Abstract P1-07-03: Unmet needs and future applications of breast cancer multigene signatures in routine clinical practice: results from the European PROCURE Project
Authors: Gnant Michael , Lænkholm Anne-Vibeke , Prat Aleix , King Judy , Curigliano Giuseppe , Harbeck Nadia , Penault-Llorca Frédérique , Cardoso Fatima 
Published: March 2023

Abstract
Background: Several Breast Cancer Multigene Signatures (BCMS) are available to profile early breast cancer (eBC) that according to current evidence, can provide reliable information on the risk of recurrence. However, knowledge regarding their perceived value and use in clinical practice is scarce. The first results regarding the panelists’ opinions on the clinical utility of BCMS were presented at SABCS Symposium 2021 (Poster P4-06-08). Here we discuss present and future recommendations for improving the use of BCMS resulting from the PROCURE Project. Methods: The Delphi survey developed by the 8 members of the Scientific Committee was administered twice to oncologists, pathologists, and surgeons across Europe. The questionnaire included 5 sections: 1) Participants’ profile and experience with BCMS, 2) Current clinical practice in eBC and use of BCMS, 3) Participants’ opinion on the utility of the BCMS in eBC according to patient profiles, 4) Agreement with a set of recommendations on the use of BCMS in clinical practice and 5) Identification of unmet needs and future applications of BCMS. 70% agreement was used to determine consensus on a topic. Results: 133 panelists from 11 European countries completed both rounds of the survey. Experts were mostly medical oncologists (72.2%) with extensive experience (more than 5 years) in the management of BC patients (97.0%) and in the use of BCMS (73.4%). Most of them worked in university hospitals (86.5%). Regarding recommendations for improving BCMS utility, according to panelists’ opinion, these genomic tests should provide prognostic as well as predictive information (82.0%), especially to help physicians when deciding on the most appropriate adjuvant chemotherapy (81.2%). Also, their evidence should be based mostly on prospective randomized clinical trials (85.0%) and they should evaluate the clinical and pathological features of the disease (91.0%). Another aspect agreed by panelists is that patients should have the right to access their BCMS results to take part in treatment decisions (85.7%). Finally, when thinking about future applications of BCMS, consensus was only reached after the second Delphi round, and according to panelists, there is a need for validating BCMS in order to know if they can predict treatment benefits in patients with ER-positive advanced/metastatic BC (78.2%) and in triple-negative eBC patients (72.2%). Likewise, panelists also agreed on the need of developing newly validated tests to evaluate the risk of distant recurrence and predict treatment benefits in the neoadjuvant setting (71.4% and 81.2%, respectively). However, no consensus was reached on the need for BCMS to give an accurate prognosis for patients with ER+ advanced and/or metastatic BC (50.4%), HER2+ advanced BC (21.8%), or triple-negative advanced BC (36.8%). Conclusions: The panelists who participated in the PROCURE Project had an extensive experience in the management of eBC patients as well as using BCMS; however, the high degree of importance that they attributed to both prognostic and predictive information reflects a misconception on the correct interpretation of BCMS results because, even if those test can be used to predict the benefit of adjuvant chemotherapy, they are primarily prognostic tools but not predictive about the effect of a specific cytotoxic intervention. These results in conjunction with the agreements regarding treatment benefit prediction reached in the neoadjuvant, the triple-negative eBC, and the metastatic settings reinforce the idea that more training is needed to highlight that BCMS should be used in the context of risk assessment in intermediate-risk eBC as well as the possibility of running those tests in core biopsies.
Citation Format: Michael Gnant, Anne-Vibeke Lænkholm, Aleix Prat, Judy King, Giuseppe Curigliano, Nadia Harbeck, Frédérique Penault-Llorca, Fatima Cardoso. Unmet needs and future applications of breast cancer multigene signatures in routine clinical practice: results from the European PROCURE Project [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-07-03.