Abstract P4-14-07: Treatment patterns for metastatic hormone receptor-positive breast cancer: Comparing expert and community practice
Authors: Timothy Quill, Sara Hurvitz, Kathy D. Miller, Ruth O'Regan, Tiffany A. Traina, Rachael Andrie, Kevin L. Obholz, Mohammad Jahanzeb
Journal: Cancer Research (2020)

Abstract Background Endocrine therapies and CDK4/6 inhibitors have dramatically improved outcomes for patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). To help inform treatment decisions among healthcare providers (HCPs) caring for patients with MBC, we have developed and regularly updated an online treatment decision support tool that provides recommendations from multiple breast cancer experts for specifically defined patient scenarios. Here we report data for HR+/HER2- MBC cases entered into the tool since 2016, capturing self-reported practice trends from HCPs compared with matched treatment recommendations from experts. Methods For the most recent MBC treatment tool (published October 2018), 5 breast cancer experts provided treatment consultation for 549 unique MBC case scenarios based on a simplified set of variables: disease phenotype, previous systemic therapy, visceral crisis (yes/no), rate of disease progression, and the presence or absence of germline BRCA1/2 mutations. HCPs used selection menus to enter patient and disease factors based on these variables along with their intended treatment plan. When completed, the experts’ treatment recommendations for that specific patient case were shown to the HCPs at which time they were asked to indicate if the expert recommendations changed their planned treatment. Results From October 2018 through June 2019, 603 HCPs entered 1127 patient case scenarios, including 581 HR+/HER2- MBC cases, in the most recent online tool. A comparison of expert and HCP treatment choices for select HR+/HER2- MBC case scenarios from the October 2016 and October 2018 tool is shown in the Table. In the setting of HR+/HER2- MBC, among those HCPs whose planned treatment differed from the consensus expert recommendation, 55% indicated that they would change their original choice of treatment. Conclusions CDK4/6 inhibitors have had a large impact on expert treatment recommendations for patients with HR+/HER2- MBC. However, data from this online treatment decision support tool suggest ongoing differences in practice between experts and community HCPs in this setting. For many cases entered into the tool, the practice of the majority of HCPs differed from expert consensus (Table). Consensus expert recommendations in this online tool changed the intended treatment plan of many using it and, therefore, can help optimize the care of patients with MBC. A detailed analysis of overall community practice trends for HR+/HER2- MBC along with a comparison of expert and HCP practice for different case scenarios will be presented. HR+/HER2- MBC Case Scenarios (no visceral crisis)Expert Consensus Recommendation (%)Expert Consensus Recommendation (%)HCP Practice Matched Expert Consensus Recommendation, % (n)HCP Practice Matched Expert Consensus Recommendation, % (n)2016201820162018de novoCDK4/6i + AI (100)CDK4/6i + AI (100)23 (111)32 (188)Previous (neo)adjuvant AICDK4/6i + FULV (92)CDK4/6i + FULV (90)22 (54)17 (77)Previous CDK4/6i + AIFULV (82)FULV ± EVE (92)0 (14)18 (40)Previous AI and CDK4/6i + FulvEVE + EXE (87)EVE + EXE (73)63 (19)28 (18) Citation Format: Timothy Quill, Sara Hurvitz, Kathy D. Miller, Ruth O'Regan, Tiffany A. Traina, Rachael Andrie, Kevin L. Obholz, Mohammad Jahanzeb. Treatment patterns for metastatic hormone receptor-positive breast cancer: Comparing expert and community practice [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-07.