23P - Consensus statements and expert recommendations for BRCAm breast cancer in the Asia-Pacific region (STREAM-AP)

Background

This modified Delphi consensus addresses practical gaps in genetic counselling and testing, risk assessment, and management of germline BRCA mutations (gBRCAm)-associated breast cancer (BC) in the Asia-Pacific region.

Methods

An expert panel of 16 medical oncologists, geneticists, and breast surgeons from the Asia-Pacific region arrived at 58 statements. The level of consensus of statements was considered at ≥75%. A survey of 134 healthcare practitioners (HCPs) (medical oncologists, geneticists, and breast surgeons) explored the real-world practices in the Asia-Pacific region.

Results

About 85% of the statements (49/58) reached a consensus and concorded with international guidelines. A significant discrepancy was observed between expert recommendations and real-world HCPs’ practice (Table). The consensus endorsed gBRCAm and gPALB2m testing in HR+/HER2- early (e) BC, high-risk identification guided by clinical trial criteria based on physician discretion and preferred adjuvant endocrine therapy (ET) + poly (ADP-ribose) polymerase inhibitors (PARPi) over ET + cyclin-dependent kinase 4 and 6 inhibitors in gBRCAm carriers with high-risk HR+/HER2- eBC cases. Table: 23P

Expert recommendations and real-world practice

CPS+EG: Clinical and pathologic stage; IO: Immunotherapy; m: Mutation.

Conclusions

Streamlined genetic testing (GT) for BRCAm TNBC patients should be considered irrespective of age at diagnosis or family history. Prioritisation for GT for BRCAm HR+/HER2- eBC who may be eligible for adjuvant PARPi is needed in the real world, where resources are limited. The oncology community must recognise and address these practice gaps by improving access to resources and education.

Clinical trial identification

Editorial acknowledgement

Professional editorial assistance in the writing of the abstract was provided by BioQuest Solutions Pte Ltd and funded by AstraZeneca UK Limited in accordance with Good Publication Practice (GPP) guidelines 2022.

Legal entity responsible for the study

AstraZeneca UK Limited.

Funding

AstraZeneca UK Limited.

