Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

Abstract

Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor‐positive (HR+)/human epidermal growth factor receptor 2‐negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self‐reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community‐based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET‐based regimens versus CT and by agent for postmenopausal HR+/HER2− mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating mBC. Among first‐line ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus‐based (EVE, 34%) and fulvestrant‐based (FUL, 15%) therapy. After first‐line ET, the most preferred second‐ and third‐line treatments were ET monotherapy (48% and 39%), ET combination therapy (31% and 19%), and CT monotherapy (13% and 30%). Comparing EVE versus FUL, physicians preferred EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for HR+/HER2− mBC in community practice suggested that after first‐line ET, ET mono‐ or combination therapy was commonly used for the second‐ and third‐line treatments and CT monotherapy for third‐ or later line treatments. CTs were used in early lines for patients with visceral symptoms.

Cost-effectiveness Analysis of Ribociclib plus Letrozole versus Palbociclib plus Letrozole in the United Kingdom

“…The proportional split of patients into endocrine and chemotherapy across both lines were based on utilization rates of case mix of treatment therapies. 18,19 These total costs were then divided by a post-progression survival of 20.5 months, 20 to estimate a monthly cost which was applied to all the patients after progression.…”

Clinical implications of tumor necrosis factor receptor 2 in breast cancer

“…Triple negative BC (TNBC) is a distinct subgroup of BC that has been shown to exhibit negative ER, PR and HER2 expression, and was characterized by more aggressive behavior compared with non-TNBC (30). In addition, patients lacking expression of ER, PR and HER2 cannot benefit from endocrine therapy and molecular targeted treatments for HER2, which is effective for ameliorating prognosis (6,7,31). In the present study, univariate and multivariate Cox regression showed that clinical stage and ER, PR and HER2 triple-status may significantly impact the OS rate of patients with BC.…”

“…As increasing attention has been paid to early detection in previous years, numerous precancerous diseases, including atypical ductal hyperplasia, ductal carcinoma in situ and atypical lobular hyperplasia, may be treated prior to malignant transformation (2). However, with the development and combination of traditional therapy methods, including surgery, chemotherapy and radiotherapy, molecular target therapy and endocrine therapy have also contributed to a breakthrough in cancer therapy, and may ameliorate prognosis significantly (3)(4)(5)(6)(7). However, at present, there remains ~500,000 BC-associated mortalities worldwide every year, which is increasing (8).…”

Outcomes research examining treatments, quality of life and costs in HER2 -negative and triple-negative metastatic breast cancer: a systematic literature review

“…Ten of these were retrospective chart reviews [29,30,[32][33][34]37,38,41,44,45], two were physician surveys [31,46] and six were analyses of secondary databases (e.g., Surveillance, Epidemiology and End Results [SEER]-Medicare database, commercial claims) [35,36,39,40,42,43]. These studies examined a variety of therapeutic options, including endocrine therapy, chemotherapy and surgery.…”

“…This study indicated that in HR-positive/HER2-negative mBC, everolimus is used in more severe (e.g., metastasis, tumor volume and performance status) patients than endocrine therapy but in less severe patients than chemotherapy. Lin et al [31] assessed physicians' preferences and self-reported prescribing patterns for endocrine therapy and chemotherapy in the treatment of HR-positive/HER2-negative mBC at community practices. Data were from a survey of 213 physicians from small/intermediate practices; of which, 58% referred to the National Comprehensive Cancer Network (NCCN) guidelines when treating mBC.…”