recurrence rate was 2.3% and the 95% confidence interval went from 1.3% to 3.8%, so that 3.8% is less than 5% so we can consider it non-inferior. 

So this is practice-changing data. When the patient comes back to my clinic next week and she is a T1 N0 luminal A breast cancer patient and asks me, ‘Do I need radiotherapy after surgery?’ I can say that the five year local regional recurrence rate is around 2.3%. This new data that was showed at ASCO proved that it is less than 5% which we had considered to be non-inferior and I would be happy skipping it. But if she says, ‘No, that’s too high a percent for me, I don’t want to take chances,’ I would recommend her radiotherapy. But obviously I would refer her to a radiation oncologist but this data looked very interesting to me, even as a medical oncologist.