Identifying drivers of first-line HR+/HER2− metastatic breast cancer treatment choices
Creators: name: Brufsky, Adam
name: Maculaitis, Martine C
name: Kopenhafer, Lewis
name: Olsen, Patrick
name: Kurosky, Samantha K
name: Arruda, Lillian Shahied
name: Heck, Wendy
name: Cha-Silva, Ashley S
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Pharmacology
subject: Biotechnology
subject: Mathematical Sciences not elsewhere classified
subject: Cancer
subject: Science Policy
subject: Hematology
subject: Infectious Diseases
subject: FOS: Health sciences

description: <b>Aim</b>: Assess factors associated with first-line (1L) treatment for HR+/HER2- metastatic breast cancer. <b>Materials &amp; methods</b>: A cross-sectional survey of 250 US oncologists was conducted. Correlations were calculated between treatment class and demographics, treatment perceptions and other clinical/nonclinical characteristics. <b>Results</b>: Efficacy and safety/tolerability were critical in oncologists’ 1L decision-making. CDK4/6i use positively correlated with proportion of Medicare and postmenopausal patients (r = 0.54–0.67). Chemotherapy use demonstrated positive correlations with perimenopausal and premenopausal patients and symptom burden (r = 0.31–0.42). Aromatase inhibitor (AI) monotherapy correlated positively with anticipated treatment compliance (r = 0.42). <b>Conclusion</b>: Efficacy and safety/tolerability were most important to 1L decision-making. Clinical characteristics corresponded with CDK4/6i and chemotherapy use. Anticipated compliance was associated with AI monotherapy use. Patients in the USA with a certain type of metastatic breast cancer (mBC, i.e., HR+/HER2−) might get chemotherapy or hormone therapy alone instead of new and potentially better medicines called cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) as their first treatment. Researchers wanted to understand how US cancer specialists decided the first treatment for this type of mBC. In a survey of 250 cancer specialists, researchers looked at different factors that might influence decision-making, including patient characteristics, doctors’ opinions about the treatments and other medical and non-medical features. This study also examined the connections between these factors and the cancer specialists’ choice of first treatment. Researchers found that cancer specialists care most about how well a treatment works and how safe it is when choosing the first treatment for HR+/HER2− mBC. They are more likely to use CDK4/6i if their patients have Medicare coverage or are older (i.e., women who have been through menopause). Chemotherapy is chosen if their patients are younger (i.e., women who are near and before menopause) or have more symptoms. Cancer specialists tend to choose first treatment with hormone therapy alone if they think their patients have a hard time following their treatment plan. The results showed that patient characteristics, doctors’ opinions of treatments and other medical and non-medical factors play a role in choosing treatment for HR+/HER2− mBC. By understanding these factors, researchers can work toward improving treatment choices for patients with this type of mBC. US #oncologists consider efficacy and safety as most important when selecting first-line treatment for #HR+/HER2− #metastaticbreastcancer. Different patient characteristics correlated with greater selection of #aromataseinhibitors, #chemotherapy and #CDK4/6inhibitors. Breast cancer (BC) is the most prevalent cancer globally, with 6% of women in the USA diagnosed with <i>de novo</i> metastatic disease. HR+/HER2− is the most common BC subtype, accounting for 87.4 new cases per 100,000 women. Endocrine therapy (ET) was traditionally preferred for HR+/HER2− metastatic disease (mBC), until recent therapeutic advances introduced cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in combination with ET. Current guidelines recommend CDK4/6i+ET as the preferred first-line (1L) treatment, with approximately 60–63% adoption in routine US clinical practice. Findings from this study highlight that US oncologists prioritize anticipated treatment efficacy and safety/tolerability in 1L treatment decisions. Patient demographics, clinical characteristics and nonclinical factors are also considerations in treatment decisions. Factors positively correlated with higher CDK4/6i use include a higher proportion of postmenopausal patients, Medicare coverage and emphasis on treatment efficacy and performance status. Increased chemotherapy use in the 1L setting is correlated with higher proportions of premenopausal and perimenopausal patients, along with an emphasis on symptom burden. Factors associated with higher aromatase inhibitor (AI) monotherapy use include greater consideration of expected lack of treatment compliance, a higher proportion of perimenopausal patients and reliance on health insurance marketplace/state exchange coverage. Oncologists perceive CDK4/6i+ET as the appropriate 1L treatment, while chemotherapy is considered for patients with a high symptom burden and AI monotherapy is chosen when tolerability is a concern.