18P - Optimizing premenopausal HR+ HER2–ve eBC management in India: Insights from expert consensus

Background

Hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 (HER2-) negative early breast cancers (eBCs) represent a significant health concern in the Indian population. Among premenopausal women with HR+ eBC, adjuvant ovarian function suppression (OFS) is considered as an integral component of treatment; however, its optimal utilization remains a subject of ongoing debate.

Methods

In response to identified gaps in clinical practice, a comprehensive questionnaire consisting of 28 statements was developed. These statements were reviewed and validated by a scientific committee, ensuring their accuracy and relevance to the study's objectives. A panel of 46 Indian experts and 1 global expert in the field of eBC were asked to rate their level of agreement/disagreement with each statement. Consensus was defined as achieving a ≥ 80% majority agreement among participants.

Results

Following two rounds of the modified Delphi technique, consensus was achieved on 19 out of 28 statements addressing critical aspects of premenopausal HR+ HER2- eBC management. The expert panel strongly recommends a comprehensive risk stratification approach for premenopausal HR+ HER2- eBC patients. Notably, Patients ≤40 years old are deemed high-risk candidates, recognizing age as an independent risk factor. For patients ≥40 years, a composite assessment incorporating clinicopathological factors (tumor grade, nodal involvement, and Ki67 score) is advised for risk assessment. For high-risk patients, OFS coupled with an Aromatase Inhibitor emerged as a recommended therapeutic strategy. The panel recommends a potential duration of up to 5 years for OFS, provided tolerability is maintained. In patients below 40 years of age, simultaneous initiation of OFS with chemotherapy is advised, while in those aged over 40 years, sequential initiation is deemed acceptable. Among the available LHRH agonists, Triptorelin stands out as the preferred choice, although the panel acknowledges similar efficacy across all options.

Conclusions

The outcomes of this consensus offer valuable guidance, enabling individualized and evidence-based approaches for OFS in Indian patients with HR+ HER2- eBC.

Clinical trial identification

Editorial acknowledgement

BioQuest Solutions Pvt Ltd.

Legal entity responsible for the study

Dr. Reddy's Laboratories.

Funding

Dr. Reddy's Laboratories.

Disclosure

All authors have declared no conflicts of interest.