Shorter Durations of Anti-HER2 Therapy for Patients with Early-Stage, HER2-Positive Breast Cancer: The Physician Perspective
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Physician Characteristics
3.2. Current Practices in the Use of Anti-HER2 Therapy
3.3. Insights on Shorter Durations of Anti-HER2 Therapy
3.4. Interest in Further Research on Shorter Durations of Anti-HER2 Therapy
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | N | N (%) |
---|---|---|
Provider Type | 42 | |
Medical oncologist | 41 (98) | |
Internist with interest in oncology | 1 (2) | |
Years in Practice | 42 | |
<5 years | 9 (21) | |
5–10 years | 13 (31) | |
10–20 years | 12 (29) | |
>20 years | 8 (19) | |
Work Setting | 42 | |
Academic (teaching) hospital | 35 (83) | |
Non-academic (community) hospital | 7 (17) | |
Province | 42 | |
Western Canada (British Columbia, Alberta, Saskatchewan, Manitoba) | 11 (26) | |
Ontario | 26 (62) | |
Eastern Canada (Quebec, Nova Scotia) | 5 (12) |
Survey Question | N | N (%) |
---|---|---|
Has your use of neoadjuvant systemic therapy in HER2 positive patients changed because of the results of the Katherine trial [27]? | 42 | |
Yes | 41 (98) | |
No | 0 (0) | |
Unsure | 1 (2) | |
If funding/access were not an issue, in what situations would you consider dual anti-HER2 therapy in the adjuvant setting (select all that apply)? | 42 | |
All HER2 patients receiving adjuvant therapy | 1 (2) | |
High-risk HER2 patients receiving adjuvant therapy | 32 (76) | |
None | 9 (21) | |
If funding/access were not an issue, in what situations would you consider dual anti-HER2 therapy in the neoadjuvant setting (select all that apply)? | 42 | |
All HER2 patients receiving adjuvant therapy | 14 (33) | |
High-risk HER2 patients receiving adjuvant therapy | 26 (62) | |
None | 5 (12) | |
If you prescribe pertuzumab in the neoadjuvant setting, do you typically continue treatment after surgery to a total of 12 months of treatment? | 37 | |
Yes | 17 (46) | |
No | 20 (54) | |
What are the barriers to the use of pertuzumab in early stage HER2 positive breast cancer (select all that apply)? | 37 | |
Lack of funding | 37 (100) | |
Added cost of treatment | 23 (62) | |
Modest or unclear benefit | 23 (62) | |
Increased risk of toxicities | 7 (19) | |
Increased healthcare resource requirements | 15 (41) |
Survey Question | N | N (%) |
---|---|---|
How frequently would you recommend 6-months of anti-HER2 therapy for patients with early stage HER2 positive breast cancer? | 42 | |
>75% of the time | 2 (5) | |
50–75% of the time | 0 (0) | |
25–50% of the time | 1 (2) | |
<25% of the time | 18 (43) | |
Never recommend 6-months of HER2 therapy | 21 (50) | |
For what reasons have you prescribed 6-months of anti-HER2 therapy (select all that apply)? | 40 | |
I feel the data supports the adoption of 6-months of adjuvant trastuzumab for some patients | 16 (40) | |
I have prescribed 6-months of therapy at patients request/preference | 10 (25) | |
I have prescribed 6-months of therapy during the COVID-19 pandemic to help reduce healthcare exposure for patients, or reduce demands on resources | 3 (8) | |
Toxicity | 4 (10) | |
I never recommend 6-months of anti-HER2 therapy | 9 (23) | |
Other: | 5 (13) | |
Elderly patients | 1 (20) | |
Cardiotoxicity | 2 (40) | |
Duration not shortened due to lack of evidence | 2 (40) | |
Which patients would you consider for treatment with 6-months of anti-HER2 therapy (select all that apply)? | 41 | |
All early stage HER2 positive patients should be considered for 6-months of HER2 therapy | 0 (0) | |
Patients with lower risk disease should be considered e.g., small tumours (≤2 cm), minimal nodal disease (0–3 nodes positive) | 17 (41) | |
Patients who experience (or are at increased risk of) toxicities e.g., cardiotoxicity | 31 (76) | |
Patients who received maximal systemic chemotherapy including an anthracycline or an anthracycline-free regimen such as docetaxel and carboplatin | 2 (5) | |
Patients who were treated with trastuzumab and pertuzumab | 0 (0) | |
Patients who achieve a pathologic complete response (pCR) with neoadjuvant therapy | 16 (39) | |
