261PD - The effect of physician's characteristics on adjuvant chemotherapy (CT) decisions for early stage HR + , HER2- breast cancer (BC) patients (pts)

Date 27 September 2014
Event ESMO 2014
Session Breast cancer, early stage
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Early Stage
Presenter Michele De Laurentiis
Citation Annals of Oncology (2014) 25 (suppl_4): iv85-iv109. 10.1093/annonc/mdu327
Authors M. De Laurentiis1, M.S. Aapro2, C. Markopoulos3, T. Mamounas4, R. Rouzier5, C. Thomssen6, J.E. Bargallo Rocha7, D. Rea8, P. Neven9, B. Linderholm10, V. Smit11, L. Landherr12, A. Petrovsky13, C. Svedman14, M. Martin Jimenez15
  • 1Department Of Senology, National Cancer Institute G. Pascale Foundation, 80131 - Naples/IT
  • 2Clinic Of Genolier, Multidisciplinary Oncology Institute, Genolier/CH
  • 3Department Of Surgery, Athens University Medical School, Athens/GR
  • 4Breast Care Center, University of Florida Health Cancer Center at Orlando Health, Orlando/US
  • 5Department Of Surgery, Institut Curie-Université Versailles-Saint-Quentin, Paris-Saint-Cloud/FR
  • 6Department Of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale)/DE
  • 7Department Of Surgery, Instituto Nacional de Cancerologia, Mexico City/MX
  • 8School Of Cancer Sciences, University of Birmingham, Birmingham/GB
  • 9Multidisciplinary Breast Centre And Gynaecological Oncology, UZ Leuven, Leuven/BE
  • 10Department Of Oncology, Sahlgrenska Academy and University Hospital, Gothenburg/SE
  • 11Department Of Pathology, Leiden University Medical Center, Leiden/NL
  • 12Department Of Oncoradiology, Uzsoki Teaching Hospital, Budapest/HU
  • 13Radiosurgery, Russian Cancer Research Center, Moscow/RU
  • 14Medical Affairs, Genomic Health, Stockholm/SE
  • 15Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid/ES

Abstract

Aim

For early stage HR + , HER2– BC pts with intermediate risk by clinical/pathologic criteria, treatment decisions should be based on sensitivity to endocrine therapy, risk of recurrence, and predicted benefit from CT. The ESMO guidelines highlight that multigene assays (MGA) may be used in these cases (Ann Oncol. 2013;suppl6:vi7-23). The MAGIC survey evaluated criteria considered for CT decisions and simulated CT recommendations for pts with different characteristics. We present CT recommendations for intermediate-risk BC pts based on characteristics of respondents.

Methods

The online survey was completed by physicians working in multidisciplinary BC teams, having ≥5 year experience. A conjoint analysis was used to model CT recommendations for simulated pts.

Results

Overall recommendations (n = 911, 52 countries) showed that BC pt profiles associated with a request for more information tended to have an intermediate/high age (>50 yr), intermediate/small tumor size, grade 1/2, low ER/intermediate Ki67 expression, and node-negative status. The table summarizes CT recommendations for 4 selected intermediate-risk BC pts. On average, CT was recommended for the 4 pt profiles by 29%, 42%, 31%, and 44% of responders. CT recommendation varied greatly among different countries for each pt profile. Physicians who always use international guidelines tended to prescribe CT more often, while those who use MGA, as expected, recommended CT less frequently for each pt profile. More-experienced physicians (ie, those who prescribe CT personally or who treat >200 pts/year) showed a slight trend to fewer CT recommendations.

Conclusions

There is high variation in CT recommendations for intermediate-risk BC pts, primarily according to country of residence. There is a need for more broadly available tools, such as MGA, to help make more-informed treatment decisions in this pt population.

Selected MAGIC survey respondent groups recommending CT for selected patient profiles Patient profile 1 (age 35–50, tumor size 1–2 cm, tumor grade 2, high ER, high PR, 14%–20% Ki67, node negative) Patient profile 2 (age 35–50, tumor size 1–2 cm, tumor grade 2, high ER, low PR, 14%–20% Ki67, node negative) Patient profile 3 (age 51–70, tumor size 2.1–3 cm, tumor grade 2, high ER, high PR, 14%–20% Ki67, node negative) Patient profile 4 (age 51–70, tumor size 2.1–3 cm, tumor grade 2, high ER, low PR, 14%–20% Ki67, node negative)
All physicians (excluding pathologists, n = 877) 29% 42% 31% 44%
All physicians – range between countries with >30 respondents 15%–41% 33%–50% 14%–48% 28%–56%
Physicians personally prescribing CT (n = 610)/not prescribing CT (n = 267) 27%/31% 42%/44% 30%/34% 43%/46%
Physicians treating 1–50 pts per year (n = 310)/ > 200 pts per year (n = 86) 32%/26% 45%/38% 36%/26% 49%/38%
Physicians always (n = 482)/often (n = 377) using international guidelines 31%/25% 45%/39% 34%/27% 47%/40%
Physicians using (n = 487)/not using (n = 390) MGA 26%/31% 39%/46% 29%/34% 41%/48%
Medical oncologist (n = 485)/surgeons or gynecologists (n = 324)/radiation oncologists (n = 38) 27%/30%/32% 42%/42%/46% 30%/32%/33% 45%/44%/46%
Physicians working in an academic hospital (n = 540)/community-based or private hospital (n = 240)/office-based or private practice (n = 77) 29%/27%/34% 42%/43%/45% 31%/31%/36% 43%/47%/47%

ER, estrogen receptor; PR, progesterone receptor

Disclosure

M. De Laurentiis: Advisory board: Genomic Health; M. Aapro: Advisory board: Genomic Health Corporate-sponsored research: Genomic Health; C. Markopoulos: Other substantive relationships: Genomic Health – Speaker's Honoraria; T. Mamounas: Advisory board: Genomic Health Inc. Other substantive relationships: Speaker's Bureau: Genomic Health Inc.; R. Rouzier: Advisory board: consultant for Genomic Health; C. Thomssen: Advisory board: Genomic Health Other substantive relationships: Speaker for Genomic Health; D. Rea: Advisory board: Genomic Health; B. Linderholm: Board of directors: Steering Committee for the BIG/EORTC/NABCG Male breast cancer project; V. Smit: Advisory board: Genomic Health Inc.; C. Svedman: Other substantive relationships: I am an employee of Genomic Health working in the medical department.All other authors have declared no conflicts of interest.