Disclosure

S.C. Lee: Financial Interests, Personal, Advisory Board, Advisory board, speaker invitations: Pfizer, Novartis, AstraZeneca, Roche, MSD; Financial Interests, Personal, Advisory Board, Advisory Board: Eli Lilly; Financial Interests, Institutional, Research Grant: Pfizer, ACT Genomics, Eisai, Taiho, MSD, Karyopharm, ASLAN Pharmaceuticals; Financial Interests, Institutional, Local PI: Roche, Novartis, Daiichi sankyo, BMS, AstraZeneca; Financial Interests, Personal, Steering Committee Member: AstraZeneca. Y.H. Park: Financial Interests, Personal, Advisory Board: AstraZeneca, Pfizer, Roche, Novartis, MSD, Daiichi Sankyo; Financial Interests, Personal, Invited Speaker: AstraZeneca, Pfizer, Roche, Novartis, MSD, Daiichi Sankyo; Financial Interests, Institutional, Other, Research Grant: AstraZeneca, Pfizer, Roche, MSD; Non-Financial Interests, Personal, Principal Investigator: AstraZeneca, Lilly, Pfizer, Novartis, MSD, Roche, Daiichi Sankyo; Financial Interests, Institutional, Writing Engagement: Pfizer. C. Singer: Financial Interests, Personal, Other, consultancy: Amgen; Financial Interests, Personal, Advisory Board, advisory function: Novartis; Financial Interests, Personal, Advisory Board, ADVISORY ROLE: Roche; Financial Interests, Personal, Other, STUDY SUPPORT: Pfizer; Financial Interests, Personal, Advisory Board, ADVISORY, Speaker HOnoraries, study support: AstraZeneca; Financial Interests, Personal, Coordinating PI, study coordinator: Amgen; Non-Financial Interests, Personal, Principal Investigator, Study: Amgen, AstraZeneca; Non-Financial Interests, Personal, Project Lead, register: Pfizer. J. Balmaña: Financial Interests, Personal, Advisory Board: AstraZeneca, Pfizer; Financial Interests, Institutional, Local PI: Pfizer, MedSir; Financial Interests, Institutional, Steering Committee Member: AstraZeneca. V.K. Tan: Financial Interests, Institutional, Invited Speaker: AstraZeneca, Roche. N.A.M. Sari: Financial Interests, Personal and Institutional, Speaker, Consultant, Advisor: AstraZeneca; Financial Interests, Institutional, Speaker, Consultant, Advisor: Pfizer, MSD, Novartis. M. Md Yusof: Financial Interests, Institutional, Advisory Board, disease and treatment indications advisory board or expert committee meeting, as panellist or chair or speaker: AstraZeneca, Specialsed Therapeutics, Roche, MSD, Pfizer, Novartis, Eli Lily, Eisai; Financial Interests, Institutional, Invited Speaker, disease and treatment indications -speaker: Amgen; Financial Interests, Institutional, Invited Speaker, invited speaker for local conferences: Zuellig Pharma; Financial Interests, Institutional, Invited Speaker, speaker: Mundi Pharma, GSK; Financial Interests, Institutional, Other, speaker for doctors only platform webinar: Docquity; Financial Interests, Personal and Institutional, Local PI, KEYNOTE 119, KEYNOTE 355, KEYNOTE B49, KEYNOTE4280A, KEYNOTE 076: MSD; Financial Interests, Personal, Advisory Board, advisory board member for amivantamab in exon 20 insertion tve cancer: Johnson and Johnson; Financial Interests, Personal, Ownership Interest, surgery and oncology centre small partnership: Integrated Oncology Centre ( Kuala Lumpur) Sdn Bhd; Financial Interests, Personal and Institutional, Funding, local funding for multicentre data collection and reporting: Mundi Pharma; Financial Interests, Personal and Institutional, Local PI, Compleement1, EPIKB3, CANOPY-A: Novartis; Financial Interests, Personal and Institutional, Local PI, CAPITELLO, L-MOCA, ADAURA-A, SERENA-4: AstraZeneca; Financial Interests, Personal and Institutional, Local PI, GLOW study: Astellas; Financial Interests, Personal and Institutional, Local PI, ARc -10 study: ARCUS 10; Non-Financial Interests, Personal, Leadership Role, secretary: Malaysian Oncological Society; Non-Financial Interests, Personal, Advisory Role, clinician advisor: Breast Cancer women association ( NGO), KANWORK ( NGO); Non-Financial Interests, Personal, Advisory Role, government led group to evaluate the cost effectiveness of neoadjuvant anti HER2 therapy: Health Technology Assessment Trastuzumab in neoadjuvant treatment early breast cancer; Non-Financial Interests, Personal, Advisory Role, Clinical Practice Guideline for Breast Cancer 2020-2021: Ministry of Health Malaysia; Non-Financial Interests, Personal, Advisory Role, Specialty Education Subcommittee: Malaysian Medical Council Malaysia; Non-Financial Interests, Personal, Principal Investigator, PALOMA-3 trial: Johnson and Johnson. F.V.F. Que: Financial Interests, Institutional, Speaker, Consultant, Advisor: AstraZeneca, Camber, GMT, Kalbe, Novartis, Roche; Financial Interests, Institutional, Advisory Board: Novartis. Y. Lu: Financial Interests, Personal, Advisory Board: Novartis, Eli Lilly, MSD, Roche, Pfizer, AstraZeneca, Eisai, Daiichii Sankyo, Gilead; Financial Interests, Institutional, Local PI: Novartis, Roche, Pfizer, MSD, Eli Lily, Eisai, AstraZeneca, Gilead, Jellox; Non-Financial Interests, Personal, Leadership Role, Chair or co-chair of steering committee of clinical trials: Novartis. N. Parinyanitikul: Financial Interests, Institutional, Speaker, Consultant, Advisor: MSD, Roche, AstraZeneca, Lilly, Novartis, Eisai, Pfizer. C.P. Pham: Financial Interests, Institutional, Speaker, Consultant, Advisor: AstraZeneca, MSD, BI, Roche. N.A.M. Taib: Financial Interests, Personal, Speaker, Consultant, Advisor: AstraZeneca, Zuellig Pharma; Financial Interests, Institutional, Research Grant: AstraZeneca. Y. Antill: Financial Interests, Institutional, Research Grant: MSD, GSK, AstraZeneca, Eisai; Financial Interests, Personal, Speaker, Consultant, Advisor: MSD, GSK, AstraZeneca, Lilly; Financial Interests, Personal and Institutional, Advisory Board: MSD, GSK, AstraZeneca. All other authors have declared no conflicts of interest.