Patients with specific barriers to treatment e.g., increased travel time to the cancer centre | 18 (44) | |
I would not recommend 6-months of anti-HER2 therapy for any patient | 5 (12) | |
Do you think data supporting 6-months of single agent adjuvant trastuzumab can be applied to patients receiving dual anti-HER2 therapy? | 42 | |
Yes | 9 (21) | |
No | 14 (33) | |
Unsure | 19 (45) | |
Do you think data regarding 6-months of single agent adjuvant trastuzumab can be applied to patients who begin anti-HER2 therapy in the neoadjuvant setting? | 42 | |
Yes | 10 (24) | |
No | 16 (38) | |
Unsure | 16 (38) |
Survey Question | N | N (%) |
---|---|---|
Do you feel more data/trials are needed to determine which patients with early stage HER2 positive breast cancer can be safely and effectively treated with a total of 6-months of trastuzumab? | 42 | |
Yes | 33 (79) | |
No | 7 (17) | |
Unsure | 2 (5) | |
We propose a clinical trial of a total of 6-months of anti-HER2 therapy in patients who receive neoadjuvant systemic chemotherapy and anti-HER2 therapy and achieve a pCR at the time of surgery. Would you offer this study to your patients? | 42 | |
Yes | 35 (83) | |
No | 3 (7) | |
Unsure | 4 (10) | |
For what reasons are you not interested in a clinical trial of 6-months of anti-HER2 therapy in patients who receive neoadjuvant systemic chemotherapy and anti-HER2 therapy and achieve a pCR at the time of surgery (select all that apply)? | 7 | |
I think there is already enough data to support 6-months of HER2 targeted therapy | 1 (14) | |
I do not think 6-months of HER2 targeted therapy is sufficient treatment in this setting | 1 (14) | |
I think there are more important clinical trials to be conducted around personalized therapy in early stage HER2 positive e.g., de-escalation of (neo)adjuvant chemotherapy | 3 (43) | |
Other: | 3 (43) | |
Depends on baseline clinical risk | 1 (33) | |
Insufficient evidence | 1 (33) | |
Depends on the trial design and goals | 1 (33) | |
Are there any reasons that may make you more reluctant to offer this trial to a patient that achieved a pCR (select all that apply)? | 42 | |
No | 12 (29) | |
Young age | 14 (33) | |
Initial clinical stage | 23 (55) | |
Hormone receptor status | 7 (17) | |
Type of chemotherapy received neoadjuvantly | 12 (29) | |
Non-use of pertuzumab in the neoadjuvant setting | 3 (7) | |
No response | 2 (5) | |
Data show that HER2 positive patients who achieve a pCR at the time of surgery after neoadjuvant systemic chemotherapy and anti-HER2 therapy have an excellent prognosis (3 yr Disease Free Survival (DFS) 96%). If these patients were to be considered for a total of 6 instead of 12 months of anti-HER2 therapy (including that received in neoadjuvant period), what potential lowering in 3 yr DFS would you be willing to accept with a total of 6-months of anti-HER2 therapy? | 42 | |
I would not be willing to accept any difference (i.e., 3 yr DFS 96%) | 11 (26) | |
1% (i.e., 3 yr DFS 95%) | 9 (21) | |
2% (i.e., 3 yr DFS 94%) | 15 (36) | |
3% (i.e., 3 yr DFS 93%) | 6 (14) | |
4% (i.e., 3 yr DFS 92%) | 1 (2) |
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Bradbury, M.; Savard, M.-F.; Vandermeer, L.; Clemons, L.; Pond, G.; Hilton, J.; Clemons, M.; McGee, S. Shorter Durations of Anti-HER2 Therapy for Patients with Early-Stage, HER2-Positive Breast Cancer: The Physician Perspective. Curr. Oncol. 2023, 30, 10477-10487. https://doi.org/10.3390/curroncol30120763
Bradbury M, Savard M-F, Vandermeer L, Clemons L, Pond G, Hilton J, Clemons M, McGee S. Shorter Durations of Anti-HER2 Therapy for Patients with Early-Stage, HER2-Positive Breast Cancer: The Physician Perspective. Current Oncology. 2023; 30(12):10477-10487. https://doi.org/10.3390/curroncol30120763
Chicago/Turabian StyleBradbury, Michelle, Marie-France Savard, Lisa Vandermeer, Lucas Clemons, Gregory Pond, John Hilton, Mark Clemons, and Sharon McGee. 2023. "Shorter Durations of Anti-HER2 Therapy for Patients with Early-Stage, HER2-Positive Breast Cancer: The Physician Perspective" Current Oncology 30, no. 12: 10477-10487. https://doi.org/10.3390/curroncol30120763